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Surgical management of liver haemangioma
Dr Chris Yau
Dept of Surgery
PWH
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Clinical scenario --- pitfall 68 F USG: 3cm hyperechoic lesion rig
ht lobe Typical haemangioma Hepatitis marker –ve, AFP CEA n
ormal FU CT scan:
7cm after 3 yr Trisegmentectomy: cholangiocarc
inoma
67 F USG: 4cm lesion left lobe Typical haemangioma Hepatitis marker, AFP CEA norm
al FU USG 1 yr
8cm mass left lobe, multiple satellite lesions right lobe
Palliative care
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ContentContent
Pathology Prevalence / Etiology Clinical presentation Diagnostic tools Surveillance Surgical management Take home message
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Liver Haemangioma --PathologyLiver Haemangioma --Pathology
First prescribed by Amboise Pare 1570 (Paris)
Benign tumour Size up to 30cm
Giant Haemangioma if size > 10cm
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Liver Haemangioma --PathologyLiver Haemangioma --Pathology
Macroscopically: red wine colored mass with lob
ulated appearance
•Microscpically:
•large endothelium lined vascular channels packed with red blood cell
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Prevelance / EtiologyPrevelance / Etiology
0.7% to 7.3 % in autopsy finding * Female predominance 1.5 – 6 : 1 ** Present most often between 3rd and 4th decade Positive correlation with female sex hormone
* Belghiti, Management of haemangioma, Stuttgart: 1993: 78-85** Yan et al, US guided percutanceous RFA for hepatic haemangioma. World J Gastroenterol, 2003 Sept 2132-2134
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Clinical PresentationClinical Presentation
Asymptomatic Epigastric pain Spontaneous hemorrhage Traumatic hemorrhage Cardiac failure
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Dignostic tools
USG: Homogenous hyperechoic
CT scan: Pre-contrast: Relative hypoden
se Early phase : Perilesional incre
ase in contrast Delayed: isodense / hyperdens
e
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Diagnostic toolsDiagnostic tools
MRI scan: T1 : hypointense T2 : heavily hyperintense
Arteriography: Golden standard Cotton Wool appearance
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SurveillanceSurveillance
NANilNilComplications
1NilNilMalignancy
NANil1Change of lesion
12 yrs12-114 months12-60 monthsFollow up period
170NilNADrop out
38323123No of pt
Leifer (US)Nippon (Japan)Gandolfi (Italy)
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Surgical TreatmentSurgical Treatment
Treatment method: Laparoscopic Vs Open Resection Vs Enucleation RFA
Indications of Surgery Uncertain diagnosis Symptomatic Lesion with documented increase in size +/- Giant haemangioma
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Surgery resultSurgery result
2.4%
12%
0
0
42
42
Ozden et
NA00Mortality
NA13%25%Morbidity
000Malignancy
1551163Conservative tx
81552Surgery
16326115No of pt
Farges et alMoreno et al
Yoon et al
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Take home message
Majority haemangioma can be treated conservatively
Existence of mimicker Repeat scan / FNAC / Surgery if uncertain di
agnosis