Hepatic cavernous hemangioma Hepatic cavernous hemangioma is the most common benign clinical tumor of the liver, most commonly seen in women, and its etiology may be related to embryonic vascular malformations. Spontaneous rupture of adult hepatic cavernous hemangioma rarely occurs, and ruptured bleeding is commonly reported in the literature as a result of medical intervention. (a) Symptoms and signs: Most hepatic cavernous hemangiomas do not cause clinical symptoms, but only a few cause abdominal pain, abdominal distension, poor appetite and other discomforts due to the huge tumor body and compression of the adjacent organs. Most of them are soft in texture and have elasticity and retraction feeling. Most of the patients have no abnormal laboratory tests. (b) B-ultrasound examination: a strong echogenic solid mass with uniform density and clear borders can be seen, and in larger hemangiomas, scattered liquid dark areas as dilated blood sinuses can be seen. (c) CT and MRI examination: Hepatic cavernous hemangioma has a characteristic enhancement pattern under enhanced CT examination, which has diagnostic significance. MRI scan T2-weighted image with clear boundary and uniform high signal area is diagnostic for hepatic hemangioma. (d) Hepatic arteriogram: the typical presentation is “early visualization and slow disappearance”, which can be distinguished from hepatocellular carcinoma. (e) Nuclear hepatic blood pool imaging: radioactive “overfilling” is its characteristic manifestation, which can be easily distinguished from hepatocellular carcinoma with hypo-radiation. ［Most of the hepatic hemangiomas with clear diagnosis do not require treatment, but those with unknown diagnosis or tumors larger than 5 cm with obvious symptoms or progressive enlargement need therapeutic intervention. (a) Surgery: Surgical resection is the most effective treatment for hepatic cavernous hemangioma. Since most patients are not associated with hepatitis cirrhosis and tumor resection is not necessary to ensure the necessary margins, surgery has a better safety profile even for extensive liver resection (e.g., trilobar resection). Hepatic hemangioma ligation is another safe and effective procedure. Hepatic artery ligation combined with postoperative radiation therapy can reduce the patient’s symptoms. (ii) Radiotherapy: palliative treatment aimed at relieving the patient’s discomfort. It is suitable for patients who cannot tolerate surgery or have diffuse and multiple lesions and for postoperative adjuvant therapy. (c) Other treatments: Interventional (TAE) treatment is less effective for the long-term treatment of larger hemangiomas, and TAE application of strongly irritating embolic agents is likely to cause serious complications such as biliary fistula and infection. Radiofrequency, microwave and cryotherapy are difficult to achieve and maintain the required temperature in larger hemangiomas. Therefore, the efficacy of these treatments alone is poor. Hepatic adenoma Hepatic adenoma is a relatively uncommon benign tumor of the liver. It is most commonly seen in women, and oral contraceptives are associated with its occurrence and development. There are three types of adenomas: hepatocellular adenoma, cholangiocellular adenoma and mixed adenoma. Most of them are asymptomatic, but the tumor may increase in size and produce symptoms of pressure, and a few may present with intra-tumoral bleeding (30%) or ruptured bleeding (70%) causing abdominal pain. [Diagnosis] This disease is easily confused with hepatocellular carcinoma, and can be differentiated from hepatocellular carcinoma by differentiating the patient’s general condition, liver function, alpha-fetoprotein and imaging examination. Most patients have a history of oral contraceptive use. [Treatment] Surgical resection is the main treatment. Complete resection with envelope has good prognosis. Hepatic artery ligation or TAE as palliative treatment can inhibit tumor growth and prevent rupture and bleeding. Emergency surgery is needed when the tumor ruptures and bleeds and becomes an emergency abdomen. If the tumor is related to oral contraceptive pills, the tumor can shrink on its own after stopping the pills. Focal nodular hyperplasia Focal nodular hyperplasia (FNH) is a benign lesion of the liver, which is a malformed tumor-like degeneration. It is most commonly seen in women and its etiology is unknown. It is usually asymptomatic and usually less than 2 cm in size and is not easily distinguished from hepatic sclerosing nodules, hepatocellular adenomas, or hepatocellular carcinomas, some of which require surgical resection to confirm the diagnosis. FNH with uncomfortable symptoms or with an unclear diagnosis can be surgically removed.