Disease classification
(1) Cavernous hemangioma: The section is honeycomb, full of blood, microscopic examination shows varying size of cystic sinusoid, filled with red blood cells, sometimes thrombus formation, fibrous tissue septum between the sinusoid, small blood vessels and small bile ducts are seen in the fibrous septum, occasionally compressed hepatocyte cords. The thrombus in the fibrous septum and sinusoids can be seen as calcification or venous stone.
(2) In sclerosing hemangioma, the lumen of the vessel is closed and the fibrous septum shows more degenerative changes.
(3) Vascular endothelial cell tumor, in which the endothelial cells are actively proliferating and prone to malignant transformation.
(4) Hepatic capillary hemangioma with narrow vascular lumen and more fibrous septal tissue.
Early symptoms
Hepatic hemangioma Hepatic hemangioma is a common benign tumor that can occur at any age, but mostly develops symptoms after middle age, more in women than in men. The occurrence of this disease may be congenital and has some relationship with endocrine. Hepatic hemangiomas are often located in the right lobe of the liver under the envelope and are mostly solitary. They are usually 3-10 cm in diameter, individually up to 36 kg, and about 10% are multiple. Small hemangiomas are mostly asymptomatic signals, often found incidentally by ultrasound during physical examination. Most of the symptomatic signals appear as indigestion, warmth, nausea, abdominal distension, or distension and discomfort in the liver area. The hemangioma grows slowly, and when it develops to a certain extent, hepatomegaly may appear, but the liver function is normal and the spleen is not enlarged.
According to the follow-up observation of more cases, it is found that many patients with hepatic hemangioma develop very slowly, and even after years of follow-up, there is no obvious development, and no malignant change is found. Therefore, any small intrahepatic hemangioma can be examined by ultrasound regularly under medical supervision for six months or one year). If symptoms such as swelling and pain in the liver area, abdominal distension and discomfort, and poor food intake occur, Chinese herbal medicine can be taken. If the hemangioma is progressively enlarging, it can be treated surgically to avoid the danger of rupture and bleeding.
Clinical manifestations
1.Small hemangioma is asymptomatic, while larger hemangioma may have swelling and pain in the liver area.
2.Small hemangioma is asymptomatic, while larger hemangioma may have a palpable mass in the right upper abdomen and a large liver.
3.Large liver, mass and compression symptoms appear due to the enlargement of tumor, which are mostly asymptomatic in early stage. Diagnosis is mainly based on ultrasound, cT, nuclear scan and hepatic arteriography to confirm the diagnosis. Smaller hemangiomas with no symptoms do not require treatment.
Smaller hemangiomas with no symptoms do not need to be treated and can be observed dynamically, while partial hepatectomy can be chosen for those with compression symptoms. Most hemangiomas are solitary and less than 4 cm in diameter. Hepatic hemangiomas are often found incidentally during ultrasound examination, and their size, shape and number are not certain.
The size, shape and number of hepatic hemangiomas are variable and are often congenital in nature. If the hepatic hemangioma is stationary and does not develop, it is usually not life-threatening. 40% of hepatic hemangiomas over 4 cm are associated with abdominal discomfort, hepatomegaly, lack of appetite and indigestion. Liver
Hemangioma may contain fibrous tissue and mechanized thrombus, which may cause swelling of the tumor and distension of the liver peritoneum due to repeated thrombosis.
Diagnostic basis
1.Distension and pain in liver area, large liver or palpable mass.
2. Color ultrasound shows hepatic hemangioma-like changes.
3.CT examination: there is a hypodense area with uniform density in the liver, and a “C”-shaped enhancement zone may appear in the edge of the tumor after enhancement.
4.Hepatic arteriogram: A “vascular lake” image appears around the lesion site, and the retention time of contrast agent is long.
5.Laparoscopy: It can observe the color and shape of liver surface tumor.
6.X-ray examination: large liver shadow, elevated diaphragm, and calcified shadow can be found.
7.ECT shows hepatic hemangioma changes.
Treatment principle
1.Tumor diameter <5cm does not need surgery, regular review and follow-up.
2.For tumor diameter 5-10cm, surgery can be considered.
3.Tumor diameter >10cm is generally treated by surgery.
4.Surgical methods are: (1) hepatic hemangioma resection or hepatic lobectomy; (2) hepatic artery ligation; (3) intraoperative cryotherapy.
5.Non-surgical treatment: (1) radiation therapy; (2) hepatic arteriography and tumor artery embolization.