1.Is hepatic hemangioma benign and can it become cancerous? Hepatic hemangioma is the most common benign tumor of liver, including sclerosing hemangioma, vascular endothelial cell tumor, capillary hemangioma and cavernous hemangioma, among which cavernous hemangioma is the most common. It is more common in women than in men. They can be solitary or multiple. There is no report of malignant transformation of hemangioma. 2.What is the cause of the disease? The exact etiology is unknown, but there are several possible causes. 1). Congenital developmental abnormalities: Hepatic hemangioma occurs as a result of congenital malformation of the terminal blood vessels of the liver, which causes abnormal proliferation of vascular endothelial cells to form hepatic hemangioma due to abnormal development of hepatic blood vessels during embryonic development. 2). Hormonal stimulation theory: Female puberty, pregnancy and oral contraceptives can accelerate the growth of hemangioma, and it is believed that female hormones may be a causative factor for hemangioma. 3). Other theories: some people think that capillary tissue is deformed after infection, which leads to capillary dilation; the blood vessels expand to form vacuoles after local necrosis of liver tissue, and their surrounding blood vessels are congested and expanded; regional blood circulation in the liver is stagnant, resulting in spongy expansion of blood vessels. 3.Does hepatic hemangioma have clinical symptoms and how does it manifest clinically? Generally speaking, patients with small hemangioma are asymptomatic in the early stage, so it is not easy to be found in the early stage, but often found by chance during normal physical examination or examination of other lesions. The clinical manifestations of hepatic hemangioma are related to the site of growth, size, growth rate, the impact of the tumor on the liver and the complications that occur. Generally, the growth is slow and the course of the disease is long. Symptoms may include epigastric pain and discomfort, anorexia, nausea and vomiting, similar to chronic liver, biliary, pancreatic and gastrointestinal diseases; or long-term fever, chills and night sweats, similar to liver abscess and tuberculosis, which may be related to bleeding, thrombosis or infection in the tumor. When the tumor enlarges, it can compress and push the neighboring organs and cause various symptoms. For example, if the tumor compresses the lower esophagus, stomach and duodenum, it may cause difficulty in swallowing, abdominal distension, abdominal pain, belching and other symptoms. 4.What are the complications of hepatic hemangioma? There are reports of serious complications such as rupture and bleeding of hepatic hemangioma in rare cases. For example, if the tumor of a swollen hemangioma ruptures (intra-abdominal bleeding and shock caused by trauma, rough physical examination, emergency delivery during childbirth, artificial respiration to squeeze the chest, etc.). Especially, spontaneous rupture and bleeding is very easy to be misdiagnosed and the mortality rate of delayed treatment is extremely high. Intra-tumoral hemorrhage into the intrahepatic bile duct can cause biliary hemorrhage, manifested as right upper abdominal cramps, fever, jaundice, and gastrointestinal bleeding. In infants and children, thrombocytopenic purpura and fibrinogen deficiency may be combined, causing fatal bleeding and hemolysis. The main cause of coagulation factor deficiency is the slow blood flow within the giant tumor, which consumes and destroys platelets and prothrombin, and the reduction of platelets under the influence of certain factors. It may also cause severe congestive heart failure due to the increased amount of blood returned to the heart as a result of arteriovenous shunts in the hemangioma, which increases the burden on the heart. 5.How should liver hemangioma be examined? Hepatic hemangioma lacks specific clinical manifestations and mainly relies on imaging examinations (such as ultrasound, CT, MRI) to make a clear diagnosis. (1) Ultrasound examination: Ultrasound of hepatic hemangioma shows high echogenicity, and those with hypoechogenicity mostly have reticular structure, uniform density, regular morphology and clear boundaries; ultrasound can be the first choice for physical screening and follow-up examination after definite diagnosis, but the diagnostic accuracy of ultrasound depends on the accurate judgment of the examining doctor, and other imaging examinations are needed for qualitative diagnosis of hemangioma. (2) Ultrasonography: For cases of hepatic hemangioma with atypical imaging performance, liver contrast ultrasonography can be considered selectively. Typical hemangioma ultrasonography shows nodular or ring-like enhancement in the periphery in the arterial phase, which gradually expands to the center with time. It can be used as a qualitative and differential diagnostic test for hemangioma. (3) Spiral enhanced CT: CT scan shows well-defined round or round-like low-density lesions in the liver parenchyma, and a few of them may be irregular in shape. The peripheral enhancement of hemangioma can be seen in the arterial phase, and the venous phase fills in the center. It is a common examination method for definite diagnosis and differential diagnosis of hemangioma. (4) MRI enhancement examination: MRI examination shows low signal in T1-weighted and high signal in T2-weighted, with uniform intensity and clear edges, and contrast with the surrounding liver, which is described as “light bulb sign”, which is the specific performance of hemangioma in MRI. Because MRI has high soft tissue resolution and provides more information in different scans, it can be the first choice for qualitative diagnosis and differential diagnosis of hemangioma, especially small hemangioma. (5) Other examination methods: liver biopsy has low accuracy and may lead to bleeding, and hepatic arteriography is an invasive examination, which is mostly unnecessary. Whole-body positron emission computed tomography (PET/CT) is valuable for excluding metabolically active malignant tumors, but it is not routinely recommended due to its economic-benefit ratio and radioactivity. 6.Should surgery be performed? There are several factors to be considered whether surgery is needed: tumor size, location, growth rate, combined serious complications, combined obvious symptoms, and whether the diagnosis is clear. (1) Size of hemangioma: according to the size of hemangioma, it can be divided into: (1) small hemangioma <5cm; (2) hemangioma 5-10cm; (3) huge hemangioma 10cm-15cm; (4) very large hemangioma >15cm. this classification has certain significance for the development of treatment plan for hepatic hemangioma, generally We believe that hemangioma >8cm can be considered for surgical treatment. (2) Location of hemangioma: located in special locations such as the first hepatic hilar, second hepatic hilar, caudate lobe, etc., because of the difficulty and risk of surgery, close to large blood vessels, early surgical treatment can be considered if the growth rate is fast or medium size. 3）Growth speed: conventional hemangioma grows slowly, if the hemangioma grows fast, surgical treatment can be considered. (4) If combined with the aforementioned serious complications or obvious symptoms, surgical treatment is feasible. For cases where the diagnosis is unclear and malignant tumors such as hemangiosarcoma cannot be ruled out, surgical treatment is recommended. 7.Is minimally invasive laparoscopic treatment possible? If the hemangioma is properly located, such as growing in the left lobe of the liver or near the edge, minimally invasive laparoscopic surgery is feasible to remove it, which is less traumatic, quicker to recover and more beautiful. 8.Are there any other treatment methods and can they be treated medically? Other treatment methods include microwave curettage, radiofrequency treatment, hepatic artery embolization, etc. For diffuse hepatic hemangioma, or huge hemangioma that cannot be removed, such as liver function loss or combined with Kasabach-Merritt syndrome, liver transplantation is also feasible. There are no effective drug treatment options for adult hepatic hemangioma.