Cavernous haemangioma

This is the most frequently occurring benign tumour of the liver. The reported incidence varies from 0.4 to 20%, the highest figure being the result of a thorough prospective search {892}. It is more frequent in females, and occurs at all ages but is least common in the paedi-atric age group. Although it usually presents in adults, it is thought to be a hamar-tomatous lesion. It is known to increase in size or even rupture during pregnancy and also may enlarge or recur in patients on oestrogen therapy. Consumption coagulopathy may occur. Cavernous

Fig. 8.63 Cavernous haemangioma. A Multilocular blood-filled structures with pale solid areas. B Large thin-walled vascular spaces.

haemangiomas are not known to undergo malignant change. Only large symptomatic tumours require surgical excision.

Macroscopically, cavernous haemangiomas vary from a few millimeters to huge tumours ('giant' haemangiomas) that can replace most of the liver. They are usually single, and soft or fluctuant. When sectioned they partially collapse due to the escape of blood and have a spongy appearance. Recent haemorrhages, organized thrombi, fibrosis and calcification may be seen. Histopathology. Lesions are typically composed of blood-filled vascular channels of varied size lined by a single layer of flat endothelial cells supported by fibrous tissue. Thrombi in various stages of organization with areas of infarction may be present, and older lesions show dense fibrosis and calcification. In scle-rosed haemangiomas, most or all of the vessels are occluded and sometimes are only demonstrable by stains for elastic tissue.

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