1Gabriela Enneria Sibarani, Md, 1Prijo Sidipratomo, 1Sahat B.R.E. Matondang, 1Jacub Pandelaki
1Division of Interventional Radiology and Cardiovascular, Department of Radiology Cipto Mangunkusumo National Central General Hospital, Universitas Indonesia, Special Capital Region of Jakarta, Indonesia
Liver hemangioma is the most commonly benign, mostly asymptomatic, and incidentally diagnosed liver tumor. When presented with size larger than 5 cm, it can become symptomatic and may lead to life-threatening spontaneous rupture. Treatment of choice of symptomatic liver hemangiomas is surgery, with the risk of massive intraoperative hemorrhage. Aim of this case report is to evaluate the outcome of transarterial embolization with or without a particulate embolic agent.
First patient, a 51-year-old female presented with pain in the right upper quadrant abdomen from a month prior to admission. A multiphase abdominal CT scan revealed a hepatic mass with an enhancing pattern in accordance with hemangioma. TAE was performed with bleomycin and lipiodol. In the second patient, a 65-years-old female, we performed TAE with bleomycin, lipiodol, and tris-acryl gelatin microspheres (TAGM). Post TAE result of both patients is the reduction in mass size and symptoms. However, with the addition of TAGM, tumor shrinkage in the second patient is more significant, with a reduction of 20-42% of the mass size, compared to 7-10% in the first patient.
Liver hemangiomas are composed of endothelial cells from the hepatic artery, suggesting an alternative therapeutic strategy with vessel occlusion. The sclerosing agent such as bleomycin, has an antineoplastic and antiangiogenic activity that may be used to achieve additional volume reduction through the prevention of blood vessel (re)growth. TAGM are non-resorbable hydrophilic particulate embolic agent that are precisely calibrated by size, with smooth and spherical in shape. To our knowledge, there are minimal studies on whether the use of particulate embolic agent would improve the efficacy of TAE for giant hepatic hemangioma, further research is recommended.
Shrinkage of liver hemangioma in patient treated with addition of TAGM is 13–32% more significant than patient treated with TAE only.