Hemangioma. Causes, symptoms, signs, diagnosis and treatment of pathology
(haemangioma) is a common benign tumor-like growth consisting of vascular tissue. Outwardly, it looks like a flat or lumpy vascular tumor of an uneven shape, pink, reddish-crimson, purple or bluish, rising above the surface of the skin.
Hemangiomas can appear in people of any age, but they are most typical for children. The most common are congenital hemangiomas, detected in newborns, arising as a result of pathology in the development of blood vessels in the embryonic period. In children, it is the most common benign vascular tumor, accounting for approximately 50% of the total number of all soft tissue formations. It is found 5–7 times more often in girls than in boys.
The tumor does not provoke obvious disorders and in most cases does not manifest itself with any symptoms, although everything depends on its location and size. A large hemangioma located on parenchymal organs, for example, in the kidney or liver, most likely can lead to mechanical compression of this and/or neighboring organs or their individual areas, as well as disruption of their functional activity. When localized in the area auricle hemangioma, when it grows, can damage eardrum, which will result in hearing loss for the child.
Although this tumor is benign, in children it manifests itself as progressive infiltrative growth without metastasis, increasing in size both in breadth and depth of the tissue.
Classification of hemangiomas
ICD-10 (International Classification of Diseases) code – D-18.0Types of hemangiomas depending on location:
Cutaneous hemangioma, located in top layer skin. Integumentary vascular tumor is the least dangerous, does not require treatment and does not lead to complications, with the exception of hemangiomas in the eye, ear and genital areas. Cutaneous hemangiomas are located on the head, even involving the scalp, as well as on any part of the face, for example, on the nose, lower or upper eyelid. Superficial hemangioma in adults can appear on any part of the body - on an arm, leg or even a finger. Multiple small vascular tumors are possible on different areas bodies.
Mucosal hemangioma. Such a tumor is localized on the mucous membrane, for example, of the lips, tongue, genitals.
Internal hemangioma, that is, a tumor of parenchymal organs - the spleen, gonads, exocrine and endocrine glands, brain, and so on. Control is limited to small hemangioma without a tendency to increase. If the tumor is large, the doctor selects conservative treatment to prevent its further development. Happens atypical form parenchymal hemangioma, most often diagnosed in the liver.
Hemangioma of the musculoskeletal system. Although it is less dangerous than parenchymal, it can lead to skeletal deformation due to rapid growth that outstrips the growth of the child’s bones.
This category includes such common spinal diseases as vertebral hemangioma. The tumor in this case is localized in the back, more specifically near the lumbar or cervical spine. Particularly dangerous is a vascular tumor of the vertebral body, which destroys it and leads to severe back pain. The spine area is the most common location for bone hemangioma; less often it is found in the bones of the pelvis or skull.
Division of hemangiomas depending on the histological structure :
Capillary or juvenile hemangioma. Consists of capillaries that are lined with a single layer of endothelial cells. Located on the surface of the skin. It is juvenile (superficial) hemangioma that has a tendency to rapid infiltrative growth.
Cavernous or cavernous vascular tumor- This is a subcutaneous hemangioma, consisting of vascular cavities of various sizes and shapes, separated by a septum. Blood in cavities usually coagulates, forming clots. Blood clots are organized due to the germination of the thrombotic mass by connective tissue.
Racemic hemangioma– a rare tumor of thick-walled convoluted venous or arterial vessels. Externally similar to congenital deformity. It is localized mainly in the neck and head area.
Combined hemangioma. Has signs of simple and cavernous hemangioma. Distributes both on the surface of the skin and in the subcutaneous tissue at the same time. The clinic depends on the predominance of the cavernous or capillary component.
Mixed capillary-cavernous hemangioma differs in the complexity of its structure. It contains elements of various tissues: vascular, lymphoid, nervous, connective. Angioneuroma, angiofibroma, hemlymphangioma and others are all mixed type hemangiomas. Their appearance, consistency and color depend on the tissues that make up the tumor. This type of hemangioma is often found in adults.
Etiology of hemangiomas
The causes of hemangiomas are not fully understood. Experts are inclined to believe that congenital hemangiomas appear due to impaired development and growth of vascular tissue during prenatal period.The tumor is also called vascular hyperplasia. This concept somewhat explains the reason for the formation of hemangioma. The process is based on the pathology of the development of vascular tissue, leading to an increase in its quantity. Determine more precisely at what stage intrauterine development the failure fails because medicine does not yet have the necessary tracking equipment. At the moment, the only substrates for research are the corpses of newborns or stillborn infants, as well as fetuses removed due to abortions.
It is possible that vasculogenesis may be disrupted when a pregnant woman takes certain medicines, as well as viral or bacterial infections suffered during this period, unfavorable environmental conditions, hormonal specifics of the baby himself, born prematurely.
Other putative factors for the appearance of vascular tumors in adults:
Hereditary predisposition.
Prolonged exposure to ultraviolet radiation (exposure to the sun).
Diseases internal organs leading to vascular disorders.
Clinical picture of hemangiomas of different types
Congenital vascular tumors are detected immediately after the baby is born, less often in the first months of life. In the first six months, intensive growth of the tumor is observed, but later the growth stops or sharply slows down. Large tumors can lead to functional and cosmetic defects of the face.The clinical picture of tumors depends on its type and location. Cutaneous hemangiomas are localized mainly on the scalp and face, less often found on the limbs or torso.
In children, simple hemangiomas can regress spontaneously. There are three stages of spontaneous disappearance of the tumor:
Stage I – in the first year of life;
Stage II – early evolution (during the first 1–5 years);
Stage III – late evolution (end of puberty).
Signs flat hemangioma– a smooth formation with clear edges of pink, red or bluish-purple color, may rise slightly above the skin level. Tumors with an uneven, bumpy surface are less common. Often the vascular spot represents a center with small dilated vessels radiating from it; such a hemangioma is called stellate. When you press on the hemangioma, it turns pale, then restores its original color. Bleeding from the tumor caused by trauma is possible.
Cavernous tumor is located under the skin in the form of a nodular formation, consisting of cavities of varying sizes filled with blood. It has a soft elastic consistency and bluish color. As the tumor grows, the color changes to blue-purple. Such hemangiomas are most often found in newborn infants. When they scream or cough, the tumor becomes more filled with blood, protruding. If you press on it, due to the outflow of blood it turns pale and collapses.
Statistics
From 1 to 3% of newborns are born with hemangiomas; in 10% of children, vascular tumors are detected during the first year of life. One of the rarest tumors is bone hemangioma, accounting for up to 1% of the total number of all benign bone tumors. Liver hemangioma is diagnosed in 7% of the adult healthy population, and in women 3 to 6 times more often than in men.
Combined hemangiomas may look like a simple vascular tumor or like a cavernous one, depending on the predominance of one or the other tissue.
Mixed tumor type comprises various types fabrics. Depending on what tissue the growth consists of, its consistency and color depend.
Symptoms of parenchymal organ tumors depend on its location and size. Pain in the organ, disruption of its functionality, cell hypoxia up to necrosis are not uncommon with hemangioma that has reached a significant size. These manifestations arise due to mechanical compression of both the organ itself on which vascular proliferation is detected and those adjacent to it.
Clinical picture spinal hemangiomas are severe pain at the localization site, with irradiation to other parts of the back. If the tumor tends to increase, then this may result in a limitation of a person’s motor activity.
Diagnosis of hemangiomas
Superficial congenital hemangiomas do not require diagnosis, since they are immediately visible, however, additional measures are required for differential diagnosis with congenital dysplasias.Diagnostic methods required to establish a diagnosis:
Physical examination with history taking, examination, palpation.
Laboratory diagnostics.
Informative non-invasive methods:
a) Ultrasound in combination with Dopplerography of the hemangioma itself or organs abdominal cavity with its internal localization;
b) MRI or CT;
c) radiography of the spine, pelvic bones, skull, and so on.
Invasive methods:
a) angiography;
b) puncture of the hemangioma followed by morphological examination.
Treatment of hemangiomas
Early treatment requires tumors in children in the first months of life, localized in the angeogenital area, face, head, eyes, and oral cavity.Actively growing hemangiomas, non-regressing cavernous hemangiomas and tumors complicated by infection, bleeding, and necrosis are subject to treatment. For simple hemangiomas that do not grow, do not cause complications, or regress, a wait-and-see approach is chosen. If in children a vascular tumor localized on the face does not go away on its own, then it must be treated with one of the methods.
Treatment methods:
Radiation therapy. Used for simple tumors that have spread to large area, also for hard-to-reach hemangiomas and in cases where another method of treatment is excluded, for example, with hemangiomas in the orbital area.
Laser therapy. Coagulation of overgrown vessels with laser.
Diathermoelectrocoagulation. Used for small pinpoint vascular formations. The essence of the method is cauterization of blood vessels with electric current.
Cryodestruction– removal of vascular growth with liquid nitrogen.
Sclerosis using injections with a special sclerosing agent.
Hormone therapy. Used to stop the growth of hemangioma in children.
Operation. Surgical removal is indicated for internal hemangiomas that cannot be removed otherwise.
Gives good results combination treatment: resection of hemangioma followed by cryodestruction or a combination of surgery with radiation exposure, hormone therapy with radiotherapy.
Treatment of hemangioma with traditional medicine
Typically, folk remedies are used only to treat tumors in adults. A compress made from kombucha infusion on the area of vascular growth gives a good effect. The bandage is applied for the whole day. The course lasts three weeks.Common treatment copper sulfate. To do this, mix a tablespoon of vitriol with half a glass of water and wipe the tumor with a cotton pad moistened with the resulting solution. Treatment lasts up to 10 days. At the same time, take a hot bath with baking soda at night (a pack of baking soda per bath). Then they make compresses from finely grated onions for 10 days.
You can try lubricating the hemangioma with fresh celandine juice.
Other methods used at home include treatment with tincture of fly agaric, bitter wormwood; infusion of oats or a collection of various herbs: coltsfoot, St. John's wort, celandine, yarrow, calendula and so on.
Complications and consequences of hemangiomas
ulceration,phlebitis,
external and internal bleeding,
addition of infection,
thrombocytopenia,
decrease in organ functions.
Forecast
The course of most tumors is benign, the prognosis is favorable. Simple vascular tumors are capable of regressing; some types are not prone to growth. If a hemangioma disrupts the functioning of organs, then the optimal method of treatment is selected, which allows you to restore all indicators and functions.Of the vascular formations of the lungs, the most common are hemangiomas - tumors consisting of anastomosing arteriovenous sinuses and cavities filled with blood. Lung hemangiomas are described in the literature under other names that characterize this type tumors as a developmental defect: “pulmonary arteriovenous aneurysms”, “varicose veins of the lung”. Despite the fact that these diseases are developmental defects, they are detected more often in older children or adults. Thus, J. Muri notes that out of 73 patients described in the literature, 11 were children under 15 years of age; 32 patients were older than this age; the ages of the others are not specified. Most observations relate to the male gender.
The localization of hemangiomas in the lung varies; most often they are located in the lung parenchyma itself. Hemangiomas are usually limited to lung tissue, however, in the literature there are descriptions of its growth from the lung into the chest wall. Lung hemangiomas are often multiple, affecting even both lungs. Sometimes they are combined with a malformation of blood vessels in the area of other organs and skin (telangiectasia). These manifestations are an indirect sign that facilitates the recognition of pulmonary hemangiomas.
Symptoms of hemangioma. Clinical manifestations depend on the size and location of hemangiomatous formations, as well as on the nature of arteriovenous fistulas. For hemangioma that forms fistulas between the pulmonary artery and pulmonary vein, i.e. directly between main vessels, hemodynamic disorder comes to the fore. A child with such a hemangioma experiences cyanosis, shortness of breath, weakness, frequent dizziness, and sometimes hemoptysis. Due to constant hypoxemia, the child is delayed in growth and development. Polycythemia gradually develops. Depending on the location of the tumor in the lung, it is sometimes possible to hear a murmur in the vessels of the lung.
Hemangiomas that form vascular fistulas within segmental arteries and veins have little clinical manifestation, the most constant sign is a gradual increase in polycythemia over many years. Percussion and auscultation data do not allow us to determine the nature of the disease. No malignant degeneration is observed.
The X-ray picture depends on the size and presence of arteriovenous connection. Typically the tumor is ovoid or spherical in shape, often with irregular scalloped but fairly distinct edges. As a rule, it is determined increased density root of the lung, apparently due to an increase in the pulmonary artery and vein. Sometimes there is a direct connection between the formation and the large vessels of the root of the lung. When X-rayed, you can often see the pulsation of the tumor, which is independent and not transmitted (from the heart) in nature. During exhalation, the shadow of the hemangioma decreases, during inhalation it increases and becomes more intense. Angiography often determines the extent of the lesion and can detect small hemangiomas that are not detected by plain fluoroscopy.
Treatment only operational. It consists of removing the affected part of the lung; most often it is necessary to perform a lobectomy and even removal of the entire lung. For multiple hemangiomas localized in both lungs, resection should be economical; the most affected areas are removed.
Pathology in the lung is a cluster of anastomosing blood vessels measuring 0.4-8.5 cm in diameter (average - 2.8 cm). It is most often formed in children after 6-7 years of age and in adults. Men are more susceptible to the disease than women. A pathological formation in the lung is characterized by a slow increase and clear boundaries separating the tumor from healthy surrounding tissues. The problem is diagnosed using X-rays, computed tomography and ultrasound. Treatment is primarily through surgical removal.
Pulmonary hemangioma is often a genetically determined and rare disease of a non-malignant nature.
General information
Varieties
- Capillary hemangiomas, found in 50% of cases, are divided into simple and hypertrophic.
- Cavernous (cavernous).
- Capillary-cavernous - mixed hemangiomas of the lungs, characterized by the largest size.
- Intrapulmonary.
- Endobronchial.
- Central.
- Peripheral.
- Solid.
- Papillary.
- Hemorrhagic.
- Alveolar.
- Sclerotizing.
Capillary pulmonary hemangiomas occur in half of the cases of hemangiomas and consist of many small blood vessels. More often, this type of formation occurs in the lungs of children in the first 2 years of life. The tumor can grow deeper and penetrate the walls of important vessels and even the membranes of veins. Cavernous hemangiomas of the lungs are formed mainly from large vessels, and they are larger in size than capillary ones. The mixed type of pathology is the largest formation, formed from different types of tissues and vessels.
Doctors call UV rays, intrauterine developmental problems, and vascular pathologies as provocateurs of pulmonary hemangioma. Return to contents
Causes of pathology
According to histogenesis, pulmonary hemangioma is a dysontogenetic pathology, the basis of the formation of which is an intrauterine deviation in the formation of vascular tissues. This disorder is accompanied by the formation of an excess number of blood vessels. Due to the fact that a vascular lung tumor consists of endothelial cells (cells lining the internal vascular walls and characterized by the ability to multiply rapidly), sharp accelerations in the growth of pathological neoplasms are possible. Until the end is unknown to medicine exact reasons formation of hemangiomas, and the suspected causes include:
- excessive exposure to ultraviolet radiation;
- hereditary tendency;
- diseases of the vascular system;
- infectious diseases suffered by the mother during the embryonic period of development, during which medications were taken.
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How does the disease manifest itself?
The course of the pathology depends on morphological features, place of formation and type of structure. Due to the fact that the pathological formation in the lungs grows slowly over several years, the primary symptoms of the tumor in 90% of cases are absent or vague. The appearance of clinical symptoms is possible with a significant increase in pathology and with accelerated growth of a benign tumor. The rapid growth of a pulmonary tumor is characterized by the following signs:
Lung hemangioma can cause problems with breathing, blood circulation, and well-being.
- pressing pain in the chest area;
- pulmonary hemorrhage;
- frequent coughing up blood;
- the formation of holes between the pulmonary artery and vein;
- shortness of breath and heavy breathing;
- cyanosis;
- dizziness associated with a lack of oxygen in the blood.
A dangerous complication of a vascular tumor in the lung is the probable rupture of the tumor, which occurs after a lung injury, especially resulting from strong prolonged pressure. The result of injury is profuse blood loss, which leads to death. Abnormal growth of pathology in the lung causes compression of blood vessels and adjacent healthy tissue. It is possible to develop a lung abscess. Transition to a malignant course occurs no more than 1% of cases.
Diagnostic measures
Often, hemangioma in the lungs is discovered by chance during a routine examination. Diagnosis of pulmonary pathology is made by a pulmonologist, who draws up a diagnostic history based on the patient’s symptoms. At initial examination When listening to the lungs with a stethoscope, noises are heard. A secondary sign of hemangioma is dilation of small skin vessels and the appearance of spider veins that are not associated with inflammation (telangiectasia). Diagnostic methods:
- Radiography. Visualizes round or oval vascular formation, which is clearly limited from the surrounding tissues, and the border is often irregular in shape.
- Computed tomography of the lungs. Determines the dilation of the vessels of the respiratory organ and the increased density of the pulmonary root. There are pulsating movements of the tumor that are not associated with respiratory movements.
- Ultrasound examination with Dopplerography. An informative method for diagnosing vascular disorders, allowing one to calculate the volume of a neoplasm and its structure.
- Bronchoscopy. Carry out with endobronchial enlargement of pathology.
- Angiography of blood vessels. A method confirming the vascular nature of the hemangioma, the characteristics of its formation and the nature of its spread.
- Biopsy. It is rarely performed to differentiate a hemangioma from a malignant tumor.
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Treatment of pulmonary hemangiomas
The main treatment method for benign pulmonary tumors is surgical removal by a thoracic surgeon. The surgeon cuts pathological formation from healthy tissue. If there is more than one tumor in the lungs, then the doctor performs an economical resection of the areas of the lung with the greatest damage. It is better to remove the formation at an early stage of the disease, while the size is minimal, but since early stage Since the formation of the pathology is asymptomatic, people often learn about the disease when the size of the tumor is significantly increased. Depending on the affected area, the following types of pathology removal are distinguished:
- fenestrated resection of the bronchus (circular removal);
- segmental excision (marginal resection);
- resection of the pulmonary lobe (lobectomy).
As a rule, surgical removal of pulmonary hemangioma provides an effective outcome from therapy.
Doctors very rarely resort to surgery complete removal lung or pneumonectomy. This method is chosen only in extreme cases when the lung cannot be saved. When the position of the hemangioma does not interfere with the organ’s ability to perform its work function and there is no tendency to grow, doctors choose a wait-and-see approach, especially for newborns and small children. Often a hemangioma forms unexpectedly and resolves on its own. Modern surgical methods and diagnostic procedures create a favorable prognosis for the treatment of pulmonary hemangioma.
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Hemangioma: symptoms, diagnosis, treatment in children
Benign neoplasms are quite common in childhood. Every tenth child under the age of one year is diagnosed with hemangioma. This is a benign tumor that originates from blood vessels. And although the process is benign, it is necessary to closely monitor the progression of hemangioma and begin treatment in a timely manner. Otherwise, you should be wary of developing complications.
Hemangioma: causes of occurrence
To the question of why hemangioma develops, scientists still cannot give a definite answer. Probable cause are the effects of adverse factors during pregnancy during the development of mesenchymal tissue of the fetus. Blood vessels are formed from this tissue. Most aggressive unfavorable factor are infectious diseases of pregnant women, in particular ARVI.
- They are often detected literally immediately after the baby is born or in the first weeks or months of life;
- Hemangiomas are more often recorded in girls;
- Hemangiomas can be of completely different sizes: from a small dot to a large spot.
Development of hemangioma in children
A characteristic sign of hemangioma is a change in its size. There are three stages in the development of hemangioma:
- Period of intensive growth;
- Period of growth cessation;
- Period of reverse development.
It is quite difficult to predict how actively the hemangioma will increase in size. Sometimes the tumor grows even several centimeters per week. It is reliably known that in premature infants, hemangiomas grow much faster than in full-term infants. Hemangiomas actively grow in the first months of a baby’s life. Once the child reaches six months of age, the growth of the neoplasm slows down. This stage is called the stunting period and lasts several years.
The further development of hemangioma is difficult to predict. Reverse development (regression) of the neoplasm often occurs. The brightness of the spot gradually decreases, and areas of white color are visible on it. After six to eight months, the hemangioma becomes pale pink and smooth. By the third or fourth year of a child’s life, only an area of depigmentation on the skin reminds of a neoplasm. It is worth noting that regression is only possible in the case of simple hemangiomas. Cavernous and combined hemangiomas never regress.
Types of hemangiomas
Hemangiomas are most often localized on the skin, but can also occur in internal organs. There are the following types of hemangiomas:
Hemangioma on the skin
Hemangiomas have their favorite places. Most often they occur in the face, scalp, neck, mouth, and hands. Much less often - on the external genitalia, legs.
Simple hemangiomas
In the structure of all hemangiomas, simple hemangiomas make up approximately 95%. A simple hemangioma is a layer of small, tightly adjacent capillary vessels. Sometimes the vessels gather into lobules. The lumen of the vessels is filled with blood. Simple hemangiomas are localized on the skin and do not penetrate the subcutaneous fat. The surface of capillary hemangiomas can be flat or nodular-lumpy.
A simple hemangioma looks like a raised red spot on the skin, which can be of varying sizes. If you press on the edge of the spot, you will notice how it gradually fades. This is due to compression of the vessel and expulsion of blood from it. But as soon as you let go of the skin, the spot immediately turns red. The spot has clear edges and is demarcated from the surrounding healthy tissue. There may be one or more of these growths on the skin.
Cavernous (cavernous) hemangiomas
Cavernous hemangioma consists of many cavities separated by septa. This type of hemangiomas is located in the subcutaneous tissue. Cavernous hemangiomas account for about 3% of all hemangiomas.
Externally, cavernous hemangioma looks like a volumetric formation that noticeably rises above the skin. The surface of the formation is rough. The skin of cavernous hemangioma is not changed. But a bluish tumor-like formation is visualized under the skin. It has a soft elastic consistency to the touch. If you press on it, the swelling decreases somewhat. But soon it regains its previous form. It is typical that when a child strains, cries, or even coughs, the tumor briefly increases in size due to blood flow to it.
Mixed hemangiomas
Mixed hemangiomas are those that are combined with other neoplasms, such as lymphangioma or lipoma. Such hemangiomas are very rare, occurring in approximately 0.6% of all cases of hemangiomas.
The color, consistency, and appearance of the tumor will depend on the tissues that make up the tumor.
Combined hemangiomas
In the structure of all hemangiomas, combined hemangiomas make up only 2%, but they are the ones that pose the greatest difficulty in treatment. Combined hemangiomas have supracutaneous and subcutaneous parts. External manifestations will depend on which of the components of the hemangioma predominates: capillary or cavernous.
Complications
Hemangioma grows quite quickly, and it is very difficult to predict its further effect on the body. Among the main complications of hemangiomas are:
- Bleeding. Develops when tumor tissue is injured. Bleeding with liver hemangioma is especially dangerous, since the volume of blood loss can be very massive.
- Ulceration. It develops mainly when hemangioma is localized in the area of the lips, perineum, and large folds of skin. Characterized by the development of an ulcer at the site of the tumor.
- Blood clotting disorder. This is due to the fact that a hemangioma, roughly speaking, is perceived by the body as a damaged vessel, which is why platelets actively flow into this area. Over time, the number of platelets in the blood decreases, which can lead to poor blood clotting.
- Inflammation and suppuration. Often associated with trauma to the tumor.
- Dysfunction of organs affected by hemangioma(impaired vision with hemangioma of the eyelid, impaired hearing with hemangioma of the ear).
Hemangioma of internal organs
Hemangioma can form in internal organs: brain, uterus, lungs, kidneys. The most common type is liver hemangioma. The tumor is usually solitary and small in size. Hemangiomas of the liver are simple (capillary) and cavernous. Capillary hemangiomas are usually small and do not exceed a few centimeters. Cavernous reach ten centimeters.
It is noteworthy that often the tumor does not cause any discomfort. This is how a person lives with an illness long time. Around the age of fifty, the size of the tumor increases and then symptoms of the disease begin to appear: dull pain in the right hypochondrium, nausea, flatulence, bowel dysfunction, jaundice.
Bone hemangioma
Bone hemangioma is a slow-growing benign tumor. More often the tumor is located in the spine, somewhat less often in the bones of the skull and pelvis, and tubular bones.
Bone hemangiomas are usually asymptomatic and are therefore discovered by chance during a routine examination. Only in 1-1.5% of all cases, bone hemangioma is accompanied by pain. Bone hemangiomas do not always require active treatment, but constant monitoring by a doctor is necessary. The thing is that an enlarging hemangioma of the spine, for example, pushes bone elements, which can cause vertebral fractures.
Diagnostics
A doctor may suspect a hemangioma during an external examination of the tumor. Firstly, the presence of a raised red spot testifies in favor of a hemangioma. Secondly, with hemangioma, the spot turns pale when pressure is applied to it and restores its shape and color after the pressure stops.
To confirm the diagnosis, as well as clarify the extent of skin damage, certain studies can be carried out:
Ultrasound is performed to study cavernous hemangiomas, as well as neoplasms of internal organs. This diagnostic method allows you to study the structure, depth, size of the hemangioma.
If hemangiomas of internal organs are suspected, computed tomography or magnetic resonance imaging is performed. These methods make it possible to detect tumors of the smallest size. In addition, only tomography can determine the presence of hemangiomas in the bones.
A clinical blood test is performed to determine complications and monitor the patient’s condition during the course of treatment. Characteristic changes in the blood with hemangiomas are a decrease in the number of platelets, and in addition, red blood cells with hemoglobin.
Treatment of hemangioma
Treatment issues must be approached individually, taking into account the characteristics of the disease in a particular child. You can often hear the opinion that hemangiomas do not need to be treated, because they can disappear on their own when the child grows up. However, this opinion is too frivolous. Indeed, simple hemangiomas can regress, but this does not happen in every case. In addition, cavernous and mixed hemangiomas are not at all capable of regressing. Thus, a wait-and-see strategy can only be applied in the case of simple uncomplicated hemangiomas with signs of regression.
There are certain indications according to which treatment of hemangioma should begin as soon as possible:
- Hemangiomas located in the head and neck area, in the mouth, anogenital area;
- Fast-growing tumors (its area doubles in a week);
- Complicated hemangiomas.
Surgical treatment: removal of hemangiomas
Surgical excision of the skin of the tumor is a generally accepted treatment for hemangiomas. However, nowadays surgical intervention is rarely resorted to. First of all, due to the fact that surgical intervention must be carried out under general anesthesia. Surgical excision of the skin may be accompanied by blood loss, and a scar remains after the operation. However, surgical excision is preferred for deep hemangiomas, as well as for mature forms of the tumor. That is, when other treatment methods are impossible.
Removal of hemangiomas with laser, cryodestruction
Modern physical methods for removing hemangiomas (cryosurgery, laser removal) have many advantages compared to surgical treatment. Such manipulations are carried out on an outpatient basis, because the procedure lasts only minutes, and there is no need to administer anesthesia to the child.
During cryodestruction, the skin is exposed to liquid nitrogen at a low temperature. The method itself is quite simple, it does not require any special preparation and is carried out without anesthesia. Hemangiomas located on the skin are targeted with liquid nitrogen within seconds, hemangiomas on the mucous membranes - within 7-15 seconds. On the third or fourth day, a crust forms on the treated area of skin; after a month, complete healing of the skin occurs. For large hemangiomas, treatment is carried out in several stages.
Laser removal is successfully used in the fight against hemangiomas. This method is used for tumors with a diameter of up to two centimeters. The laser causes thermal destruction of the tumor. The advantages of the method are that the possibility of bleeding is eliminated, since the laser beam cauterizes the vessels. A crust forms in the affected area, which disappears after two to three weeks. In its place a small scar is exposed.
Conservative treatment
Hemangiomas can be treated conservatively. One of the methods used in the fight against cavernous and combined hemangiomas is sclerosing therapy. A sclerosing agent - 70% alcohol - is injected into the tumor. This leads to an inflammatory reaction and thrombosis of the vessel, due to which the blood supply to the hemangioma stops. Soon the hemangioma can regress. Typically, several repetitions of procedures are required to achieve the desired result.
In the fight against extensive hemangiomas, hormonal therapy is also used. For this purpose, the child is prescribed Prednisolone. Towards the end hormone therapy the volume of the angioma decreases and growth stops; whitish areas appear on the surface of the hemangioma healthy skin. If necessary, the course of hormonal therapy can be continued after one to two months. However, with the help of such treatment, achieving the desired cosmetic effect, that is, the complete disappearance of the hemangioma will not be possible. Therefore, you will have to resort to other methods of treatment.
The beta blocker Propranolol can also be used in the treatment of hemangiomas. The drug leads to constriction of tumor vessels, stimulating replacement vascular wall scar tissue.
For angiomas with complex localization, for example, in the orbital area or occupying a fairly large area, radiation therapy is used.
In any case, the decision on the need for dynamic observation or active treatment is made by the pediatric surgeon. Therefore, if your baby has a hemangioma, you should consult a doctor and not wait for self-healing.
Grigorova Valeria, medical observer
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Lung hemangioma - Tumors and cysts of the chest cavity in children
Lung hemangiomas, or vascular formations, consist of countless anastomosing arteriovenous vessels and cavities filled with blood. Lung hemangiomas are described in the literature under other names that characterize this type of tumor as a developmental defect: pulmonary arteriovenous aneurysms, varicose veins of the lung. Despite the fact that these formations are a developmental defect, they are detected more often in older children or adults. Thus, Muré (1953) notes that out of 73 patients described in the literature, 11 were children under 15 years of age. MikuJas et al. (1972) describe 2 patients with arteriovenous fistulas, one of them was a 7-year-old child.
The localization of hemangiomas in the lung varies; most often they are located in the lung parenchyma itself. Typically, hemangiomas are limited to the lung tissue, but in the literature there are descriptions of its growth from the lung into the chest. Lung hemangiomas are often multiple, affecting even both lungs. Sometimes they are combined with a malformation of blood vessels in the area of other organs and skin (telangiectasia). These manifestations are an indirect sign that facilitates the recognition of pulmonary hemangiomas.
Clinical manifestations depend on the size and location of hemangiomatous formations, as well as on the nature of arteriovenous fistulas. With hemangioma with fistulas between the pulmonary artery and pulmonary vein, i.e. directly between the great vessels, hemodynamic disorder comes first. A child with such a hemangioma experiences cyanosis, shortness of breath, weakness, frequent dizziness, and sometimes hemoptysis.
Depending on the location of the tumor in the lung, a vascular murmur can sometimes be heard.
Hemangiomas that form vascular fistulas within segmental arteries and veins have little clinical manifestation. The most consistent feature is a gradual increase in polycythemia over many years.
Percussion and auscultation data do not allow us to determine the nature of the disease. No malignant degeneration is observed. In some cases, small hemangiomas in the lungs are discovered by chance. Thus, I. G. Klimkovich and co-authors (1967) provide a description of a pulmonary hemangioma that was asymptomatic in a 4-year-old child.
The X-ray picture depends on the size of the hemangioma and the presence of an arteriovenous connection. Typically the tumor is ovoid or spherical in shape, often with irregular scalloped but fairly distinct edges. As a rule, an increased density of the lung root is determined, apparently due to an increase in the pulmonary artery and vein. Sometimes there is a direct connection between the formation and the vessels of the lung root. With transillumination and x-ray kymograms, it is possible to see the pulsation of the tumor, which is independent and not transmitted (from the heart) in nature. During exhalation, the shadow of the hemangioma decreases, during inhalation it increases and becomes more intense.
Angiography often determines the extent of the lesion and makes it possible to detect small hemangiomas that are not detected by plain fluoroscopy (E. N. Meshalkin, E. A. Damir, 1956).
Lung hemangioma
Pulmonary hemangioma is a rare benign tumor-like formation of the lungs, represented by a conglomerate of overgrown and anastomosing blood vessels. Symptoms of a tumor may include hemoptysis, chest pain, shortness of breath, cyanosis, weakness, and spontaneous pulmonary hemorrhage. The diagnosis of pulmonary hemangioma is based on the clinical picture, radiography and CT scan of the chest, angiography, bronchoscopy, ultrasound with Doppler ultrasound of blood flow. Treatment of hemangioma is surgical, usually excision of the tumor, economical resection of the affected area of the lungs or bronchus, and lobectomy.
Lung hemangioma
Pulmonary hemangioma is an intrapulmonary or endobronchial vascular tumor of mesodermal origin with a benign course. Hemangiomas can develop in any organ, but are rarely detected in the lungs. In addition to hemangiomas, pulmonology also has to deal with other angiomas - hemangioendothelioma, hemangiopericytoma, lymphangioma, glomus tumor. Lung hemangiomas are characterized by clear demarcation from surrounding tissues, fairly slow growth and lack of tendency to malignancy. Vascular tumor of the lungs is more often detected in older children and adults, mainly males. Pulmonary hemangioma can be combined with another pathology of vascular development - telangiectasia of the skin and various organs.
Causes of pulmonary hemangioma
According to histogenesis, hemangioma is a dysontogenetic formation. The formation of pulmonary hemangioma is based on a congenital disorder of the development of vascular tissue (vasculogenesis), accompanied by its hyperplasia and the appearance of excess vascular buds. Vascular tumor cells begin their growth at the embryonic stage or shortly after the birth of the child. As part of a pulmonary hemangioma, atypically located elements of the vascular wall are detected, primarily, cells of the internal lining of blood vessels - endothelial cells, which have the ability to reproduce.
The risk of developing pulmonary hemangioma in a newborn increases if the mother’s pregnancy was complicated by taking certain medications (hormones, etc.), viral or bacterial infections, or an unfavorable environmental environment. In adults, possible factors for the appearance of pulmonary hemangioma are hereditary predisposition, prolonged exposure to ultraviolet radiation, internal pathology contributing to vascular disorders.
Classification of pulmonary hemangioma
Hemangioma is a round tumor, surrounded by a connective tissue capsule, of dense or densely elastic consistency, which may have various shades pink or red. The size of a hemangioma can vary from a few millimeters to 20 or more centimeters in diameter.
According to morphological criteria, hemangiomas can be capillary (simple or hypertrophic), cavernous (cavernous), combined and mixed. Capillary hemangiomas (about 50% of all types of this tumor) are represented by the proliferation and interweaving of dilated capillaries, usually with proliferation and hyperplasia of the endothelium, located in the form of concentric groups and elongated cords. More common in infants. Capillary hemangiomas are characterized by infiltrating growth, intensive new formation of small thin-walled vessels that even grow into the walls of arteries and veins.
Cavernous hemangiomas consist of multiple blood-filled arteriovenous cavities (sinusoidal areas) with thin connective tissue septa and endothelial lining. They are formed from larger blood vessels and can be significant in size. Combined (capillary-cavernous) hemangiomas combine proliferating areas of immature capillary elements and cavernous sinuses, limited by mature endothelial cells. Mixed hemangiomas are formed by different types of tissue (for example, angiokeratoma).
According to the localization of pulmonary hemangiomas, they are predominantly intrapulmonary, less often endobronchial; can be central or peripheral. Multiple hemangiomas affecting one or both lungs are common. There is a special sclerosing pulmonary hemangioma (pneumocystoma, fibroxanthoma, vascular endothelioma, alveolar angioblastoma) - a benign neuroendocrine pulmonary tumor, which contains hemangiomatous foci (angiomatous component). Pulmonary hemangioma is usually limited to the lung tissue and does not spread further; There are isolated cases of its invasion into the chest.
Symptoms of pulmonary hemangioma
The clinical picture of pulmonary hemangioma depends on the diameter, location and nature of the vascular formation. Due to slow growth over many years, the manifestations of a small hemangioma may be absent or quite sparse. Symptoms of pulmonary hemangioma usually develop when complications occur. At rapid growth ulceration of the tumor is possible. Patients may be bothered by chest pain, hemoptysis, spontaneously occurring pulmonary hemorrhages (especially with cavernous hemangiomas).
With pulmonary hemangioma, which forms vascular (arteriovenous) fistulas between the pulmonary artery and vein, hemodynamic disorders occur. Chronic hypoxemia leads to shortness of breath, cyanosis and frequent dizziness; in children, growth and development may also be delayed. With vascular fistulas located at the level of segmental branches, the course of pulmonary hemangioma is asymptomatic. There is a gradual increase in polycythemia. Sometimes it is possible to detect noise in the vessels of the lung at the site of the tumor.
The danger of pulmonary hemangioma is possible rupture tumors (with trauma or severe ulceration) with massive blood loss and risk of death. It is possible to develop compression syndrome of blood vessels and tissues, infection of ulcerated hemangioma with the appearance of purulent process in the lungs and deterioration of the patient's condition.
Diagnosis of pulmonary hemangioma
The diagnosis of pulmonary hemangioma is established by a pulmonologist and is based on anamnesis and clinical picture (presence of episodes of hemoptysis or pulmonary hemorrhage), radiography, CT scan of the chest, ultrasound with Doppler, angiography of pulmonary vessels, bronchoscopy. Typically, pulmonary hemangiomas are discovered accidentally or already at the stage of complications. An indirect sign of a tumor can be the presence of telangiectasia in other organs and on the skin.
On a chest x-ray, hemangioma is visualized as a spherical or oval shape, having clear but usually irregular scalloped edges. An increased density of the lung root is often determined due to an increase in the pulmonary vessels. It is possible to detect a direct connection of the hemangioma with the pulmonary vessels, establish the autonomous pulsation of the tumor, a decrease in its shadow during exhalation, an increase in size and darkening during inspiration.
Ultrasound with Doppler sonography is highly informative in vascular tumors, as it allows you to determine the volume of the hemangioma, its structure and hemodynamic state. Angiography confirms the vascular nature of the tumor formation, its localization and extent, and the characteristics of the hemangioma (clear limitation, presence of areas with a lobular structure, peripheral or axial nature of the blood supply). With endobronchial growth of a vascular formation, bronchoscopy is advisable.
The morphological, endoscopic and clinical-radiological picture of pulmonary hemangioma corresponds to the signs of a benign tumor. Differential diagnosis of pulmonary hemangioma is carried out with congenital angiodysplasias, other benign and malignant tumors of this localization.
Treatment of pulmonary hemangioma
Treatment of pulmonary hemangioma is only surgical; depending on the affected area, it comes down to excision of the tumor within healthy tissue, fenestrated or circular resection of the bronchus, segmental or marginal lung resection, removal of the pulmonary lobe (lobectomy), rarely - removal whole lung(pneumonectomy). Surgical interventions are performed by thoracic surgeons.
In the case of multiple pulmonary hemangiomas in both lungs, economical resection of the most affected areas is performed. It is advisable to remove hemangioma at an earlier date, while the size of the formation is small and there are no secondary irreversible changes in the lungs. When pulmonary hemorrhage develops with significant blood loss, blood transfusions, plasma and blood substitute transfusions are performed.
Watchful waiting can be used in case of peripheral location of pulmonary hemangioma and absence of complications in elderly and old age. The prognosis of pulmonary hemangioma with timely surgical treatment is favorable.
Hemangioma- this is a children's benign tumor, developing from cells of vascular tissue, and representing a voluminous neoplasm consisting of many small vessels ( capillaries). The child is either born with a hemangioma ( in 30% of cases), or it develops in the first weeks of life.
The most intensive growth is observed in the first six months of a child’s life, after which the growth processes slow down or stop altogether, and the process of reverse development may begin. In more severe cases, the hemangioma may continue to grow at an older age, increase in size and grow into nearby organs and tissues with their subsequent destruction. This leads to both a serious cosmetic defect and disruption of the functions of various organs and systems, which can have the most unfavorable consequences.
Hemangioma is quite common and occurs in every tenth newborn. It appears three times more often in girls than in boys. The most commonly affected areas are the face, neck and scalp ( up to 80% of all skin hemangiomas).
Interesting Facts
- The number of hemangiomas in a child can vary from one or two to several hundred.
- They occur as small hemangiomas ( 2 – 3 mm), and huge ( up to several meters in diameter).
- Hemangiomas in adults are detected extremely rarely and are a consequence of their incomplete cure in childhood.
- Small hemangiomas may disappear on their own by the age of five.
- Hemangioma is characterized by the most aggressive growth among all benign tumors.
Causes of hemangioma
Today, science does not have a clear opinion about the causes of hemangioma. It is known that the development of this tumor is associated with a disruption of the process of vascular formation during the period of intrauterine development of the fetus. Formation of fetal vessels
During the growth of the fetus in the womb, the first blood vessels begin to form at the end of the 3rd week of embryonic development from a special embryonic tissue - mesenchyme. This process is called angiogenesis.Depending on the mechanism of vascular development, there are:
- primary angiogenesis;
- secondary angiogenesis.
Characterized by the formation of primary capillaries ( the smallest and thinnest blood vessels) directly from the mesenchyme. This type of vascular formation is characteristic only of the early period embryonic development. Primary capillaries do not contain blood and consist of a single layer of endothelial cells ( in the adult body, endothelial cells line the inner surface of blood vessels).
Secondary angiogenesis
It is characterized by the growth of new vessels from already formed ones. This process is determined genetically and is also controlled by local regulatory factors.
Thus, with the development of an organ and an increase in its mass, the deeper sections begin to lack oxygen ( hypoxia). This triggers a number of specific intracellular processes, which result in the release of a special substance - vascular endothelial growth factor ( VEGF, Vascular endothelial growth factor).
This factor, acting on the endothelium of already formed vessels, activates its growth and development, as a result of which new vessels begin to form. This leads to an increase in oxygen delivered to the tissues, which inhibits the production of VEGF. In this way, angiogenesis is controlled in later stages of fetal development and after birth.
It is important to note that fetal tissues have a pronounced ability to recover from various types of injuries and damage. As a result of any, even the most minor injury ( compression, rupture of a small vessel and hemorrhage) healing processes are activated, including secondary angiogenesis with the possible subsequent development of hemangiomas.
Theories of hemangioma occurrence
Today, there are more than a dozen theories trying to explain the mechanisms of the appearance and development of hemangiomas, but none of them is able to independently cover all aspects of this disease.The most plausible and scientifically substantiated are:
- stray cell theory;
- fissural ( slotted) theory;
- placental theory.
The most modern and scientifically substantiated theory, according to which hemangioma occurs as a result of a violation of the development of capillaries from the mesenchyme. During embryogenesis, accumulations of immature blood vessels form in organs ( capillaries), which then turn into veins and arteries. After the formation of an organ, a certain amount of unused immature vascular tissue may remain in it, disappearing over time.
Under the influence of certain factors, this process is disrupted, as a result of which involution of capillaries is not observed, but, on the contrary, activation of their growth is noted. This can explain the birth of children with hemangioma, or its appearance in the first weeks of a child’s life. It also becomes clear that this tumor can form in almost any tissue of the body.
Fissural theory
At the initial stages of embryo development, the so-called embryonic clefts are distinguished in the area of the skull - the future location of the sensory organs ( eyes, ear, nose) and mouth opening. At week 7, blood vessels and nerves that take part in the formation of organs grow into these gaps.
According to the fissural theory, hemangioma occurs in the fetus as a result of impaired development of vascular primordia in these areas. This explains the more frequent location of these neoplasms in the area of natural facial openings ( around the mouth, eyes, nose, ears), however, the mechanism of development of hemangiomas in other areas of the skin remains unexplained ( on the torso and limbs) and in internal organs.
Placental theory
It is assumed that endothelial cells of the placenta enter the bloodstream of the fetus and are retained in its organs and tissues. During the period of intrauterine development, maternal factors inhibiting angiogenesis do not allow vascular tissue to actively grow, however, after birth, their effect ceases and intensive growth of hemangioma begins.
Mechanism of occurrence of hemangioma
Despite the diversity of theories, what they have in common is the presence of immature embryonic vascular tissue in the skin and other organs, where it should not normally be present. However, this is not enough for the development of hemangioma. The main factor that triggers the process of capillary growth and tumor formation is tissue hypoxia ( lack of oxygen).Therefore, different pathological conditions leading to disruption of oxygen delivery to the fetus or newborn child are potentially risk factors for the occurrence of hemangioma. These data have been confirmed by many scientific studies.
The appearance of hemangioma can be promoted by:
- Multiple pregnancy. When two or more fetuses develop in the uterus, the likelihood of having children with hemangioma is increased.
- Fetoplacental insufficiency. Characterized by insufficient oxygen delivery ( and other substances) to the fetus due to a violation of the structure or function of the placenta.
- Trauma during childbirth. When a child passes through the birth canal, the tissues of the head are compressed quite strongly, which disrupts the normal blood circulation in them. Long ( or, conversely, too fast) childbirth, narrow birth canal or large fetal size can provoke the development of local hypoxia with subsequent formation of hemangioma in the scalp and face.
- Eclampsia. This condition develops during pregnancy or childbirth and is characterized by a pronounced increase in maternal blood pressure with possible loss consciousness and convulsions, as a result of which the delivery of oxygen through the placenta to the fetus is disrupted.
- Smoking during pregnancy. When you smoke, part of your lungs fills up tobacco smoke, as a result of which the amount of oxygen entering the body decreases. If the maternal body is able to tolerate this condition relatively easily, then in the fetal body hypoxia can cause enhanced growth capillary tissue and the development of hemangioma.
- Intoxication. Impact of various occupational hazards, as well as alcohol abuse during pregnancy increases the risk of having a child with hemangioma.
- Mother's age. It has been scientifically proven that childbirth after 40 years is associated with increased risk the presence of various developmental anomalies in the fetus, including vascular neoplasms.
- Prematurity. Starting from 20 to 24 weeks of pregnancy, surfactant is produced in the lungs of the fetus - a special substance without which pulmonary respiration is impossible. A sufficient amount of it accumulates only by the 36th week of pregnancy, so the respiratory processes in premature babies are disrupted, which leads to tissue hypoxia.
Development of hemangioma
Distinctive feature of these neoplasms is a clear staged nature of their course.In the process of development of hemangiomas, they are distinguished:
- A period of intense growth. Characteristic of the first weeks or months after the onset of hemangioma and, as a rule, stops by the end of the first year of life ( exceptions are possible). Externally, the tumor is bright red in color, constantly increasing in diameter, as well as in height and depth. The growth rate varies within varying limits - from insignificant to very pronounced ( a few millimeters per day). This period is the most dangerous in terms of the development of complications ( ulceration of the tumor, germination into neighboring organs and their destruction).
- Period of growth cessation. In most cases, by the end of the first year of life, the growth of the vascular neoplasm stops, and until the age of 5–6 years it increases slightly, corresponding to the growth of the child.
- Period of reverse development. In approximately 2% of cases, complete spontaneous disappearance of the hemangioma is observed. Some time after growth stops ( in months or years) the surface of the tumor becomes less bright and may ulcerate. The capillary network gradually disappears, which is replaced either by normal skin ( for small, superficially located hemangiomas), or scar tissue ( in the case of voluminous formations growing into the deep layers of the skin and subcutaneous tissues).
Types of hemangiomas
Depending on the nature of growth, structure and location of the hemangioma, the method of its treatment is chosen, therefore, when making a diagnosis, it is also necessary to determine the type of tumor. Depending on the structure there are:
- Capillary ( simple) hemangiomas. They occur in 96% of cases and represent a dense capillary network of bright red or dark crimson color, rising above the surface and growing into the deep layers of the skin. This form is considered the initial stage of the development of the disease and is characterized by the intensive formation of new capillaries, prone to sprouting into the surrounding tissues and destroying them.
- Cavernous hemangiomas. Are the result further development capillary hemangiomas. In the process of growth and increase in size, as a result of capillaries overflowing with blood, some of them expand and rupture, followed by hemorrhage into the hemangioma tissue. The consequence of this process is the formation of small, blood-filled cavities ( cavern), the inner surface of which is lined with endothelial tissue.
- Combined hemangiomas. Combined hemangioma is classified as a transitional stage from capillary to cavernous form. It is a tumor in which there is an alternation of immature capillary tissue with cavities filled with blood ( caverns). The increase in tumor size occurs mainly due to the formation of new capillaries, which subsequently also undergo transformation into cavities, up to complete replacement of the hemangioma.
- Skin hemangiomas. Occurs in 90% of cases. They can be single or multiple, capillary or cavernous type.
- Hemangiomas of internal organs. Almost always accompanied by multiple hemangiomas of the skin. May vary depending on structure and shape. Damage to the liver, spine, bones and muscles is considered the most common and dangerous.
What do hemangiomas look like on the skin?
Hemangiomas can affect any part of the skin, but are most often observed in the face, neck and scalp. Their appearance varies depending on the structure.| Hemangioma on the skin | Detailed description | Photo |
| Capillary hemangioma | It is a painless volumetric formation of elastic consistency, rising above the surface of the skin by several millimeters. The edges are uneven, clearly demarcated from healthy skin, which is practically unchanged. The surface is lumpy, lobed, bright red or dark crimson in color. When pressure is applied, the tumor may turn slightly pale, restoring its original color after the pressure is removed. |  |
| Cavernous hemangioma in the facial area | Volumetric, painless formation, fully or partially protruding above the surface of the skin ( often the hemangioma is located deeper, and only a small part of it rises above the skin). The edges are uneven, clearly demarcated from intact skin. The surface is swollen and rough. When pressed, the formation collapses and may turn slightly pale. When the pressure stops, there is a gradual restoration of the original size and color of the tumor. |  |
| Cavernous hemangioma of the leg (under cutaneous form) | The bulk of the tumor is located in more deep tissues (in subcutaneous fat, in muscles) and reaches significant sizes. The affected area is enlarged ( in comparison with a symmetrical healthy area of the body). Numerous capillaries are visible on the surface of the skin. When pressed, the firm, elastic consistency of the tumor is determined. |  |
| Combined hemangioma of the hand (cutaneous form) | It is characterized by a widespread, voluminous formation of bright red color, rising above the surface of the skin. The affected areas do not have clear boundaries; in some places there is a transition to deeper layers of the skin. The surface is uneven, bumpy. In some places there are more prominent tubercles of a dark crimson color, which collapse when pressed ( caverns). |  |
Diagnosis of hemangioma
Despite the fact that hemangioma is a benign tumor, its rapid growth can be accompanied by a serious cosmetic defect ( when located in the face, head, neck). In addition, when located in internal organs, this neoplasm can lead to their destruction, posing a danger to human health and even life. The diagnosis and treatment of hemangiomas is carried out by a pediatric surgeon, who, if necessary, can involve other specialists.
The diagnostic process includes:
- examination by a doctor;
- instrumental studies;
- laboratory research;
- consultations with other specialists.
Examination by a doctor
If at birth or in the first weeks of life a red spot is found on the child’s skin, rapidly increasing in size, you should consult a doctor as soon as possible, since hemangiomas are often characterized by very rapid, destructive growth.What questions will the surgeon ask?
- When did education appear?
- Does the size of the tumor change ( how much and over what period of time)?
- Was any treatment used and was it effective?
- Did the child’s parents or grandparents have hemangiomas, and if so, what was their course?
- Carefully examine the tumors and surrounding areas.
- Examine the structure of the tumor in detail under a magnifying glass.
- Determines the consistency of the formation, the nature of changes when pressed.
- Will change the size of the tumor ( to determine the intensity of growth at subsequent visits).
- Carefully examine all the skin of the child in order to identify previously undetected hemangiomas.
Instrumental studies
Usually, there are no difficulties in diagnosing hemangioma, and the diagnosis is made based on a survey and careful examination. Instrumental methods diagnostics are used to identify lesions of internal organs, as well as when planning surgical removal of a tumor.In the instrumental diagnosis of hemangiomas the following are used:
- thermometry;
- thermography;
- ultrasonography;
- biopsy.
Thermometry
A research method that allows you to measure and compare the temperature of certain areas of the skin. For this purpose, a special device is used - a thermocouple, which consists of two electrodes connected to an electrical sensor. One of the electrodes is installed on the surface of the tumor, the second - on a symmetrical but unaffected area of the skin. The sensor allows you to determine the difference in temperature with an accuracy of 0.01ºС.
Hemangioma, being a dense network of capillaries, is supplied with blood better than normal skin, therefore, the temperature in the area of this tumor will be slightly higher. An increase in temperature by 0.5 - 1ºC compared to unaffected skin indicates active tumor growth.
Thermography
A safe, fast and inexpensive research method that allows you to identify areas of the skin with elevated temperatures. The principle of the method is based on the same phenomena as thermometry.
The patient sits in front of a special infrared camera, which records thermal radiation from the surface of the skin for a certain time. After digital processing of the received information, a heat map of the area under study appears on the monitor, on which warmer lesions are displayed in red, and relatively cold ones in blue.
Unlike thermometry, which allows you to determine the temperature only on the surface of the tumor, thermography provides more accurate information about the spread of the hemangioma and allows you to more clearly determine its boundaries, often located deep in the soft tissues.
Ultrasonography ( Ultrasound)
Ultrasound examination is a safe method with no contraindications that allows one to determine the presence of space-occupying formations in internal organs, as well as to identify the presence of cavities in cutaneous and subcutaneous hemangiomas. Modern ultrasound machines are quite compact and easy to use, which allows diagnostic procedure right in the doctor's office.
The method is based on the principle of echogenicity - the ability of various tissues of the body to reflect sound waves, and the degree of reflection will vary depending on the density and composition of the fabric. The reflected waves are recorded by special sensors, and after computer processing, an image of the organ under study is formed on the monitor, reflecting the density and composition of its various structures.
Indications for ultrasound are:
- determination of the structure of hemangioma ( cavernous or capillary);
- determining the depth of the hemangioma;
- suspicion of hemangiomas of internal organs ( liver, kidney, spleen and other localization).
- clarification of tumor size when planning surgery.
- Capillary component of hemangioma. Represents small areas of medium or increased echogenicity ( a dense network of capillaries reflects sound waves to a greater extent than surrounding tissues), with a heterogeneous structure and unclear contours.
- Cavernous component. A cavern is a cavity filled with blood. The density of blood, and, consequently, its ability to reflect sound waves, is less than that of a dense capillary network, therefore, on ultrasound, cavities are defined as areas decreased echogenicity (against the background of a hyperechoic capillary network), round or oval in shape, ranging in size from 0.1 to 8 - 10 millimeters.
CT scan ( CT)
A modern high-precision method that allows you to identify tumors of internal organs ranging in size from several millimeters.
The essence of the method lies in the ability of tissues to absorb X-rays passing through them. To conduct the study, the patient lies down on a special retractable table of the computed tomograph and is placed inside the device. A special device begins to rotate around it, emitting X-rays, which, when passing through the tissues of the body, are partially absorbed by them. The degree of absorption depends on the type of tissue ( the maximum ability to absorb X-rays is observed in bone tissue, while they pass almost completely through air spaces and cavities).
The rays passing through the body are recorded by a special device, and after computer processing, a detailed and clear image of all organs and tissues of the area under study appears on the monitor.
It must be remembered that performing a computed tomography scan is combined with receiving a certain dose of radiation, and therefore the purpose of this study must be strictly justified.
Indications for CT scanning are:
- suspicion of hemangioma of the liver and other organs;
- inaccurate ultrasound data;
- planning surgical removal of hemangioma ( in order to clarify the size of the tumor and the involvement of neighboring organs).
- Liver hemangioma ( and other internal organs). Represents education reduced density, round or oval in shape with uneven edges and heterogeneous structure.
- Hemangioma of bones. Since bone tissue absorbs x-rays as much as possible, its normal CT image will be the densest ( white). When hemangioma grows, bone tissue is destroyed and replaced by a capillary network, as a result of which bone density decreases, and darker areas are noted in their projection, corresponding to the extent of the tumor. Fractures resulting from the destruction of bone tissue may be recorded.
- early childhood ( due to high radiation exposure);
- claustrophobia ( fear of confined spaces);
- presence of tumor diseases ( possible negative impact of CT on their course);
- presence of metal structures ( prostheses, implants) in the area of research.
A modern high-precision diagnostic method that allows you to examine in detail the structure of the spine and spinal cord. Performing an MRI is absolutely safe and harmless; the only contraindication is the presence of metal parts in the human body ( implants, prostheses).The principle of magnetic resonance imaging is the same as in CT, but instead of X-rays, the phenomenon of nuclear resonance is used, which manifests itself when the human body is placed in a strong electromagnetic field. As a result, the atomic nuclei are released certain type energy, which is recorded by special sensors, and after digital processing is presented on the monitor as an image of the internal structures of the body.
The main advantages of MRI over CT are the absence of radiation and a clearer image of the soft tissues of the body ( nerves, muscles, ligaments, blood vessels).
Indications for MRI of the spine are:
- Suspicion of compression of the spinal cord by a tumor. Such suspicions may be caused by the presence of multiple hemangiomas on the skin in combination with gradually developing clinical symptoms spinal cord injury ( impaired sensitivity and motor functions arms, legs and other parts of the body).
- Planning surgery to remove a tumor.
- Inaccurate data with other research methods.
- Growth of hemangioma into the vertebral bodies. At the same time, their bone structure is damaged, partially or completely replaced by capillary tissue.
- The degree of compression of the spinal cord by the tumor. A vascular formation is identified that protrudes into the lumen of the spinal canal and compresses the spinal cord or grows into it ( in this case, spinal cord tissue at the level of the lesion is not detected).
- The degree of tumor invasion into the ligamentous apparatus of the spine.
This method allows you to most accurately determine the structure and size of the hemangioma and assess the involvement of neighboring organs and tissues.
The essence of the method is to inject a special contrast agent into the vein or artery from which the tumor is supplied with blood. This procedure is carried out under the control of CT or MRI, which makes it possible to assess the speed and intensity of the spread of the contrast agent in the capillary network of the hemangioma.
Angiography is quite dangerous method diagnostics, therefore it is prescribed only in extreme cases, when it is necessary to determine the size of the tumor as accurately as possible ( when planning surgical operations in the face, head, neck area).
Absolute contraindications for angiography are:
- allergy to contrast agent;
- renal failure and/or liver failure.
This study includes intravital sampling of body tissues for the purpose of subsequent examination of their structure and cellular composition under a microscope. Performing a biopsy comes with certain risks, the most dangerous of which is bleeding. In addition, the diagnosis can be confirmed without this study, so the only justified indication for a biopsy is the suspicion of malignant degeneration of the hemangioma.
Early signs of malignancy of hemangioma may be:
- Change in tumor surface – disruption of the usual structure, intensive growth in height and depth, ulceration or peeling.
- Change in consistency – the structure becomes heterogeneous, denser areas appear.
- Color change - Darker brown or black areas appear.
- Changes in nearby skin areas - signs of inflammation appear ( redness, swelling, soreness, local increase temperature).
- Incisional biopsy. Most commonly used for sampling skin hemangioma. Under sterile conditions after treating the tumor and surrounding tissues ethyl alcohol Local anesthesia is performed on the area from which the material is planned to be collected. A scalpel is used to excise a certain area of the skin, which must include the tumor tissue and adjacent intact skin.
- Needle biopsy. More often used to collect material from internal organs ( liver, spleen, muscles and bones). Under ultrasound control, a special hollow game with sharp edges is inserted directly into the tumor tissue, with both peripheral and central parts of the tumor entering the needle.
Material obtained from biopsy ( biopsy), is placed in a sterile tube and sent to the laboratory, where, after special processing and staining, a microscopic examination of the structure and cellular composition of the tumor is performed, and a comparison is made with undamaged areas of the skin.
All hemangiomas removed surgically, must also be sent for histological examination without fail.
Laboratory research
Laboratory research methods are not very informative in the process of diagnosing hemangiomas and are more often used to identify complications of the disease, as well as to monitor the patient’s condition during treatment.The most informative is a general blood test ( UAC), although its changes are nonspecific and can occur in other diseases.
Blood is drawn in the morning on an empty stomach. After pre-treatment with alcohol, the skin ring finger it is pierced with a special needle to a depth of 2–4 mm, after which several milliliters of blood are drawn into a pipette.
Characteristic changes in the UAC are:
- Thrombocytopenia. A condition characterized by a decrease in the number of platelets in the blood due to their increased destruction in the hemangioma tissue, which is clinically manifested by increased bleeding of the skin and mucous membranes.
- Anemia. Decrease in the amount of hemoglobin and red blood cells in the blood. Anemia is a consequence of bleeding and hemorrhages caused by thrombocytopenia.
Consultations with other specialists
To help make a diagnosis, as well as in the event of various complications of hemangioma, the pediatric surgeon may need to consult specialists from other areas of medicine.The diagnostic process may involve:
- Oncologist – if malignant degeneration of the tumor is suspected.
- Dermatologist – with ulceration of hemangiomas or in the presence of concomitant skin lesions.
- Infectious disease specialist – with the development of an infectious process in the area of hemangioma.
- Hematologist – with the development of complications from the blood system ( severe thrombocytopenia and/or anemia).
Treatment of hemangiomas
Previously, a wait-and-see approach was recommended for hemangiomas in children, but recent research data suggest the opposite - the earlier treatment of the disease begins, the fewer complications and residual effects can develop. This statement is due to the unpredictable and often rapid growth of the tumor, which is relatively short time can increase several times and grow into neighboring organs and tissues. Evidence also supports early treatment statistical research, according to which only 2% of skin hemangiomas undergo complete independent reverse development, and in more than 50% of cases visible cosmetic defects remain on the skin ( scarring).
In the treatment of hemangiomas the following is used:
- physical removal methods;
- surgical method removal;
- drug therapy.
Physical methods for removing hemangiomas
This group includes methods of physical impact on hemangioma tissue, resulting in its destruction and subsequent removal.TO physical methods relate:
- cryodestruction;
- laser irradiation;
- sclerosing therapy;
- electrocoagulation;
- close focus x-ray therapy.
It is used to remove superficial or shallowly located skin hemangiomas, the size of which does not exceed 2 cm in diameter. The essence of the method is to expose the tumor to liquid nitrogen, the temperature of which is -196ºС. In this case, the tumor tissue is frozen, killed and rejected, followed by replacement with normal tissue. Removal of large tumors can result in extensive scarring, which is a serious cosmetic defect.
The main advantages of this method are:
- high-precision destruction of tumor tissue;
- minimal damage to healthy tissue;
- relative painlessness;
- minimal risk bleeding;
- fast recovery after the procedure.
The whole procedure takes a few minutes, after which the area of the hemangioma is treated with a solution of potassium permanganate, and the patient can go home. Usually 2 – 3 cryotherapy sessions are required with breaks of 3 – 5 days. After treatment is completed, the area where the hemangioma used to be must be treated with brilliant green for 7 to 10 days until a dense crust forms. Complete healing occurs within a month.
Laser irradiation
A modern method of removing superficial and deeper skin hemangiomas with a diameter of up to 2 cm using a laser.
The main effects of laser radiation are:
- thermal destruction of irradiated tissues ( charring and evaporation);
- blood clotting in vessels exposed to laser ( prevents bleeding);
- stimulation of the process of restoration of normal tissue;
- prevention of scar formation.
A dense crust forms at the site of exposure, which peels off on its own after 2 to 3 weeks. A small scar may form underneath ( at large sizes remote hemangioma).
Sclerosing therapy
This method can be used to remove larger hemangiomas located on the skin or in internal organs. The principle of the method is based on the cauterizing and coagulating ability of some chemical substances, which are injected into the hemangioma tissue, causing destruction of blood vessels and cavities, followed by their replacement with scar tissue.
Currently, 70% alcohol is used to harden hemangiomas. The procedure must be performed by an experienced surgeon under sterile conditions. The area of skin around the hemangioma is injected with a solution of novocaine ( for the purpose of pain relief), after which 1 to 10 ml of alcohol is injected into the tumor tissue with a syringe ( depending on the size of the tumor).
After 2 - 3 hours, inflammation and tissue swelling appears at the injection site, and after 2 - 3 days the area of the hemangioma thickens and becomes painful. The procedure is repeated several times with a break of 7–10 days. Complete disappearance of hemangioma is observed in the period from 3 months to 2 years from the end of treatment.
Electrocoagulation
A method of destroying tumor tissue through exposure to high-frequency pulsed electric current. When exposed to current on living tissues, rapid rise their temperatures reach several hundred degrees, followed by destruction, charring and rejection of dead masses.
The main advantage of this method is the minimal risk of bleeding, since high temperatures lead to blood clotting in the vessels feeding the hemangioma and sclerosis ( scarring) their lumen.
Using an electric knife, you can remove superficial and intradermal hemangiomas, and electrocoagulation can also be used as helper method at surgical removal tumors.
Close focus X-ray therapy
Consists in local influence x-rays onto the hemangioma tissue, which leads to the destruction of the tumor capillaries. X-ray therapy is rarely used as an independent method of treating hemangioma and is more often used in preoperative period in order to reduce the size of the tumor, which will reduce the volume of the operation.
The impact of X-ray radiation on the body, especially children, is associated with a number of side effects, the most dangerous of which is the possibility of developing a malignant neoplasm. In this regard, close-focus radiography is used exclusively in rare cases if other treatment methods are ineffective.
Surgical method for removing hemangiomas
As an independent treatment method, it is used for small superficial skin formations located in areas of the body where postoperative scar less significant in cosmetic terms ( in men in the back, legs).During the operation, under general anesthesia, the entire tumor and 1–2 mm of surrounding healthy skin are removed. When the hemangioma is located in deeper tissues and internal organs, the scope of the operation is determined by the size of the tumor and the degree of germination into the affected organ.
Quite often in the preoperative period they are used conservative methods treatment ( drug therapy, radiation therapy), which results in a reduction in tumor size, which reduces the volume of surgery and causes less injury to nearby organs ( muscles, bones).
Drug treatment of hemangiomas
Until recently, drug therapy was practically not used in the treatment of hemangiomas. However, scientific research recent years found that some drugs have a beneficial effect on the course of the disease, slowing down the growth process and reducing the size of the tumor.However, complete disappearance of hemangioma as a result of drug therapy alone is observed in only 1–2% of cases, therefore this method treatment is most often used as preparatory stage before surgery or physical removal tumors.
| Name of the medication | Mechanism of action | Directions for use and doses |
| Propranolol | The drug blocks certain vascular receptors ( B2-adrenergic receptors), which affects hemangioma. The action of propranolol is due to:
| Taken orally. The initial dose is 1 mg per kilogram of body weight per day, divided into two doses ( in the morning and in the evening). If there is no effect ( manifested in slowing down the growth of hemangioma and reducing its size) the dose can be increased to 3 mg/kg/day. The course of treatment is from 6 months. During treatment, performance indicators should be monitored weekly. of cardio-vascular system (to measure arterial pressure, heart rate, perform an electrocardiogram). |
| Prednisolone | Steroid hormonal drug, the effect of which is due to the activation of scar tissue formation in the area of hemangioma. As a result, the capillaries are compressed, blood flow through them stops, they become empty and destroyed, replaced by scar tissue. The effects of prednisolone are:
| Taken orally after meals with a glass of water.
|
| Vincristine | An antitumor drug, the effect of which is due to the blocking of cell division processes, as a result of which the growth of hemangioma slows down and stops. The drug has a mass side effects, and therefore is prescribed only when other medications are ineffective. | It is administered intravenously, once a week, at a dose of 0.05 - 1 mg per square meter of body surface. During treatment, it is necessary to regularly monitor the composition of peripheral blood ( conduct general analysis blood at least 2 times a month). |
Consequences of hemangioma
If treatment of hemangioma is started incorrectly and untimely, a number of complications can develop that pose a threat to human health and life. Most dangerous complications hemangiomas are:
- germination and destruction of nearby organs;
- destruction of muscles, bones, spine;
- compression and/or destruction of the spinal cord ( with the development of paralysis);
- destruction of internal organs ( liver, kidneys, spleen and others);
- ulceration of hemangioma and infection;
- malignancy;
- thrombocytopenia and anemia;
- cosmetic defect ( untreated hemangiomas and their scars can persist throughout life).
- original location of the tumor;
- speed and nature of growth;
- time of treatment initiation;
- adequacy of treatment measures.
Sclerosing hemangioma of the lungs- benign tumor, first described by A. Libow and D.S. Hubbel in 1956. The authors believed that the tumor originates from vascular endothelial cells. Sometimes it is classified as a hamartoma; a congenital variant of the pathology cannot be ruled out. It is sometimes referred to as an intravascular sclerosing bronchoalveolar tumor. By 1993, foreign literature described 300 cases (84% of women and 16% of men) of sclerosing pulmonary hemangioma. Synonyms for tumor are pneumocystoma, sclerosing angioma, fibroxanthoma, vascular endothelioma, alveolar angioblastoma.
Disease more often it is asymptomatic (in 50-90% of cases according to various authors), sometimes hemoptysis and chest pain are detected. The age of patients ranged from 7 to 83 years (average age 45 years). The literature describes 13 observations of this disease in streets under 20 years of age. The longest duration of the disease without surgical treatment is 30 years.
More often tumor has the appearance of a round or oval node of dense consistency, with a clear boundary, ranging in size from 0.4 to 8.2 cm in diameter (on average 2.8 cm), there are foci of calcification. The tumor grows slowly and affects mainly the lower lobes of the lungs (29% of all locations). The diffuse variant of the tumor is described in 5% of patients. There are four histological types of tumor structure: solid (32%), papillary (28%), hemorrhagic (38%), sclerosing (2%).
Most often microscopically tumor presented different areas with areas with predominant cell type, papillary structure, a combination of cellular and fibrous types, with the formation of hemangiomatous structures. Quite often, infiltration of lymphocytes, plasma cells and mast cells can be observed in the tumor.
Tumor cells usually of medium size, have round, oval or slightly elongated nuclei with reticulate chromatin, centrally located inconspicuous nucleoli, and a small rim of eosinophilically stained cytoplasm. Cell boundaries are usually unclear. The cells usually form papillary structures that are located at the border between hemangiomatous lesions and hemorrhage areas. Sometimes tumor tissue covered with a layer of cuboidal or flat cells. Immunohistochemical examination reveals cytokeratin, epithelial membrane antigen, vimentin, and alkaline phosphatase.
Adjacent to lung parenchyma tumors is compressed, but the tumor does not have a capsule.
Tumor prognosis favorable. It should be differentiated from inflammatory pseudotumor.
Bronchoalveolar tumor.
First tumor was described in 1973. Radiologically, the tumor is represented by multiple nodes in both lungs; an increase in the number and size of nodes can be observed. Tumor cells are of endothelial rather than epithelial origin. At histological examination on initial stages development is visible lymphoid infiltration interalveolar septa with their protrusion into the lumen of the alveoli in the form of polyps.
The part that appears in clearance, covered with hypertrophied type II alveolocytes, the base consists of micromatous connective tissue containing acidic glycosaminoglycans. Subsequently, the stroma hyalinizes, and vesicular nuclei appear in it. As the progression progresses, the alveoli become filled with acellular, pale-colored fibrous tissue, which may become calcified. The same tissue can fill the lumens and walls of the bronchi and bronchioles, branches of the pulmonary artery and veins. The described tumor is slowly progressing with a low degree of malignancy.
