Radiofrequency ablation (RFA) of atypical hepatic hemangioma

Objective: To report 2 cases of percutaneous RFA of large hepatic hemangioma.

Methods: Two patients with large tumors, previously misdiagnosed as hepatocellular carcinoma with imaging methods, were treated with US-guided multipolar RFA, using general anesthesia. In the first case (male, age 53, tumor size 7.8cm, right hepatic lobe) the insertion of the three bipolar electrodes with diameter 1.8mm made an impression of a soft tumor, but without any extraordinary physical parameters of ablation. During the procedure suspicion for little amount of fluid around the liver appeared and RFA was stopped. Fine-needle aspiration biopsy (FNAB) was made with bloody appearance and the examination revealed fresh blood and endothelial cells, which was diagnostic for hemangioma. Cold compression and haemostatic drugs were applied and a subhepatic signaling catheter was inserted surgically. The patient was monitored closely for 24 hours in cooperation with a surgeon's team. The patient recovered uneventfully and was discharged. The follow-up doesn't reveal any consequences. In the second case (male, age 78, size 10cm) during the procedure accumulation of fluid near the liver surface was observed and RFA was stopped. FNAB established fresh blood. The following observation doesn't reveal aggravation of the hemorrhage and only medical treatment was applied, without blood transfusion. There were not any consequences during the follow-up.

Conclusion: Despite haemostatic effect of radiofrequent current, the course of potential hemorrhage is unpredictable and hemangioma is still not indicated routinely for local ablation. Absence of underlying viral liver disease raises suspicion in hepatocellular origin of the tumor.