There are multiple lumps in the liver, and the tumor indicators are normal, but in the end it was found to be a malignant tumor!

A friend who is usually healthy and in a happy mood is disturbed by an examination report
.
It turned out that shortly after the physical examination, my friend received a call from the physical examination agency, saying that multiple nodules had been found on her liver and asked her to go to the hospital for further examination
.

My friend didn't care at first, she felt that she didn't have any discomfort, there would be no major problems, so she went to a small hospital in front of her house for an examination
.
Unexpectedly, after getting the test results, the solemn-faced doctor suggested that she go to a large hospital for further examination, because there were many lumps in her liver, and the small hospital could not diagnose it
.
My friend panicked at this time, and quickly contacted me, thinking of our hospital hospitalization for a clear diagnosis
.

Is it benign or malignant?

We gave her blood routine, liver function and tumor indicators, etc.
, and there were no abnormalities
.
Abdominal magnetic resonance found multiple lesions of different sizes in the liver parenchyma, the largest of which was located in the right lobe of the liver, about 3x2 cm in size, and the enhanced scanning lesions showed progressive strengthening
.
The imaging doctor considered a friend's liver mass to be a benign tumor
.

Although the imaging department suspected a benign lesion, because my friend's liver was not abnormal during the physical examination a year ago, we were still not at ease about the lesion that developed so rapidly within a year, so we suggested that she do an ultrasound to see if she could perform a liver puncture examination to confirm the nature of
the lesion.
Unexpectedly, the results of ultrasound contrast suspected that the tumor in her liver was malignant
.

Fig.
1 Picture of MRI enhanced scan A.
Arterial phase B.
Portal phase

Complete the examination and finally confirm the diagnosis

It seems that only a liver puncture can confirm the
diagnosis.
But my friend was afraid of the invasive examination of liver puncture, so he went to one of our local most authoritative hospitals for the treatment of hepatobiliary diseases for magnetic resonance imaging examination
.
The results of angiography showed local capsular fold at the margin of the right lobe of the liver, multiple small nodules were visible in the parenchyma, the contrast scanning lesion was peripheral ring strengthening, the DWI lesion was diffuse restricted hyperintensity, and the diagnosis was considered hepatic epithelioid angioendothelioma (HEH).

My friend underwent surgery, and the pathology after the operation confirmed that it was liver HEH
.

Understanding liver HEH

■Liver HEH

Hepatic HEH is a rare low-grade malignancy that originates in blood vessels
.
It occurs mostly in superficial or deep soft tissues, but can also be found in organs
such as the lungs, bones, brain, and small intestine.
Hepatic HEH is rare and insidious in onset, often manifested as multiple masses of the liver, which is easily misdiagnosed as liver metastases
.

■Etiology

The etiology of hepatic HEH is not well known and may be related to
oral contraceptives, progestogen disorders, alcoholism, HBV infection, and liver transplantation.
Hepatic HEH is more common in women, often without any signs and symptoms, laboratory tests are not abnormal, most patients are found
by physical examination accidentally.
My friend is a middle-aged woman who accidentally found liver HEH, liver function and tumor index tests unexpectedly
found in the physical examination.

■Clinical manifestations

The characteristic imaging manifestations of liver HEH include halo sign, capsular fold at the lesion
, etc.
Most lesions are located in the right lobe of the liver, often distributed under the capsule, due to the scarring of tumor fibers, the phenomenon of capsule shrinkage
is formed.
The center of the tumor lesion shows a halo sign
due to the lack of blood supply, necrotic liquefaction, and higher signal.

■Diagnosis

The only way to confirm the diagnosis of hepatic HEH is pathological examination
.
The tumor tissue of HEH is composed of fibrotic oligocyte and rich cell regions, with lumens or vacuoles forming within the cells, in which single or multiple red blood cells
are visible.

■Treatment

Treatment of hepatic HEH includes surgical resection, transarterial chemotherapy embolization, liver transplantation and medication, and the preferred method of treatment is surgery
.
Thalidomide has anti-angiogenic effects, can inhibit the formation of tumor blood vessels, there are literature reports that thalidomide can be used to treat liver HEH, there is still a large amount of research data to verify the efficacy
of thalidomide in the treatment of liver HEH.

My friend surgically removed the largest mass in the right lobe of the liver, and the other masses were treated with radiofrequency under ultrasound guidance, which also achieved good results
.

■Prognosis

Hepatic HEH is a low-grade malignant tumor with a significantly better prognosis than other liver malignancies
.
It has been reported that some patients can achieve a good prognosis
even without any treatment, with regular follow-up.