Hepatic Hemangioma

Hemangiomas are considered to be vascular malformations; they are probably congenital in origin and have no potential to become cancer.
This is by far the most common benign tumor discovered in general population. Usually it is found incidentally during abdominal ultrasound or CT scan/MRI examination performed for other indications. The tumor is found in both men and women, but female to male ratio is 3:1. In around 40% of patients multiple hemangiomas are found.
The majority of hemangiomas found in adults are small (less than 5cm), but they could grow and reach giant proportions. Even very large tumors tend not to cause any symptoms, unless they become extremely large and compress surrounding structures such as stomach or duodenum producing vague abdominal pain, nausea or vomiting. Occasionally (extremely rare) there could be thrombosis of the tumor blood vessels or bleeding inside the tumor causing increased abdominal pain, abnormal liver function tests and fever.

The diagnosis is made on Ultrasound, MRI or CT scan imaging that show very typical appearance of these tumors. Biopsy is generally not recommended due to high risk of bleeding.
Generally these tumors are managed by observation and repeat imaging.  Precautation to be taken that a malignant lesion should not be misdiagnosed as haemangioma and treated by observation.
The indications for surgery of these tumors are complications such as rupture with bleeding ( rare but has 60% mortality), rapid change in size, persistent abdominal pain without other sources, nausea and vomiting due to compression effect and development of Kasabach-MerrKasabach-Merritt phenomenon is characterized by profound thrombocytopenia (low platelet count), microangiopathic hemolytic anemia, a consumptive coagulopathy,.
The vast majority of hepatic hemangiomas require no treatment. If a hepatic hemangioma is large, especially if it is causing symptoms, surgical resection  or enucleation  remains the definitive approach to hepatic hemangiomas.
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