# Pingyangmycin-loaded drug-eluting beads transarterial embolisation for giant cavernous haemangioma of the liver: A case report

## TL;DR

A 59-year-old man with a large liver hemangioma was successfully treated with a new embolization technique using pingyangmycin-loaded beads, showing significant tumor shrinkage and symptom improvement.

## Contribution

This is the first reported case of using pingyangmycin-loaded drug-eluting beads for treating giant cavernous hemangioma of the liver.

## Key findings

- The patient's hemangioma size decreased from 187.5 mm to 63.2 mm after two embolization sessions.
- Clinical symptoms like cough and sputum resolved following treatment.
- DEB-TACE was found to be effective and safe in this case, with minimal post-procedure complications.

## Abstract

Cavernous haemangioma of the liver (CHL) is the most common venous malformation of the liver. Surgical resection is considered the gold standard for large symptomatic haemangiomas. Transarterial embolisation has demonstrated acceptable efficacy with lower rates of morbidity and mortality. We report the first case of a 59-year-old man with a giant CHL treated using pingyangmycin drug-eluting bead transarterial embolisation (DEB-TACE).

A 59-year-old man presented to our hospital with cough and sputum, most probably related to the mass effect of the haemangioma and secondary lung collapse. Computed tomography (CT) revealed a 187.5 mm × 142.7 mm cavernous haemangioma located in the right lobe of the liver. He underwent DEB-TACE, and a 2.6-F microcatheter was used to selectively catheterise the right hepatic artery. One vial of 300–500-μm CalliSpheres microspheres loaded with 8-mg pingyangmycin and two vials of 100–300-μm microspheres were injected through the microcatheter until the disappearance of CHL staining.

The patient experienced mild abdominal pain on the second day after embolisation. A reduction in CHL size to 106.7 × 141.3 mm was observed on the 1.1-month follow-up CT. We performed a second similar DEB-TACE, which resulted in further size reduction to 83.1 × 50.1 mm, as detected on the follow-up CT at 4.6 months. At the 8.7-month follow-up, his clinical symptoms improved with no cough or sputum and the CHL size further reduced to 63.2 × 55.8 mm.

We report the first case of a giant CHL treated using DEB-TACE. Although DEB-TACE may be an effective and safe alternative for treating of giant CHL, an in vitro study on the efficient loading and binding of pingyangmycin with microspheres and more comparative studies with larger samples are required to further confirm its safety and efficacy.