Cavernous hemangiomas are the most common benign tumors of the liver. Giant cavernous hemangiomas, defined as those larger than 4 cm in diameter, can reach enormous proportions. Newer imaging modalities, although often demonstrating characteristic features that strongly suggest the diagnosis, should not be augmented by biopsy because of the risk of hemorrhage. Elective surgical resection may be indicated for symptomatic giant lesions and for those with an atypical appearance where the diagnosis is in doubt. Between October 1986 and May 1991, we treated 10 patients with giant hemangiomas by enucleation or enucleation plus resection. Median operative blood loss was 800 mL (range, 200 to 3000 mL). One patient required reoperation for control of postoperative hemorrhage. Detailed pathologic examination has demonstrated an interface between hemangiomas and the normal liver tissue that allows enucleation. Enucleation is an underused procedure that if carefully performed allows resection of giant hemangiomas with a reduced blood loss and the preservation of virtually all normal hepatic parenchyma.
Tumors of the duodenum are relatively rare, accounting for about 1-2% of all gastrointestinal neoplasms. Nevertheless diagnosis and therapy are important, as 50% of all duodenal neoplasms are malignant. In the period 1987-1992 we treated 14 patients with duodenal neoplasms (11 men, 3 women, age 30-81 years [median 60.4]). 5 patients had undergone previous treatment for malignant tumors (4 genito-urinary tract, 1 rectum). The main symptoms were pain (43%), malaise (43%), weight loss (43%), anemia (28%), jaundice (28%), obstruction (22%), nausea and/or vomiting (22%). Diagnostic investigations were upper endoscopy (93%), computed tomography of the abdomen (72%), angiography or duplex-sonography (22%). Preoperative histology was malignant in 43%, benign in 22% and unclear in 35%. Surgery consisted of the following: duodenopancreatectomy (Whipple procedure) in 4 (31%), segmental resection in 2 (15%), local resection in 2 (15%), transduodenal excision of the ampulla of Vater in 1 (7.5%), modified Finney pyloroplasty in 1 (7.5%), gastroenterostomy in 2 (15%) and choledocho-jejunostomy in 1 (7.5%). One patient refused surgery or chemotherapy. The definitive histologies in the 13 operated cases were adeno-carcinoma in 8 (62%), leiomyosarcoma in 1 (8%), leiomyoma in 2 (15%), and tubulo-villous adenoma in 2 (15%). The tumors were located in pars I in 3 (22%), in pars II in 9 (64%) and in pars III in 2 (14%). There were no postoperative complications in 9 patients (70%). 2 patients had an abscess of the abdominal wall or multiple entero-cutaneous fistulas, and 2 patients died from multiple organ system failure. The 30-day mortality was 15.4% (2/13).(ABSTRACT TRUNCATED AT 250 WORDS)
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