Should I be concerned if an MRI reveals a liver hemangioma?

Cavernous hemangioma is a concept familiar to many young parents. This term refers to a vascular formation that appears in newborns immediately after birth or a few weeks later. It is not just a noticeable cosmetic defect. If such a formation is injured, severe bleeding may occur, since it is associated with deep vessels.

The most common location of the tumor is the head or neck area. Less commonly, formations occur in other parts of the baby’s body. Specialists of the SANMEDEXPERT clinic will perform safe removal of cavernous hemangioma using the most modern methods.

Table of contents

1. Etiology and pathogenesis
2. Clinical manifestations
3. Treatment methods
4. Medicinal methods
5. Surgical methods
6. Hardware methods

Hemangioma (capillary hemangioma, capillary hemangioma) is a benign tumor that develops from hyperplastic vascular endothelium. It is often absent at birth, but appears in childhood and is characterized by progressive growth.

In our company you can purchase the following equipment for removing hemangiomas:

• M22 (Lumenis)
• AcuPulse (Lumenis)
• Fraxel (Solta Medical)
• UltraPulse (Lumenis)

A feature of hemangiomas is the possibility of spontaneous involution, therefore the treatment tactics for these neoplasms are selected individually for each patient, based on the current state of the tumor and its dynamics. Spontaneous regression distinguishes hemangiomas from other vascular malformations, such as port-wine stains.

According to statistics, capillary hemangiomas occur in 1–2% of newborns, with about 50% of neoplasms forming on the head (often in the eye area) and neck. 30% of patients say that their parents or doctors recorded signs of hemangioma immediately after birth, but the majority note the onset of manifestation of this neoplasm at the age of 6 months. The ratio of men to women in the incidence of hemangioma is 1:3.

About radicular symptoms

In this case, we are talking about the appearance of sharp, shooting pains, reminiscent of an electric shock. They are provoked by any movement, shaking of the spine, that is, coughing, laughing, sneezing, straining in the toilet. This pain occurs when older people experience a shooting pain in the lower back, or lumbago.

With the long-term existence of radicular symptoms, a secondary, myofascial-tonic syndrome occurs. The deep-lying back muscles near the affected vertebra react to the surrounding inflammation, to the impacted fracture, with constant, chronic spasm. As a result of spasm, the muscle is deprived of the ability to promptly remove lactic acid, that is, waste products. She is deprived of nutrition from the arterial capillaries, which are also spasmed. This situation forms a vicious circle, and it can be broken either by eliminating the defective vertebra, or, if it is impossible for some reason to carry out restorative surgery, by prescribing central muscle relaxants and wearing a corset with limited mobility in the back, but this is not the best way out. provisions.

How often does radicular pain occur with hemangiomas? Very rarely, out of all diagnosed vertebral hemangiomas in all parts, disc collapse with the development of radicular symptoms occurs in 0.1% of cases. Therefore, the main “suppliers” of radicular symptoms can be considered protrusions and herniations of intervertebral discs.

Etiology and pathogenesis

Today, it is believed that capillary hemangioma is a hamartomatous proliferation (i.e., a nodular benign tumor-like formation representing a tissue developmental abnormality) of vascular endothelial cells. To date, no specific gene mutations or obvious hereditary characteristics have been found that would be 100% responsible for the appearance of hemangiomas.

In its development, hemangioma goes through 2 phases - proliferative and involutive. The proliferative phase usually begins 8–18 months after tumor manifestation and is characterized by progressive growth of the tumor. Histologically, it is characterized by an increase in the number of endothelial and mast cells, the latter stimulating further vascular growth.

The proliferative phase gives way to the involutive phase , which is characterized by gradual regression of the hemangioma. It exhibits a reduction in angiogenesis, apoptosis of endothelial cells, a decrease in the activity of mast cells and dilation of vascular channels. About 50% of all neoplasms undergo involution before the age of 5 years, and about 75% - before the age of 7 years.

Causes

To date, scientists cannot name the exact cause of hemangioma, but there are many assumptions about this. One of the theories for the occurrence of this tumor in humans is considered to be a viral-infectious factor that occurs in the first 12 weeks of pregnancy. It is during this period of intrauterine development that the formation and establishment of a system of blood vessels occurs, and the influence of infection can change their properties, which subsequently leads to the formation of intraorganic or superficial hemangiomas.

Clinical manifestations

A simple hemangioma is a red, bumpy neoplasm that rises above the surface of the surrounding healthy skin ( Fig. 1 ). Cavernous hemangioma is located in the subcutaneous fatty tissue and looks like a bluish tumor ( Fig. 2 ). Combined hemangioma is located both on the surface and inside the skin. There are also mixed hemangiomas , which are combined with lipomas, fibromas, keratomas and other neoplasms.

An important differential feature of hemangiomas is blanching when pressed - this distinguishes them from port-wine stains.

Rice. 1. Simple capillary hemangioma

https://www.danderm-pdv.is.kkh.dk/atlas/7-65.html

Rice. 2. Cavernous hemangioma

https://www.danderm-pdv.is.kkh.dk/atlas/7-69-2.html

Depending on the location, hemangioma can cause various complications. Thus, a periobrital tumor in 43–60% of cases provokes amblyopia - “switching off” the affected eye from the visual process. Located in the larynx, the tumor can cause stridor and airway obstruction. In general, despite the benign nature of hemangiomas, about 10% of them are destructive in nature, causing serious aesthetic defects.

Symptoms of liver hemangioma in adults

Most liver hemangiomas do not cause any unpleasant symptoms; they are discovered when the patient is examined for another disease.
Small (a few millimeters to 2 cm in diameter) and medium-sized (2 to 5 cm) are not treated, but should be monitored regularly. Such monitoring is necessary because about 10% of hemangiomas increase in size over time for unknown reasons.

Giant liver hemangiomas (more than 10 cm) usually have symptoms and complications that require treatment. Symptoms most often include pain in the upper abdomen as the large mass presses on the surrounding tissue and liver capsule. Other symptoms include:

• poor appetite;
• nausea;
• vomiting;
• quick feeling of fullness while eating;
• feeling of bloating after eating.

Liver hemangioma may bleed or form blood clots that trap fluid. Then abdominal pain appears.

Treatment methods

Primary therapy for capillary hemangiomas is simple dynamic observation . Since most tumors (up to 75%) regress with age, there is usually no need for their treatment. However, hemangiomas can cause complications that require therapy:

1. Systemic complications - congestive heart failure, thrombocytopenia, hemolytic anemia, nasopharyngeal obstruction.
2. Ophthalmological complications - disturbance of the visual axis, compression of the optic nerve, severe proptosis (protrusion) of the eyeball, anisometropia (difference in eye refraction).
3. Dermatological complications - maceration and erosion of the epidermis, infection of the neoplasm, severe cosmetic defect.

Diagnostics

Computer and magnetic resonance imaging reign supreme in the diagnosis of hemangiomas. Even the term “diagnosis of vertebral hemangiomas” is absurd, since they do not hurt and do not manifest themselves in any way, and therefore there is no point in looking for them. This can only be done during a scientific study on the incidence of vascular tumors of the vertebrae.

Therefore, almost 100% of the detection of all hemangiomas are accidental findings. They begin to be monitored, and with a reasonable approach, seeing a growing vascular tumor, when it reaches a certain size, and taking into account the risk factors and dangers outlined above, radical treatment is carried out, which makes the patient forget about the hemangioma. In some cases, hemangioma is initially suspected during an X-ray examination of the spine, but to accurately confirm the diagnosis, the patient is still sent for a tomography. There are no other diagnostic methods, just as there are no laboratory tests for hemangioma.

Medicinal methods

Depending on whether the patient has a particular complication, treatment tactics will be different - for example, topical corticosteroids may be prescribed. At the same time, the clinical response to even the most powerful drugs develops quite slowly—over several weeks. Therefore, this method is not suitable for vision-threatening conditions.

Injectable corticosteroids provide a faster effect: blanching of hemangiomas is observed already on days 2–3, and involution becomes noticeable after 2–4 weeks. The success rate of this therapy is about 75%.

Systemic corticosteroids are used for amblyogenic life-threatening lesions. A marked response is usually observed in 30% of patients, a moderate response in 40%, and no response in 30%.

Alpha-2a interferon is prescribed when hemangioma is resistant to corticosteroid therapy. Despite its good effectiveness, its use is associated with undesirable side effects: fever, arthralgia, retinal angiopathy.

Propranolol can be used to treat hemangiomas , although the evidence base is relatively weak and mainly consists of anecdotal cases. However, some studies indicate that propranolol may prevent loss of visual acuity in the case of periocular hemangioma.

For some superficial (and in some cases deeply located) neoplasms of a limited area, timolol .

Classification of hemangioblastomas

Macroscopically, brain hemangioblastomas are divided into 4 types:

• solid formation - a soft-tissue purple node enclosed in a membrane, on a cut it appears as a spongy mass (occurs in 30% of cases);
• large smooth-walled cyst - a cystic formation with a cavity containing a yellowish transparent liquid, on the wall of which a small nodule (mural nodulus) of the tumor is identified (incidence rate - 60%);
• mixed type - a neoplasm characterized by the presence of a solid node, within which numerous small cysts are found (diagnosed in 4%);
• simple cyst - an ordinary smooth-walled cyst that does not contain a mural node (observed in 6%).

The predominant localization of hemangioblastomas is the posterior cranial fossa (PCF). Typical lesion sites:

• left and right cerebellar hemispheres (85%);
• IV ventricle (6%);
• cerebellar vermis (5%);
• brainstem (3%);
• cerebellopontine angle (1%).

According to the latest data, there is not a single report of the transformation of hemangioblastomas into a malignant form.

Hardware methods

CO2 laser was previously used to remove hemangiomas , which has a good hemostatic effect. The disadvantage of the CO2 laser is long-term rehabilitation due to damage to the integrity of the skin, as well as the formation of a scar at the site of the removed hemangioma. Pulsed dye laser ( PDL) is effective only for superficial tumors. Its effect develops quite slowly, which does not allow the use of the PDL laser for complications. Currently, intensive pulsed light - IPL and long-pulse Nd:YAG laser 1064 nm, as well as their combination, are used to treat hemangiomas for aesthetic purposes. These techniques are non-ablative and are based on selective heating of pathological vessels due to the absorption of light energy by hemoglobin.

Questions from our users:

• hemangiomas on the skin of the abdomen causes
• hemangiomas on the skin of the neck
• hemangiomas on the skin during pregnancy
• hemangioma on the skin treatment

Why choose the clinic “Mama Papa Ya”

The network of family clinics “Mama Papa Ya” offers medical services for hemangiomas to patients of any age. The clinic's branches are located in Moscow and other cities. Advantages of visiting this medical institution:

• the opportunity for children and adults to get advice from doctors of various profiles - dermatologist, cosmetologist, surgeon, neurologist, pediatrician;
• individual decision on the need to remove hemangioma;
• the use of low-traumatic methods of tumor removal;
• affordable prices for diagnostic and therapeutic procedures.

To obtain a doctor’s consultation, we invite you to call the clinic’s phone number listed on the website and make an appointment at a convenient time. You can also leave a request by filling out a special form on our website.

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I really liked Dr. Vlasova. Pleasant and sweet woman, a good specialist. I received an answer to all my questions, the doctor gave me a lot of good advice. I was more than satisfied with the visit.

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We visited the “Mama Papa Ya” Clinic with our child. A consultation with a pediatric cardiologist was needed. I liked the clinic. Good service, doctors. There was no queue, everything was the same price.

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Today I was treated at the clinic, I was satisfied with the staff, as well as the gynecologist. Everyone treats patients with respect and attention. Many thanks to them and continued prosperity.

Iratyev V.V.

The Mama Papa Ya clinic in Lyubertsy is very good. The team is friendly and responsive. I recommend this clinic to all my friends. Thanks to all doctors and administrators. I wish the clinic prosperity and many adequate clients.

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Nutrition

Nutrition for liver hemangioma plays a significant role in getting rid of it. The patient is required to be prescribed a diet so as not to provoke a worsening of the situation (sharp proliferation of atypical cells).

A diet for liver hemangioma in adults and children involves excluding from the diet such foods as:

• carbonated drinks;
• alcohol and low-alcohol drinks;
• any chocolate;
• egg yolks;
• hot spices;
• pears, melons;
• fresh bread.

You should limit your consumption of fatty, fried, smoked, and salty foods.

Instead, you need to focus on:

• low-fat fish;
• liver;
• dairy products;
• viscous porridge;
• vegetables;
• not sour fruits.

Vitamin B12 may be additionally prescribed.