How Common Are Hemangiomas in Adults?

Hemangiomas are a congenital malformation of blood vessels. Hemangiomas that occur in the liver are more common than other organs. According to statistics, the incidence is about 2%.

Chinese name: Intrahepatic hemangioma

Foreign name: liver hemangioma

Causes and common diseases of intrahepatic hemangioma

Intrahepatic hemangioma is a common benign tumor in the liver. Can occur at any age, can be single or multiple. Intrahepatic hemangiomas have extremely slow or relatively quiescent internal blood flow.

Differential diagnosis of intrahepatic hemangioma

Intrahepatic hemangiomas can be histologically divided into intrahepatic capillary hemangiomas and cavernous hemangiomas, and confirmed on B-ultrasound and other examinations.

1. Intrahepatic capillary hemangiomas, often smaller, generally 1 to 3 cm in diameter, are caused by local hyperplasia. B-mode ultrasound imaging showed enhanced echo and clear realm in the ward. Carefully observe that the large blood vessels in the liver are closely related or closely related to capillary hemangioma, and the follow-up observations have little change. Lesions with sharp edges or sharp echoes are highly suggestive of the disease. Strong echogenic lesions with a diameter of less than 3 cm, with clear boundaries, asymptomatic and good follow-up, may be intrahepatic capillary hemangiomas.

2. Diagnosing cavernous hemangioma is difficult, and its B ultrasound image has many variations, that is, low echo type and mixed echo type. The images are more complex and non-characteristic, resembling primary or secondary liver tumors. Other checks are required.

Intrahepatic hemangioma examination

B-mode ultrasound can be used as the first choice for examination of intrahepatic hemangiomas. This method is non-invasive, painless, and requires no special preparation. It can be used repeatedly and is easy for patients to accept. Angiography, computed tomography (CT), Doppler ultrasound, and magnetic resonance imaging are also available.

Intrahepatic hemangioma treatment principles

As the detection rate of hepatic hemangioma is increasing, the choice of treatment timing and plan is a question worthy of attention. After the diagnosis is clear, the patient's condition should be evaluated first to determine the clinical classification; secondly, the indications should be grasped, the advantages and disadvantages should be weighed, and overtreatment should be avoided; once again, comprehensive consideration should be taken to formulate a plan, which should be based on the principle that the smallest trauma will achieve the maximum therapeutic effect. Nowadays, with the advancement of technology, there are various treatment methods for hepatic hemangioma. Here, we summarize the various treatment schemes available today. Specialists should strictly grasp the guidelines according to specific conditions and personalize and customize treatment schemes. .

Clinical observation and drug treatment of intrahepatic hemangioma

The clinical observation is suitable for all patients without persistent clinical symptoms and severe comorbidities, especially for patients with tumors larger than 5 cm in diameter. Periodic review is recommended. If symptoms such as persistent abdominal pain, bloating, and complications aggravate, it is recommended to proceed further. Intervention. The treatment of adult hemangiomas is only reported in individual cases, and its efficacy is still being explored, including the inhibitors sorafenib and bevacizumab. For infants and young children with hepatic hemangiomas complicated by anemia or heart failure, hormonal intervention is preferred. For patients with high-flow heart overload, propranolol is well tolerated and effective, which can reduce liver blood flow, thereby reducing the diameter of hepatic hemangiomas, reducing tumor size, and relieving the heart. Symptoms of dysfunction and hypothyroidism, when drug intervention fails or is accompanied by spontaneous rupture and bleeding, arterial embolism or hepatic artery ligation, liver lobectomy, or liver transplantation surgery can be selected.

Percutaneous hepatic arterial embolization

Studies have found that hepatic hemangioma may have a blood supply branch derived from the hepatic artery. Therefore, interventional embolization may occlude small branches of the peripheral arterial artery, fibrosis of hemangioma, terminate tumor growth, promote tumor shrinkage, improve clinical symptoms, and achieve therapeutic goals. . For example: in the case of neonatal congenital giant hemangioma with neonatal failure and severe heart failure, in order to reduce the heart load, TAE can reduce the heart load; or in patients with huge hemangiomas with KM syndrome, TAE can Relieve the symptoms of platelet drop and abnormal blood coagulation. However, a large sample of TAE in the clinical treatment of hepatic hemangioma is still lacking, and TAE may cause extensive bile duct injury and stenosis. The reason is related to bile duct ischemia caused by the use of sodium cocosoleate or ethanol as an embolization agent. The effect of arterial embolization is not stable and the recurrence rate is high. Therefore, TAE is currently mainly used in clinical practice: 1. Huge hemangiomas rapidly increase in the short term, and embolism lays the foundation for two-stage surgical resection; 2. Jaundice caused by tumor compression of the biliary tract or manifestations of wasting coagulopathy, and improvement in the short term Patients with clinical symptoms.

Radiofrequency ablation of intrahepatic hemangiomas

The principle of hepatic hemangioma is basically similar to the treatment of liver cancer. In the treatment, the method of pre-destructing the main blood supply area of hemangioma can be used to completely destroy the hemangioma as much as possible to reduce the occurrence of residual lesions. With the development of technology, radiofrequency ablation of percutaneous hepatic hemangiomas, radiofrequency ablation of laparoscopic or open hepatic hemangiomas have been reported. Now, our center and some domestic centers have successfully performed huge hemangiomas larger than 10 cm. In the case of RFA, the treatment process was safe and the treatment effect was satisfactory. After long-term follow-up, tumor volume decreased and clinical symptoms eased. There is no uniform standard to choose in terms of the treatment approach. Generally, it is selected based on clinical characteristics such as tumor size and location. Under laparoscopic or laparotomy, simultaneous hepatic artery block can reduce the risk of RFA. Bleeding and increase the effectiveness of treatment. Therefore: 1. Patients with huge hemangiomas with clinical symptoms such as abdominal pain. The tumor is located in the liver parenchyma, and there is a needle injection path through the liver parenchyma. There are no large blood vessels, bile ducts and important organs around, and patients with good coagulation function. 2 2. Patients with rapid tumor growth and patients with heavy mental burdens; 3. Large hepatic hemangiomas that are not suitable for surgical resection can be treated with RFA. RFA is a small trauma and high safety treatment. There may be some complications after RF surgery: including bleeding, abscess formation, gastrointestinal perforation, liver failure, bile duct injury, portal vein thrombosis, hemopneumothorax requiring drainage, etc. The incidence rate is 0.6 to 8.9%, and the area of burning is too large. Hemoglobinuria is prone to occur over time, so it is necessary to pay close attention to complications such as bleeding tendency and necrotic tissue infection after surgery. Active and effective prevention and treatment of hemoglobinuria damage to the body.

Intrahepatic hemangioma surgery

1. Surgical resection: it is the earliest radical method used in the treatment of hepatic hemangiomas. The surgical methods include: hemangiomas ablation, irregular resection, hepatic segment or hepatic liver and enlarged hepatectomy, and ligation of the affected hepatic artery. Ablation and resection are the most common methods today, and the surgical approach can be open or laparoscopic. Many literatures report that surgical treatment is safe and effective for patients with asymptomatic or symptomatic hemangiomas, but the prognosis of the asymptomatic patients and those undergoing clinical observation is not significantly different after a long-term follow-up comparison. With the deepening of the understanding of liver hematomas and the greater trauma that surgery may bring, the grasp of the indications for surgery needs to be more and more strict. Combining the advantages of surgical treatment, it is recommended to choose surgical treatment for the following conditions: 1. Hepatomas with spontaneous rupture and bleeding or accidents, with clear subhepatic or abdominal hemorrhage with hemorrhagic shock; 2. There are obvious clinical symptoms, such as Abdominal pain, abdominal mass, or concomitant wasting coagulopathy (hemangioma-thrombocytopenia syndrome); 3. Pregnant women with a planned subcapsular hemangioma are recommended to undergo prophylactic surgery to avoid the risk of tumor rupture and bleeding during pregnancy . 4. Emergency treatment requires emergency treatment; 5. Inability to distinguish benign and malignant lesions, especially those with hepatitis B and cirrhosis. It is not recommended for patients who are asymptomatic or whose tumor diameter is less than 5 cm, but who strongly demand surgery. The size and location of the tumor, the amount of liver tissue resection, the blood loss during the operation, and the blood transfusion are the risk factors that affect the postoperative complications of the hepatic hemangioma. However, the risk of the operation is mainly related to the blood loss during the operation and the blood transfusion. Blood loss to reduce postoperative complications of hepatic hemangioma.

2. Liver transplantation: Liver transplantation is the ultimate treatment for many end-stage liver diseases. In recent years, there have been multiple reports of using live liver transplantation to treat huge hepatic hemangioma. For liver hemangioma with KM syndrome that cannot be removed clinically, Patients with large hepatic hemangiomas with severe liver damage, multiple intra-hepatic arteriovenous short circuits, and diffuse hemangiomas may be considered for liver transplantation.