A common and minor condition, liver angioma is a benign tumor that affects the hepatic blood vessels. In the vast majority of cases, it does not cause any symptoms and it is not necessary to operate.
What is a liver angioma?
Angioma of the liver, also called hemangioma or hepatic angioma, is a benign tumor that grows at the expense of blood vessels and forms a small mass of abnormal vessels.
Typically, the angioma presents as an isolated, well-defined round lesion less than 3 cm in diameter (less than 1 cm every other time). The angioma is stable and does not cause any symptoms. Multiple angiomas may be disseminated in the liver.
The lesion can also take an atypical form. There are giant angiomas measuring up to 10 cm, others take the form of small fully fibrous nodules (sclerotic angiomas), and others are calcified or connected to the liver by a pedicle …
Some angiomas can change in size in the long term, without degenerating into malignant tumors.
It is a lesion with no identified cause, probably of congenital origin. Some hepatic angiomas may be under the influence of hormones.
Angiomas are often discovered incidentally during an abdominal ultrasound. When the liver is healthy and the tumor is less than 3 cm long, the nodule found is clearly identifiable and there is no need for further examination.
When the angioma is atypical or in patients with underlying liver disease, such as cirrhosis or liver cancer, it may be confused with other types of tumors on ultrasound. Diagnosis is particularly difficult for small angiomas in patients with malignant tumors.
Other imaging tests with contrast media injection (ultrasound, CT or MRI) should then be performed to confirm the diagnosis. MRI is the most sensitive and specific examination and can remove doubt more than nine times out of ten.
If the diagnosis could not be made by imaging tests, a biopsy may be considered. The doctor will perform a puncture by inserting a needle transcutaneously. The accuracy of the diagnosis reaches 96%.
The persons concerned
In the absence of symptoms and given the role played by chance in the diagnosis, it is difficult to know exactly how many people are carriers of liver angiomas. The EASL (the European association for the study of the liver) estimates that about 0.4% to 20% of the population would be concerned (around 5% when the estimate is made on a series of imaging tests, but up to 20% in studies that have focused on necropsied livers).
Hepatic angiomas are found in people of all ages, including infants, but are more commonly seen in people aged 30 to 50 years, with a female predominance.
Hormonal treatments may play a role in increasing the size of certain angiomas in the liver. However, studies show that this risk is minor and a priori safe. Oral contraception, in particular, is not contraindicated in women with non-active tumors and can be continued without special monitoring.
Symptoms of a liver angioma
Most of the time, the angioma is and will remain asymptomatic.
Large angiomas, however, can compress adjacent tissues and cause inflammation and pain.
In rare cases, other complications may occur:
- thrombosis (formation of a clot),
- Kasabach-Merritt syndrome (MCS) is characterized by an inflammatory reaction and bleeding disorder,
- intra-tumoral hemorrhage, or even effusion of blood into the peritoneum by rupture of the angioma (hemoperitoneum)…
Treatments for liver angioma
There is no need to treat – or even monitor – angiomas that are small, stable, and cause no symptoms.
In other cases, arterial embolization (obstruction) may be proposed. Management may also be based on medical treatment with corticosteroids or other medications. More rarely, surgery will be considered to remove the tumor.
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