From the Guidelines
Yes, a 31-year-old female with a 6.0 x 5.1 cm hepatic hemangioma requires surveillance, as the size of the hemangioma is greater than 5 cm, which may increase the risk of rupture during pregnancy 1.
Key Considerations
- The risk of hepatic rupture in a giant (>4 cm) liver haemangioma is 3.2%, with increased risk in peripherally located and exophytic lesions 1.
- Haemangiomas can usually be managed conservatively, but close monitoring is recommended, especially during pregnancy 1.
- Imaging is recommended during each trimester of pregnancy to monitor haemangioma size in those at higher risk of rupture (large or exophytic) 1.
- The decision to intervene should be approached with caution and be determined on a case-by-case basis, guided by symptoms and risk to maternal and fetal outcomes 1.
Surveillance and Management
- Ultrasound monitoring of the hemangioma during each trimester of pregnancy is recommended to assess for any changes in size or symptoms 1.
- Consultation with a hepatobiliary surgeon and interventional radiology should be considered to discuss the best therapeutic approach 1.
- New onset of symptoms should prompt investigation, and the decision to intervene should be made on a case-by-case basis 1.
From the Research
Hepatic Hemangioma Surveillance
The provided studies discuss various cases of hepatic hemangiomas, their symptoms, and treatment options.
- A 31-year-old female with a 6.0 x 5.1 cm hepatic hemangioma is considered to have a giant hemangioma, as some studies suggest that hemangiomas larger than 4 cm or 5 cm are referred to as giant 2, 3.
- Giant hepatic hemangiomas can manifest different kinds of symptoms and are prone to life-threatening manifestations like rupture or torsion 2.
- Most hemangiomas do not express any symptoms, and therefore, no treatment is needed except for patients who manifest symptoms or have giant pedunculated hemangiomas 2.
- Surveillance may be necessary for giant hepatic hemangiomas, especially in women taking oral contraceptives, as they are at a higher risk of complications 2, 4, 5.
- Imaging is needed to rule out these tumors, and most often, pedunculated hemangioma is harder to be defined on imaging 2.
Treatment Options
- Treatment options for giant hepatic hemangiomas vary depending on the size, location, and symptoms of the tumor.
- Surgery is often reserved for symptomatic or complicated cases, such as rupture or torsion 2, 4, 5.
- In some cases, liver transplantation may be the best achievable option 4.
- Other treatment options, such as transcatheter arterial chemoembolization, may be considered for certain cases 6.
Risk of Complications
- Giant hepatic hemangiomas are at a higher risk of complications, such as rupture or torsion, which can be life-threatening 2, 5.
- The risk of complications is higher in women taking oral contraceptives, as estrogen can lead to endothelial cell proliferation and organization in vascular structure 2.
- Regular surveillance and monitoring may be necessary to detect any changes in the tumor size or symptoms, and to prevent complications 2, 4, 3.