Giant cavernous hemangiomas of the liver

P. Díez Redondo, R. Velicia Llames and A. Caro-Patón

Service of Digestive Diseases. University Hospital of Río Hortega. Valladolid. Spain

A 38-year-old woman was attended in our unit complaining unspecific discomfort in the right hypochondrium. She mentioned to have taken oral contraceptives up to two years earlier. The laboratory data at presentation was as follows: mild thrombopenia, AST 48 U/L, ALT 28 U/L, GGT 159 U/L, alkaline phosphatase 593 U/L, coagulation tests and proteinogram were normal. Abdominal ultrasound revealed multiple hepatic nodules of variable density. Abdominal computer tomography (Fig. 1) showed a large hypodense mass occupying the whole of the right hepatic lobe and a part of the left lobe, the latter displaying compensatory hypertrophy. Intravenous injection of contrast medium enhanced the image of the mass from periphery to center. Hepatic arteriography, during arterial phase, revealed an opacification corresponding to large concentrations of blood in both hepatic lobes. Consequently, a giant cavernous hemangioma of the liver was diagnosed. During the following 16 years, the patient remained asymptomatic with normal transaminases, mild thrombopenia, and no coagulation impairment. The hemangioma has since hardly increased in size. Because of this favourable outcome, our attitude has remained conservative so far.

Cavernous hemangiomas are the most common benign tumors of the liver, and are found in 5% of autopsies (1). In general, they are sporadic tumors, but some exceptional cases have been described that suggest a possible familial predisposition (2,3). They are usually small in size and asymptomatic. However, when measuring more than 4 centimeters, they are considered giant-sized and may be associated with disseminated intravascular coagulation. Reports exist showing a relationship between oral contraceptives and increase in size, symptomatology (4), and even recurrence of these tumors (5).

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