Correct Answer

d) If surgery is planned, peripherally located hemangiomas should be enucleated

Explanation

Hepatic hemangiomas are the most common benign tumors of the liver and are usually detected incidentally. Management depends on symptoms, complications, and diagnostic certainty, not size alone.

• Size and surgery:
  Lesion size alone, even when greater than 10 cm (giant hemangioma), is not an indication for surgery if the patient is asymptomatic.
• Oral contraceptives and pregnancy:
  Although estrogen exposure may cause hemangioma enlargement, there is no strong evidence that oral contraceptive pills or pregnancy significantly increase the risk of rupture. Routine avoidance is not recommended.
• Role of arterial embolization:
  Arterial embolization is not performed routinely. It is reserved for:
  • Symptomatic patients unfit for surgery
  • Acute bleeding
  • Preoperative reduction of tumor vascularity
• Surgical technique:
  When surgery is indicated (symptoms, complications, or diagnostic uncertainty), enucleation is preferred for peripherally located hemangiomas because it:
  • Preserves maximum liver parenchyma
  • Results in less blood loss
  • Has lower morbidity compared to formal hepatic resection

Teaching Points

• Hepatic hemangioma is the most common benign liver tumor
• Size alone is not an indication for surgery
• Most asymptomatic hemangiomas require only observation
• Enucleation is preferred over resection when surgery is needed
• Embolization is reserved for selected symptomatic or high-risk cases