Hepatic hemangiomas (cavernous hemangiomas) are the most common benign hepatic tumors, representing about 70% of HFLs diagnosed during MRI. Their prevalence from autopsy reports reaches up to 20%. They are more common in women (3:1).
Hepatic hemangiomas are considered to be vascular malformations or hamartomas of congenital origin that enlarge by ectasia rather than by hyperplasia or hypertrophy.
Hormonal influence over tumor growth is suggested by enlargement during pregnancy and estrogen & progesterone therapy and regression after withdrawal of therapy.
Hemangiomas are often solitary, but multiple lesions may be present in up to 40% of patients. They can be found in both lobes of the liver but are more common in the right lobe. They may be associated with hemangiomas in other organs, biliary hamartomas, and focal nodular hyperplasia.
They range in size from a few millimeters to over 20 cm. The majority are <5 cm. The larger lesions may be pedunculated.
Microscopically, the tumor is composed of cavernous vascular spaces of varying sizes lined by a single layer of flat endothelium and filled with blood.
Most patients with hepatic hemangiomas are asymptomatic and are typically discovered incidentally at laparotomy, autopsy, or during imaging performed for unrelated conditions.
Symptoms are more likely with large lesions (>5 cm) in young women.
The most common symptoms are