angioma is the collective term for vascular tumors that originate from blood or lymphatic vessels. Angiomas can be superficially localized (on the skin and mucous membranes), in the muscles, in the internal organs (heart, lungs, uterus, liver, spleen, etc.), accompanied by bleeding of different intensities. The diagnosis of angiomas is based on examination data, X-ray examination (angiography, lymphangiography), ultrasound. Surface angiomas can be removed by cryotherapy, electrocoagulation, sclerotherapy, X-ray therapy; In other cases, surgical intervention is required.
The term “angioma” in vascular surgery combines various anomalies of the blood vessels (hemangiomas) or lymphatic vessels (lymphangiomas). According to a number of researchers, angioma is an intermediate link between a tumor and a developmental malformation.
Angiomas can be localized in different tissues and organs, single and multiple (angiomatosis). The morphological basis of the angioma consists of enlarged blood vessels or lymphatic vessels. The size and shape of the angiomas is very different; Hemangiomas have a red-blue color, lymphangiomas are colorless. Angiomas occur more frequently in childhood and account for up to 70-80% of all congenital malformations in children. Angiomas are prone to progression, sometimes extremely quickly. Angioma should be distinguished from telangiectasias – the dilation of blood vessels with the presence of arterio-venous aneurysms.
Angiomas are mainly found in the top Half of the trunk, including the head and neck (up to 80% of cases). Fewer frequently are angiomas of the throat, lungs, eyelids and eye sockets, liver, bones, external genital organs, etc.
Causes of angiomas
In most cases, angiomas are congenital. The sources of angiomas are believed to be persistent fetal anastomoses between arteries and veins. Angioma increases due to the growth of the tumor’s vessels themselves, which germinate and destroy surrounding tissues, such as the growth of malignant tumors. The real causes of congenital angiomas are not known.
Sometimes angiomas appear after traumatic injuries or accompany other diseases (e.g. cirrhosis of the liver or malignant neoplasm of internal organs).
Classification of angiomas
First, angiomas are differentiated from blood vessels (hemangiomas) and angiomas from lymphatic vessels (lymphangiomas).
From a histological point of view, a distinction is made between monomorphic and polymorphic angiomas. Monomorphic angiomas are the actual vascular formations that originate from a certain element of the blood vessel (hemangiendothelioma, hemangioperitocytes, leiomyomas). A sign of polymorphic angioma is the combination of different elements of the vascular wall, it is possible to change one type of tumor into another.
Types of hemangiomas
The type of structure distinguishes simple, cavernous, branched, combined and mixed angiomas.
A simple (capillary, hypertrophic) hemangioma is the proliferation of newly formed capillaries, small arterial and venous vessels. Capillary hemangiomas are localized on the skin or mucous membranes in the form of bright red (arterial angiomas) or bluish violet (venous angiomas). The sizes of the capillary hemangiomas vary – from limited to large. When pressed on the vascular tumor, its color fades. The capillary hemangioma is very rarely converted into a malignant hemangiothothelioma.
Cavernous (cavernous) hemangiomas are formed by wide, sponge-like cavities filled with blood. Externally, such an angioma is a cluster of purple cyanotic color with a bumpy surface and a soft, elastic consistency. Palpable or radiological in the thickness of the angioma, angiolitis or phlebolitis can be determined – dense, globular, deformed thrombi. Cavernous hemangiomas usually have a subcutaneous position. For them, a symptom of temperature asymmetry is typical – when touched, the vascular tumor is hotter than the surrounding tissue. When pressure is placed on the tumor, the hemangioma resigns and fades due to blood drainage, and when tense, it becomes stressed and increased (the so-called erectile symptom caused by the blood flow).
The branched (ratseluznaja) hemangioma is represented by the wreath of sinuous, twisted vascular strands. A characteristic feature of this type of angioma is the pulsation, jitter and noise above it, above the aneurysm. It is rare, mainly localized on the limbs, sometimes on the face. The slightest trauma in angiomas can lead to threatening bleeding.
Combined hemangiomas combine superficial and subcutaneous localization (simple and cavernous angioma). The clinical manifestations depend on the predominance of one or the other component of the angioma.
Hemangiomas of a mixed structure come from vessels and other tissues (hemlympangiomas, angiofibromas, angioneuromas, etc.).
In the form of the following types of angiomas: star-shaped, flat, nodular, serpentine. Old angiomas are separated in a series of vascular tumors, representing several small, rounded formations of pink-red color. Older angiomas appear after 40 years.
Types of lymphangiomas
A distinction is made between simple, cavernous and cystic vascular formations among the lymphangiomas.
Simple lymphangiomas include enlarged, endothelial-lined and lymph-filled tissue gaps. This type of angioma mainly develops in the muscles of the tongue and lips and is a soft, colorless tumor on the outside.
Cavernous lymphangiomas are multi-chamber cavities formed by lymphatic vessels with thick walls made of muscle and fiber tissue.
Cystic lymphangiomas grow as a type of chill cyst and can reach considerable dimensions. They are found in the neck, in the groin area, in the mesentery of the intestine, retroperitoneal tissue. Attachment of a secondary infection can cause fistulas and prolonged, exhausting patients to cause lymphorrhea.
Symptoms of angiomas
Clinical manifestations of angiomas depend on the type of vascular tumor, its location, size, and flow properties. Hemangiomas are usually found shortly after the birth of the child or in the first months of life. Angiomas are 3-5 times more common in newborns than in boys. A rapid increase in angiomas can be observed in infants: for example, the spotted hemangioma can reach a diameter of several centimeters within 3-4 months and capture a significant surface.
Vascular tumors can be placed on any part of the body; Localization distinguish angioma pokrownym tissues (skin, subcutaneous tissue, the mucous membranes of the mouth and genitals), musculoskeletal system (bones and muscles), the internal organs (liver, lungs, etc.). If the presence of hemangiomas accompanies pokrownym tissues cosmetic defect, the hemangioma internal organs can lead to various disorders such important functions as breathing, nutrition, vision, urination, defecation.
Bone hemangiomas located in the back, pelvis, skull, long tubes, extremity bones. The bones more often have multiple erectile tissue angiomas that can be accompanied by pain growth, skeletal malformations, pathological fractures, radicular syndrome and t. D. Angiomas are particularly dangerous brains that can lead to epilepsy or subarachnoid hemorrhage.
As the growth progresses, ulceration and inflammation with angiomas can be observed, followed by the development of thrombosis and phlebitis. The most serious complication is bleeding; If large and deep angiomas are traumatized, emergency surgery may be required to stop the bleeding. In some cases, self-healing angiomas occur, which are associated with spontaneous thrombosis and obliteration of the vessels that supply the tumor. At the same time, the angioma fades or disappears completely.
Angiomas from lymphatic vessels are more commonly found in children of the first year of life. The location of their primary location is the skin and subcutaneous tissue.
Lymphangiomas are located in places where regional lymph nodes accumulate: on the neck, tongue, lips, cheeks, armpits and groin, mediastinum, retroperitoneum, in the area of the mesentery root. They are defined as painful swelling, which sometimes reaches a significant size. In most cases, the growth of lymphangiomas is slow, of complications, usually suppurative.
Diagnosis of angiomas
The diagnosis of superficial angiomas in typical cases is not difficult and is based on examination and palpation data of vascularization. The characteristic color and the ability to contract with pressure are characteristic signs of angioma.
For angiomas of complex localizations, a complex of visualization studies is used. Bone detects hemangioma by radiography of long bones, spine, ribs, pelvis, skull. For the diagnosis of internal organs angiomas, angiography used brain vessels, kidneys, lungs and limfangiografiyu t. D. Ultrasound examination to determine the deep angioma distribution structure and anatomical location and topographical features of the tumor, measured blood flow velocity in the peripheral vessels and parenchymal hemangioma. Angioma throat found during the ENT doctor inspection.
If lymphangitis is suspected, a diagnostic puncture is held so that a clear yellowish liquid is obtained from the tumor. The differential diagnosis of lymphangioma is carried out with a cyst of the neck, spinal hernia, lipoma, teratoma, lymphadenitis of the neck.
Treatment of angiomas
Absolute indications for urgent treatment of angiomas are: the rapid growth of the tumor, extensive lesions, localization of vascular lesions of the head and neck, ulcerations or bleeding, disorders of the function of the affected organ. Observative waiting if justified signs of spontaneous regression of tumor vessels are warranted.
Surgical treatment is indicated with deep angioma. Surgical treatments can include angiomas resulting in vascular suturing, vascular tumor suturing, or complete excision within healthy tissue.
Radiation therapy is used to treat angiomas of complex anatomical locations (e.g. angiomies of the eye socket or the retrobulbar area) or simple large hemangiomas. With extensive angiomas of the outer cover layers, hormone therapy with prednisolone is sometimes effective.
With regard to point angiomas, electrocoagulation, laser removal, cryodestruction can be used. For small but deep angiomas, sclerotherapy is performed – local injections of 70% ethyl alcohol that cause aseptic inflammation and scarring of the vascular tumor. Internal organ angiomas after preliminary angiography may undergo embolization.
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