title: Giant cavernous liver hemangiomas: is it the time to change the size categories?
abstract: BACKGROUND
  Four different sizes (4, 5, 8 and 10 cm in diameter) can be found in the literature to categorize a liver hemangioma as giant. The present review aims to clarify the appropriateness of the size category "giant" for liver hemangioma.
  
  
  METHODS
  We reviewed the reports on the categorization of hemangioma published between 1970 and 2014. The number of hemangiomas, size criteria, mean and range of hemangioma sizes, and number of asymptomatic and symptomatic patients were investigated in patients aged over 18 years. Liver hemangiomas were divided into four groups: <5.0 cm, 5.0-9.9 cm, 10.0-14.9 cm and ≥15.0 cm in diameter. Inclusion criteria were noted in 34 articles involving 1972 (43.0%) hemangiomas (>4.0 cm).
  
  
  RESULTS
  The patients were divided into the following groups: 154 patients (30.0%) with hemangiomas less than 5.0 cm in diameter (small), 182 (35.5%) between 5.0 cm and 9.9 cm (large), 75 (14.6%) between 10.0 and 14.9 cm (giant), and 102 (19.9%) more than 15.0 cm (enormous). There were 786 (39.9%) asymptomatic patients and 791 (40.1%) symptomatic patients. Indications for surgery related to symptoms were reported in only 75 (3.8%) patients. Operations including 137 non-anatomical resection (12.9%) and 469 enucleation (44.1%) were unclearly related to size and symptoms.
  
  
  CONCLUSIONS
  The term "giant" seems to be justified for liver hemangiomas with a diameter of 10 cm. Hemangiomas categorized as "giant" are not indicated for surgery. Surgery should be performed only when other symptoms are apparent.
authors.affiliation: Departments of General Surgery, Hamad General Hospital, Doha, Qatar; Department of Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy. idicarlo@unict.it.
authors.forename: Isidoro
authors.initials: I
authors.lastname: Di Carlo
authors.forename: Renol
authors.initials: R
authors.lastname: Koshy
authors.forename: Saif
authors.initials: S
authors.lastname: Al Mudares
authors.forename: Annalisa
authors.initials: A
authors.lastname: Ardiri
authors.forename: Gaetano
authors.initials: G
authors.lastname: Bertino
authors.forename: Adriana
authors.initials: A
authors.lastname: Toro
mesh_terms: D006392:Hemangioma, Cavernous / Q000145:classification / Q000150:complications / Q000473:pathology* / Q000601:surgery; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000145:classification / Q000150:complications / Q000473:pathology* / Q000601:surgery; D011237:Predictive Value of Tests; D012307:Risk Factors; D009626:Terminology as Topic; D047368:Tumor Burden