Liver Hemangiomas: Growth, Treatment, and Symptoms - Gastroenterology and Hepatology

Will a hepatic hemangioma spread?

Last May during a health check, a suspected liver tumor measuring 1 cm was found.
A CT scan in June showed no abnormalities.
In September, an ultrasound revealed three lesions over 1 cm, and by December, five lesions over 1 cm were detected during follow-up.
Should further examinations be conducted in this process? What treatment options are available? Additionally, since October, I have been experiencing similar neuropathic pain in my abdomen and chest.
Could this be related?

Anonymous, 30~39 year old female. Ask Date: 2002/01/21

Dr. Yang Guojun reply Gastroenterology and Hepatology

Hepatic hemangiomas may present in a multifocal manner; however, if a patient shows an increasing number of lesions during follow-up, it could be due to two reasons: 1.
The patient may have had multiple lesions initially, and as their fatty liver improves, these lesions become more apparent.
2.
It is possible that the previously identified hemangiomas are now exhibiting new characteristics, such as the emergence of additional tumors that could be other types of cancers, or the original lesions may be a mix of hemangiomas and non-hemangiomas.
If the liver tumors are less than 1 cm, they are often not visible on CT scans and MRIs; however, the absence of visibility does not imply that they are not present.
Therefore, it is recommended to continue with monthly ultrasound scans.

Reply Date: 2002/01/21

More Info

Liver hemangiomas are the most common benign tumors of the liver, often discovered incidentally during imaging studies such as ultrasound or CT scans. They are composed of a mass of blood vessels and are generally asymptomatic. Your situation, where you have observed a progression from one hemangioma to multiple lesions over a relatively short period, raises some important considerations regarding diagnosis, monitoring, and potential treatment.

Understanding Dynamic Liver Triphasic Imaging Protocol
The dynamic liver triphasic imaging protocol is a specialized CT scan technique that captures images of the liver at three distinct phases after the administration of contrast material: the arterial phase, the portal venous phase, and the delayed phase. This protocol is crucial for differentiating between various types of liver lesions, including hemangiomas, focal nodular hyperplasia (FNH), and hepatocellular carcinoma (HCC). Each type of lesion has a characteristic enhancement pattern that can be observed during these phases. If your CT scan was not performed using this protocol, it may limit the radiologist's ability to definitively characterize the lesions, which could necessitate further imaging studies.

Need for Further Evaluation
Given the increase in the number of lesions from one to five within a year, it is advisable to consult your healthcare provider about the necessity of further imaging studies, such as an MRI with liver-specific contrast agents or a follow-up CT scan using the dynamic liver triphasic protocol. These imaging modalities can provide more detailed information about the nature of the lesions and help rule out any malignancy.

Growth Rate of Liver Hemangiomas
Liver hemangiomas typically grow very slowly, if at all. Many remain stable in size for years, and it is not uncommon for them to be discovered incidentally during imaging for unrelated reasons. The growth rate can vary significantly among individuals, and while some hemangiomas may increase in size, others may not change at all. In your case, the observation of multiple lesions warrants careful monitoring, but it does not necessarily indicate aggressive behavior.

Treatment Options
Most liver hemangiomas do not require treatment unless they are symptomatic or significantly large (generally over 4-5 cm), which could lead to complications such as pain or rupture. In asymptomatic cases, the standard approach is regular monitoring through imaging studies, typically every 6 to 12 months. If symptoms arise or if the hemangiomas grow significantly, treatment options may include surgical resection or embolization, but these are rare and usually reserved for complicated cases.

Symptoms and Their Relation to Hemangiomas
You mentioned experiencing a sensation similar to nerve pain in your abdomen and chest. While liver hemangiomas are often asymptomatic, larger lesions can cause discomfort or a feeling of fullness due to their size or location. However, it is essential to consider other potential causes for your symptoms, such as gastrointestinal issues, musculoskeletal pain, or even anxiety. It would be prudent to discuss these symptoms with your healthcare provider, who may recommend further evaluation to determine their cause.

Conclusion
In summary, while liver hemangiomas are generally benign and often require no treatment, the increase in the number of lesions and any accompanying symptoms should be taken seriously. Regular follow-up with imaging studies is essential to monitor the situation. If you have concerns about your symptoms or the nature of the lesions, do not hesitate to reach out to your healthcare provider for further evaluation and guidance. They can provide personalized recommendations based on your specific circumstances and health history.

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