1. Surgical management of liver haemangioma Dr Chris Yau Dept of Surgery PWH

2. Clinical scenario --- pitfall 68 F USG: 3cm hyperechoic lesion right lobe Typical haemangioma Hepatitis marker –ve, AFP CEA normal FU CT scan: 7cm after 3 yr Trisegmentectomy: cholangiocarcinoma 67 F USG: 4cm lesion left lobe Typical haemangioma Hepatitis marker, AFP CEA normal FU USG 1 yr 8cm mass left lobe, multiple satellite lesions right lobe Palliative care

3. Content Pathology Prevalence / Etiology Clinical presentation Diagnostic tools Surveillance Surgical management Take home message

4. Liver Haemangioma --Pathology First prescribed by Amboise Pare 1570 (Paris) Benign tumour Size up to 30cm Giant Haemangioma if size > 10cm

5. Liver Haemangioma --Pathology Macroscopically: red wine colored mass with lobulated appearance Microscpically: large endothelium lined vascular channels packed with red blood cell

6. Prevelance / Etiology 0.7% to 7.3 % in autopsy finding * Female predominance 1.5 – 6 : 1 ** Present most often between 3rd and 4th decade Positive correlation with female sex hormone * Belghiti, Management of haemangioma, Stuttgart: 1993: 78-85 ** Yan et al, US guided percutanceous RFA for hepatic haemangioma. World J Gastroenterol, 2003 Sept 2132-2134

7. Clinical Presentation Asymptomatic Epigastric pain Spontaneous hemorrhage Traumatic hemorrhage Cardiac failure

8. Dignostic tools USG: Homogenous hyperechoic CT scan: Pre-contrast: Relative hypodense Early phase : Perilesional increase in contrast Delayed: isodense / hyperdense

9. Diagnostic tools MRI scan: T1 : hypointense T2 : heavily hyperintense Arteriography: Golden standard Cotton Wool appearance

10. Surveillance NANil Complications 1Nil Malignancy NANil1Change of lesion 12 yrs12-114 months12-60 monthsFollow up period 170NilNADrop out 38323123No of pt Leifer (US)Nippon (Japan)Gandolfi (Italy)

11. Surgical Treatment Treatment method: Laparoscopic Vs Open Resection Vs Enucleation RFA Indications of Surgery Uncertain diagnosis Symptomatic Lesion with documented increase in size +/- Giant haemangioma

12. Surgery result 2.4% 12% 0 0 42 Ozden et NA00Mortality NA13%25%Morbidity 000Malignancy 1551163Conservative tx 81552Surgery 16326115No of pt Farges et alMoreno et alYoon et al

13. Take home message Majority haemangioma can be treated conservatively Existence of mimicker Repeat scan / FNAC / Surgery if uncertain diagnosis