Hepatic hemangioma pathophysiology: Difference between revisions
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==Overview== | ==Overview== | ||
Development of hepatic hemangioma is the result of genetic mutations, overexpression of angiogenic fators and downregulation of inhibitors of angiogenesis.<ref name="PapafragkakisMoehlen2011">{{cite journal|last1=Papafragkakis|first1=Haris|last2=Moehlen|first2=Martin|last3=Garcia-Buitrago|first3=Monica T.|last4=Madrazo|first4=Beatrice|last5=Island|first5=Eddie|last6=Martin|first6=Paul|title=A Case of a Ruptured Sclerosing Liver Hemangioma|journal=International Journal of Hepatology|volume=2011|year=2011|pages=1–5|issn=2090-3456|doi=10.4061/2011/942360}}</ref> Hepatic hemangioma may be associated with [[Kasabach-Merritt syndrome]], [[hereditary hemorrhagic telangiectasia]], hepatic arterio-portal shunts, extra hepatic hemangiomata, [[hemolytic anemia]], [[ | Development of hepatic hemangioma is the result of genetic mutations, overexpression of angiogenic fators and downregulation of inhibitors of angiogenesis.<ref name="PapafragkakisMoehlen2011">{{cite journal|last1=Papafragkakis|first1=Haris|last2=Moehlen|first2=Martin|last3=Garcia-Buitrago|first3=Monica T.|last4=Madrazo|first4=Beatrice|last5=Island|first5=Eddie|last6=Martin|first6=Paul|title=A Case of a Ruptured Sclerosing Liver Hemangioma|journal=International Journal of Hepatology|volume=2011|year=2011|pages=1–5|issn=2090-3456|doi=10.4061/2011/942360}}</ref> Hepatic hemangioma may be associated with [[Kasabach-Merritt syndrome]], [[hereditary hemorrhagic telangiectasia]], hepatic arterio-portal shunts, extra hepatic hemangiomata, [[hemolytic anemia]], [[focal nodular hyperplasia]].<ref name=radiopeadia>Associations of hepatic hemangioma. Dr Yuranga Weerakkody et al. Radiopaedia (2015). http://radiopaedia.org/articles/hepatic-haemangioma-3. Accessed on November 7, 2015</ref> On gross pathology, variable in size, well circumscribed, and classically subcapsular are findings of hepatic hemangioma.<ref name=Librepthology>Gross pathology of hepatic hemangioma. Librepathology 2015. http://librepathology.org/wiki/index.php/Hemangioma_of_the_liver. Accessed on October 20, 2015</ref> On microscopic histopathological analysis channels lined by benign endothelium containing RBCs, surrounding (non-endothelial) cells without significant atypia are findings of hepatic hemangioma.<ref name=Librepathology>Microscopic features of hepatic hemangioma. Librepathology 2015. http://librepathology.org/wiki/index.php/Hemangioma_of_the_liver. Accessed on October 20, 2015</ref> | ||
==Pathophysiology== | ==Pathophysiology== | ||
==Pathogenesis== | ==Pathogenesis== | ||
The pathogenesis of hemangiomas has not been elucidated, but there are two competing theories. | The pathogenesis of hepatic hemangiomas has not been elucidated, but there are two competing theories. | ||
===First theory=== | ===First theory=== | ||
*The first theory supports the notion that | *The first theory supports the notion that hepatic hemangioma may be the result of overexpression of angiogenic factors and downregulation of inhibitors of angiogenesis. | ||
:*Vascular endothelial growth factor | :*Overexpression of angiographic factors, such as:<ref name="PapafragkakisMoehlen2011">{{cite journal|last1=Papafragkakis|first1=Haris|last2=Moehlen|first2=Martin|last3=Garcia-Buitrago|first3=Monica T.|last4=Madrazo|first4=Beatrice|last5=Island|first5=Eddie|last6=Martin|first6=Paul|title=A Case of a Ruptured Sclerosing Liver Hemangioma|journal=International Journal of Hepatology|volume=2011|year=2011|pages=1–5|issn=2090-3456|doi=10.4061/2011/942360}}</ref> | ||
:*Basic fibroblast growth factor | ::*[[Vascular endothelial growth factor]] | ||
:*Metalloproteinases | ::*[[Basic fibroblast growth factor]] | ||
* | ::*[[Metalloproteinases]] | ||
:*Tissue inhibitor of metalloproteinase-I | :*Downregulation of inhibitors of angiogenesis, such as:<ref name="PapafragkakisMoehlen2011">{{cite journal|last1=Papafragkakis|first1=Haris|last2=Moehlen|first2=Martin|last3=Garcia-Buitrago|first3=Monica T.|last4=Madrazo|first4=Beatrice|last5=Island|first5=Eddie|last6=Martin|first6=Paul|title=A Case of a Ruptured Sclerosing Liver Hemangioma|journal=International Journal of Hepatology|volume=2011|year=2011|pages=1–5|issn=2090-3456|doi=10.4061/2011/942360}}</ref> | ||
::*[[Metalloproteinase|Tissue inhibitor of metalloproteinase-I]] | |||
===Second theory=== | ===Second theory=== | ||
*The second theory | *The second theory suggests that the presence of liver hemangiomas involves a genetic background of mutations.<ref name="PapafragkakisMoehlen2011">{{cite journal|last1=Papafragkakis|first1=Haris|last2=Moehlen|first2=Martin|last3=Garcia-Buitrago|first3=Monica T.|last4=Madrazo|first4=Beatrice|last5=Island|first5=Eddie|last6=Martin|first6=Paul|title=A Case of a Ruptured Sclerosing Liver Hemangioma|journal=International Journal of Hepatology|volume=2011|year=2011|pages=1–5|issn=2090-3456|doi=10.4061/2011/942360}}</ref> | ||
* | :*[[Metalloproteinases]] accumulate in the endoplasmic reticulum of the tumor cells. Accumulation may result in the following: | ||
:*Self-digestion | ::*Self-digestion | ||
:*Vacuole formation | ::*Vacuole formation | ||
* | *Cavernous hemangioma cell to downregulate Derlin-1. | ||
:*Derlin-1 is a protein | :*Derlin-1 is a protein encoded by [[DERL1]]. When overexpressed, derlin-1 protein induces the dilated endoplasmic reticulum to return to its normal size. | ||
==Associated Conditions== | ==Associated Conditions== | ||
Hepatic hemangioma may be associated with:<ref name=radiopeadia>Associations of hepatic hemangioma. Dr Yuranga Weerakkody et al. Radiopaedia (2015). http://radiopaedia.org/articles/hepatic-haemangioma-3. Accessed on November 7, 2015</ref> | Hepatic hemangioma may be associated with:<ref name=radiopeadia>Associations of hepatic hemangioma. Dr Yuranga Weerakkody et al. Radiopaedia (2015). http://radiopaedia.org/articles/hepatic-haemangioma-3. Accessed on November 7, 2015</ref> | ||
*[[Kasabach-Merritt syndrome]] | *[[Kasabach-Merritt syndrome]] | ||
*[[Hereditary hemorrhagic telangiectasia]] ([[Osler-Weber-Rendu disease]]) | *[[Hereditary hemorrhagic telangiectasia]] ([[Hereditary hemorrhagic telangiectasia|Osler-Weber-Rendu disease]]) | ||
*Hepatic arterio-portal shunts | *Hepatic arterio-portal shunts | ||
*Extra hepatic hemangiomata | *Extra hepatic hemangiomata | ||
*[[Hemolytic anemia]] | *[[Hemolytic anemia]] | ||
*Consumptive coagulopathy | *[[DIC|Consumptive coagulopathy]] | ||
*[[Focal nodular hyperplasia]] | *[[Focal nodular hyperplasia]] | ||
==Gross Pathology== | ==Gross Pathology== | ||
On gross pathology, | On gross pathology, a well circumscribed, subcapsular tumor may be suggestive of hepatic hemangioma.<ref name=Librepthology>Gross pathology of hepatic hemangioma. Librepathology (2015). http://librepathology.org/wiki/index.php/Hemangioma_of_the_liver. Accessed on October 20, 2015</ref> | ||
==Microscopic Pathology== | ==Microscopic Pathology== | ||
On microscopic histopathological analysis channels lined by benign endothelium containing RBCs, surrounding (non-endothelial) cells without significant atypia are findings of hepatic hemangioma.<ref name=Librepathology>Microscopic features of hepatic hemangioma. Librepathology (2015). http://librepathology.org/wiki/index.php/Hemangioma_of_the_liver. Accessed on October 20, 2015</ref> | On microscopic histopathological analysis channels lined by benign endothelium containing RBCs, surrounding (non-endothelial) cells without significant atypia are findings of hepatic hemangioma.<ref name=Librepathology>Microscopic features of hepatic hemangioma. Librepathology (2015). http://librepathology.org/wiki/index.php/Hemangioma_of_the_liver. Accessed on October 20, 2015</ref> | ||
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[[Category:Needs overview]] | [[Category:Needs overview]] | ||
[[Category:needs content]] | [[Category:needs content]] | ||
[[Category:Up-To-Date]] | |||
[[Category:Oncology]] | |||
[[Category:Medicine]] | |||
[[Category:Gastroenterology]] | |||
[[Category:Surgery]] | |||
[[Category:Hepatology]] | |||
Latest revision as of 01:56, 27 November 2017
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Hepatic hemangioma pathophysiology On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Nawal Muazam M.D.[2]
Overview
Development of hepatic hemangioma is the result of genetic mutations, overexpression of angiogenic fators and downregulation of inhibitors of angiogenesis.[1] Hepatic hemangioma may be associated with Kasabach-Merritt syndrome, hereditary hemorrhagic telangiectasia, hepatic arterio-portal shunts, extra hepatic hemangiomata, hemolytic anemia, focal nodular hyperplasia.[2] On gross pathology, variable in size, well circumscribed, and classically subcapsular are findings of hepatic hemangioma.[3] On microscopic histopathological analysis channels lined by benign endothelium containing RBCs, surrounding (non-endothelial) cells without significant atypia are findings of hepatic hemangioma.[4]
Pathophysiology
Pathogenesis
The pathogenesis of hepatic hemangiomas has not been elucidated, but there are two competing theories.
First theory
- The first theory supports the notion that hepatic hemangioma may be the result of overexpression of angiogenic factors and downregulation of inhibitors of angiogenesis.
- Overexpression of angiographic factors, such as:[1]
- Downregulation of inhibitors of angiogenesis, such as:[1]
Second theory
- The second theory suggests that the presence of liver hemangiomas involves a genetic background of mutations.[1]
- Metalloproteinases accumulate in the endoplasmic reticulum of the tumor cells. Accumulation may result in the following:
- Self-digestion
- Vacuole formation
- Cavernous hemangioma cell to downregulate Derlin-1.
- Derlin-1 is a protein encoded by DERL1. When overexpressed, derlin-1 protein induces the dilated endoplasmic reticulum to return to its normal size.
Associated Conditions
Hepatic hemangioma may be associated with:[2]
- Kasabach-Merritt syndrome
- Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease)
- Hepatic arterio-portal shunts
- Extra hepatic hemangiomata
- Hemolytic anemia
- Consumptive coagulopathy
- Focal nodular hyperplasia
Gross Pathology
On gross pathology, a well circumscribed, subcapsular tumor may be suggestive of hepatic hemangioma.[3]
Microscopic Pathology
On microscopic histopathological analysis channels lined by benign endothelium containing RBCs, surrounding (non-endothelial) cells without significant atypia are findings of hepatic hemangioma.[4]
Gallery
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![Intermediate magnification micrograph of a cavernous hemangioma of the liver, also hepatic cavernous hemangioma, liver hemangioma,cavernous liver hemangioma. H&E stain. No liver tissue is observed.[4]](/images/3/31/Cavernous_liver_hemangioma_-_intermed_mag.jpg)
Intermediate magnification micrograph of a cavernous hemangioma of the liver, also hepatic cavernous hemangioma, liver hemangioma,cavernous liver hemangioma. H&E stain. No liver tissue is observed.[4]
-
![High magnification micrograph of a cavernous hemangioma of the liver, also hepatic cavernous hemangioma, liver hemangioma,cavernous liver hemangioma. H&E stain. No liver tissue is observed.[4]](/images/a/a6/Cavernous_liver_hemangioma_high_magnification.jpg)
High magnification micrograph of a cavernous hemangioma of the liver, also hepatic cavernous hemangioma, liver hemangioma,cavernous liver hemangioma. H&E stain. No liver tissue is observed.[4]
![Intermediate magnification micrograph of a cavernous hemangioma of the liver, also hepatic cavernous hemangioma, liver hemangioma,cavernous liver hemangioma. H&E stain. No liver tissue is observed.[4]](/index.php/File:Cavernous_liver_hemangioma_-_intermed_mag.jpg)
![High magnification micrograph of a cavernous hemangioma of the liver, also hepatic cavernous hemangioma, liver hemangioma,cavernous liver hemangioma. H&E stain. No liver tissue is observed.[4]](/index.php/File:Cavernous_liver_hemangioma_high_magnification.jpg)
References
- ↑ 1.0 1.1 1.2 1.3 Papafragkakis, Haris; Moehlen, Martin; Garcia-Buitrago, Monica T.; Madrazo, Beatrice; Island, Eddie; Martin, Paul (2011). "A Case of a Ruptured Sclerosing Liver Hemangioma". International Journal of Hepatology. 2011: 1–5. doi:10.4061/2011/942360. ISSN 2090-3456.
- ↑ 2.0 2.1 Associations of hepatic hemangioma. Dr Yuranga Weerakkody et al. Radiopaedia (2015). http://radiopaedia.org/articles/hepatic-haemangioma-3. Accessed on November 7, 2015
- ↑ 3.0 3.1 Gross pathology of hepatic hemangioma. Librepathology 2015. http://librepathology.org/wiki/index.php/Hemangioma_of_the_liver. Accessed on October 20, 2015
- ↑ 4.0 4.1 4.2 4.3 Microscopic features of hepatic hemangioma. Librepathology 2015. http://librepathology.org/wiki/index.php/Hemangioma_of_the_liver. Accessed on October 20, 2015