Liver and intrahepatic bile ducts - Tumor

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Liver and intrahepatic bile ducts - Tumor

Benign tumors

Hemangioma

Reviewers: Deepali Jain, M.D. (see Reviewers page)
Revised: 9 January 2013, last major update February 2012
Copyright: (c) 2004-2013, PathologyOutlines.com, Inc.

See also Soft tissue chapter

General
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● Most common primary hepatic tumor
● Usually an incidental finding, found in 1% of routine autopsies and 20% of autopsies with extensive investigation
● More common in adults than children, 75% in women, who are more likely symptomatic
● 10% enlarge with follow-up, may be related to pregnancy or oral contraceptives
● No known risk of malignant transformation
● Associated with multiple focal nodular hyperplasia syndrome
● Fibrotic tumors may be precursor of solitary necrotic nodules
● Capillary: solitary capillary hemangiomas are extremely rare
● Cavernous: giant cavernous hemangiomas (> 4-10 cm) rarely rupture and require resection

Treatment
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● Excision or observation (may involute)

Gross description
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● Solitary (70-90%), usually 2-4 cm, tumors up to 20 cm are overrepresented in studies of excisions
● Soft, red-purple, well-circumscribed; subcapsular or deep
● Tumors collapse when sectioned as blood oozes out

Micro description
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● Variably-sized vascular spaces lined by flat endothelial cells and myxoid or fibrous stroma
● Large fibrous septa may trap bile ducts
● Variable thrombosis, calcification, phleboliths
● Increased fibrosis with age of lesion may obliterate lumen
● Border may be irregular
● May see cavernous hemangioma-like vessels (HLV) in adjacent liver

Micro images
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Cavernous hemangioma: contributed by Dr. Shilpa Jain

Positive stains
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● Elastin and trichrome may expose vessels in old fibrous lesions

Differential diagnosis
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● Hemangiomatosis
● Hereditary hemorrhagic telangiectasia: aberrant portal vessels, dilated vascular channels within portal tracts
● Infantile hemangioendothelioma: atypia present, although not necessarily everywhere
● Peliosis hepatis: no fibrous septa

End of Liver and intrahepatic bile ducts - Tumor > Benign tumors > Hemangioma

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