Angioma of the liver : Symptoms & treatment

Liver angioma is a benign tumor that affects the blood vessels of the liver. In the vast majority of cases, it causes no symptoms and does not require surgery.

What is a liver angioma?

Definition

Angioma of the liver, also called hemangioma or hepatic angioma, is a benign tumor that develops at the expense of blood vessels and forms a small mass of abnormal vessels.

Typically, the angioma presents as an isolated, well-demarcated, round lesion less than 3 cm in diameter (less than 1 cm in every other case). The angioma is stable and causes no 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 entirely fibrous nodules (sclerotic angiomas), others are calcified or connected to the liver by a pedicle…

Some angiomas may change in size over time, without developing into malignant tumors.

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Cause

This is a lesion with no identified cause, probably of congenital origin. Some hepatic angiomas may be influenced by hormones.

Diagnosis

The angioma is often discovered incidentally during an abdominal ultrasound. When the liver is healthy and the tumor is less than 3 cm in size, the identified nodule is clearly identifiable and no further examination is required.

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. In particular, the diagnosis is very difficult for small angiomas in patients with malignant tumors.

Other imaging examinations with injection of contrast products (ultrasound, CT or MRI) must then be performed to confirm the diagnosis. MRI is the most sensitive and specific examination, and removes the doubt more than nine times out of ten.

If the diagnosis cannot be made by imaging tests, a biopsy may be considered. The physician will perform a puncture by inserting a needle through the skin. The diagnostic accuracy is up to 96%.

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The people 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 (European Association for the Study of the Liver) estimates that between 0.4% and 20% of the population is affected (around 5% when the estimate is made on series of imaging examinations, but up to 20% in studies of autopsied livers).

Hepatic angiomas are found in people of all ages, including infants, but they are more frequently observed in people aged 30 to 50 years, with a female predominance.

Risk factors

Hormonal treatments may play a role in increasing the size of some liver angiomas. However, studies show that this risk is minor and a priori without danger. In particular, oral contraception is not contraindicated in women with non-progressive tumors and can be continued without special monitoring.

Symptoms of an angioma of the liver

Most of the time, the angioma is and will remain asymptomatic.

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Large angiomas, however, can compress adjacent tissue and cause inflammation and pain.

Complications

In rare cases, other complications can occur:

  • thrombosis (formation of a clot),
  • Kasabach-Merritt syndrome (SKM) characterized by an inflammatory reaction and a coagulation disorder,
  • intra-tumor hemorrhage, or even effusion of blood in the peritoneum by rupture of the angioma (hemoperitoneum) …

 Treatments for angioma of the liver

Small, stable, symptom-free angiomas do not need to be treated – or even monitored.

In other cases, arterial embolization (obstruction) may be proposed. Management may also be based on medical treatment with corticosteroids or other drugs. More rarely, surgery will be considered to remove the tumor.