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A liver hemangioma, also known as hepatic hemangioma, is the most common noncancerous condition in the liver. This benign mass is composed of abnormal blood vessels from the hepatic artery.
The majority of liver hemangiomas are not life-threatening, do not present with signs and symptoms, and will not require any treatment or interventions. Even if left untreated, they will not develop into cancer. In some cases, they only produce symptoms when they get particularly big.
Hepatic hemangiomas affect up to 20% of the population. Many liver hemangiomas are found incidentally while investigating for other conditions. Although it is considered a mass, it does not suggest that anything is wrong with the liver and will not harm it either.
Symptoms
Most cases of hepatic hemangiomas do not develop any signs and symptoms. In some symptomatic case, the signs and symptoms of are as follows:
- Upper right abdominal pain
- Early satiety (fullness after eating a small portion)
- Nausea and vomiting
- Bloating after meal
- Lack of appetite
Even if you have a hepatic hemangioma, similar signs and symptoms can also occur but is caused by a different condition. These symptoms are generally unspecific and may be a result of something else, as liver hemangiomas rarely have signs and symptoms.
It is recommended to visit a healthcare provider if any of the signs and symptoms occur and affects one’s daily activities.
Causes
Liver hemangiomas develop from unknown causes. Research suggests that the genes play a role. It may be congenital or genetically inherited. It can affect both adults and children.
Most liver hemangiomas have an average size of 3 centimeters or approximately 1.5 inches wide. It typically develops from a single aberrant cluster of blood vessel. In rare cases, small hemangiomas can develop into “giant hemangiomas” which can grow up to 10 centimeters or more. Occasionally, hemangiomas can develop in groups.
There is no known reason why most hemangiomas never grow and never manifests any symptoms. Only a small percentage of people will experience symptoms from a hepatic hemangioma and will need medical attention.
Risk factors
A hepatic hemangioma can occur in anyone, but there are factors that increases one’s risk, such as:
- Age: Liver hemangiomas most frequently occurs in people in their 30s, 40s, and 50s.
- Sex: It affects women three times more frequently than men. The rise in estrogen especially during female puberty increases the risk that a liver hemangioma can occur and grow faster.
- Pregnancy: The increase in estrogen level, especially during pregnancy, can affect the development of liver hemangiomas. Compared to women who have never been pregnant, women who have experience pregnancy are more likely to have a hepatic hemangioma.
- Hormone replacement therapy: Liver hemangiomas may be diagnosed more frequently in women who are prescribed with hormone replacement treatment (estrogen or estrogen combined with progestin) for menopausal symptoms than in those who do not.
Diagnosis
Liver hemangiomas are often discovered while investigating the liver for other concerns. To confirm a diagnosis, common tests include:
- Ultrasound provides a contrast-enhanced images of the liver. During the procedure, the body tissues are subjected to high-frequency sound waves, and the echoes are captured and converted into images.
- Computerized tomography (CT) scanning creates images of a cross-section of the body using X-rays and technology. To allow detailed examination, the device takes photographs that reveal very tiny “slices” of the liver.
- Magnetic resonance imaging (MRI) is a method that produces precise images of the liver using a large magnet, radio waves and a computer. It does not use radiation.
- Scintigraphy, a nuclear scan that creates an image of the hemangioma using the radioactive trace element called technetium-99m (Tc-99m).
In some cases, the doctor may require additional imaging and blood test to confirm the diagnosis. The patient’s medical history and other risk factors also contributes to correct diagnosis.
Treatment
Most liver hemangiomas are small and require no treatment. It may resolve on its own over time. However, the doctor may suggest keeping it under observation. To keep track of any changes, an imaging scan once or twice a year is recommended. The majority of hemangiomas never change or expand. If they do, it typically happens slowly—about 2mm annually.
Liver hemangiomas may require a more thorough monitoring and treatment. The treatment options for liver hemangiomas vary on the location, size of the tumor, number of hemangioma and general health of the patient.
Possible treatments for people with liver hemangiomas include:
- Surgical removal of liver hemangioma: The doctor might advise surgery to remove the lump if the hemangioma can be easily detached from the liver.
- Surgical removal of the part of the liver that includes the hemangioma: If the mass is too attached in the liver, the doctor may recommend removing it together with the portion of the liver.
- Blocking the hemangioma’s blood supply: Through hepatic artery ligation and arterial embolization, the hemangioma may cease to develop or shrink if there is no blood flow. Because it has access to neighboring blood arteries, healthy liver tissue is unaffected.
- Liver transplant: The doctor may suggest surgery to remove the liver and replace it with a liver from a donor in cases that the hemangiomas are numerous and massive and that other methods failed to cure it.
- Radiation therapy: Due to the availability of safer and more efficient therapies, this one is often the last option. Strong energy beams, like X-rays, are used in radiation therapy to harm the hemangioma’s cells.
