Lege Artis Medicinae

[Asymptomatic hepatic giant haemangioma]

KOVÁCS GÁBOR, NYIKOS Orsolya, GERVAIN Judit

FEBRUARY 20, 2009

Lege Artis Medicinae - 2009;19(02)

[INTRODUCTION - Haemangioma is the most common type of benign hepatic tumors. Haemangiomas are usually asymptomatic, except for those that exceed five centimeters in size and are called “giant” haemangiomas. Malignant transformation has not been noted and therefore only regular follow-up is recommended for smaller haemangiomas. Surgical intervention becomes necessary only if symptoms or complications occur. Nevertheless, atypical presentation can cause a significant differential diagnostic problem. CASE REPORT - The authors report the case of a 51-year old woman with a focal hepatic abnormality diagnosed during a routine abdominal ultrasound examination. Results of the subsequent computed tomography scan suggested a multiple hepatocellular carcinoma based on the morphological appearance. Following oncology consultation, she was admitted to our department for liver biopsy. Histology did not reveal any malignancy. This result together with the lack of symptoms and complaints and the normal laboratory test results shifted the likely diagnosis towards a benign haemangioma. Blood-pool scintigraphy confirmed this diagnosis. CONCLUSIONS - Haemangiomas are benign hepatic tumors. They are often diagnosed accidentally, by routine abdominal ultrasound examination. If an abdominal ultrasound raises suspicion of haemangioma, abdominal MRI scan or blood-pool scintigraphy is recommended to be performed in order to exclude malignancy for lesion sizes of <2 cm or >2 cm, respectively. The reported case is considered important because of the differential diagnostic problems the large size and the atypical presentation of the given haemangioma imposed. Ultrasound-guided liver biopsy via fine-needle aspiration has previously been contraindicated. This invasive procedure can be performed in patients with focal hepatic pathology if diagnosis cannot be established by non-invasive tests, especially if malignancy is suspected. It can be performed conditional on the localization of the tumor, the patient’s general condition, the laboratory results, and if there is a therapeutic consequence of the biopsy results.]

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