Hemangioma

 Incidence ranges from < 1% to 7.3% in autopsy studies






Clinical Issues




• Majority discovered incidentally
image Clinically silent

– Tumors under 4 cm rarely symptomatic

image When symptomatic, present with abdominal pain, hepatomegaly, palpable mass

• More frequent in older patients and women

• Treatment is surgical resection or ablative therapy if symptomatic; otherwise observation

• Complications rare but include rupture and consumptive coagulopathy


Macroscopic




• Usually solitary and subcapsular

• Cut surface shows dark red, spongy mass composed of blood-filled cavities

• Most < 4 cm


Microscopic




• Dilated, variably sized vascular spaces
image Lined by flat, bland endothelial cells

image Fibrin thrombi may be present in vascular spaces

• Connective tissue septa of varying widths

• Older lesions frequently contain involutional changes such as fibrosis, thrombosis, calcification
image Can usually detect underlying vascular architecture even if involutional change is extensive

image
Gross Specimen
The cut surface of this partial hepatectomy specimen shows a spongy red mass directly beneath the capsule. Normal liver is to the left of the tumor image. (Courtesy G. Gray, MD.)


image
Dilated Vascular Channels Filled With Blood
This hemangioma has a somewhat irregular interface with the normal liver on the right. The lesion consists of dilated vascular channels filled with blood with intervening fibrous septa.

image
Dilated Vascular Spaces
Hemangiomas are composed of dilated vascular spaces with a bland, flat endothelial lining. The intervening fibrous bands are paucicellular and of varying thickness. Note the organizing thrombus in a vascular space image .

image
Fibrosis
This hemangioma shows marked fibrosis, a common involutional change due to thrombosis over time. Residual typical dilated vascular channels are seen in the center of the picture.


TERMINOLOGY


Synonyms




• Cavernous hemangioma, sclerosing hemangioma


Definitions




• Benign vascular tumor
image Most common primary tumor of liver


ETIOLOGY/PATHOGENESIS


Unknown




• Possibly congenital

• Postulated but unproven role of sex hormones


CLINICAL ISSUES


Epidemiology




• Incidence
image Ranges from < 1% to 7.3% in autopsy studies

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Apr 20, 2017 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Hemangioma

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