Angioma is a collective name for vascular tumors originating from blood or lymphatic vessels. Diseases can have a superficial localization (on the skin and mucous membranes), located in muscles, internal organs (heart, lungs, uterus, liver, spleen, etc.), accompanied by bleeding of varying intensity. Diagnosis is based on examination data, X-ray examination (angiography, lymphangiography), ultrasound. Superficial angiomas can be removed by cryotherapy, electrocoagulation, sclerotherapy, X-ray therapy; in other cases, surgical intervention is required.
D18.0 Hemangioma of any localization
The term “angioma” in vascular surgery combines various kinds of anomalies of blood (hemangiomas) or lymphatic (lymphangiomas) vessels. According to a number of researchers, the disease is an intermediate link between a tumor and a malformation. Angiomas can be localized in various tissues and organs, there are single and multiple (angiomatosis).
The morphological basis of angioma consists of dilated blood or lymphatic vessels. The size and shape of angiomas vary widely; hemangiomas have a red-blue color, lymphangiomas are colorless. They are more common in childhood, accounting for up to 70-80% of all congenital neoplasms in children. This pathology is prone to progression, sometimes extremely fast. Telangiectasia should be distinguished from angioma – dilation of blood vessels with the presence of arterio-venous aneurysms. Angiomas are located mainly on the upper half of the trunk, including the head and neck (up to 80% of cases). Angiomas of the pharynx, lungs, eyelids and eye sockets, liver, bones, external genitalia, etc. are less common.
Causes of angioma
In most cases, angiomas are congenital in nature. It is believed that the sources of development are persistent fetal anastomoses between arteries and veins. The increase in size occurs due to the proliferation of the vessels of the tumor itself, which germinate and destroy the surrounding tissues, similar to the growth of malignant tumors. The true causes of congenital angiomas are not known.
Sometimes angiomas occur after traumatic injuries or accompany the course of other diseases (for example, cirrhosis of the liver or malignant neoplasms of internal organs).
First of all, there are angiomas of blood vessels (hemangiomas) and lymphatic vessels (lymphangiomas). From a histological point of view, monomorphic and polymorphic forms are distinguished. Monomorphic – true vascular formations originating from one or another element of a blood vessel (hemangioendotheliomas, hemangiopericytomas, leiomyomas). A sign of polymorphic angioma is a combination of various elements of the vascular wall, the transition of one type of tumor to another is possible.
Types of hemangiomas
According to the type of structure, there are simple, cavernous, branched, combined and mixed.
- Simple (capillary, hypertrophic) is an overgrowth of newly formed capillaries, small arterial and venous vessels. Capillary hemangiomas are localized on the skin or mucous membranes in the form of a spot of bright red (arterial angiomas) or bluish-purple (venous) color. The sizes of capillary hemangiomas vary – from limited to giant. When pressing on a vascular tumor, its color pales. Capillary hemangioma rarely transforms into malignant hemangioendothelioma.
- Cavernous (cavernous) are formed by wide spongy cavities filled with blood. Externally, such a tumor is a node of purplish-cyanotic color, with a bumpy surface and a soft-elastic consistency. Palpationally or radiographically, angiolitis or phlebolitis can be detected in the thickness – dense, spherical, decontaminated blood clots. Cavernous hemangiomas usually have a subcutaneous location. For them, a typical symptom of temperature asymmetry is that the vascular tumor is hotter to the touch than the surrounding tissues. When pressing on the affected area, due to the outflow of blood, the hemangioma subsides and pales, and when straining, it tightens and increases (the so-called erectile symptom caused by blood flow).
- Branched (raceluse) hemangioma is represented by a plexus of expanded, sinuous vascular trunks. A characteristic feature of this type is the pulsation, trembling and noises defined above it, as over an aneurysm. It is rare, mainly localized on the extremities, sometimes on the face. The slightest traumatization of an angioma can lead to threatening bleeding.
- Combined combine a superficial and subcutaneous location (simple and cavernous angioma). Clinical manifestations depend on the predominance of one or another component. Hemangiomas of mixed structure originate from vessels and other tissues (hemlimphangiomas, angiofibromas, angioedromas, etc.).
The following types of angiomas are distinguished by shape: stellate, flat, nodular, serpiginous. Separately in the row of vascular tumors are senile angiomas, representing multiple small rounded formations of pink-red color. Senile angiomas appear after 40 years.
Types of lymphangiomas
Among lymphangiomas, simple, cavernous and cystic vascular formations are distinguished.
- Simple include enlarged tissue slits lined with endothelium and filled with lymph. This type develops mainly in the muscles of the tongue and lips and outwardly represents a soft colorless tumor.
- Cavernous are multi-chamber cavities formed by lymphatic vessels with thick walls of muscle and fibrous tissue.
- Cystic grow like chyletic cysts and can reach significant sizes. They are found in the neck, in the groin, in the mesentery of the intestines, retroperitoneal tissue. The addition of a secondary infection can cause the formation of fistulas and prolonged, debilitating lymphorrhea.
Symptoms of angioma
Clinical manifestations depend on the type of vascular tumor, its localization, size and features of the course. Hemangiomas are usually found shortly after the birth of a child or in the first months of his life. Newborn girls are 3-5 times more common than boys. Infants may experience rapid growth: for example, in 3-4 months, a point hemangioma can increase to several centimeters in diameter, capturing a significant surface.
Vascular tumors can be located on any part of the body; taking into account the localization, angiomas of the integumentary tissues (skin, subcutaneous tissue, mucous membranes of the oral cavity and genitals), musculoskeletal system (muscles and bones), internal organs (liver, lungs, etc.) are distinguished. If the presence of hemangiomas of the integumentary tissues is accompanied by a cosmetic defect, then hemangiomas of internal organs can lead to various kinds of violations of such important functions as breathing, nutrition, vision, urination, defecation.
Bone tumors can be located in the spine, pelvic bones, skull, long tubular bones of the extremities. In the bone tissue, multiple cavernous forms are more common, the growth of which can be accompanied by pain, skeletal deformity, pathological fractures, radicular syndrome, etc. Brain angiomas are particularly dangerous, which can lead to epilepsy or subarachnoid hemorrhage.
During the growth process, ulceration and inflammation of angiomas may occur, followed by the development of thrombosis and phlebitis. The most threatening complication is bleeding; when extensive and deep angiomas are traumatized, emergency surgery may be required to stop the bleeding. In some cases, there is self-healing associated with spontaneous thrombosis and desolation of the vessels feeding the tumor. In this case, the angioma gradually fades or disappears completely.
Angiomas from lymphatic vessels are more often found in children of the first year of life. The place of their predominant localization is the skin and subcutaneous tissue. Lymphangiomas are localized in places of accumulation of regional lymph nodes: on the neck, tongue, lips, cheeks, in the axillary and inguinal regions, mediastinum, retroperitoneal space, in the mesentery root area. They are defined as painful swelling, sometimes reaching significant sizes. In most cases, the growth of lymphangiomas is slow, suppuration is usually found among the complications.
Diagnosis of angioma
Diagnosis of superficial angiomas in typical cases is not difficult and is based on the data of examination and palpation of vascular formation. Characteristic coloration and the ability to contract when pressed are characteristic features. For complex localizations, a complex of imaging studies is used:
- Radiography. Bone is detected by radiography of tubular bones, spine, ribs, pelvic bones, skull. For the diagnosis of internal organs, angiography of the vessels of the brain, kidneys, lungs, lymphangiography, etc. is used.
- Ultrasound. Ultrasound examination makes it possible to determine the depth of the spread, structure and anatomical and topographic features of the tumor location, to measure the blood flow rate in the peripheral vessels and parenchyma of the hemangioma.
- Other research. Pharyngeal angiomas are detected during an examination by an otolaryngologist. If a lymphangioma is suspected, a diagnostic puncture is performed, which allows to obtain a clear yellowish liquid from the tumor.
Differential diagnosis is carried out with a neck cyst, spinal hernia, lipoma, teratoma, neck lymphadenitis.
Treatment of angiomas
Absolute indications for emergency treatment are: rapid growth of the tumor, the extent of the lesion, localization of vascular formation in the head and neck, ulceration or bleeding, impaired functioning of the affected organ. A wait-and-see tactic is justified with signs of spontaneous regression of a vascular tumor.
- Surgical treatment. Shown at a deep location. Surgical methods of treating angiomas may include ligation of adductor vessels, stitching of a vascular tumor or its complete excision within healthy tissues.
- Radiation therapy. It is used for the treatment of complex anatomical localizations (for example, angiomas of the orbit or retrobulbar space) or simple hemangiomas of a large area. With extensive angiomas of the outer integuments, hormonal treatment with prednisone is sometimes effective.
- Methods of physical destruction. Electrocoagulation, laser removal, cryodestruction can be used for point forms.
- Sclerotherapy. In small, but deeply located places, sclerosing therapy is used – local injections of 70% ethyl alcohol, causing aseptic inflammation and scarring of the vascular tumor.
- Embolization. Angiomas of internal organs after preliminary angiography can be embolized.