Hepatic haemangiomas: possible association with female sex hormones.
OBJECTIVE
The association of hepatic haemangiomas with female sex hormones is not entirely clear. We prospectively evaluated the impact of female sex hormones on the natural history of liver haemangiomas.


METHODS
We followed 94 women with 181 haemangiomas diagnosed by ultrasound for a period of1-17 years (mean 7.3 (5.5) years). The location, number, size, and ultrasonographic pattern of the lesions were evaluated. Patients were also evaluated by questionnaire for gynaecological and reproductive history. We compared the change in number and size of haemangiomas in patients who received or did not receive exogenous hormonal treatment.


RESULTS
Age at first period was inversely associated with the size of haemangiomas (r = 0.181, p = 0.015) while age at menopause was positively correlated with the number of haemangiomas detected at first ultrasound (r = 0.542, p<0.0001). During follow up, no change in the ultrasonographic pattern or number of haemangiomas was observed. An increase in the size of the lesions was demonstrated in 5/22 (22.7%) hormone therapy exposed patients compared with 7/72 (9.7%) controls. Three variables (ultrasonographic pattern, number of haemangiomas, and hormone therapy) predicted whether or not a given haemangioma would increase in size. A hypoechoic pattern increased the risk of progression while a hyperechoic pattern decreases that risk (p = 0.003). The number of haemangiomas was inversely associated with the likelihood of progression (p = 0.006) and hormone therapy increased the risk of haemangioma enlargement (p = 0.05).


CONCLUSIONS
Hepatic haemangiomas seem to be influenced by both endogenous and exogenous female sex hormones although significant enlargement occurs only in a minority of patients. Consequently, routine liver ultrasound follow up in women with hepatic haemangiomas receiving hormone therapy appears appropriate.
Department of Gastroenterology, The E Wolfson Medical Center, Holon 58100, Israel. shirin@wolfson.health.gov.il
V
V
Glinkova
O
O
Shevah
M
M
Boaz
A
A
Levine
H
H
Shirin
D000328:Adult; D000367:Age Factors; D018450:Disease Progression; D015914:Estrogen Replacement Therapy / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D012739:Gonadal Steroid Hormones / Q000502:physiology*; D006391:Hemangioma / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008113:Liver Neoplasms / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D008572:Menarche; D008593:Menopause; D008875:Middle Aged; D011446:Prospective Studies
D012739:Gonadal Steroid Hormones