What Is a Hepatic Hemangioma?

Hepatic hemangioma is a relatively common benign tumor of the liver, and cavernous hemangioma is most common in clinical practice. Patients often have no obvious discomfort and are often found on B-ultrasound or abdominal surgery. There is no evidence that it is likely to change.

Basic Information

English name

liver hemangioma

Visiting department

Vascular surgery

Common causes

Congenital abnormalities, hormonal stimulation, etc.

Common symptoms

When hemangiomas> 5cm, abdominal mass may appear

Causes of hepatic hemangioma

The exact cause is not clear, and there are the following theories:

Congenital dysplasia

The occurrence of hepatic hemangioma is caused by congenital malformations of the peripheral blood vessels in the liver. During the development of the embryo, hepatic vascular endothelial cells are abnormally proliferated to form hepatic hemangioma due to abnormal development of the liver blood vessels.

2. Hormone stimulation theory

Female puberty, pregnancy, oral contraceptives, etc. can speed up the growth of hemangioma. It is believed that female hormones may be a pathogenic factor for hemangioma.

3. Other doctrines

Some people think that the capillary tissue deforms after infection, leading to the expansion of capillaries. After local necrosis of the liver tissue, the blood vessels expand to form a vacuole, and the surrounding blood vessels are congested and dilated;

Classification of hepatic hemangioma

1. According to pathology, it can be divided into 4 types:

(1) Cavernous hemangioma is the most common;

(2) Sclerosing hemangioma;

(3) Hemangioendothelial cell tumor;

(4) Capillary hemangiomas.

2. Classified by tumor size:

(1) Small hemangiomas <5cm;

(2) Hemangiomas 5-10cm;

(3) giant hemangioma 10cm ~ 15cm;

(4) Extra large hemangiomas> 15cm.

This classification has certain significance for the development of treatment plans for hepatic hemangioma.

Clinical manifestations of hepatic hemangioma

Hepatic hemangioma usually has no obvious discomfort. When the hemangioma increases to more than 5cm, the following symptoms may appear:

Abdominal mass

The abdominal mass has a sexy cyst, no tenderness, and the surface is smooth or not smooth. When auscultating the mass, occasionally a conductive vascular noise can be heard.

2. Gastrointestinal symptoms

Pain and / or discomfort in the right upper abdomen, loss of appetite, nausea, vomiting, belching, fullness after eating, and other indigestion symptoms.

3. Compression symptoms

Giant hemangiomas can push and compress the surrounding tissues and organs. Compression of the lower end of the esophagus may cause difficulty in swallowing; compression of the extrahepatic biliary tract may occur with obstructive jaundice and gallbladder fluid; compression of the portal vein system may cause splenomegaly and ascites; compression of the lungs may cause dyspnea and atelectasis; compression of the stomach and The intestine may show symptoms of the digestive tract.

4. Hepatic hemangioma rupture and bleeding

Hepatic hemangioma rupture and bleeding can cause severe upper abdominal pain, as well as bleeding and shock symptoms. Most of the hepatic hemangiomas growing below the costal arch are ruptured and bleeding due to external forces.

5.Kasabach-Merritt syndrome

Thrombocytopenia, coagulation abnormalities caused by depletion of a large number of coagulation factors. Its pathogenesis is blood retention in giant hemangiomas, which consumes a large amount of red blood cells, platelets, coagulation factors , V, , and fibrinogen, causing abnormalities in the coagulation mechanism and can further develop into DIC.

6. Other

Necrosis can occur when a pedicled hemangioma growing outside the liver is twisted, with severe abdominal pain, fever, and collapse. Individual patients due to huge hemangioma accompanied by arteriovenous fistula formation, increased blood volume to the heart, leading to heart failure.

Liver hemangioma examination

Hepatic hemangioma lacks specific clinical manifestations. Imaging examination (such as B-mode, CT, MRI) is the main method for diagnosing hepatic hemangioma.

1.B-ultrasound

The B-ultrasound of hepatic hemangioma is hyperechoic, and those who are hypoechoic have a reticular structure, uniform density, regular morphology, and clear boundaries. The larger hemangioma section may be lobular, and the internal echo is still mainly enhanced. It may be pipe network or irregular nodular or blocky low echo area. Sometimes calcified hyperechoic and Rear sound and shadow, caused by thrombosis, mechanization or calcification in the blood vessel cavity.

2. Contrast ultrasound

For cases of hepatic hemangiomas with atypical imaging findings, hepatic angiography may be considered. The typical contrast-enhanced ultrasonography of hemangioma shows nodular or ring-shaped enhancement around the arterial phase, and gradually expands to the center with time. This expansion process is slow, and the portal and delayed lesions are still in an enhanced state. To surrounding liver tissue.

3. Helical enhanced CT

CT plain scans show clear or circular low-density lesions with a clear inner boundary of the liver parenchyma, and a few can be irregular.

4.MRI examination

MRI examinations have a low T ₁ weighted signal and a high T ₂ weighted signal, with uniform intensity, clear edges, and obvious contrast with the surrounding liver. It is described as "bulb sign", which is the specific manifestation of hemangioma in MRI.

5. Other

Liver biopsy has low accuracy and can cause bleeding. Hepatic arteriography is an invasive test and is unnecessary. Whole body positron emission computed tomography (PET / CT) is of certain value for the exclusion of metabolically active malignancies.

Hepatic Hemangioma Treatment

Surgical treatment

At present, the treatment methods of hepatic hemangioma include hemangiomas resection, hemangio suture, hepatic artery ligation, microwave curing, radiofrequency treatment, and hepatic artery embolization. For diffuse hepatic hemangiomas, or unresectable giant hemangiomas, such as decompensated liver function or Kasabach-Merritt syndrome, liver transplantation is also feasible.

2. Non-surgical treatment

(1) Hepatic artery embolization (TAE) TAE treatment of hepatic hemangioma is based on hepatic hemangioma, which is mainly supplied by the hepatic artery. Thrombosis can be formed in the tumor after embolization of the artery. Thrombosis and fibrosis cause the tumor to form a fibroid structure. The purpose of shrinking and sclerosing hemangioma.

(2) Microwave curing and radiofrequency treatment of hepatic hemangioma. Microwave curing and radiofrequency treatment of hepatic hemangioma. Microwave can transform into heat energy to coagulate surrounding tissues, make the tumor locally shrink and harden, and achieve the purpose of curing the tumor.