Liver hemangioma

　　Firstly, Etiology

　　It is currently believed that liver cavernous hemangioma is a congenital developmental abnormality or hamartoma, gradually expanding with the growth of the liver. Some people believe that it may be related to endocrine factors, and women who have had multiple pregnancies or taken estrogen orally are more prone to the disease.

　　Secondly, Pathogenesis

　　The size of liver hemangiomas varies greatly, with small ones only a few millimeters in size and large ones with a diameter exceeding 20cm. Generally, those with a diameter exceeding 10cm are called giant hemangiomas. About 85% of liver hemangiomas are solitary, located in the right lobe of the liver, and often close to the liver surface, showing expansive growth and usually clearly demarcated from the surrounding liver parenchyma. Macroscopically, they appear dark red or purple, may be irregularly lobulated; microscopically, the lesions contain many thin-walled venous sinuses of varying sizes, lined with a single layer of epithelium, and separated by fine fibrous septa. They can be divided into 4 types according to the amount of fibrosis tissue in the tumor.

　　1、Liver cavernous hemangioma:The tumor section appears honeycomb-like, composed of blood sinusoids of varying sizes. In large lesions, there may be central fibrosis areas caused by old hemorrhage or thrombosis. This type is the most common, and the liver hemangiomas referred to in clinical practice generally refer to this type.

　　2、Sclerosing hemangioma:Vascular lumen collapse or closure, increased fibrous tissue, and hard tumor texture.

　　3、Vascular endothelial cell tumor:It is a tumor originating from liver vascular endothelial cells, prone to malignant transformation, and this type is rare in clinical practice.

　　4、Liver capillary hemangioma:Vascular lumen stenosis and hyperplasia of fibrous tissue are its characteristics, and this type is rare in China.

　　1、Larger tumor:It may compress surrounding organs, causing abdominal distension, abdominal pain, nausea and vomiting, loss of appetite, and discomfort in the liver area.

　　2、Liver hemangioma:There is a possibility of rupture leading to massive intraperitoneal hemorrhage. Larger tumors (＞4cm) may compress surrounding organs, causing abdominal distension, abdominal pain, nausea and vomiting, loss of appetite, and discomfort in the liver area. Giant hemangiomas may present with a mass in the upper right abdomen and liver enlargement during physical examination. The mass surface is smooth, with moderate texture and clear boundaries, may be tender, and can move up and down with respiration.

　　The clinical manifestations of this disease are closely related to the size and location of the tumor. Smaller tumors (〈4cm) may not show any自觉 symptoms and are often discovered during B-ultrasound or CT examinations; larger tumors (〉4cm) may compress surrounding organs, causing abdominal distension, abdominal pain, nausea and vomiting, loss of appetite, and discomfort in the liver area. Giant hemangiomas may present with a mass in the upper right abdomen and liver enlargement during physical examination. The mass surface is smooth, with moderate texture and clear boundaries, may be tender, and can move up and down with respiration. There is a possibility of rupture leading to massive intraperitoneal hemorrhage in liver hemangiomas, but spontaneous rupture is extremely rare, and possible triggers include percutaneous liver biopsy or abdominal trauma.

　　Since this disease often has no clinical symptoms, many patients are found during physical examinations such as ultrasound. If clinical symptoms occur, appropriate examination methods mentioned above should be chosen, and diagnosis should be clear without difficulty.

　　1. Clinical manifestations.

　　2. Laboratory and other auxiliary examinations.

　　There is currently no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of the disease. Replace high-fat, high-sugar, and high-calorie foods with healthy foods and drinks. Eat a variety of vegetables and fruits, whole grains, and legumes, reduce the intake of red meat (beef, pork, and mutton), avoid eating processed meats, limit the intake of high-salt foods. To prevent tumors, try not to drink alcohol. If you do drink, limit the daily amount to no more than 2 cups for men and no more than 1 cup for women.

　　Liver function is usually normal, AFP is negative, and some may have slight reduction in the number of whole blood cells, and occasionally a slight increase in serum AKP.

　　1. Ultrasound:It is often used as the first-line examination method, showing clear boundaries with homogeneous high echo masses. Large hemangiomas may show reticular echo inhomogeneity and sometimes calcification.

　　2. CT:The CT manifestations of typical hemangiomas are homogeneous low-density masses with clear boundaries on unenhanced scans; dynamic CT scanning with contrast demonstrates peripheral enhancement, which gradually fills towards the center and has the same density as the surrounding liver tissue.

　　3. MRI:The specificity of detecting hemangiomas can reach 92% to 100%, and hemangiomas have a high T2 signal, while the T1 intensity is equal to that of the surrounding tissue.

　　4. Radionuclide blood pool scanning:Blood pool scanning using 99mTc-labeled red blood cells, in which liver hemangiomas show early non-filling, followed by gradual filling from the periphery, with an extended filling period. The sensitivity of this examination method can reach 90%, and it is a highly specific non-invasive examination.

　　5. Liver arteriography:This method has a high accuracy in diagnosing the disease and can show hemangiomas of 1-2 cm in size, which appear as early contrast agent filling and persistent staining, and may have characteristic 'cotton ball' or 'snow tree'-like manifestations. This method is a traumatic examination and is not used as the first choice in clinical practice.

　　6. Biopsy of living tissue:Although fine needle aspiration cytology is relatively safe, it often does not yield diagnostic conclusions; if a standard needle such as Menghini or Trucut is used, the risk of puncture increases, and there have been reports of puncture causing fatal hemorrhage, therefore, biopsy should be avoided as much as possible.

　　First, suitable foods:High heat production and nutritious foods such as lean meat, chicken, fish, milk products, and soy products. Fresh vegetables, such as celery, spinach, tomatoes, radishes, garlic, and fresh bamboo shoots. Sea products such as kelp, nori, jellyfish, and algae. Those with habitual constipation should eat foods such as bananas, persimmons, watermelons, cantaloupes, water chestnuts, honey, royal jelly, and cornstarch, as well as black fungus and silver ear.

　　Two. Unsuitable Foods:Eat less greasy food, avoid smoking and drinking, and high cholesterol foods such as animal brains, spinal cord, internal organs, yolks, shellfish (such as clams), and mollusks (such as squid, cuttlefish, fish eggs).

　　Three. Food Therapy Recipes

　　1. Danshen and Frog Soup

　　[Ingredients] Danshen 24 grams, frog 250 grams, dried red dates 4 pieces.

　　[Preparation] Choose a live frog, kill it, remove the intestines and claws, and skin it. Wash the danshen and dried red dates (with the seeds removed). Put all the ingredients together in a pot, add an appropriate amount of water, bring to a boil over high heat, then simmer over low heat for 2 hours. Season with salt to taste.

　　[Usage] Drink the soup and eat the meat. It can be taken regularly.

　　2. Hawthorn and Malt Drink

　　[Ingredients] Raw hawthorn 20 grams, raw malt 10 grams.

　　[Preparation] Cut the raw hawthorn into pieces, wash it, and wash the malt. Put them all in a covered teacup and pour boiling water over them. Steep for 2 to 3 minutes and it is ready to drink.

　　[Usage] Take the juice as tea and drink it. It can be taken regularly.

　　3. Notoginseng and Turtle Shell Stewed Lean Pork

　　[Ingredients] Lean pork 120 grams, notoginseng 10 grams, turtle shell 30 grams, dried red dates 4 pieces.

　　[Preparation] Wash the notoginseng, turtle shell, and dried red dates (with the seeds removed), and wash the lean pork. Put all the ingredients together in a steaming bowl, add an appropriate amount of boiling water, and simmer over low heat for 2 to 3 hours. Season with salt to taste.

　　[Usage] Drink the soup and eat the meat, which can be taken regularly.

　　1. Treatment

　　Most patients with liver hemangioma do not need special treatment after diagnosis. Female patients should consider stopping the use of oral contraceptives. For larger or giant hemangiomas (over 6cm), those with symptoms or patients with heavy psychological burden can undergo elective surgery to remove the tumor to prevent tumor rupture and bleeding. For those who cannot tolerate surgery but need treatment, liver artery embolization or ligation can be performed first, and then elective surgery can be scheduled after the condition stabilizes. Radiotherapy may be helpful in making the tumor shrink and become fibrous on the basis of liver artery embolization or ligation.

　　For those who do not want or are not suitable for surgical treatment, traditional Chinese medicine and herbal medicine treatment can also be tried. In clinical practice, traditional Chinese medicine often divides it into three types: liver qi stagnation, phlegm and dampness retention, and deficiency of both liver and spleen, for differential diagnosis and treatment, which can often alleviate symptoms.

　　2. Prognosis

　　This disease has no potential for malignancy, develops slowly, and has a good prognosis.