Autopsy and Case Reports
Autopsy and Case Reports
Short Communication

Giant hepatic hemangioma in a patient with cirrhosis: challenging to manage

Marlone Cunha-Silva; Clauber Teles Veiga; Larissa Bastos Eloy da Costa; Simone Reges Perales; Amanda Avesani Cavotto Furlan; Elaine Cristina de Ataíde; Ilka de Fátima Santana Ferreira Boin; Tiago Sevá-Pereira

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Giant hepatic hemangiomas are occasional in patients with cirrhosis. It remains a challenge to decide on the need for treatment and choose the most appropriate intervention. A 62-year-old woman was recently diagnosed with cirrhosis and complained of upper abdominal fullness, reduction in oral food intake, and weight loss of 6 kg over the last three years. Upper digestive endoscopy evidenced thin-caliber esophageal varices and significant extrinsic compression of the lesser gastric curvature. Abdominal computed tomography revealed an exophytic tumor in the left hepatic lobe, measuring 11.5 cm, which had progressive centripetal contrast enhancement from the arterial phase, compatible with hepatic hemangioma. Serum tumor markers were negative, and her liver function was unimpaired. The patient underwent surgical resection (non-anatomical hepatectomy of segments II and III) which had no immediate complications, and the histopathological evaluation confirmed cavernous hepatic hemangioma. Two weeks later, she was admitted to the emergency room with jaundice, signs of hepatic encephalopathy, and moderate ascites, and was further diagnosed with secondary bacterial peritonitis. As no perforations, abscesses, or fistulas were observed on subsequent imaging tests, clinical management was successfully carried out. This case highlights that giant hepatic hemangiomas may be symptomatic and warrant treatment. In the setting of cirrhosis and portal hypertension, physicians should be aware of the risk of hepatic decompensation following surgical resection, even in patients with Child-Pugh class A.


Case Reports, Hemangioma, Liver Cirrhosis


1 Dong W, Qiu B, Xu H, He L. Invasive management of symptomatic hepatic hemangioma. Eur J Gastroenterol Hepatol. 2019;31(9):1079-84. PMid:31021878.

2 Di Carlo I, Koshy R, Al Mudares S, Ardiri A, Bertino G, Toro A. Giant cavernous liver hemangiomas: is it the time to change the size categories? Hepatobiliary Pancreat Dis Int. 2016;15(1):21-9. PMid:26818540.

3 Mastropasqua M, Kanematsu M, Leonardou P, Braga L, Woosley JT, Semelka RC. Cavernous hemangiomas in patients with chronic liver disease: MR imaging findings. Magn Reson Imaging. 2004;22(1):15-8. PMid:14972389.

4 Ribeiro MA Jr, Papaiordanou F, Gonçalves JM, Chaib E. Spontaneous rupture of hepatic hemangiomas: a review of the literature. World J Hepatol. 2010;2(12):428-33. PMid:21191518.

5 Yu JS, Kim KW, Park MS, Yoon SW. Hepatic cavernous hemangioma in cirrhotic liver: imaging findings. Korean J Radiol. 2000;1(4):185-90. PMid:11752953.

6 Xie QS, Chen ZX, Zhao YJ, Gu H, Geng XP, Liu FB. Outcomes of surgery for giant hepatic hemangioma. BMC Surg. 2021;21(1):186. PMid:33832476.

7 Farhat W, Ammar H, Said MA, et al. Surgical management of giant hepatic hemangioma: a 10-year single center experience. Ann Med Surg. 2021;69:102542. PMid:34457247.

8 Eghlimi H, Arasteh P, Azade N. Orthotopic liver transplantation for Management of a Giant Liver Hemangioma: a case report and review of literature. BMC Surg. 2020;20(1):142. PMid:32600292.

9 Jiang T, Zhao Z, Cai Z, Shen C, Zhang B. Case report: giant abdominal hemangioma originating from the liver. Front Oncol. 2023;13:1165195. PMid:37588097.

10 Citterio D, Facciorusso A, Sposito C, Rota R, Bhoori S, Mazzaferro V. Hierarchic interaction of factors associated with liver decompensation after resection for hepatocellular carcinoma. JAMA Surg. 2016;151(9):846-53. PMid:27248425.

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