liver hemangioma
Introduction
Introduction to hepatic hemangioma Hepatic hemangioma (hepatichemangioma) is the most common type of benign liver tumor, and its cause may be congenital dysplasia of hepatic vessels. Increased incidence of women during multiple pregnancies or progesterone use suggests that progesterone may be associated with hepatic hemangioma. The clinical manifestations of this disease are closely related to the size and location of the tumor. The small tumor (<4cm) may have no self-conscious symptoms, and most of them are found when doing B-ultrasound or CT examination. basic knowledge The proportion of illness: 0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: abdominal distension, abdominal pain, liver cancer
Cause
Causes of hepatic hemangioma
Congenital dysplasia (30%):
The occurrence of hepatic hemangioma is caused by congenital vascular malformation of the peripheral liver. During the development of the embryo, due to abnormal liver vascular development, the vascular endothelial cells are abnormally proliferated to form hepatic hemangioma.
Infection factor (15%):
Some people think that capillary tissue is deformed after infection, leading to telangiectasia. After local necrosis of liver tissue, the blood vessels dilate to form vacuoles, and the surrounding blood vessels are congested and dilated; the regional blood circulation in the liver is stagnant, causing the blood vessels to form a sponge-like expansion.
Endocrine factors (20%):
Female puberty, pregnancy, oral contraceptives can accelerate the growth of hemangioma, and it is believed that female hormone may be a causative factor of hemangioma.
Pathogenesis
The size of hepatic hemangioma varies greatly. The small one is only a few millimeters, the larger one can exceed 20cm in diameter. Generally, the diameter of more than 10cm is called giant hemangioma, and about 85% of hepatic hemangioma is single, located in the right lobe of the liver. It is often close to the surface of the liver and is expansively growing. It is clearly separated from the surrounding liver parenchyma. The naked eye is dark red or blue-violet. It can be irregularly lobulated. Under the microscope, the lesion contains many thin walls of various sizes. The venous cavity is lined with a single layer of epithelium with fine fibrous septa between the cavities. According to the number of fibrotic tissues in the tumor, it can be divided into 4 types:
Hepatic cavernous hemangioma
The cut surface of the tumor is honeycomb-shaped and consists of sinusoids of different sizes. In the large lesions, the central fibrosis zone caused by old hemorrhage or thrombosis can be seen. This type is the most common, clinically known hepatic hemangioma. More refers to this type.
2. Sclerosing hemangioma
The vascular cavity collapses or closes, the fibrous tissue increases, and the tumor is hard.
3. Vascular endothelial cell tumor
It is a tumor derived from hepatic vascular endothelial cells and is easily malignant. This type is clinically rare.
Hepatic capillary hemangioma
Vascular cavity stenosis, fibrous tissue proliferation is a feature of this type, this type is rare in China.
Prevention
Hepatic hemangioma prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease. Pay attention to maintain adequate sleep, avoid overwork, pay attention to work and rest, pay attention to the regularity of life, avoid long time desk, so as to avoid liver itching. At the same time as the diet care of hepatic hemangioma, it is necessary to avoid violent physical exercise or heavy physical labor to prevent the tumor from rupturing and bleeding due to excessive pressure, and thus endangering life.
Complication
Hepatic hemangioma complications Complications, abdominal distension, abdominal pain, liver cancer
1. The larger tumor can compress the surrounding organs to cause abdominal distension, abdominal pain, nausea and vomiting, loss of appetite, and pain in the liver area.
2. Hepatic hemangioma has the possibility of rupture causing massive bleeding in the abdominal cavity.
Symptom
Hepatic hemangioma symptoms Common symptoms Fetal spasm loss of appetite Abdominal discomfort Liver capsule hematoma rupture Coagulopathy Dyspepsia Upper abdominal discomfort Liver enlargement Tumor calcification Thrombocytopenia
The clinical manifestations of this disease are closely related to the size and location of the tumor. The small tumor (<4cm) can be free of any self-conscious symptoms, mostly found when doing B-ultrasound or CT examination; the larger tumor (>4cm) It can compress the surrounding organs, such as abdominal distension, abdominal pain, nausea and vomiting, loss of appetite, pain in the liver area, etc. The giant hemangioma may have a right upper abdomen mass, liver enlargement and other signs during the examination, and the surface of the mass is smooth and medium in texture. Clear, there may be tenderness, moving up and down with the breathing, hepatic hemangioma has the possibility of rupture caused by intra-abdominal hemorrhage, but spontaneous rupture is rare, the possible cause is percutaneous liver biopsy or abdominal trauma.
Because the disease has no clinical symptoms, many patients are found in the B-ultrasound and other physical examination; if clinical symptoms appear, the above-mentioned examination method should be used appropriately, and the diagnosis should be no difficulty.
1. Clinical manifestations.
2. Laboratory and other auxiliary inspections.
Examine
Hepatic hemangioma
Liver function is more normal, AFP is negative, and some may have a slight decrease in whole blood cells, and occasionally a slight increase in serum AKP.
1. B-ultrasound: often used as the preferred method of examination, showing a uniform and high echogenic mass with clear boundaries. Large hemangioma can be seen with uneven echogenicity, sometimes with calcification.
2. CT: CT findings of typical hemangiomas are low-density masses with uniform density and clear boundaries; dynamic CT scans of venography show increased density from the periphery, and then gradually fill the center and wait with the surrounding liver tissue. density.
3. MRI: The specificity of detecting hemangiomas can reach 92% to 100%. Hemangiomas have high T2 signals, while T1 intensity is equal to the surrounding.
4. Radionuclide blood pool scanning: blood pool scanning was performed with 99mTc-labeled red blood cells. The hepatic hemangioma showed early filling, and then gradually filled from the periphery, and the filling period was extended. The sensitivity of this method was 90. % is a highly specific, non-invasive test.
5. Hepatic angiography: high accuracy for the diagnosis of this disease, can show hemangioma of 1 ~ 2cm size, showing early contrast agent filling and continuous staining, can have a characteristic "cotton cluster" or "snow tree" Performance, this method is a traumatic examination, clinical is not the first choice.
6. Biopsy: Although fine needle aspiration cytology is relatively safe, it often does not lead to diagnostic conclusions; if a standard needle, such as Menghini or Trucut, is used, the risk of puncture is increased and there is already a puncture Reports of fatal bleeding, so biopsy should be avoided.
Diagnosis
Diagnosis and diagnosis of hepatic hemangioma
The disease needs to be differentiated from liver malignant tumors and other benign tumors. In liver malignant tumors, it is mainly differentiated from primary liver cancer, especially small liver cancer. Primary liver cancer is complicated with liver cirrhosis. The disease progresses rapidly and the course of disease is short. AFP often Positive, liver metastases often have a history of primary gastrointestinal tumors, it is not difficult to make a differential diagnosis, in the liver benign tumors are mainly identified with congenital hepatic cysts, congenital hepatic cysts have a long course, most of the lesions are multiple, 1 3 to 1/2 with polycystic kidney disease, imaging examination can be further identified.
