Recurrent giant hemangiomas of liver: Report of two rare cases with literature review

Abstract

Most hepatic hemangiomas (HHs) are small, asymptomatic and do not require clinical intervention. Surgical resection is only indicated for symptomatic hemangiomas. We report here cases of recurrent HHs in 2 women of 37 and 40 years old, who initially presented with abdominal pain and mass. Radiological examination of each tumor revealed a solitary tumor of 14 and 20 cm in diameter, respectively. Surgical liver segmental resections were performed in both, and the diagnosis of cavernous hemangioma was confirmed. Both patients had recurrent tumor on subsequent radiological examination 4-5 years after the initial surgery. In the first patient, a 15 cm recurrent hemangioma was resected, but multiple hemangiomas were again detected 8 years later occupying the other hepatic lobe, which was not amendable for resection. In the second patient, a 16 cm hemangioma was seen on radiogram, and because the lesion was not symptomatic, conservative observation was offered. Recurrence after liver resection of giant hemangioma is extremely rare. The pathogenesis of tumor progression and recurrence is unknown, as is the management of these patients with recurrent hemangioma, particularly when it is extensive and unresectable.

Keywords: Giant hemangioma; Liver; Recurrent hemangioma.

Figure 1

Case 1 (patient 6 in Table 1). Micrograph of the first recurrent hemangioma in the left hepatic lobe shows typical cavernous hemangioma (A: HE, × 100); and multiple foci of hemangioma-like vessels adjacent to the main tumor (B: HE, × 40) and at a distant from the main lesion (C: HE, × 40). D: Magnetic resonance image reveals recurrent hemangiomas involving right hepatic lobe 7 yr after left lobe resection for recurrent hemangioma. R: Right; L: Left; P: Peripheral.

Figure 2

Case 2 (patient 7 in Table 1). A: Right lobe resection specimen of case 2 with cavernous hemangioma (HE, × 100); B: Multiple hemangioma-like vessels in the surrounding liver parenchyma (HE, × 40); C-E: Computed tomography scan images [initial giant hemangioma in the right hepatic lobe (C), image after resection shows no residual hemangioma (D), and recurrent hemangioma in right lobe of liver, 4 years after second resection (E)]. R: Right; L: Left; P: Peripheral.