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Comment & Response
April 2015

Growth Assessment of Hepatic Venous Malformations

Author Affiliations
  • 1Department of Surgery, St Jude Children’s Research Hospital, Memphis, Tennessee
JAMA Surg. 2015;150(4):370-371. doi:10.1001/jamasurg.2014.3930

To the Editor With regard to the recent publication in JAMA Surgery of the article entitled “Assessing Normal Growth of Hepatic Hemangiomas During Long-term Follow-up” by Hasan et al,1 some discussion is pertinent. Hepatic venous malformations are common in adults and are often incorrectly called hepatic hemangiomas. In 2007, Christison-Lagay et al2 from the Vascular Anomalies Clinic at Children’s Hospital Boston in Boston, Massachusetts, classified hepatic hemangiomas into 3 categories (focal, multifocal, and diffuse) based on clinical presentation, radiographic appearance, pathologic features, and natural history and following the guidelines of the International Society for the Study of Vascular Anomalies. Focal tumors are the hepatic form of the cutaneous, rapidly involuting congenital hemangioma, a hypervascular lesion that does not demonstrate GLUT1 immunoreactivity, a marker of infantile hemangioma. Multifocal hepatic hemangiomas are GLUT1-positive lesions and undergo the typical course of involution of cutaneous infantile hemangioma. Extensive hepatic involvement is seen in diffuse (GLUT1-positive) infantile hepatic hemangiomas with a more serious clinical course that are potentially complicated by severe hypothyroidism secondary to the overproduction of type III iodothyronine deiodinase within the tumors. The natural history of infantile hemangioma is characterized by rapid postnatal growth and slow regression during childhood, whereas the natural history of rapidly involuting congenital hemangioma is characterized by a fully formed tumor at birth that involutes in the first 12 to 18 months after birth. The International Society for the Study of Vascular Anomalies accepted the classification of vascular anomalies by Mulliken and Glowacki,3 who divided these lesions into 2 distinct categories: vascular tumors and vascular malformations.