Hepatic hemangioma is the most common benign tumor of liver, most of which are cavernous hemangioma. It is clinically seen in people of all ages, but it is more common in 30~50 years old.
1.Does hepatic hemangioma need treatment?
Hepatic hemangioma is a benign tumor, and no malignant transformation has been reported. Once a small asymptomatic hepatic occupancy is diagnosed as hepatic hemangioma, doctors and patients often do not need to take any treatment.
2.How to confirm the diagnosis of hepatic hemangioma?
It is important to confirm the diagnosis of hepatic hemangioma. Although hepatic vessels have typical features on enhanced CT, a few solid tumors with rich blood supply are often difficult to distinguish from them. Conversely, large hepatic hemangiomas with extensive fibrosis formation are often misdiagnosed as hepatocellular carcinoma. The small size of hemangioma or the presence of fibrosis is often the main cause of clinical misdiagnosis. Currently, we believe that the correct diagnosis of hepatic hemangioma should be made by combining ultrasound, CT and MRI, and if all three confirm the diagnosis of hemangioma, the misdiagnosis rate is greatly reduced.
Patients should also exclude a history of hepatitis B. Those with positive history of hepatitis B should not be easily diagnosed as hemangioma, and there are many lessons of misdiagnosis in this regard.
3.What treatment methods should be adopted for hepatic hemangioma?
As mentioned above, most hepatic hemangiomas should be followed and observed, and no treatment can be taken. At present, some hospitals have carried out many minimally invasive methods to treat hepatic hemangioma, such as radiation, microwave, intervention, freezing and sclerotherapy. We do not recommend these minimally invasive treatments for patients who are not contraindicated to surgery. Because.
(i) all treatment methods other than surgery have the possibility of complications of varying severity, for example, interventional treatment can cause serious complications such as intrahepatic bile duct necrosis, liver abscess or even sepsis;
Most of the other treatments only partially reduce the size of the tumor, and it is difficult to achieve a cure;
Surgical resection can remove the lesion and clarify the diagnosis. Surgical resection is the most thorough and effective treatment method for hepatic hemangioma.
4.Will hepatic hemangioma grow to be big if not removed?
The growth rate of most hepatic hemangiomas is very slow, statistically only about 10% of patients will gradually increase, the fastest growing patients, the annual growth rate is 0.3~0.5cm, most patients have no change. Therefore, for patients with 5cm tumor, ultrasound examination should be performed regularly (about once every six months), and if the tumor is found to be growing too fast or producing pressure symptoms, surgery can be considered.
5.Will hepatic hemangioma rupture?
So far, medical reports of spontaneous rupture of hepatic hemangioma are very rare, and there are less than 40 cases reported worldwide.
6.Which patients have indications for surgery?
The indications for surgery of hepatic hemangioma are not like malignant tumors, so we should control them strictly. Surgical resection can be considered for the following patients.
①History of hepatitis B. It is difficult to exclude the possibility of hepatocellular carcinoma;
(ii) Compression symptoms, such as gastrointestinal tract compression symptoms;
③ Combined with other diseases that require surgical treatment, such as gallbladder stones, can be combined with hepatic hemangioma resection during surgery;
The urgency of surgical treatment is not as urgent as that of malignant tumors, and there are options for a long period of time.
In conclusion, the majority of patients with diagnosed hepatic hemangioma can be followed up and observed. Only a few patients with fast-growing tumors or those with huge tumors at the first diagnosis can be considered for surgical resection of the tumor, which is less urgent than malignant tumors, and the patients have more options. Other modalities, such as intervention, are not recommended for the treatment of hepatic hemangiomas.
For those patients who do not need treatment, psychological treatment is the main treatment modality, especially for those patients who are found to have hemangioma and feel symptomatic, psychological treatment is especially important, and surgical treatment cannot completely eliminate these patients’ concerns.