Think Hemangioma Think Well: Giant Pedunculated Hepatic Cavernous Hemangioma. A Case Report

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Think Hemangioma Think Well: Giant Pedunculated Hepatic Cavernous Hemangioma. A Case Report Marco Di Serafino 1 & Francesca Iacobellis 1 & Paolo Pizzicato 2 & Gaspare Oliva 1 & Luigi Barbuto 1 & Salvatore Minelli 1 & Giuseppina Marino Marsilia 3 & Severo Campione 3 & Martino Trunfio 4 & Luigia Romano 1 Accepted: 9 November 2020 / Published online: 19 November 2020 # Springer Nature Switzerland AG 2020

Abstract Hepatic haemangiomas are the most common benign hepatic tumour; they are usually solitary, less than 5 cm in size, and clinically silent. Giant cavernous haemangiomas are a minor subset of hepatic haemangiomas, often symptomatic due to a mass lesion, complications or compression of adjacent structures. Few of these are pedunculated—often difficult to diagnose because of their exophytic development and greater tendency towards complications through the twisting of their peduncle. We report the case of a 55-year-old woman with a giant pedunculated hepatic cavernous haemangioma causing abdominal pain, with epigastralgia mimicking a gastric stromal tumour. We discuss the diagnostic workup, focusing on the useful of computed tomography and magnetic resonance imaging findings and giving a brief report of the therapeutic management and literature review. Keywords Giant pedunculated cavernous haemangiomas . Liver . Diagnostic imaging . Surgery

Introduction Haemangiomas are the most common benign hepatic tumours. The prevalence of haemangioma in the general population ranges from 1–2% to 20% [1–3]. The female-to-male ratio varies from 2:1 to 5:1. They occur at all ages [1–3]. They are generally solitary, less than 5 cm in size, and remain asymptomatic in a large majority of cases. The natural history of haemangiomas is variable: most remain stable; some may grow or involute [3]. Giant cavernous haemangiomas are a minor subset of hepatic haemangiomas. They are considered atypical and consist of congenital and progressively growing This article is part of the Topical Collection on Imaging * Marco Di Serafino [email protected] 1

Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, Antonio Cardarelli St 9, 80131 Naples, Italy

2

Department of Advanced Biomedical Sciences, “Federico II” University Hospital, Naples, Italy

3

Department of Anatomy and Pathological Histology, “Antonio Cardarelli” Hospital, Naples, Italy

4

Department of General and Specialized Surgery, “Antonio Cardarelli” Hospital, Naples, Italy

vascular malformations, resulting in microscopic or macrosco pic cav erno us spac es [3– 5]. The ter m ‘ giant haemangioma’ is reserved for lesions larger than 5 cm, which are often symptomatic due to mass effect, compression of adjacent organs, or haemorrhage [3, 4]. Exophytic cavernous hepatic haemangiomas—especially the pedunculated forms— are a rare subset of giant haemangioma and often difficult to diagnose because of their exophytic development and tendency towards complications arising from the twisting of the peduncle [6]. According to a previous literatur