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혈관성 종양

Benign Vascular Hepatic Tumor

  • 김도영 (연세대학교 의과대학 내과학교실)
  • Kim, Do Young (Department of Internal Medicine, Yonsei University College of Medicine)
  • 발행 : 2013.03.01

초록

Hemangioma is the most common type of benign vascular hepatic tumor. It is more prevalent in women with a 5:1 female: male ratio with a mean age of 50 years. Symptoms related to hemangiomas are mostly absent even in giant (> 10 cm) ones. The most feared complication of hemangioma is abdominal hemorrhage caused by rupture, the risk of which is nearly zero for hemangiomas < 5 cm and rupture rarely occurs even in patients with giant hemangiomas. The diagnosis of hemangioma depends on the findings in imaging modalities such as US, dynamic computed tomography (CT), and magnetic resonance imaging (MRI). The typical features of hemangiomas in US are well-circumscribed hyperechoic nodule, iso- or hypoechoic nodule with hyperechoic rim. In a liver with underlying fatty change, hemangioma may appear as a hypoechoic nodule. It is necessary to proceed on other high-resoultion modality (CT or MRI) if the finding in US is atypical or the patient has chronic liver disease. The characteristics of hemangiomas in CT or MRI is peripheral globular enhancement with centripetal progression and persistence of enhancement in delayed phase. Although it is controversial, follow-up with annual US scans is advised for the newly diagnosed hemangiomas.

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참고문헌

  1. Semelka RC, Sofka CM. Hepatic hemangiomas. Magn Reson Imaging Clin N Am 1997;5:241-253.
  2. Trotter JF, Everson GT. Benign focal lesions of the liver. Clin Liver Dis 2001;5:17-42. https://doi.org/10.1016/S1089-3261(05)70152-5
  3. Saegusa T, Ito K, Oba N, et al. Enlargement of multiple cavernous hemangioma of the liver in association with pregnancy. Intern Med 1995;34:207-211. https://doi.org/10.2169/internalmedicine.34.207
  4. Spitzer D, Krainz R, Graf AH, Menzel C, Staudach A. Pregnancy after ovarian stimulation and intrauterine insemination in a woman with cavernous macrohemangioma of the liver: a case report. J Reprod Med 1997;42:809-812.
  5. Vilgrain V, Boulos L, Vullierme MP, Denys A, Terris B, Menu Y. Imaging of atypical hemangiomas of the liver with pathologic correlation. Radiographics 2000;20:379-397. https://doi.org/10.1148/radiographics.20.2.g00mc01379
  6. Takahashi T, Kuwao S, Katagiri H, Kakita A. Multiple liver hemangiomas enlargement during long-term steroid therapy for myasthenia gravis. Dig Dis Sci 1998;43:1553-1561. https://doi.org/10.1023/A:1018875117599
  7. Ito N, Kawata S, Tsushima H, et al. Increased circulating transforming growth factor beta1 in a patient with giant hepatic hemangioma: possible contribution to an impaired immune function. Hepatology 1997;25:93-96. https://doi.org/10.1002/hep.510250117
  8. Mathieu D, Zafrani ES, Anglade MC, Dhumeaux D. Association of focal nodular hyperplasia and hepatic hemangioma. Gastroenterology 1989;97:154-157. https://doi.org/10.1016/0016-5085(89)91429-7
  9. Fonseca V, Havard CW. Portal hypertension secondary to azathioprine in myasthenia gravis. Postgrad Med J 1988;64: 950-952. https://doi.org/10.1136/pgmj.64.758.950
  10. Hotokezaka M, Kojima M, Nakamura K, et al. Traumatic rupture of hepatic hemangioma. J Clin Gastroenterol 1996; 23:69-71. https://doi.org/10.1097/00004836-199607000-00020
  11. Scribano E, Loria G, Ascenti G, Vallone A, Gaeta M. Spontaneous hemoperitoneum from a giant multicystic hemangioma of the liver: a case report. Abdom Imaging 1996;21:418-419. https://doi.org/10.1007/s002619900095
  12. Baer HU, Dennison AR, Mouton W, Stain SC, Zimmermann A, Blumgart LH. Enucleation of giant hemangiomas of the liver: technical and pathologic aspects of a neglected procedure. Ann Surg 1992;216:673-676. https://doi.org/10.1097/00000658-199212000-00009
  13. Ishak KG, Rabin L. Benign tumors of the liver. Med Clin North Am 1975;59:995-1013. https://doi.org/10.1016/S0025-7125(16)31998-8
  14. McArdle CR. Ultrasonic appearances of a hepatic hemangioma. J Clin Ultrasound 1978;6:124. https://doi.org/10.1002/jcu.1870060217
  15. Bree RL, Schwab RE, Glazer GM, Fink-Bennett D. The varied appearances of hepatic cavernous hemangiomas with sonography, computed tomography, magnetic resonance imaging and scintigraphy. Radiographics 1987;7:1153-1175. https://doi.org/10.1148/radiographics.7.6.3321218
  16. Moody AR, Wilson SR. Atypical hepatic hemangioma: a suggestive sonographic morphology. Radiology 1993;188: 413-417. https://doi.org/10.1148/radiology.188.2.8327687
  17. Perkins AB, Imam K, Smith WJ, Cronan JJ. Color and power Doppler sonography of liver hemangiomas: a dream unfulfilled? J Clin Ultrasound 2000;28:159-165. https://doi.org/10.1002/(SICI)1097-0096(200005)28:4<159::AID-JCU1>3.0.CO;2-B
  18. Freeny PC, Marks WM. Hepatic hemangioma: dynamic bolus CT. AJR Am J Roentgenol 1986;147:711-719. https://doi.org/10.2214/ajr.147.4.711
  19. Quinn SF, Benjamin GG. Hepatic cavernous hemangiomas: simple diagnostic sign with dynamic bolus CT. Radiology 1992;182:545-548. https://doi.org/10.1148/radiology.182.2.1732978
  20. Oto A, Kulkarni K, Nishikawa R, Baron RL. Contrast enhancement of hepatic hemangiomas on multiphase MDCT: can we diagnose hepatic hemangiomas by comparing enhancement with blood pool? AJR Am J Roentgenol 2010;195:381-386. https://doi.org/10.2214/AJR.09.3324
  21. Yamashita Y, Ogata I, Urata J, Takahashi M. Cavernous hemangioma of the liver: pathologic correlation with dynamic CT findings. Radiology 1997;203:121-125. https://doi.org/10.1148/radiology.203.1.9122378
  22. Kim T, Federle MP, Baron RL, Peterson MS, Kawamori Y. Discrimination of small hepatic hemangiomas from hypervascular malignant tumors smaller than 3 cm with threephase helical CT. Radiology 2001;219:699-706. https://doi.org/10.1148/radiology.219.3.r01jn45699
  23. Silva AC, Evans JM, McCullough AE, Jatoi MA, Vargas HE, Hara AK. MR imaging of hypervascular liver masses: a review of current techniques. Radiographics 2009;29: 385-402. https://doi.org/10.1148/rg.292085123
  24. Cronan JJ, Esparza AR, Dorfman GS, Ridlen MS, Paolella LP. Cavernous hemangioma of the liver: role of percutaneous biopsy. Radiology 1988;166(1 Pt 1):135-138. https://doi.org/10.1148/radiology.166.1.3275965
  25. Nakaizumi A, Iishi H, Yamamoto R, et al. Diagnosis of hepatic cavernous hemangioma by fine needle aspiration biopsy under ultrasonic guidance. Gastrointest Radiol 1990; 15:39-42. https://doi.org/10.1007/BF01888731
  26. Tung GA, Cronan JJ. Percutaneous needle biopsy of hepatic cavernous hemangioma. J Clin Gastroenterol 1993;16: 117-122. https://doi.org/10.1097/00004836-199303000-00008
  27. Mungovan JA, Cronan JJ, Vacarro J. Hepatic cavernous hemangiomas: lack of enlargement over time. Radiology 1994;191:111-113. https://doi.org/10.1148/radiology.191.1.8134554
  28. Leifer DM, Middleton WD, Teefey SA, Menias CO, Leahy JR. Follow-up of patients at low risk for hepatic malignancy with a characteristic hemangioma at US. Radiology 2000;214:167-172. https://doi.org/10.1148/radiology.214.1.r00ja09167
  29. Nishida O, Satoh N, Alam AS, Uchino J. The effect of hepatic artery ligation for irresectable cavernous hemangioma of the liver. Am Surg 1988;54:483-486.
  30. Gaspar L, Mascarenhas F, da Costa MS, Dias JS, Afonso JG, Silvestre ME. Radiation therapy in the unresectable cavernous hemangioma of the liver. Radiother Oncol 1993; 29:45-50. https://doi.org/10.1016/0167-8140(93)90172-5