Hepatic epithelioid vascular endothelial cell tumor

　　Pathogenesis

　　Multiple foci in the liver, with focal diameters ranging from a few millimeters to several centimeters. The tumor tissue is tough, with a brownish-yellowish color mixed with white. The cut surface shows a sandy-grained structure, without liver cirrhosis.

　　Histological examination shows unclear boundaries of tumor nodules, often involving multiple adjacent liver acini, such as the terminal small veins of the liver and the portal area, but these structures still remain clear. Tumor cells often proliferate along sinusoids, terminal small veins, and portal vein branches, or invade the Glisson's capsule. The proliferation of tumor cells within the acini leads to the gradual atrophy and ultimate disappearance of the liver plates; tumors can also form clots, polyps, or cluster-like protuberances within veins. The morphology of tumor cells is irregular, with multiple jagged projections, resembling 'dendritic' cells, or they may be round, containing abundant 'epithelioid' cells with rich cytoplasm. Nucleus atypia and mitotic figures can be observed. Tumor cells possess many characteristics of epithelial cells, all having a basement membrane, pinocytotic vesicles, and Weibel-Palade bodies. Unlike normal epithelial cells, tumor cells contain a large amount of cytoplasmic microfilaments, and there are also a large number of dense bodies within the tumor cells.

　　Hepatic epithelioid vascular endothelial cell tumor is generally located in the internal part of the liver lobe, because the anatomical relationship around the liver is complex, the liver tissue and hemangioma have abundant blood supply, and complications often occur after surgical operation. Common complications include infection, intra-abdominal hemorrhage, postoperative bile leakage, and critically ill patients may experience postoperative liver function failure, which is life-threatening.

　　Infection is a common complication of abdominal surgery, generally due to the lack of strict aseptic operation during surgery, the presence of infection foci in the patient's skin, abdomen, or biliary tract system, contamination of the wound, abdomen, and even intra-abdominal organs by pathogens during surgery, which can lead to infection. In severe cases, it may cause systemic acute inflammatory response and infectious shock.

　　Postoperative intra-abdominal hemorrhage is one of the common complications of hepatic epithelioid vascular endothelial cell tumor surgery, generally occurring within one day after surgery, mostly due to incomplete hemostasis during surgery or the detachment of vascular ligatures, as the liver tissue has abundant blood supply and the internal structure of the liver hemangioma is complex. If hemostasis is not performed well, it may lead to local hemorrhage or severe hemorrhage. Since blood is the body's own tissue, a small amount of intra-abdominal hemorrhage will not cause obvious symptoms, but a large amount of hemorrhage can cause patients to experience hypotension and shock, which requires special attention. If active hemorrhage is found, an exploratory laparotomy should be performed actively to locate the bleeding site.

　　Gastric anorexia, aversion to food, nausea, episodic vomiting, upper abdominal pain, weight loss, signs of liver and spleen enlargement, 20% of patients may have jaundice, advanced patients may experience systemic failure, and occasionally patients may present with symptoms similar to Budd-Chiari syndrome.

　　1. Strengthen physical exercise to enhance physical fitness, exercise more in the sunshine, and sweat more to expel acidic substances from the body through sweat, thus avoiding the formation of an acidic constitution.

　　2. Develop good living habits, quit smoking, and limit alcohol consumption. The World Health Organization predicts that if people stop smoking, the world's cancer rate will decrease by 1/3 after 5 years. Secondly, do not drink excessively. Cigarettes and alcohol are highly acidic substances, and long-term smokers and drinkers are prone to acidic体质.

　　3. Avoid eating too much salty and spicy food. Do not eat overheated, underheated, expired, or deteriorated food. Elderly or weak individuals with certain genetic diseases can prevent brain tumors by moderately consuming anti-cancer foods and alkaline foods with high alkalinity, and maintaining a good mental state.

　　4. Maintain a good attitude towards stress, combine work and rest, and do not overwork. Traditional Chinese medicine believes that stress leads to overwork and physical weakness, causing immune function to decline, endocrine imbalance, and internal metabolism disorder, leading to the deposition of acidic substances in the body. Stress can also lead to mental tension, causing qi stagnation and blood stasis, internal heat, and other symptoms.

　　No specific tests, including ALP, GGT increased, AFP, CEA normal.

　　The abdominal X-ray shows the liver is filled with calcified areas, similar to liver metastasis of colon cancer, B-ultrasound shows inhomogeneous echoes of multiple nodules; CT manifestations are also diverse, showing multiple low-density areas with moderate enhancement of peripheral blood vessels, multiple low vascular points in the tumor, sometimes small bile duct dilatation, some intrahepatic portal vein branches are not visible, and the liver contour does not change; angiography shows multiple low vascular masses in the liver.

　　What kind of food is good for liver epithelial vascular endothelial cell tumor patients: diet should be light, and dietary搭配 should be reasonable. Vascular malformation experts point out that patients with vascular malformations should pay attention to nutritional balance in their dietary methods, try to diversify their food, eat more high-protein, high-vitamin, low-animal-fat, easily digestible foods, fresh fruits, and vegetables, avoid stale, deteriorated, or刺激性 things, eat less smoked, roasted, pickled, fried, and salty foods, and match coarse and fine grains for staple foods to ensure nutritional balance.

　　1. Treatment

　　Most of this disease is multifocal in the liver, with few opportunities for surgical resection, so chemotherapy and radiotherapy are the main treatment methods. 1 patient survived for 15 years and is still healthy after liver transplantation, with good results, so it is considered a good indication for liver transplantation.

　　2. Prognosis

　　The prognosis of this disease is difficult to predict. Even without treatment, patients can survive for a long time after onset. Whether it is related to autoimmune disease cannot be confirmed at present. But it has a better prognosis than primary liver cancer. Reports indicate that radiotherapy, chemotherapy, and liver resection in 1 case, respectively, survived for 3 years, 9 years, and 15 years. Ishak et al. reported 32 cases, including 9 cases without treatment, with an average survival of 9.8 years.