Co-existence of a giant splenic hemangioma and multiple hepatic hemangiomas and the potential association with the use of oral contraceptives: a case report

George Chatzoulis¹ , Andreas Kaltsas¹ , Stauros Daliakopoulos¹ , Osama Sallam² , Kaltsa Maria⁴ , Kostas Chatzoulis¹ and Ioannis Pachiadakis³

¹Department of Surgery, 424 Military Hospital, Grigoriou Labraki 3, 54636 Thessaloniki, Greece

²Department of Pathology St Loukas Hospital Thessaloniki, Greece

³Department of Gastroenterology, 424 Military Hospital Thessaloniki, Greece

⁴Department of Linguistics, University of Cambridge, UK

author email corresponding author email

Journal of Medical Case Reports 2008, 2:147doi:10.1186/1752-1947-2-147


Published:	7 May 2008

Abstract

Introduction

Hepatic and splenic hemangiomas are common benign tumors that mainly affect female patients. Giant splenic hemangiomas are extremely rare, especially when correlated with multiple hepatic hemangiomas. Pathogenetic mechanisms between hemangiomas and oral contraceptives, as well as therapeutic approaches, are analyzed in this case report, in particular for the management of synchronous splenic and hepatic hemangiomas.

Case presentation

We report here a 42-year-old woman with a giant splenic hemangioma, multiple hepatic hemangiomas and a history of oral estrogen intake for many years. At first it was difficult to determine the organ from which the giant hemangioma originated. Angiography proved extremely helpful in tracing its origin in the spleen. Hematomas in the giant hemangioma posed a significant threat of rupture and catastrophic hemorrhage. We left the small hepatic hemangiomas in place, and removed the spleen along with the giant splenic hemangioma.

Conclusion

Diagnostic pitfalls in the determination of the origin of this giant hemangioma, attribution of its origin to the spleen angiographically, the unusual co-existence of the giant splenic hemangioma with multiple hepatic ones, and the potential threat of rupture of the giant hemangioma are some of the highlights of this case report. Estrogen administration represents a pathogenic factor that has been associated with hemangiomas in solid organs of the abdominal cavity. The therapeutic dilemma between resection and embolization of giant hemangiomas is another point of discussion in this case report. Splenectomy for the giant splenic hemangioma eliminates the risk of rupture and malignant degeneration, whereas observation for the small hepatic ones (<4 cm) was the preferable therapeutic strategy in our patient.