Hemangioma

Introduction to hemangioma Hemangioma (haemangioma) is a congenital benign tumor or vascular malformation. It is more common in infants born or shortly after birth. It originates from residual embryonic hemangioblasts, and active endothelium-like germs invade adjacent tissues to form endothelial-like veins. After management, it is connected with the remaining blood vessels to form a hemangioma. The intratumoral blood vessels are self-contained and are not connected to the surrounding blood vessels. Hemangioma occurring in the oral and maxillofacial region accounts for 60% of systemic hemangioma, most of which occurs in facial skin, subcutaneous tissue and oral mucosa, such as tongue, lip, and fundus, and a few occur in the jaw or deep tissue. . basic knowledge The proportion of illness: 0.005% Susceptible population: more common in the birth of a baby or shortly after birth Mode of infection: non-infectious Complications: congestive heart failure

Hemangioma etiology

Causes:

At present, most scholars believe that during the development of human embryos, especially in the early stages of vascular differentiation, due to the small-scale misconfiguration of the control gene segments, the tissue differentiation of specific parts is abnormal and develops into hemangioma. In the early embryonic period (8-December), the embryonic tissue is mechanically damaged. Local tissue hemorrhage causes some hematopoietic stem cells to be distributed to other embryonic characteristic cells, some of which differentiate into vascular-like tissues and eventually form hemangioma.

Pathogenesis:

Aneurysms are composed of a large number of proliferating blood vessels. In the early embryos, the primitive vessels are tubular bodies composed solely of endothelial cells. They form a dense network in the middle of the interstitial, and then with the development of various organs, the original veins. The pipe network gradually differentiates into many vascular plexuses and lymphatic plexus associated with organs.

During the embryonic development of blood vessels, there are roughly plexiform stages, three stages of reticular stage and tube dry period. If obstacles or abnormalities occur during normal development of a certain stage, abnormalities of normal developmental morphology at this stage may occur. In the plexus stage, if some capillaries stop developing, capillary hemangioma will occur; in the reticular stage, if the enlarged blood vessels gather into a mass and tend to fuse together, a cavernous hemangioma can be expressed.

Microscopically, the hemangioma has various forms, but the basic structure is similar, that is, there are well-developed vascular-like tissues, such as the outer layer, the middle layer and the intima epithelium. The diameter of the lumen is 1 to 10 mm, and there is connective between the blood vessels. The tissue is a matrix, and the common clinical hemangioma is cavernous hemangioma, capillary hemangioma and mixed type 3.

1. Capillary hemangioma: has well-developed monolayer endothelial cells and a small amount of connective tissue as the matrix. There are only a small number of blood cells in the lumen, which is a localized lobulated mass with clear boundaries and slightly protruding on the skin surface. The color is bright red and varies in size. Due to the narrow lumen, it rarely turns white when pressed.

2. Cavernous hemangioma: has well-developed blood vessels, wide lumen, full of blood cells, soft body, protruding on the skin surface, unclear boundaries, purple blue, compressive, whitened after being compressed Cavernous hemangioma is larger and thicker than capillary hemangioma, often invading subcutaneous tissue, and is dilatant, often invading deep tissues in the neck.

3. Capillary-cavernous hemangioma (mixed type): It has the characteristics of the above two kinds of hemangioma, which is more common, and capillary hemangioma is often distributed on the surface of cavernous hemangioma.

Hemangioma prevention

External treatment and compression method, long-term use cotton pad or rubber sponge directly placed outside the affected area, injection method, with Xiaozhiling injection and 1% procaine 1:1 injection into the tumor, the dose depends on the size of the tumor It is generally injected 4-5 ml in the range of 3 cm.

Hemangioma complications Complications, congestive heart failure

Complications of hemangioma include ulcers, hemorrhage, infection, vital organ dysfunction, congestive heart failure and limb deformity caused by musculoskeletal damage. For example, hemangioma invades the cervical vertebra, and nerve root compression symptoms such as pain and upper limbs may occur. Feelings and movement disorders.

The syndrome of hemangioma is:

1, bone hypertrophic varices.

2, thrombocytopenia hemangiomas syndrome.

3, brain facial tube tumor syndrome.

4, abnormal chondroma hemangioma syndrome.

5, Lindon-Von-Hippel syndrome.

6, Steiner-Vorner syndrome.

7, hemangioma balloon tumor.

Symptoms of hemangioma Common symptoms Thumb, food, middle finger... Diffuse vascular keratosis vascular malformation Liver congestion, swallowing, airway obstruction

1. Appearance characteristics of the tumor (wine spot or bayberry, etc.).

2. Fading or shrinking.

3. Positive position test, percussion and venous stone, puncture and extraction of whole blood (sponge type), sputum pulsation, auscultation, murmur, compression of the blood supply artery and murmur disappeared (vine-like).

4. Angiography shows contrast agent concentration or vascular malformation.

5. Histopathological examination confirmed the diagnosis.

The symptoms and signs of cervical hemangioma depend on the type, size, invasion site, depth and extent of the tumor. Most hemangioma invade superficial tissues, such as subcutaneous tissue of the skin; invading muscles, deep blood vessels, throat, and pharynx, There are fewer tissues such as cervical vertebrae. If they have invaded deep tissues, some corresponding symptoms such as dysphagia, airway obstruction, vomiting, and massive bleeding may occur.

Hemangioma examination

1, line head plain film examination: in some cases, calcification spots and vascular groove thickening, a small number of increased intracranial pressure or pineal body displacement.

2, EEG examination: It has been reported that 90% of cases of cerebral vascular malformations present EEG abnormalities, mostly localized abnormalities, only a few are diffuse changes. EEG abnormalities have nothing to do with the age and stage of the sick child. The range of cerebral vascular malformations is more than 2 to 3 cm in diameter or hematomas are present. The EEG changes are more significant, and the authors of epilepsy are more common. The deformity is located in the parotid lobe with more localized abnormalities than the occipital lobe and posterior fossa.

3, imaging examination: is an important method to determine the location and extent of cerebrovascular disease.

Diagnosis and diagnosis of hemangioma

diagnosis

According to the clinical manifestations, the diagnosis of cervical hemangioma is not difficult. However, if some important organs such as the carotid artery and the throat are invaded in the deep neck, special attention should be paid to the diagnosis. The puncture of the tumor is very helpful for diagnosis. For example, blood can be diagnosed.

Differential diagnosis

Different from glomus tumor, angiosarcoma, etc., its characteristics are as follows:

1. A glomus tumor refers to a sharp painful mass in the toenail bed and its vicinity. The pain is particularly painful when it is cold. It is located in the lower jaw. It can be seen that the toenail is locally raised and the surface may be light red, purple or slightly dark. Do not let touch.

2. Angiosarcoma is rare, the tumor is nodular, painless, purple-red, superficially easy to hemorrhage and ulceration, many scattered and disorderly tumor vessels seen under the microscope, tumor cells proliferate in the basement membrane, Attached to the inner wall of the blood vessel, forming a nodular protrusion in the lumen, the tumor cells are mostly fusiform, the undifferentiated person is polygonal, the endothelium-like cells, the nucleus is large, the deep staining, the nuclear division is more, and the multinuclear giant cells are visible.

Immunohistochemistry is of great significance for the diagnosis and differential diagnosis. Sensitive endothelium markers, VIII-related antigens, CD31, CD34, etc. can be selected to help diagnose.

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