Growing Liver Hemangiomas: When to Seek Treatment - Gastroenterology and Hepatology

Q: Growing Liver Hemangiomas: When to Seek Treatment

Hello Ms. <br>TATA： A small number of benign hemangiomas may still enlarge (possibly related to female hormones?). <br>It may be considered to perform fine needle aspiration or core needle biopsy to confirm that the cells are normal, although there are some risks involved. <br>Ch

Hemangioma that grows?

Hello Dr.
Chen, I undergo a health check-up approximately every two years, which includes an abdominal ultrasound.
Over the past sixteen years, I have had about seven check-ups.
Four years ago, I was first diagnosed with a hepatic hemangioma measuring about 1.5 cm.
Two years ago, it grew to 2.75 cm, and during this year's check-up, it has increased further to nearly 4 cm, along with three additional lesions measuring 1.5 cm each.
Based on the recommendation of the physician who conducted my check-up, I went to a regional hospital for an MRI, and the size descriptions and diagnoses were consistent with what was previously noted.
According to educational materials from various hospitals, hemangiomas typically do not grow significantly after adulthood; however, mine seems to be growing steadily.
I can't help but worry that my hepatic hemangioma may be atypical and I am concerned about the possibility of it continuing to grow (potentially exceeding 5 cm in two years, along with the smaller lesions).
Should I consider early intervention? Therefore, I seek your expert opinion.
Thank you.

TATA, 40~49 year old female. Ask Date: 2011/11/28

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello Ms.
TATA: A small number of benign hemangiomas may still enlarge (possibly related to female hormones?).
It may be considered to perform fine needle aspiration or core needle biopsy to confirm that the cells are normal, although there are some risks involved.
Changhua Hospital cares about your health!

Reply Date: 2011/11/28

More Info

Liver hemangiomas are the most common benign tumors of the liver, typically characterized by a proliferation of blood vessels. They are often asymptomatic and discovered incidentally during imaging studies, such as ultrasound or CT scans. The concerns you have regarding the growth of your liver hemangiomas are valid, especially given the increase in size you’ve observed over the years.

Understanding Dynamic Liver Triphasic Imaging Protocol
The "dynamic liver triphasic imaging protocol" refers to a specific CT scan technique that evaluates the liver in three phases: the arterial phase, the portal venous phase, and the delayed phase. This method allows for a more detailed assessment of liver lesions, helping to differentiate between various types of liver tumors, including hemangiomas and focal nodular hyperplasia (FNH). The arterial phase captures the enhancement of blood vessels, while the portal venous phase shows how the liver parenchyma absorbs the contrast agent. If your CT scan did not follow this protocol, it may limit the ability of the radiologist to make a definitive diagnosis, which is why further imaging might be recommended.

When to Seek Further Evaluation
Given that your hemangiomas have shown significant growth—1.5 cm to 4 cm over four years, along with the appearance of additional smaller lesions—it is reasonable to consider further evaluation. While many hemangiomas remain stable and do not require treatment, those that grow larger than 4-5 cm or exhibit rapid growth may warrant closer monitoring or even intervention. The general recommendation is to follow up with imaging every 6 to 12 months, but in your case, discussing the possibility of more frequent imaging or a referral to a specialist in liver diseases may be prudent.

Growth Rate and Treatment Considerations
The growth rate of liver hemangiomas can vary significantly among individuals. While many hemangiomas remain stable, some can grow slowly over time. The concern arises when hemangiomas exceed 4-5 cm, as larger lesions can lead to complications such as abdominal pain, pressure symptoms, or, in rare cases, rupture. Surgical intervention is typically reserved for symptomatic hemangiomas or those that show rapid growth, especially if they exceed 10 cm.

Currently, there are no medications specifically designed to shrink liver hemangiomas. The standard approach is careful monitoring through imaging. If your hemangiomas continue to grow or if you start experiencing symptoms, surgical options such as resection or embolization may be considered.

Lifestyle Considerations
In terms of lifestyle, there are no specific restrictions for individuals with liver hemangiomas. However, it is advisable to avoid activities that could lead to abdominal trauma, as larger hemangiomas may be more susceptible to bleeding. Regular follow-ups with your healthcare provider are essential to monitor the size and symptoms of the hemangiomas.

Conclusion
In summary, while liver hemangiomas are generally benign and often do not require treatment, your case presents a scenario where further evaluation and monitoring are warranted due to the observed growth. Engaging in a detailed discussion with your healthcare provider about the potential need for dynamic imaging and the implications of your hemangiomas is crucial. Regular monitoring and a proactive approach will help ensure that any changes in your condition are addressed promptly.

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