Hemangioma of the liver: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Hemangioma of the liver is the most common benign liver tumor. It is found in 5% of autopsies. A wider use of methods for scanning the liver helps to improve the diagnosis of this tumor. Hemangiomas are usually single and have small dimensions, but sometimes they are large and multiple.
Usually the hemangioma of the liver is subcapsular, under the diaphragm surface of the right lobe of the liver and sometimes has a leg. On a cut it has a round or wedge-shaped shape, a dark red color and resembles honeycomb; The fibrous capsule of the tumor may contain foci of calcification. A histological examination reveals a network of branched communicating spaces containing erythrocytes. On tumor cells, the factor VIII of blood coagulation can be expressed.
The tumor cells are lined with flat endothelial cells and contain a small amount of connective tissue, although in some cases it may be significant.
[Symptoms of a hemangioma of the liver
In most patients, the hemangioma of the liver is asymptomatic and is diagnosed accidentally. With giant hemangiomas (diameter more than 4 cm), they often succeed in palpating; because of thrombosis of the tumor can occur pain.
Symptoms of tumor compression of adjacent organs are possible. Occasionally, vascular noise is heard over the hemangioma.
Where does it hurt?
Diagnosis of liver hemangioma
On the survey radiographs, one can see a calcified capsule.
Ultrasound reveals a solitary echogenic formation with smooth, well-defined contours. Characteristic is the amplification of the acoustic signal as it passes through the blood in the cavernous sinuses.
At CT with contrasting there is an accumulation of a contrast substance in a venous bed of a tumor in the form of puddles. It diffuses from the peripheral parts to the center, and after 30-60 minutes the darkening acquires a homogeneous character. With dynamic CT after intravenous jet infusion of contrast medium, globular darkening areas are visible. Calcification can be detected, which is a consequence of previous bleeding or thrombus formation.
On magnetic resonance tomograms, the tumor looks like a region of high signal intensity. The relaxation time T2 exceeds 8 ms. MRT is especially valuable in the diagnosis of hemangiomas in small sizes.
One-photon emission CT with labeled 99m Tc erythrocytes reveals a long-term retention of radioactivity over the tumor, caused by a delay in the blood.
Angiography is indicated only in those cases when using a CT scan fails to confirm the diagnosis. The tumor displaces large hepatic arteries in one direction. They are not enlarged, they narrow, as usual, as the branches branch off. The cavernous spaces of the tumor filled with contrast material have the form of a ring or semicircle due to fibrosis of the central regions. In hemangiomas, the contrast agent may be delayed up to 18 s.
Puncture biopsy of the liver (sighting). Liver biopsy with a thin needle is usually safe, but the need for it is absent due to the sufficient informative nature of the visualization methods of the study.
What do need to examine?
Treatment of hemangioma of the liver
Treatment of hemangioma of the liver is usually not required, since the tumor does not increase in size and the clinical symptoms do not increase. The possibility of rupture of the tumor is not an indication for surgical intervention. With severe pain syndrome or fast growth of the liver hemangioma, liver resection is used, which usually consists of lobotomy or segmentectomy.