Angioreticuloma

Introduction to vascular reticuloma Vascular reticuloma is a benign tumor that originates from the embryonic residual tissue of mesodermal cells and is an intracranial true vascular tumor that occurs in the cerebellum. In 1926, Lindau conducted a careful study of vascular reticuloma, and found a relationship between vascular reticuloma and renal tumors, renal cysts and pancreatic cysts, and retinal hemangioma. When the vascular reticuloma of the brain or spinal cord is accompanied by pancreatic, renal cysts or benign tumors of the kidney, it is called Lindau disease. When the retinal hemangioma is associated with a vascular reticuloma of the central nervous system or a pathological change of Lindau disease, it is called vonHippel-LindausDisease (VHL disease). Vascular reticuloma is suitable for surgical treatment, and total resection of the tumor can cure the disease. Cystic vascular reticuloma and solid vascular reticuloma have different surgical methods. Cystic vascular reticuloma only removes small tumor nodules without removing the cyst wall; solid vascular reticuloma requires The entire tumor is removed. basic knowledge Sickness ratio: 0.5% Susceptible people: no special people Mode of infection: non-infectious Complications: intracranial hemorrhage

Causes of vascular reticuloma

Cause (75%):

The etiology of vascular reticuloma is unknown. In 2000, WH0 classified it as an unidentified tumor. Because vascular reticuloma often involves retinal hemangioma pancreatic cysts, pheochromocytoma, etc., and these lesions are derived from the mesoderm and have a family tendency, it is considered to have genetic factors. Oertelt et al believe that about 5% of cases have a family history, which is autosomal dominant, and men and women have the same penetrance. The gene for VHL disease is located on chromosome 3p25-p26, adjacent to 3p13-p14, which contains chromosomal translocations in pure familial renal cell carcinoma.

Pathogenesis (20%):

Vascular reticuloma is a result of an obstacle that occurs during integration between mesoderm and epithelial tissue components due to the continued lack of integration between blood vessels and parenchyma. It is easy to occur in the cerebellum because the embryo participates in the development of the cerebellum at the third month. Such tumors originate from the blood vessels that form the choroid plexus of the fourth ventricle. Sabin believes that vascular reticuloma is caused by interstitial differentiation to produce vascular primitive plasma and red blood cells. In the tumor, the formation of blood vessels is preceded by the appearance of obvious cytoplasmic vacuoles, which are then gradually liquefied, resulting in the original plasma and the tumor cyst fluid as the original plasma.

The tumor can be seen by the naked eye as cystic or cystic, and there are also cystic changes in the tumor. The tumor is clear, purple-red, tough, with different diameters, and is closely related to the brain tissue. There may be vasodilation near the meninges. There may be brownish yellow hemosiderin deposited in the wall of the capsule and in the tumor nodules. 80% of tumors are cystic, especially those with cerebellar vesicles. The capsule contains yellow or yellow-brown liquid, mostly between 10 and 100 ml. The cystic fluid protein content is high and it is easy to solidify into a jelly-like form. The protein content of the cyst fluid can be up to 3~4g per 100ml, and the tumor wall of the tumor exudate is smooth, there is a tumor nodule rich in blood vessels, and 1/4 tumor is rich in substantial blood supply such as sinusoidal red tumor. The nodules protrude into the capsule about 2cm in size, but some tumor nodules are less than 1cm, and some are even hidden in the wall of the capsule. It is not easy to be found. The larger the individual tumors are up to 10cm in diameter, which is purple bright red, yellow soft, blood. It is easy to bleed and clear the boundary with surrounding brain tissue. In most cases, a single case of a single tumor may have multiple tumors distributed in different parts of the brain.

Vascular reticuloma prevention

Don't be too salty. If you reduce salt, salted products, and eat more fresh vegetables and fruits, the incidence of gastric cancer will decline. Nitrite is the number one killer of tumors. Non-fresh vegetables, pickled ham, and kimchi all contain this carcinogen. Under normal conditions, the nitrite in the diet will not cause harm to human health. Only when the nitrite is excessively ingested and the body lacks vitamin C, it will cause harm to the human body.

Vascular reticuloma complications Complications intracranial hemorrhage cerebral edema

1. Intracranial hemorrhage or hematoma is not related to intraoperative hemostasis. With the application of surgical microscope and the improvement of surgical techniques, this complication has rarely occurred. Careful hemostasis before the wound can be used to reduce or avoid postoperative intracranial hemorrhage.

2. Cerebral edema and postoperative high intracranial pressure can be used to reduce intracranial pressure glucocorticoids to reduce brain edema.

3. The loss of nerve function is related to the important functional area and important structure of intraoperative injury. The injury should be avoided as much as possible during the operation.

Symptoms of vascular reticuloma common symptoms, visual acuity, dizziness, drinking water, cough, difficulty swallowing, hoarseness

The history of the disease varies, and the growth of the solid tumor is slow. It can last for several years or longer. The cystic period is shorter than weeks, weeks or years. Occasionally, acute onset of tumor due to sudden cystic changes or tumor stroke. The posterior cranial fossa tumor is easy to oppress and block the fourth ventricle, causing cerebrospinal fluid circulation obstruction, and its course of disease is also short. Tumors located in the cerebellar hemisphere often have increased intracranial pressure and cerebellar symptoms with a forced head position. 90% of patients have symptoms of increased intracranial pressure, manifested as headache, dizziness, vomiting, optic disc edema and vision loss. Vomiting is seen in 80% of cases, vision loss accounts for 30%, and neck stiffness accounts for 11%. Cerebellar tumors are often accompanied by nystagmus, ataxia, unstable walking, dizziness, vision loss, posterior group cranial nerve palsy, etc. Individual cases have medullary symptoms, manifested as dysphagia, throat hoarseness, hiccups, throat reflex disappearance diet Cough and so on. Those located in the cerebral hemisphere may have corresponding symptoms and signs depending on their location, and may have different degrees of hemiplegia and hemianopia of the lateral sensory disturbance. A few have seizures.

In addition, clinical manifestations are related to pathological typing. Capillary and mixed tumors are prone to form larger cysts. The symptoms of increased intracranial pressure are rapid, the course of disease is short, and the symptoms of forced head and brain stem are prone to occur. Cell type tumors have higher physical components, slower progression, and later onset of symptoms. Sponge type is prone to intratumoral hemorrhage, with a short course of disease, large fluctuations in symptoms, and often sudden deterioration. If the bleeding breaks into the subarachnoid space, meningeal irritation may occur.

Physical examination may have cranial nerve disorders, trigeminal sensation hypothyroidism, and III, IVVI cranial nerve partial paralysis. 90% of patients have optic disc edema on the fundus, and a few have visible hemangioma or tumor hemorrhage. Congenital diseases of the internal organs include hepatic cysts, polycystic kidney disease, epididymitis, adrenal pheochromocytoma, epididymal tubular adenoma, and the like.

Examination of vascular reticuloma

1.CT performance:

1 Cyst type: The cystic low-density area with larger cerebellar hemisphere, CT value is about 10HU. The flat-walled nodules with equal density can be seen from several millimeters to 2cm, and the tumor edge is clear.

2 Substantial type: The lumps are of equal density or slightly higher density during plain scan, and are nodular or lobulated, with unsmooth edges or pointed protrusions.

3 can have edema around the tumor, but also no edema. Can be accompanied by hydrocephalus on the screen.

4 When the enhanced scan is performed, the wall nodules or solid masses are obviously evenly strengthened.

2. MR performance:

1 lesions are mostly located in the posterior fossa (cebra hemisphere, crotch), round, more clear and sharp edges, contoured.

2 Tumors showed a uniform cystic lesion and a small wall nodule protruding into it; T1 weighted cystic area was low signal, wall nodule was equal signal; T2 weighted cystic area was higher signal, nodule was relative Low signal.

3 often one or more thick blood vessels reach into the stove.

4 The posterior wall nodules were obviously strengthened, and the surrounding cystic areas were not strengthened.

5 The fourth ventricle is often under pressure, causing hydrocephalus on the screen.

Diagnosis and diagnosis of vascular reticuloma

Diagnostic criteria

The majority of intracranial vascular reticuloma occurs under the curtain. Adults with symptoms of cerebellar tumor and increased intracranial pressure should consider the possibility of this disease, especially the following:

1. Patients with vascular reticuloma have been confirmed in the family.

2. There are true red blood cell hyperplasia and hyperhemoglobinemia.

3. Retinal hemangioblastoma was found in the eye.

4. Hepatic hemangioma, polycystic kidney disease, pancreatic cyst, etc. were found in the abdominal viscera.

5. Confirmed and diagnosed by cerebral angiography, CT and MRI.

Differential diagnosis

1 Cerebellar astrocytic glioma: When cystic lesions are predominant, wall nodules are often larger, may have calcification, and enhanced enhancement of scanning wall nodules is often more obvious, but less than hemangioblastoma. MR can sometimes show a vascular shadow of a blood flow signal in a tumor of a hemangioblastoma, which can provide more information for its differential diagnosis.

2 metastatic tumor: a nodular or ring-enhanced mass, the margin of the nodule is regular, smooth, peritumoral edema is more obvious, can be multiple lumps, and most occur in middle-aged and elderly people, most have a history of primary tumor. Generally not difficult to identify.

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