Angioma – the collective name of the vascular tumors proceeding from blood or lymphatic vessels. Angioma can have superficial localization (on skin and mucous membranes), to settle down in muscles, internals (heart, lungs, a uterus, a liver, a spleen, etc.), being followed by bleedings of various intensity. Diagnostics angiy is based on data of survey, a radiological research (an angiography, a limfangiografiya), ultrasonography. Superficial angioma can be removed by cryotherapy, electrothermic coagulation, sclerotherapy, X-ray therapy; in other cases surgical intervention is required.
The term "angiom" in vascular surgery unite different anomalies blood (gemangioma) or lymphatic (limfangioma) vessels. According to a number of researchers, the angioma is an intermediate link between a tumor and a malformation.
Angioma can be localized in various fabrics and bodies, happen single and multiple (). The morphological basis of an angioma is made by expanded blood or lymphatic vessels. The sizes and a form angiy vary over a wide range; gemangioma have red-blue color, limfangioma colourless. Angioma meet at children's age more often, making up to 70 — 80% of all congenital new growths at children. Angioma are inclined to progressing, sometimes extremely bystry. The teleangioektaziya should distinguish from an angioma – expansion of blood vessels with existence of arterio-venous aneurisms.
Angioma settle down mainly on the top half of a trunk, including the head and a neck (to 80% of cases). Less often angioma of a throat, lungs, a century and eye-sockets, a liver, bones, genitalia and so forth meet.
Development reasons angiy
In most cases angioma have congenital character. It is considered that development sources angiy are persistiruyushchy fetalny anastomoza between arteries and veins. Increase in an angioma happens due to growth of vessels of the tumor which sprout and destroy surrounding fabrics, like growth of malignant tumors. The true causes congenital angiy are not known.
Sometimes angioma arise after traumatic damages or accompany the course of other diseases (for example, cirrhosis or malignant new growths of internals).
First of all, distinguish angioma of blood vessels (gemangioma) and an angioma of lymphatic vessels (limfangioma).
From the histologic point of view distinguish monomorfny and polymorphic angioma. Monomorfny angioma – the true vascular educations proceeding from this or that element of a blood vessel (a gemangioendotelioma, a gemangioperitsitoma, a leyomioma). The combination of various elements of a vascular wall is a sign of a polymorphic angioma, transition of one type of a tumor to another is possible.
As a structure distinguish the simple, kavernozny, branchy, combined and mixed angioma.
Simple (capillary, hypertrophic) the gemangioma represents growth of neogenic capillaries, small arterial and venous vessels. Capillary gemangioma are localized on skin or mucous in the form of a spot bright red (arterial angioma) or cyanotic-crimson (venous angioma) colors. The sizes capillary gemangiy are various – from limited to huge. When pressing on a vascular tumor, its color turns pale. The capillary gemangioma is extremely seldom transformed to a malignant gemangioendotelioma.
Kavernozny (cavernous) gemangioma are formed by the wide spongy cavities filled with blood. Externally such angioma represents knot of crimson and cyanotic coloring, with a hilly surface and soft a consistence. Or radiological in the thickness of an angioma angiolita or flebolita – dense, spherical shape obezystvlenny blood clots can be defined by Palpatorno. Kavernozny gemangioma usually have a hypodermic arrangement. The symptom of temperature asymmetry - to the touch a vascular tumor more hotly than surrounding fabrics is typical for them. When pressing on a tumor, owing to outflow of blood, the gemangioma is fallen down and turns pale, and at a natuzhivaniye - strains and increases (the so-called, erectile symptom caused by blood inflow).
The branchy (ratselyuzny) gemangioma is presented by a texture of expanded, twisting vascular trunks. Characteristic of this type of an angioma is the pulsation defined over it, trembling and noise, as over aneurism. Meets seldom, it is generally localized on extremities, sometimes on a face. The slightest travmatization of an angioma can cause the menacing bleeding.
The combined gemangioma combine a superficial and hypodermic arrangement (a simple and kavernozny angioma). Clinical manifestations depend on prevalence of this or that component of an angioma.
Gemangioma of the mixed structure proceed from vessels and other fabrics (a gemlimfangioma, an angiofibroma, an angionevroma, etc.).
In a form allocate the following versions angiy: star-shaped, flat, nodal, serpiginozny. Separately among vascular tumors there are senile angioma representing multiple small roundish formations of rose-red color. Senile angioma appear after 40 years.
Among limfangiy allocate simple, kavernozny and cystous vascular educations.
The expanded fabric cracks covered endoteliy and filled with a lymph belong to simple limfangioma. This type angiy develops mainly in muscles of language and lips and externally represents a soft colourless tumor.
Kavernozny limfangioma – the multichamber cavities formed by lymphatic vessels with thick walls from muscular and fibrous tissue.
Cystous limfangioma grow as hilezny cysts and can reach the considerable sizes. They meet in a neck, in a groin, in bryzheyka of guts, zabryushinny cellulose. Accession of a secondary infection can cause formation of fistulas and long, exhausting the patient, .
Clinical manifestations of an angioma depend on type of a vascular tumor, its localization, the sizes and features of a current. Gemangioma usually are found soon after the birth of the child or in the first months of his life. Occur at newborn girls of an angioma by 3-5 times more often than at boys. At babies rapid growth angiy can be observed: so, in 3-4 months the dot gemangioma can increase to several centimeters in the diameter, having taken a considerable surface.
Vascular tumors can settle down on any parts of the body; taking into account localization distinguish angioma of integumentary fabrics (skin, hypodermic cellulose, mucous membranes of an oral cavity and genitals), the musculoskeletal device (muscles and bones), internals (a liver, lungs, etc.). If existence gemangiy integumentary fabrics is followed by cosmetic defect, then gemangioma of internals can lead to different violations of such important functions as breath, food, sight, an urination, defecation.
Bone gemangioma can settle down in a backbone, bones of a basin, a skull, long tubular bones of extremities. In a bone tissue multiple kavernozny angioma which growth can be followed by pains, deformation of a skeleton, pathological changes, radicular a syndrome etc. meet more often. Special danger is constituted by brain angioma which can lead to epilepsy or subarakhnoidalny hemorrhage.
In the course of growth the ulceration and an inflammation angiy with the subsequent development of thromboses and phlebitis can be noted. As the most terrible complication serves the krovoyotecheniye; at a travmatization extensive and gluyoboky angiy the emergency surgery for a bleeding stop can be required. In some cases self-healing angiy, connected with a spontaneous trombirovaniye and a zapustevaniye of the vessels feeding a tumor meets. At the same time the angioma gradually turns pale or completely disappears.
Angioma from lymphatic vessels are found in children of the first year of life more often. As the place of their primary localization serves skin and hypodermic cellulose.
Limfangioma are localized in places of a congestion of regionarny lymph nodes: on a neck, language, lips, cheeks, in axillary and inguinal area, a sredosteniye, a zabryushinny prostranyostvo, in the field of a root of a bryzheyka. They are defined in the form of the painful swelling sometimes reaching the considerable sizes. In most cases growth limfangiy slow, from complications usually meets suppuration.
Diagnostics superficial angiy in typical cases does not represent difficulties and is based on data of survey and a palpation of vascular education. Characteristic coloring and ability to reduction when pressing are characteristic signs of an angioma.
At angioma of difficult localizations the complex of the visualizing researches is used. Bone gemangioma come to light by means of a X-ray analysis of tubular bones, a backbone, edges, bones of a basin, a skull. For diagnostics angiy internals use an angiography of vessels of a brain, kidneys, lungs, a limfangiografiya etc. Ultrasonography allows to determine depth of distribution of an angioma, structure and anatomo-topographical features of an arrangement of a tumor, to measure blood-groove speed in peripheral vessels and a parenchyma of a gemangioma. Angioma drinks come to light during survey of the otolaryngologist.
At suspicion on limfangiy the diagnostic puncture allowing to receive transparent yellowish liquid from a tumor is carried out. The differential diagnosis of a limfangioma is proyovodit with a cyst of a neck, spinal gryyozhy, a lipoma, teratomy, neck lymphadenitis.
Absolute indications to urgent treatment angiy are: rapid growth of a tumor, extensiveness of defeat, localization of vascular education in the head and a neck, an ulceration or bleeding, violation of functioning of the struck body. Waiting tactics is justified at signs of spontaneous regression of a vascular tumor.
Surgical treatment is shown at a deep arrangement of an angioma. Surgical methods of treatment angiy can include bandaging of the bringing vessels, a proshivaniye of a vascular tumor or its full excision within healthy fabrics.
Radiation therapy is applied to treatment angiy difficult anatomic localizations (for example, angiy an orbit or retrobulbarny space) or simple gemangiy the big area. At extensive angioma of external covers sometimes effective is a hormonal treatment Prednisolonum.
Concerning dot angiy electrothermic coagulation, removal by the laser, cryodestruction can be used. At the small, but deeply located angioma skleroziruyushchy therapy - the local injections of 70% of ethyl alcohol causing an aseptic inflammation and scarring of a vascular tumor is applied. Angioma of internals after a preliminary angiography embolization can be subjected.