Association of tumor size and internal echo pattern with coagulopathy associated with hepatic hemangioma

Maruyama,Shigeo; Koda,Masahiko; Matono,Tomomitsu; Isomoto,Hajime

doi:10.3892/mco.2021.2245

Association of tumor size and internal echo pattern with coagulopathy associated with hepatic hemangioma

Authors:
- Shigeo Maruyama
- Masahiko Koda
- Tomomitsu Matono
- Hajime Isomoto
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Affiliations: Department of Internal Medicine, Maruyama Medical Clinic, Hamada, Shimane 697‑0034, Japan, Department of Internal Medicine, Hino Hospital, Hino, Tottori 689‑4504, Japan, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Tottori 683‑8504, Japan
Published online on: February 26, 2021 https://doi.org/10.3892/mco.2021.2245
Article Number: 83
Copyright: © Maruyama et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Little is known concerning causal factors associated with the size and echogenicity of hepatic hemangiomas. The aim of the present study was to investigate the associations between tumor size and echo pattern and coagulation factors, and to elucidate the growth pattern of hemangiomas. In 214 consecutive patients with hepatic hemangiomas, ultrasonography was performed to determine total tumor number, size, echogenicity and location, and serum laboratory tests for liver function and coagulation factors were carried out. The ultrasonographic appearance of hemangiomas was homogeneous in 75.7% of cases and mixed in 24.3% of cases. A mixed echo pattern was seen in 1 out of 145 masses (0.7%) with a diameter <20 mm, in 30 out of 48 (62.5%) with a diameter of 20‑40 mm, and in all of the 21 (100%) with a diameter >40 mm. Platelet counts (P<0.0001) and fibrinogen levels (P<0.01) were lower in patients with larger and mixed tumors. Levels of thrombin‑antithrombin III complex (TAT), D‑dimer, and fibrin and fibrinogen degradation products (FDP) were significantly elevated along with an increase in tumor size (all P<0.0001), and the number of patients with the abnormal values of TAT, D‑dimer, and FDP was significantly higher in the mixed group than in the homogeneous group (all P<0.0001). Fibrinogen (P<0.01), platelet count (P<0.001), portal vein diameter (P<0.0001), splenic index (P<0.01), and levels of TAT, D‑dimer and FDP (all P<0.0001) were significantly associated with tumor size. Multivariate analysis revealed TAT, D‑dimer and FDP as independent predictors of tumor size. The internal echo pattern became mixed as size increased. The size and echogenicity of hemangiomas were closely associated with coagulation factors. Therefore, it was speculated that differences in size and echogenicity were caused by intratumoral thrombosis and subsequent hemorrhage.

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1	Ito H, Tsujimoto F, Nakajima Y, Igarashi G, Okamura T, Sakurai M, Nobuoka S and Otsubo T: Sonographic characterization of 271 hepatic hemangiomas with typical appearance on CT imaging. J Med Ultrasonics. 39:61–68. 2012.PubMed/NCBI View Article : Google Scholar
2	Li J, Huang L, Liu C, Yan J, Xu F, Wu M and Yan Y: New recognition of the natural history and growth pattern of hepatic hemangioma in adults. Hepatol Res. 46:727–733. 2016.PubMed/NCBI View Article : Google Scholar
3	Okano H, Shiraki K, Inoue H, Ito T, Yamanaka T, Deguchi M, Sugimoto K, Sakai T, Ohmori S, Murata K, et al: Natural course of cavernous hepatic hemangioma. Oncol Rep. 8:411–414. 2001.PubMed/NCBI View Article : Google Scholar
4	Kim GE, Thung SN, Tsuji WM and Ferrell LD: Hepatic cavernous hemangioma: Underrecognized associated histologic features. Liver Int. 26:334–338. 2006.PubMed/NCBI View Article : Google Scholar
5	Gandolfi L, Leo P, Solmi L, Vitelli E, Verros G and Colecchia A: Natural history of hepatic hemangiomas: Clinical and ultrasound study. Gut. 32:677–680. 1991.PubMed/NCBI View Article : Google Scholar
6	Gibney RG, Hendin AP and Cooperberg PL: Sonographically detected hepatic hemangiomas: Absence of change over time. Am J Rentgenol. 149:953–957. 1967.PubMed/NCBI View Article : Google Scholar
7	Erdogan D, Busch ORC, Delden OM, Bennink RJ, Kate FJ, Gouma DJ and Guiik TM: Management of liver hemangiomas according to size and symptoms. J Gastroenterol Hepatol. 22:1953–1958. 2007.PubMed/NCBI View Article : Google Scholar
8	Duxburg MS and Garden OJ: Giant hemangioma of the liver: Observation or resection? Dig Surg. 27:7–11. 2010.PubMed/NCBI View Article : Google Scholar
9	Carlo ID, Koshy R, Mudares SA and Ardiri A: Giant carvenous liver hemangiomas: Is it the time to change the size categories? Hepatobiliary Pancreat Dis Int. 15:21–29. 2016.PubMed/NCBI View Article : Google Scholar
10	Herman P, Coata ML, Machado MA, Pugliese V, D'Albuquerque LA, Machado MC, Gama-Rodrigues JJ and Saad WA: Management of hepatic hemangiomas: A 14-year experience. J Gastrointest Surg. 9:853–859. 2005.PubMed/NCBI View Article : Google Scholar
11	Bozkaya H, Cinar C, Unalp OV, Parildar M and Oran I: Unusual treatment of Kasabach-Merritt syndrome secondary to hepatic hemangioma: Embolization with bleomycin. Wien Klin Wochenschr. 127:488–490. 2015.PubMed/NCBI View Article : Google Scholar
12	Hall GW: Kasabach-Merritt syndrome: Pathogenesis and management. Br J Hematol. 112:851–862. 2001.PubMed/NCBI View Article : Google Scholar
13	Rodriguez V, Lee A, Witman PM and Anderson PA: Kasabach-merritt phenomenon: Case series and retrospective review of the mayo clinic experience. J Pediatr Hematol Oncol. 31:522–526. 2009.PubMed/NCBI View Article : Google Scholar
14	O'Rafferty C, O'Regan GM, Irvine AD and Smith OP: Recent advances in the pathobiology and management of Kasabach-Merritt phenomenon. Br J Hematol. 171:38–51. 2015.PubMed/NCBI View Article : Google Scholar
15	Hoekstra LT, Bieze M, Erdogan D, Roelofs JJ, Beuers UH and Gulik TM: Management of giant hemagiomas: An update. Expert Rev Gastroenterol Hepatol. 7:263–268. 2013.PubMed/NCBI View Article : Google Scholar
16	Mewes T, Moldenhauer H, Pfeifer J and Papenberg J: The Kasabach-Merritt syndrome: Severe bleeding disorder caused by celiac arteriography-reversal by heparin treatment. Am J Gastroenterl. 84:965–971. 1989.PubMed/NCBI
17	Wada H and Sakuragawa N: Are fibrin-related markers useful for the diagnosis of thrombosis? Semin Thromb Hemost. 34:33–38. 2008.PubMed/NCBI View Article : Google Scholar
18	Lee SY, Niikura T, Iwakura T, Sakai Y, Kuroda R and Kurosaka M: Thrombin-antithrombin III complex tests: A useful screening tool for postoperative venous thromembolism in lower limb and pelvic fracture. J Orthop Surg. 25:1–6. 2017.PubMed/NCBI View Article : Google Scholar
19	Deng Y, He L, Yang J and Wang J: Serum D-dimer as an indicator of immediate mortality in patients with in-hospital cardiac arrest. Thromb Res. 143:161–165. 2016.PubMed/NCBI View Article : Google Scholar
20	Tang L, Liu K, Wang J, Wang C, Zhao P and Liu J: High preoperative plasma fibrinogen levels are associated with distant metastases and impaired prognosis after curative resection in patients with colorectal cancer. J Surg Oncol. 102:428–432. 2010.PubMed/NCBI View Article : Google Scholar
21	Wang GY, Jiang N, Yi HM, Wang GS, Zhang JW, Li H, Zhang J, Zhang Q, Yang Y and Chen GH: Pretransplant elevated plasma fibrinogen level is a novel prognostic predictor for hepatocellular carcinoma recurrence and patient survival following liver transplantation. Ann Transplant. 21:125–130. 2016.PubMed/NCBI View Article : Google Scholar
22	Suzuki H, Nimura Y, Kamiya J, Kondo S, Nagino M, Kanai M and Miyachi M: Preoperative transcatheter arterial embolization for giant carvenous hemangioma of the liver with consumption coagulopathy. Am J Gastroenterol. 92:688–691. 1997.PubMed/NCBI
23	Blix S and Aas K: Giant hemangioma, thrombocytopenia, fibrinogenopenia, and fibrinolytic activity. Acta Med Scand. 169:63–70. 1961.
24	Wochner RD, Kulapongs P and Bachmann F: 125I-fibrinogen turnover and coagulation studies in a patient with Kasabach-Merritt syndrome. J Lab Clin Med. 70(997)1967.
25	Hillman RS and Philips LL: Clotting-fibrinolysis in a cavernous hemangioma. Am J Dis Child. 113:649–653. 1967.PubMed/NCBI View Article : Google Scholar
26	Iwaki Y: Pathophysiology of portal hypertension. Cli Liver Dis. 18:281–291. 2014.PubMed/NCBI View Article : Google Scholar
27	McConnell M and Iwakiri Y: Biology of portal hypertension. Hepatol Int. 12 (Suppl 1):S11–S23. 2018.PubMed/NCBI View Article : Google Scholar
28	Mehta G, Gustot T, Mookerjee RP, Garcia-Pagan JC, Fallon MB, Shah VH, Moreau R and Jalan R: Inflammation and portal hypertension-The undiscovered country. J Hepatol. 61:155–163. 2014.PubMed/NCBI View Article : Google Scholar
29	Shirabe K, Bekki Y, Gantumur D, Araki K, Ishii N, Kuno A, Narimatsu H and Mizokami M: Mac-2 binding protein glycan isomer (M2BPGi) is a new serum biomarker for assessing liver fibrosis: More than a biomarker of liver fibrosis. J Gastroenterol. 53:819–826. 2018.PubMed/NCBI View Article : Google Scholar
30	Toshima T, Shirabe K, Ikegami T, Yoshizumi T, Kuno A, Togayachi A, Gotoh M, Narimatsu H, Korenaga M, Mizokami M, et al: A novel serum marker, glycosylated Wisteria floribunda agglutinin-positive Mac-2 binding protein (WFA(+)-M2BP), for assessing liver fibrosis. J Gastroenterol. 50:76–84. 2015.PubMed/NCBI View Article : Google Scholar
31	Kobayashi T, Kawano M, Tomita Y, Tamano M, Saigusa S, Horinaka M, Monma T, Koguma T, Yanagisawa N, Ohe T, et al: Follow-up study of hepatic hemangiomas. Nippon Shokakibyo Gakkai Zasshi. 92:41–46. 1995.PubMed/NCBI(In Japanese).
32	Miyaki D, Aikata H, Waki K, Murakami H, Hashimoto Y, Nagaoki H, Katamura Y, Kataoka T, Takagi S, Hiramatsu K, et al: Significant regression of a cavernous hepatic hemangioma to a sclerosed hemangioma over 12 years: A case study. Nippon Shokakibyo Gakkai Zasshi. 108:954–961. 2011.PubMed/NCBI(In Japanese).
33	Yeh WC, Yang PM, Huang GT, Sheu JC and Chen DS: Long-term follow-up of hepatic hemangiomas by ultrasonography: With emphasis on the growth rate of the tumor. Hepatogastroenterology. 54:475–479. 2007.PubMed/NCBI
34	Nghiem HV, Bogost GA, Ryan JA, Lund P, Freeny PC and Rice KM: Cavernous hemangiomas of liver: Enlargement over time. Am J Rentgenol. 169:137–140. 1997.PubMed/NCBI View Article : Google Scholar
35	Bree RL, Schwab RE and Neiman HL: Solitary echogenic spot in the liver: Is it diagnostic of a hemangioma? Am J Rentgenol. 140:41–45. 1983.PubMed/NCBI View Article : Google Scholar
36	Tsumaki N, Waguri N, Yonayama O, Hama H, Kawahisa J, Yokoo K, Aiba T, Furukawa K, Sugimura K, Igarashi K, et al: A case of sclerosed hemangioma with a significant morphological change over a period of 17 years. Kanzo. 49:268–274. 2008.
37	Ogawa K, Takeuchi K, Okuda C, Tamura T, Koizumi Y, Koyama R, Imamura T, Inoue Y and Arase Y: Change in size of hepatic hemangiomas during long-term observation: 80 lesions with observation for over 10 years. Jpn J Med Ultrasonics. 41:749–756. 2014.