It is the most common benign tumor of the liver. It is more common in women. It is a vascular ball, does not become cancerous and is not dangerous if it does not reach large sizes. It is seen in 2-20% of the population.
Enlargement may occur when the hormone estrogen is increased (e.g., during pregnancy, use of birth control pills or hormone replacement therapy).
Most hemangiomas can be recognized by typical images on ultrasound or MRI. Biopsy is not performed due to the risk of bleeding.
Most hemangiomas are superficial, single, small (<2 cm) masses located superficially in the right liver that do not cause distress and do not require treatment.
However, a large (>5 cm) hemangioma can cause pain by stretching the liver capsule. It can cause problems by pressing on the surrounding organs. A large hemangioma, especially located in the left liver, may put pressure on the stomach and cause symptoms such as early satiety, fullness, delayed gastric emptying and vomiting. If there are clinical manifestations, then there is also an indication for treatment.
Larger (>10 cm) hemangiomas have an increased risk of spontaneous bleeding and require immediate intervention. In addition, a serious clinical picture may occur, which begins with blood clotting inside giant hemangiomas, characterized by thrombocytopenia, microangiopathic hemolytic anemia and consumption coagulopathy (Kasabach–Merritt syndrome).
Surgical resection or arterial embolization with bleomycin-lipiodol mixture can be performed.
It is common in women between the ages of twenty and 50. They are benign tumors (K:E = 6:1). It is thought to be associated with the birth control pill in women and high alcohol consumption in men. Most of them are less than 5 cm in length and are found incidentally. There is no risk of cancer. Although surgical removal is sometimes recommended, most patients are followed up.
Although rare, it can be confused with adenoma or malignant liver tumors. However, its appearance is typical in MRI taken with gadoxetic acid. However, in cases of doubt, diagnosis can be made with biopsy.
It is rare and benign. However, it is not as innocent as hemangioma and FNH. With growth, the risk of bleeding and cancerization increases.
Drugs or conditions that increase sex hormones such as estrogen and testosterone can be counted as the cause of adenoma (such as using birth control pills or pregnancy). For this reason, it is more common in women of childbearing age (20-44 years).
It is diagnosed on MRI taken on suspicion on ultrasound. Biopsy can also be performed.
In women, it may regress after the cessation of birth control pills and cease to be a problem. There are patients who are followed up in this way. However, surgical removal of large adenomas in number and size is recommended due to the increased bleeding (10-25%) and the risk of cancerization (10-13%) as they grow.
Since the risk of bleeding and cancerization of adenomas detected in men is high regardless of their size, it is recommended to remove them by open or laparoscopic surgery.
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Prof. Dr. Sedat Karademir
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