Hemangioma of the liver

Hemangioma of the liver
Diagnosis in short
Cavernous liver hemangioma. H&E stain.
LM DDx	epithelioid hemangioendothelioma, angiosarcoma, metastatic disease
Site	liver
Clinical history	often an incidental finding
Symptoms	+/-upper abdominal pain
Radiology	well circumscribed mass
Prognosis	benign
Clin. DDx	metastatic disease
Treatment	usually follow-up, non-conservative if very large

Hemangioma of the liver, also liver hemangioma and hepatic hemangioma, is a benign vascular tumour of the liver, that may be mistaken for metastatic disease.

Hemangiomas, more generally, are dealt with in the hemangioma article.

General

• Benign.
  • Can be hard to differentiate from metastatic disease on imaging.
• May cause congestive heart failure in infants - if large.
• May rupture and be life-threatening.

Clinical:

• Do not grow in size - can be followed if small or medium size (<10 cm).
• Usually an incidental finding (incidentaloma) and often asymptomatic.
  • Large lesions may present with upper abdominal pain.

Gross

• Variable size.
• Well circumscribed.
• Classically subcapsular.^{[citation needed]}

Microscopic

Features:

• Channels lined by benign endothelium containing RBCs.
• Surrounding (non-endothelial) cells without significant atypia.

DDx:

• Epithelioid hemangioendothelioma - atypical perivascular cells, classically with cytoplasmic vacuolization ("blister cells").
• Angiosarcoma.
• Metastatic disease.

Images

• 

  Cavernous liver hemangioma - intermed. mag. (WC/Nephron)

• 

  Cavernous liver hemangioma - high mag. (WC/Nephron)

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Liver Lesion, Core Biopsy:
- Cavernous hemangioma.
- NEGATIVE for malignancy.

Micro

The sections show dilated vascular spaces containing red blood cells that are lined by endothelial cells without significant atypia. The vascular spaces are separated by bland fibrous tissue.

Abnormal perivascular cells are not identified. The background liver is without atypia and does not have appreciable fat.

See also

• Hemangioma.
• Vascular tumours.