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Cavernous hemangioma of the liver: Factors affecting disease progression in general hepatology practice
BACKGROUND: Although for asymptomatic hepatic hemangiomas conservative management is generally recommended, factors affecting the disease course are still not very well understood. AIM: To determine disease characteristics of cavernous hemangioma and factors affecting its progression in patients from a general hepatology clinic in Tehran, Iran. METHODS: We reviewed medical records of 198 patients with cavernous hemangioma of the liver visiting a large private hepatology clinic in Tehran from 1997 to 2007. Of a total of 198 cases, 129 could be followed up for a period of 3.2±2.5 years, and 80 of these had 1-5 repeated sonographies. RESULTS: Patients were between 27 and 84 years old (mean age: 44.3±10.9 years), and 131 (66.2%) were female. Thirty-six patients (18.2%) had giant hemangiomas. Abdominal pain was the primary reason for evaluation in 100 (50.5%) patients. Abdominal pain at the beginning of the follow-up was significantly associated with having irritable bowel syndrome [odds ratio (OR)=8.3; 95% confidence interval (CI): 3.1-28.7] or other gastrointestinal diseases (OR=3.9; 95% CI: 2.6-10.2), but not with hemangioma size, number, or location. During follow-up, having a single giant lesion at the time of diagnosis, adjusted for age, sex, and presence of irritable bowel syndrome, was a strong predictor of persistent pain during follow-up (OR=11.1; 95% CI: 3.2-38.6). In repeated sonographies, 35% showed an increased size, which was significantly associated only with having a single lesion (P=0.04). CONCLUSION: Many symptoms in hepatic hemangioma are attributable to accompanying gastrointestinal diseases. Patients with a single giant lesion are more likely to have persistent pain, and single lesions are more likely to grow in size.