Managing a Benign Liver Hemangioma: When No Symptoms Require Action

The endoscopy report indicates that the hepatic hemangioma is slightly compressing the stomach?

Hello Dr.
Yeh: I recently underwent an upper gastrointestinal endoscopy, and the report mentioned that a benign hemangioma in the left lobe of my liver is slightly compressing the stomach.
The doctor who performed the endoscopy seemed to emphasize this point.
I have no discomfort in my stomach or body, and this liver hemangioma has been stable and monitored for many years.
I would like to ask if there is any need for special treatment in this situation of slight compression, even though I am asymptomatic.
Thank you.

A Li, 40~49 year old female. Ask Date: 2019/01/23

Dr. Ye Qianyu reply Family Medicine

Hello, based on your description, it is suspected that the liver tumor is compressing the gastric body.
Since the nature of the liver tumor is unknown, it is difficult to predict changes.
Additionally, it is important to know the size of the liver tumor; even if it is benign, if it is too large or located on the surface of the liver, it is advisable to consult a hepatobiliary and gastroenterology specialist to determine if intervention is necessary.

"For vascular tumors smaller than 2 centimeters, it is sufficient to have follow-up ultrasound examinations every 3 to 6 months.
However, if it enlarges or exceeds 2 centimeters, the physician may arrange for additional imaging studies, such as a CT scan or MRI, if deemed necessary.
Although ultrasound examinations are quite accurate, they cannot provide a definitive diagnosis, and other imaging modalities may be needed to assist in diagnosis.
If the CT scan or MRI still cannot clarify the situation, the physician may consider performing a liver biopsy to directly extract cells from the tumor for pathological analysis.

However, for vascular tumors, it is recommended to monitor for at least 3 years to ensure safety.
This is because there was a case in the past where a patient diagnosed with a vascular tumor showed no issues after two years of follow-up, only to discover that what was believed to be a vascular tumor was actually a malignant tumor two and a half years later.
This was not a misdiagnosis by the physician, but rather a reflection of the unpredictable nature of malignant tumors.

Many patients ask whether benign tumors need to be surgically removed.
In fact, this is not necessary as long as regular follow-up examinations are conducted to understand the characteristics and size of the tumor, which should show no significant changes.
There is no need for medication unless the vascular tumor is too large or located on the surface of the liver, raising concerns about the risk of rupture and bleeding, in which case surgical removal may be considered, but this is very rare."
(Excerpt from the article by the Hepatobiliary Disease Prevention and Treatment Academic Foundation) It is recommended that you take the time to return to the facility that diagnosed your liver tumor to consult with your physician about the characteristics and size of your liver tumor, and to have regular follow-ups.
Thank you for your inquiry!

Reply Date: 2019/01/23

More Info

Managing a benign liver hemangioma, especially when it is asymptomatic, can be a nuanced process. In your case, where the hemangioma is slightly compressing the stomach but you are not experiencing any discomfort, the approach typically leans towards observation rather than intervention.
Liver hemangiomas are the most common benign tumors of the liver, often discovered incidentally during imaging studies for other reasons. They are composed of a mass of blood vessels and are usually asymptomatic. Most hemangiomas do not require treatment unless they cause symptoms or complications, which is rare. The fact that your hemangioma has been stable over the years is a positive indicator.

Monitoring and Follow-Up
1. Regular Imaging: Since your hemangioma has been stable, regular follow-up with imaging studies, such as ultrasound or MRI, is usually recommended. This helps to ensure that there are no changes in size or characteristics that might warrant further investigation or intervention.

2. Symptom Awareness: While you currently have no symptoms, it’s important to remain vigilant for any changes. Symptoms that could indicate a problem include abdominal pain, nausea, or any changes in your digestive patterns. If you experience any of these, it would be prudent to consult your healthcare provider.

3. Consultation with Specialists: If the hemangioma is causing pressure on the stomach, it may be beneficial to discuss this with a gastroenterologist or a hepatologist. They can provide insights into whether the pressure is significant enough to warrant further action or if it is within a normal range for benign conditions.

When to Consider Treatment
Treatment options for liver hemangiomas are generally reserved for cases where the hemangioma is large (typically over 4-5 cm), symptomatic, or causing complications such as bleeding. Surgical options include:
- Resection: Surgical removal of the hemangioma may be considered if it is large and symptomatic.

- Embolization: This is a less invasive procedure that involves blocking the blood supply to the hemangioma, causing it to shrink.

However, given your situation where the hemangioma is stable and asymptomatic, these interventions are unlikely to be necessary.

Conclusion
In summary, for a benign liver hemangioma that is stable and asymptomatic, the best course of action is typically regular monitoring and maintaining open communication with your healthcare provider. If there are any changes in your condition or if you start to experience symptoms, further evaluation may be warranted. It’s always a good idea to discuss any concerns with your doctor, who can provide personalized advice based on your medical history and current health status.
Maintaining a healthy lifestyle, including a balanced diet and regular exercise, can also contribute to overall liver health. Remember, the key is to stay informed and proactive about your health while trusting the monitoring process for benign conditions like a liver hemangioma.

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