Synchronous regression of nontarget hepatic hemangiomas following direct sclerotherapy of a symptomatic giant hemangioma: A report of two cases

Hepatic hemangiomas are the most common benign mesenchymal tumors of the liver. Occasionally, they can appear as giant hepatic hemangiomas with a diameter greater than 5 cm, causing symptoms such as abdominal pain. Giant hepatic hemangiomas can be treated via surgery or minimally invasive procedures like transarterial chemoembolization or the more recently introduced direct sclerotherapy. We report 2 cases of symptomatic giant hepatic hemangiomas that were successfully treated with percutaneous direct sclerotherapy using bleomycin-lipiodol, which unexpectedly resulted in synchronous multifocal regression of other nontargeted hemangiomas in different liver segments. These 2 cases highlight that direct percutaneous sclerotherapy effectively treats giant hepatic hemangiomas and occasionally may induce the unexpected synchronous regression of untreated, nontarget lesions. This phenomenon suggests potential systemic or inflammatory mechanisms and raises the hypothesis that targeting a primary lesion might influence remote hemangiomas, warranting further prospective investigation.