Epidemiology

Frequency: hepatic hemangioma (most common) > focal nodular hyperplasia (FNH) > hepatocellular adenoma (rare)

Etiology

• Hepatic hemangioma: possible hormonal component; estrogen therapy associated with increased growth
• FNH
  • Mostly unknown
  • Suggested to be the result of a localized hyperplastic reaction by hepatocytes to an underlying arteriovenous malformations
• Hepatocellular adenoma: oral contraceptives and anabolic steroids

Diagnostics

• Ultrasonography: best initial test
• Biopsy
  • Performed to confirm the diagnosis if imaging is inconclusive
  • Contraindicated in hepatic hemangiomas, as it may cause bleeding
  • Pathology
    • Hepatic hemangioma
      • Cavernous vascular spaces of variable size, lined by flat endothelial cells