Liver & intrahepatic bile ducts
Benign / nonneoplastic
Hemangioma
Author: Deepali Jain, M.D.
Topic Completed: 1 February 2012
Minor changes: 1 August 2020
Revised: 25 January 2019, 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
Definition / general | Treatment | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Differential diagnosisCite this page: Jain D. Hemangioma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/livertumorhemangioma.html. Accessed August 10th, 2020.
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
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
