Enucleation of Giant Hemangiomas of the Liver Technical and Pathologic Aspects of a Neglected Procedure

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Abstract
Cavernous hemangiomas arc the most common benign tumors of the liver. Giant cavernous hemangiomas, defined as those larger than 4 cm in diameter, can reach enormous proportions. Newer imaging modalities, although often demonstrating characteristic features that strongly suggest the diagnosis, should not be augmented by biopsy because of the risk of hemorrhage. Elective surgical resection may be indicated for symptomatic giant lesions and for those with an atypical appearance where the diagnosis is in doubt. Between October 1986 and May 1991, we treated 10 patients with giant hemangiomas by enuclcation or enuclcation plus resection. Median operative blood loss was 800 mL (range, 200 to 3000 mL). One patient required reoperatin for control of postoperative hemorrhage. Detailed pathologic examination has demonstrated an interface between hemangiomas and the normal liver tissue that allows enucleation. Enucleation is an underused procedure that if carefully performed allows resection of giant hcmangiomas with a reduced blood loss and the preservation of virtually all normal hepatic parenchyma.

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