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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 13  |  Issue : 4  |  Page : 244-250

Homoeopathic treatment of hepatic haemangioma with ovarian cyst


1 Regional Research Institute for Homoeopathy, Agartala, Tripura, India
2 Central Council for Research in Homoeopathy, Ministry of Ayush, Government of India, New Delhi, India

Date of Submission09-Apr-2019
Date of Acceptance22-Nov-2019
Date of Web Publication27-Dec-2019

Correspondence Address:
Dr. Abhijit Chakma
Regional Research Institute for Homoeopathy, (Under Central Council for Research in Homoeopathy), Joy Krishna Kobra Para Road, Khumulwng, Jirania, Agartala - 799 045, Tripura
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijrh.ijrh_28_19

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  Abstract 


Introduction: This is a case of multimorbidity in a 35-year-old patient suffering from hepatic hemagioma with ovarian cyst. There was hepatomegaly with multiple well-defined homogenously echogenic nodular lesion (largest nodule of size 1.64 X 1.64 cm) in both lobes of liver suggestive of haemangioma. The right ovarian cyst was 2.26 X 1.25 cm in size with pelvic congestion syndrome. Case Summary: This case was treated with individualized homoeopathy for a period of 5 months at the outpatient department (OPD) of Regional Research Institute for Homoeopathy, Agartala. Homoeopathic medicine Pulsatilla, was given to the patient on the basis of individualistic approach. The patient not only improved in her presenting complaints but also there was change in diagnostic parameters. Post treatment outcome corroborated with follow up laboratory investigations that showed significant changes. Ultrasonography revealed no obvious abnormality after homoeopathic treatment with improvement in pelvic congestion syndrome. This case report suggests that a correctly chosen homoeopathic medicine can be beneficial even in complicated and unusual cases.

Keywords: Hepatic haemangioma, Homoeopathy, Individualisation, Outcome in Relation to Impact on Daily Living, Ovarian cyst, Pulsatilla


How to cite this article:
Chakma A, Sarangi MR. Homoeopathic treatment of hepatic haemangioma with ovarian cyst. Indian J Res Homoeopathy 2019;13:244-50

How to cite this URL:
Chakma A, Sarangi MR. Homoeopathic treatment of hepatic haemangioma with ovarian cyst. Indian J Res Homoeopathy [serial online] 2019 [cited 2020 Jul 14];13:244-50. Available from: http://www.ijrh.org/text.asp?2019/13/4/244/274018




  Introduction Top


Hepatic haemangioma (HH) is the most common benign liver tumour and is frequently detected incidentally during imaging examinations,[1],[2] consisting of clusters of blood-filled cavities, lined by endothelial cells, fed by the hepatic artery. Typical haemangiomas, the so-called capillary haemangiomas, range from a few mm to 3 cm, do not increase in size over time and therefore are unlikely to generate future symptomatology. Small (0 mm–3 cm) and medium (3 cm–10 cm) haemangiomas are well-defined lesions and may not require active treatment if there are no troublesome complaints. However, the so-called giant liver haemangiomas, of up to 10 cm (most commonly) and even 20+ cm in size (according to occasional reports) can and usually will develop symptoms and complications that require prompt surgical intervention or other kind of therapy.[3] HH generally presents with upper abdominal pain. The cause of HH is not known, it may be congenitally determined and there are researchers who reported cases of HH running in families, suggesting a possible genetic connection, others with mesenchymal origins.[3] There are no data in literature to advocate for malignant transformation. Prime management for HH is supervision through imaging methods at every 6 months or annually. According to the existing data, there is no known pharmacological therapy which is able to reduce the size of HH. Surgery is indicated if there is rapid growth in size or pain despite analgesics or both.[4] In Homoeopathy, there are no scientific papers found in terms of successful treatment outcome in HH. The positive outcome of this case shall add to an evidence of the usefulness of Homoeopathy in treating such a disease.

Ovarian cysts (OCs) are sacs filled with fluid which are present in or on the ovaries and are common during the reproductive period.[5],[6],[7] Patients with OC may have symptoms of irregular or non-existent periods, acne, weight gain, pelvic pain, high blood pressure, lower back pain, breast tenderness, abdominal pressure, dysmenorrhoea, dysparaeunia and nausea.[8] The two most common types of cysts are: (i) Follicle cysts – In a normal menstrual cycle, an ovary releases an egg each month and grows inside a tiny sac called a follicle. When the egg matures, the follicle breaks open to release the egg. Follicle cysts form when the follicle does not break open to release the egg. This causes the follicle to continue growing into a cyst; (ii) Corpus luteum cysts Once the follicle breaks open and releases the egg, the empty follicle sac shrinks into a mass of cells called corpus luteum. Corpus luteum cysts form if the sac does not shrink. Instead, the sac reseals itself after the egg is released, filling up fluid inside. Most corpus luteum cysts go away after a few weeks. They may bleed or twist the ovary and cause pain.[5],[6],[7],[9] When managing giant benign OCs, laparoscopy is considered a safe and minimally invasive surgical procedure. Ultrasound-guided drainage with excision of giant OCs is a safe and appropriate modality of treatment.[10] Various articles are found on effectiveness of homoeopathic medicines in ovarian cystic diseases, but most of them are mainly case reports.[11],[12],[13],[14],[15] This case report enlightens the readers about Homoeopathy as a treatment option for treating haemangioma with OC.


  Case Report Top


A female patient aged 35 years who was under supervision of a gynaecologist for some time came to the outpatient department of Regional Research Institute for Homoeopathy, Agartala, with complaints of dull-aching pain in the lower back (lumbosacral region) and in the lower abdomen (both occurs on and off but aggravated during menses; >from warm application). There was pain in the right upper quadrant of abdomen (no specific modalities) with scanty menses for the last 11 months. Investigations revealed a cyst in the right ovary with HH and anaemia. With no significant change in complaints with 5–6 months of allopathic treatment, she switched over to Homoeopathy. On further enquiry, it was elucidated that all these complaints had started gradually, but pain in the right hypochondrium was worsening for the last 1½ months.

The patient had a past history of cholecystectomy 4 years ago with no known post-operative complications and family history, except for the fact that her, mother has been suffering from rheumatic problems. The patient was of moderate built, fair complexion, homemaker by profession and was social and living happily with her spouse and one son. The mental generals reflected a very mild, gentle, co-operative nature, and loved company with desire for spices and dry fish. She had intolerance to meat (pork) which caused loose, mucoid stool. She was thirstless and thermally chilly (felt excessive chill in the winter season). Menses were regular but scanty and clotted for the last 2–3 years. Local and systemic examination revealed mild pallor with no other obvious abnormality.

Diagnostic focus and assessment

Investigations such as blood (routine), blood sugar (fasting and post-prandial), liver function test, ultrasonography (USG – whole abdomen and transvaginal), cervical  Pap smear More Details, quantiferon TB Gold, urine (routine and culture) and Vitamin-D were carried out. USG (whole abdomen and transvaginal) and blood (routine) suggested hepatomegaly with multiple well-defined homogenously echogenic nodule lesions in both the lobes – suggestive of haemangioma (larger one is 1.64 cm × 1.64 cm) and right OC (2.26 cm × 1.25 cm) with pelvic congestion syndrome and low haemoglobin (9.80 g%). All other reports were normal. Post-treatment outcome corroborated with follow-up laboratory investigations with significant changes. USG (whole abdomen) revealed no obvious abnormality after 3–4 months of continuous homoeopathic treatment with improvement in pelvic congestion syndrome and haemoglobin level [Figure 1], [Figure 2], [Figure 3], [Figure 4].
Figure 1: Ultrasound after treatment

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Figure 2: Ultrasound after treatment

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Figure 3: Blood test report before treatment

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Figure 4: Blood test report after treatment

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Therapeutic intervention

After analysing the symptoms of the case, the characteristic generals and particular symptoms were considered for framing the totality. Among important mental generals were prominent mildness, gentle attitude, liking for company and feeling bad when alone; decreased thirst, chilly patient, intolerance to meat (pork), desire for spices, scanty and clotted menstrual flow are among important physical generals, and particular symptoms such as pain in the right hypochondrium and low back pain were considered for final selection of the medicine. Miasmatic evaluation of all the presenting symptoms was done with the help of Repertory of miasms,[16] which showed the predominance of Psora, as shown in [Table 1]. Repertorial analysis using Synthesis Repertory from the Radar software was done considering the above symptomatology.[17] The repertorisation chart is presented at [Figure 5]. The first six medicines with maximum score (based on mental and physical generals, important particular symptoms) in the descending order are Lycopodium, Pulsatilla, Arsenic, Belladonna, Sepia and Natrum mur. After going through textbooks of Materia Medica,[18],[19] medicines such as Lycopodium – a right sided, hot, male-dominant drug does not cover the eliminating symptoms; Arsenicum album – although chilly patient but mental, restlessness, anxiety and thirstlessness are lacking; Belladonna – an acute remedy with opposite mentality to Pulsatilla and Sepia – a commonly used drug for climacteric complaints, especially heat flushes, irregular menses with relaxed pelvic organs, resulting in uterine prolapse were considered. The mild nature observed while talking, behaviour of the patient along with thirstlessness and aggravation from pork were very prominent in the patient and thus considered as eliminating rubrics: Pulsatilla seemed to be the most suitable remedy in this case and prescribed in the 30th potency on the 1st visit considering mildness, feels bad when alone; less thirst, intolerance to meat (pork), anaemia, scanty and clotted menstrual flow were among other important physical generals. Particular symptoms such as pain in the hypogastrium during menses and cyst in the ovary were also considered.
Table 1: Miasmatic analysis

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Figure 5: Repertorisation sheet

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Prescription

The medicine was of SBL Pvt. Ltd Pharmaceutical Company and procured from local market.

Improvement assessment

The timeline of the case including the 1st visit and subsequent follow-up is given in [Table 2]. Time-to-time assessment of complaints was done with the help of Outcome in Relation to Impact on Daily Living (ORIDL)[20] instrument, and after 3–4 months of treatment, clinical improvement corroborated with laboratory investigations [Table 3]. Before and after treatment, key investigations are given in [Figure 1].
Table 2: Follow-up and outcomes

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Table 3: Outcome in relation to impact on daily living score

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  Discussion Top


No scholarly articles were found in PubMed, Researchgate, Google Scholar, ISeek, CORE-Hom and AYUSH Research Portal (search made during December 2018 to March 2019) regarding works carried out till date on scope of Homoeopathy in HH. However, a few case reports on Ovarian Cyst treated with Homeopathy have been published.[11],[12],[13],[14],[15] but mostly are of case reports. This is a rare case successfully treated with homoeopathic medicines. In this case individualistic approach, attitude and manner of conversation of patient, her mental condition temperament, characteristic physical generals and particulars were taken into consideration. The ORIDL instrument [20] (formerly referred to as the Glasgow Homoeopathic Hospital Outcomes Scale) has been used in this case to measure patient's views of the outcome of their care. The scale allows the person to assess their outcome by relating this to impact on their daily life.

Although HH and OCs have chances of self-regression, we cannot wait for a considerable period to let them resolve spontaneously. There are reports where probability for self-regression of HH or OC is mentioned ranging from a few weeks to months, but none of them has given tangible data or mentioned about any observational studies to assert that HH and OCs are self-regressing. There is no conclusive scientific evidence that these abnormal growths may turn into malignancy; however, to avoid unseen complications, sometimes, surgical removal is suggested.[4],[10] At this juncture, Homoeopathy may have a role to play as it is safe to use, it may help to annihilate the abnormal growth and restore the health. The beauty and core concept of Homoeopathy is individualisation, i.e., treat the patient not the disease. With individualistic approach, this patient was benefitted by homoeopathic medicines (positive ORIDL score).

Both the HH and OC were improved as evident from follow-up investigation. Pork aggravation altered; low back pain secondary to pelvic congestion also improved. Although this single case report cannot draw any certain conclusion, more number of case reports and observational studies/clinical trials on HH and OC are warranted.

Acknowledgement

We are thankful to Dr. Anil Khurana, Director General In-charge, Dr. Raj K. Manchanda, Ex-Director General, CCRH, for their suggestions to report such success stories in systematic manner for dissemination among scientific community. Last but not the least, we are grateful to the patient who gave consent to share this case report.

Informed consent

Due consent was obtained from the patient to disseminate the information as scientific case report. The patient understands that her name, photographs and initials will not be published.

Financial support and sponsorship

Nil.

Conflicts of interest

None declared.



 
  References Top

1.
Heiken JP. Distinguishing benign from malignant liver tumours. Cancer Imaging 2007;7:S1-14.  Back to cited text no. 1
    
2.
Kim JM, Chung WJ, Jang BK, Hwang JS, Kim YH, Kwon JH, et al. Hemorrhagic hemangioma in the liver: A case report. World J Gastroenterol 2015;21:7326-30.  Back to cited text no. 2
    
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Bajenaru N, Balaban V, Savulescu F, Campeanu I, Patrascu T. Hepatic hemangioma –Review. J Med Life 2015;8:4-11.  Back to cited text no. 3
    
4.
Schwartz SI, Husser WC. Cavernous hemangioma of the liver. A single institution report of 16 resections. Ann Surg 1987;205:456-65.  Back to cited text no. 4
    
5.
Dawn CS. Textbook of Gynaecology and Contraception. 8th ed. Calcutta: Dawn Books Publication; 1985.  Back to cited text no. 5
    
6.
Difference between Ovarian Cyst and Pcos; 11 July, 2017. Available from: https://www.londonwomenscentre.co.uk/info/news/difference-ovarian-cysts-pcos. [Last updated on 2017 Jul 11; Last accessed on 2019 Mar 15].  Back to cited text no. 6
    
7.
Horowitz NS. Management of adnexal masses in pregnancy. Clin Obstet Gynecol 2011;54:519-27.  Back to cited text no. 7
    
8.
Ross EK, Kebria M. Incidental ovarian cysts: When to reassure, when to reassess, when to refer. Cleve Clin J Med 2013;80:503-14.  Back to cited text no. 8
    
9.
Trimble EL. The NIH consensus conference on ovarian cancer: Screening, treatment, and follow-up. Gynecol Oncol 1994;55:S1-3.  Back to cited text no. 9
    
10.
Abduljabbar HS, Bukhari YA, Al Hachim EG, Alshour GS, Amer AA, Shaikhoon MM, et al. Review of 244 cases of ovarian cysts. Saudi Med J 2015;36:834-8.  Back to cited text no. 10
    
11.
Gimeno ML. Homoeopathic treatment of ovarian cysts. Br Homeopath J 1991;80:143-8.  Back to cited text no. 11
    
12.
Das D, Samadder A, Kayal SK, Khuda-Bukhsh AR. Removal of large sized ovarian cysts by potentized homeopathic remedies: A myth or a dependable alternative option. Int J Complement Alt Med 2016;3:88.  Back to cited text no. 12
    
13.
Das D, Khuda-Bukhsh AR. A patient with uterine fundal leiomyoma and a large hemorrhagic cyst in right ovary cured by homeopathic remedies – A case report. Indian J Med Case Rep 2016;5:13-9.  Back to cited text no. 13
    
14.
Das D, Haque S, Samaddar A, Kayal SK, Khuda-Bukhsh AR. Removal of large sized ovarian cysts in three patients by administration of a single remedy, Thuja occidentalis: Hormonal assay and ultrasonographic images. J Integrative Med Ther 2016;3:9.  Back to cited text no. 14
    
15.
Gupta G, Singh N, Singh R, Singh S, Nayak C, Khuran A. Evidence based clinical study on the effect of homoeopathic medicines in cases of ovarian cysts. Indian J Res Homoeopathy 2011;5:36-42.  Back to cited text no. 15
  [Full text]  
16.
Patel RP. Chronic miasms in homoeopathy and their cure with classification of their rubrics/symptoms. In: Dr. Kent's Repertory (Repertory of Miasms). Indian edition. Kottayam: Hahnemann Homoeopathic Pharmacy; 1996.  Back to cited text no. 16
    
17.
Schroyens F. Synthesis – Repertorium Homoeopathicum Syntheticum. 9.1 Ver. New Delhi: B Jain Publishers (P) Ltd.; 2009.  Back to cited text no. 17
    
18.
Boericke W. New Manual of Homoeopathic Materia Medica and Repertory. 9th ed. New Delhi: B Jain Publishers (P) Ltd.; 2001.  Back to cited text no. 18
    
19.
Allen HC. Keynotes and Characteristics with Comparisons of some of the Leading Remedies of the Materia Medica. 9th ed. New Delhi: B Jain Publishers (P) Ltd.; 1986.  Back to cited text no. 19
    
20.
Reilly D, Mercer SW, Bikker AP, Harrison T. Outcome related to impact on daily living: Preliminary validation of the ORIDL instrument. BMC Health Serv Res 2007;7:139.  Back to cited text no. 20
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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