Hemangioma

Liver and intrahepatic bile ducts - tumor
Benign tumors / conditions
Hemangioma

Author: Deepali Jain, M.D. (see Authors page)

Revised: 16 November 2017, last major update February 2012

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Hemangioma[TI] liver[TI] free full text[sb]

See also: Soft tissue topic

Table of Contents

Cite this page: Jain, D. Hemangioma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/livertumorhemangioma.html. Accessed October 16th, 2018.

Definition / general

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 followup, 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

Excision or observation (may involute)

Gross description

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

Microscopic (histologic) description

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

Microscopic (histologic) images

Images hosted on other servers:

Images contributed by Dr. Shilpa Jain:

Cavernous hemangioma

Positive stains

Elastin and trichrome may expose vessels in old fibrous lesions

Differential diagnosis

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