Vascular malformation

Introduction Vascular tumors are also called tubular tumors, or hemangiomas and lymphangiomas respectively; however, some vascular diseases are not true tumors, so they can only be called vascular malformation. It is a tumor or deformity derived from blood vessels or lymphatic vessels. Generally speaking, vascular malformation is a group of abnormal mature blood vessels with certain occupying properties, and the damage is mainly due to rupture and bleeding, or vascular embolism. Hemangiomas are more common in infants born (about 1/3) or shortly after birth (within 1 month). It originates from residual embryonic hemangioblasts. Traditional Chinese medicine believes that it is related to fetal heat and blood heat, which is caused by dysfunction of heart and liver. The histopathological features of hemangiomas are rich in proliferating and active vascular endothelial cells, with angiopoiesis and aggregation of mast cells.

Cause

Causes of vascular malformations

Abnormal expansion and communication of capillaries, veins, and arteries or lymphatic vessels with normal cellular endothelial tissue and biological properties. The vascular endothelial cells did not proliferate abnormally, surrounded by normal reticular connective tissue, and smooth muscle tissue was seen inside. The vast majority (89.3%) were found after birth, and then grew slowly with age, never subsiding.

an examination

Related inspection

Angiography, general radiography, angiography

Examination of vascular malformations

1. Among the tumorous lesions, only the hemangioma is a true tumor, and the others are vascular malformations. Most of the strawberry-like hemangioma in the old classification belongs to this category.

2. Increased venular malformation from the perspective of histopathology, the diameter of the venule should be thinner than the capillary vein (50 ~ 200um). The clinical port-wine stain (PWS) should be a venous malformation rather than a capillary type. The venous malformation should be a cavernous hemangioma in the old classification.

3. The microcapsule type of lymphatic malformation seems to include capillary type and spongy lymphoma in the old classification; while the large cyst type is equivalent to cyst type or cystic water tumor in the old classification.

4. The venous-lymphatic malformation in the mixed type should refer to the so-called spongy lymphangioma in the old classification and clinically. The venous-lymphatic malformation refers to a capillary lymphangioma or a vascular lymphangioma in the old classification.

Differential diagnosis

Vascular malformation confusing symptoms

Hemangioma and vascular malformation are two different vascular diseases, and their treatment methods and prognosis are different. Therefore, it should be distinguished from vascular malformation when diagnosing hemangioma.

In general, hemangiomas and vascular malformations can be identified by the following aspects:

1 onset time: hemangioma mostly occurs from 1 week to 1 month after birth, and vascular malformations have appeared at birth;

2 growth rate: hemangioma has a rapid growth (growth period) and a slow regression (regression period) process. Vascular malformations may develop, but the rate of development is slow;

3 colors: superficial hemangioma is bright red, the color of the proliferative phase gradually deepens, and the color changes from bright red to dark purple at the beginning of retreat, and finally becomes variegated. After the retraction is completed, some children have residual skin and subcutaneous tissue degeneration: scar , atrophy, depigmentation, telangiectasia and loose skin. The skin on the surface of the deep hemangioma is raised, normal color or blue. Vascular malformations have different colors depending on the differences in capillary lymphatic vessels, veins or arteries contained therein;

4 lesion temperature: hemangioma is normal or slightly higher, vascular malformation is significantly increased or normal;

5 texture: hemangioma, such as rubber, can not empty the blood by pressure, the position test is negative, the resolved hemangioma is residual fibrous adipose tissue, the texture becomes soft; and the vascular malformation is soft, easy to compress, finger pressure can Quickly empty the blood, and the position test is positive;

6 imaging examination: mainly color B ultrasound and MRI. Color Doppler: can distinguish between hemangioma and vascular malformation, and further distinguish between various types of vascular malformations. Color B super can show the level, size, blood supply, etc. of the lesion, which is very helpful for treatment; MRI: can not only show the extent of the lesion, but also show the characteristics of hemorheology, distinguishing hemangioma and vascular malformation Gold standard; three-dimensional CT: because it can clearly show the condition of the blood vessels in the lesion and its anatomical relationship with the surrounding tissue, it is helpful for differential diagnosis;

7 Determination of estrogen: The level of serum estradiol in patients with hemangioma is significantly higher than that of vascular malformation and healthy children of the same age;

8 Immunohistochemical examination: basic fibroblast growth factor (bFGF): the concentration of urinary bFGF in children with proliferative hemangioma was significantly higher than that in children with regressive hemangioma, vascular malformation and control. Vascular endothelial cell growth factor (VEGF): The VEGF concentration in the proliferative phase of hemangioma was significantly higher than that in the regressive hemangioma, vascular malformation and negative control. Proliferating cell nuclear antigen (PCNA): The positive rate of PCNA expression and the count of mast cells in proliferative hemangioma were significantly higher than those in infantile hemangioma and various vascular malformations. Glucose transporter-1 (Glut1): In early hyperplasia, more hemangioma endothelial cells express Glut1, and the mid-proliferation phase, most of the microvascular endothelial cells and scattered endothelial cells express Glut1, and the proliferative phase, Glut1 expression is rapidly weakened; Tumor microvascular endothelial cells do not express Glut1. All spongy venous malformations, arteriovenous malformations, capillary malformations, small arteries and veins and microvessels in normal soft tissues do not express Glut1;

9 gene chips can also be used as new tools in the future. It has been reported that infantile hemangiomas are associated with chromosome 5q31-33.

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