Hemangioma of the liver: causes, treatment, what is dangerous
Hemangioma of the liver is considered to be one of the most common tumors of this organ. Only according to surveys it is diagnosed in 2% of the inhabitants of the earth, and the actual figure of prevalence is 7%. The average age of patients ranges between 30 and 50 years, women patients more is about five times than men. This is probably due to the action of female hormones estrogens, which provoke the growth of tumors.
Hemangioma is a vascular tumor that the absolute majority of patients are benign and not prone to malignancy. A tumor is formed in the parenchyma of the liver during fetal development, when the process of forming the blood vessels of the fetus adversely impact the environmental conditions experienced by the pregnant woman. It is usually detected in adults.
5-10% of children of early age it is possible to detect in the first year of life, but, as a rule, such education themselves disappear in the next 3-4 years.
Hemangioma many researchers attach an intermediate position between the tumor and malformation, and this type of vascular tumor is referred a variety of benign vascular neoplasms. In favor of the tumor, says the possibility of re-growth (recurrence) and ingrowth formation in liver tissue (invasion), but often the multiplicity of these tumors are more characteristic of the malformation.
Hemangioma are usually asymptomatic, its presence is found randomly, ultrasound examination of abdominal cavity organs. Asymptomatic small tumors makes them non-hazardous, but are among the possible complications rupture of blood vessels and bleeding, which can cost lives.
Causes and types of liver hemangiomas
Causes of liver hemangiomas is not known, but the role of the following factors:
- Reception during pregnancy certain medications – steroids, estrogens, clomiphene, human chorionic gonadotropin;
- Congenital malformations, when hemangioma of the liver occurs as part of other syndromes
The real reason for the formation and growth of hemangiomas has yet to be defined, and the gene responsible for this process, not found, although familial cases tumors are described.
Types of hemangiomas are determined by its structure. Release:
The tumor may be single or multiple. In the latter case, the risk of complications is higher and the treatment can be very difficult. Focal hemangioma looks like a red-bluish bumpy or smooth node soft consistency. When pressure is applied it decreases and then increases again, filling with blood. Dimensions are usually within 1-2 cm, and a giant hemangioma is considered to be exceeding 4-5 cm, the Tumor grows very slowly, but in women during pregnancy could increase significantly.
Usually the tumor has a structure cavernous hemangioma, consisting of multiple large vascular cavities filled with blood. This neoplasia usually solitary, can grow to huge size and cause a variety of symptoms of liver dysfunction and systemic blood flow.
Capillary hemangioma is extremely rare and is constructed of small vessels of capillary type, this variety grows slower than the cavernous, seldom reaching a large size. Some experts even doubt the possibility of the formation of capillary hemangioma in the liver as a vascular malformation.
Education can be the areas of calcium deposits, fibrosis, blood clots, and in frequently repeated small hemorrhages hemangioma sklerosiruta and turns dense gray node.
The tumor can be located in the depth of any lobe of the liver, and superficial. It happens that it goes beyond the body, communicating with him through thin legs. These tumors carry a high risk of bleeding, since the slightest impact on the abdomen or blunt trauma to cause a rupture of its vessels.
Symptoms of hemangioma liver
Hemangioma are usually asymptomatic for years without letting themselves known and viewsas accidentally by ultrasound or laparoscopy in conjunction with other reasons. Small hemangiomas can not be found in the patient’s life.
If the tumor is 4 cm or more, approximately half of the patients may complaint. To interpret them sparingly and only after a thorough examination can establish whether the tumor causes symptoms or cause other diseases of the digestive system. A third of patients after surgical removal of the hemangioma complaints persist that speaks in favor of the original bessimptomnom tumor formation.
The most frequent signs of the tumor are:
- A feeling of heaviness in the right hypochondrium;
- Nausea, feeling of fullness of stomach, vomiting;
Usually the most typical symptoms are soreness and feeling of heaviness in the right hypochondrium, associated with the increase in size of the liver. The pain may be inconsistent, it is usually aching, soft. When you break the vessel hemangiomas or thrombosis the pain becomes acute and the patient requires emergency medical care.
If the hemangioma is large and compresses the adjacent organs of the abdominal cavity, there are signs of dysfunction of the stomach or intestines (nausea, vomiting, abdominal pain). Possible jaundice with the defeat of the bile duct or the evacuation of bile from the gallbladder. For compression of the large vascular trunks developing heart failure, edema of the lower extremities with compression of the inferior Vena cava.
Long asymptomatic hemangiomas can result its rupture and hemorrhage, then the first signs of the tumor will become acute abdominal pain and signs of shock (sudden loss of pressure, disturbance of consciousness and the function of vital organs). Massive blood loss and irritation of the peritoneum streamed with blood threaten the patient’s life and require immediate medical measures.
In rare cases with diffuse tumor growth may develop liver failure, and gigantic nodes, which accumulates a significant amount of blood can provoke a bleeding disorder associated with thrombocytopenia, and DIC-syndrome with characteristic thrombosis and bleeding (syndrome Kasabach-Merritt).
Suspected tumor on symptoms is difficult, because appear likewise many other diseases of the abdominal organs. On examination, the patient no signs of tumors not detected, but in rare cases, giant hemangiomas, the doctor may feel an enlarged liver or even the tumor nodule jutting out into the abdominal cavity.
General and biochemical blood tests do not show specific signs of tumor. They may be signs of thrombocytopenia, reduction of fibrinogen for large tumors that contain large amount of blood. When compression of the bile ducts may increase bilirubin, but with the defeat of the large volume of parenchyma of the liver, elevated liver enzymes, what happens, however, is extremely rare. If the tumor is gigantic, the analysis can detect signs of inflammation, e.g., increased ESR.
The most affordable and informative method of diagnosis of hemangioma of the liver is an ultrasound, which is painless, harmless and can be conducted in patients of all ages, even in the presence of severe comorbidity. Ultrasound examination can be supplemented with Doppler and contrast enhancement, which greatly improves the sensitivity and efficiency of the method.
During the ultrasound the physician may only assume the existence of hemangiomas, found in liver homogenous entity with clear boundaries. To confirm the diagnosis, the patient performed a CT scan with contrast of the hepatic vessels.
The most informative and sensitive method of research is considered to be an MRI, which can also be carried out with the introduction of contrast. Using MRI we can determine the exact size, tumor localization, «to consider» delicatest its structure and even the fluid levels in the vascular cavities, which are formed due to «stratification» of stagnant blood corpuscles and plasma.
If the CT or MRI the doctor receives insufficient information, the patient can be held radioisotope study, arteriography and even biopsies, which are not widely used because of the risk of dangerous complications.
Simple answer as to treat the hemangioma and whether it is worth to do it, no. The tumor is benign and most patients are asymptomatic, and the risk of any surgery on the liver is quite high.
Treatment of hemangiomas is not required if there is no symptoms of the tumor, the risk of complications and malignancy is minimal, and absolute confidence in the purity of the tumor.
Indications for treatment may be:
The most feared complication hemangioma of the liver is its rupture and bleeding. In such cases, you may need an emergency operation, but it is quite dangerous and the mortality from such resections is high, therefore, it is recommended to ligate the hepatic artery or to carry out its embolization, and when the patient’s condition stabiliziruemost, it will be possible and resection of the tumor portion of the liver.
The issue of the need for removal of giant hemangiomas is still not resolved. Part surgeons are of the opinion that an operation is necessary in view of the probability of rupture of the tumor, but the risk of operative complications and death reaches 7%, which is unacceptable in benign tumors. In addition, various studies show that the risk of complications of giant hemangiomas of the minimum even in the absence of any treatment, so the size of the tumor should not be a reason for surgical treatment. Most experts agree that monitoring even a large hemangioma is asymptomatic, it is completely safe for the patient. Observation possible only when there is not the slightest doubt of the correctness of the diagnosis of hemangioma.
The conservative therapy to get rid of hemangioma, no, but the main and most effective treatment is its surgical removal. To get rid of the tumor by enucleation of the tumor node or liver resection.
Enucleation means the husking tumor tissue from liver parenchyma. Such removal is possible due to the fact that around the hemangiomas formed a pseudocapsule of compressed liver tissue, and on the periphery of the tumor are absent bile ducts. When enucleation of the hemangioma, it is possible to preserve existing hepatic parenchyma, which is considered a benefit compared with resection. Of course, centrally located tumors to velosite harder than nodes on the periphery of the body, the operation will be longer, and the patient may lose more blood, but in General, this intervention is well tolerated by patients and gives a minimum of complications.
Resection involves removal of a section of the liver along with the tumor. This operation is preferred for large hemangiomas and their deep location. If the doctor doubts the purity of the tumor, the patient is also shown resection.
In some cases, a radical treatment is not possible because of severe condition of the patient, the multiplicity of liver hemangioma, location of tumors close to major blood vessels. To help the doctor can come embolization of the arteries feeding the tumor, which is becoming the method of choice for such patients.
Embolization involves the insertion of a sclerosing solution (polyvinyl alcohol) in tumor vessels that are «sealed», leading to a reduction in the size of tumors. In giant hemangioma embolization may be a preparatory step before the planned operation when reducing the size of the tumor will facilitate the upcoming intervention.
The search of benign methods of treatment of hemangioma continues. So, tried out radio-frequency destruction of the tumor, which can be done through the skin or laparoscopically. The procedure has already shown good results. Ligation of the vessels feeding the tumor, can also be very effective.
For tumors that are technically impossible to remove, can be treated with radiation for several weeks, giving a decrease in tumor size, symptomatology and, consequently, the risk of complications.
The most radical method of treatment of inoperable hemangioma is liver transplantation, but because of the complexity of the donation and the surgery itself is carried out very rarely.
Prevention in the case of hemangioma of the liver does not exist. It is important to detect the tumor, and patients with this pathology are in need of follow-up. When newly diagnosed tumors ultrasound performed every three months during the year. Particularly noteworthy are the patients who receive hormonal drugs and pregnant women, which likely further growth of the hemangioma. In this case, ultrasound of the liver is carried out every three months. The rest of the patients, if neoplasm growth is not happening enough annual ultrasonic testing.