Hemangiomas can be divided into two types in nature: one is abnormal vascular development during embryonic development, vascular malformation (hamartoma) caused by excessive development or abnormal differentiation of blood vessels, and the other is true due to abnormal proliferation of vascular endothelial cells. Tumor. According to its structure, it is divided into four types, and the clinical course and prognosis are different. In addition, hemangioma is often one of the manifestations of certain syndromes, such as Sturge-Weber syndrome, which is wine pigmented spot and ipsilateral leptomeningoma, Klippel Trenaunna's triple syndrome, which is wine pigmented spot plus venous malformation, and differences in limb length; Parkes-Weber' syndrome is similar to Klippel Trenaunay's triad syndrome, and the latter is often accompanied by arteriovenous fistulas.
Common types
Orange spots: present after birth, the size of the spots varies, and they are orange-red or light red. They are not higher than the surface of the skin. They will fade with light pressure. The color will become darker when crying. Orange spots are more common on the forehead, upper eyelids, and occipital area. They usually disappear on their own within a few months after birth and do not need to be treated.
Port wine stains: also known as port wine stains. It is present after birth. It is a light red or dark red patch that does not fade when pressed, does not rise above the surface of the skin, is located in the dermis, and is composed of a network of capillaries. After birth, erythema increases in proportion to the growth of the body, but the scope does not expand. Nevus erythematosus does not go away on its own. In addition to affecting the appearance of erythema, there are generally no other hazards. If necessary, cryotherapy can be used.
Capillary hemangioma: It is more common in the skin, with the most common in the occiput, head, face, limbs and back. It is no longer longer than the lips and tongue. Capillary hemangiomas vary in size. The large ones can occupy most of the face or limbs, and the small ones are only a few millimeters higher than the skin. Capillary hemangioma generally exists after birth, grows rapidly within 6 months, and gradually stops growing after one or two years of age. It affects the appearance, and there is a risk of hemorrhage after damage. Parents should pay close attention to it. If the hemangioma is small, the growth rate is slow, and it is not in the exposed area, it can disappear after it stops growing. If the hemangioma grows faster and seriously affects the appearance, it should be treated immediately, and can be treated with isotope application and other methods.
Cavernous hemangioma: It can occur in the skin, subcutaneous tissue, muscle, and even liver and kidney. The appearance is purple-red, with tortuous and swollen venules around it. The palpable is soft and elastic. It shrinks when squeezed, and recovers when the pressure is removed. This type of hemangioma increases with the age of the baby, and sometimes grows very large and deep, severely damaging the appearance and destroying normal tissues. Once the diagnosis is confirmed, treatment should be carried out immediately, with injection of sclerosing agent or surgical resection.
Triangular hemangioma: It is more common in the extremities. There are many branch-shaped expanded blood vessels on and around the surface. The skin is dark red or blue-purple in partial twists and turns. Sometimes the blood vessels may be pulsating or blood vessel murmurs may be heard. For this type of hemangioma, surgery should be done as soon as possible, and elastic bandages can also be used to wrap the limbs to relieve symptoms such as soreness in the limbs.
Keratinizing hemangioma: Keratinizing hemangioma is rare, more common in children or young people, but can also be seen in the elderly. Some manifested as red or dark red round papules on the extended side of the toe (finger), with warty-like proliferation on the surface, rough and hard. Strong pressure can fade, and the capillary network can be seen in the center. This type is more common in women. The other is male patients, which are more common in middle and old age. They are red or dark red round maculopapular rashes of the whole scrotal skin. The surface is hyperkeratosis, rough and hard. Lesions can occur frequently, often complicated by varicocele.
Diagnosis
The diagnosis of blood vessel or vascular malformation is not difficult. Deep hemangioma or vascular malformation should be confirmed by body movement experiment and puncture.
1. The appearance of the tumor (wine spot or bayberry, etc.).
2. Press to fade or shrink.
3. Positive body position test, palpation and phlebolithiasis, puncture and draw out coagulated blood (sponge type), palpation has a pulsating sensation, auscultation of hair-like murmur, compressed blood supply artery and murmur disappear (sponge type).
4. Angiography shows the concentration of contrast agent or vascular malformation in the tumor area.
5. Confirmed by histopathological examination.
Differential diagnosis
Hemangiomas need to be distinguished from hemorrhagic nodules. The former has a typical appearance and the characteristics of disappearing or lightening with finger pressure. If necessary, needle aspiration can be used to draw blood from hemangioma, and bleeding nodules are old blood that can be mixed. There are other ingredients. Hemangiomas need to be distinguished from hemorrhagic nodules. The former has a typical appearance and the characteristics of disappearing or lightening with finger pressure. If necessary, needle aspiration can be used to draw blood from hemangioma, and bleeding nodules are old blood that can be mixed. There are other ingredients. It is distinguished from glomus tumors and angiosarcomas, and its characteristics are as follows:
1. Glomus tumors: sharp and painful masses on the finger, toenail bed and its vicinity. The pain is especially severe when irritated by cold. Under the nails, the fingers and toenails can be seen locally bulging, and the surface can be light red, purple or slightly darker, and most of them are not allowed to be touched.
2. Angiosarcoma is rare, the tumor is nodular, painless, purple-red, superficial ones are easy to bleed and ulcerate. Under the microscope, there are many disordered tumorous blood vessels. The tumor cells proliferate in the basement membrane and can attach to the inner wall of the blood vessel to form nodules protruding from the lumen. Tumor cells are mostly spindle-shaped, and undifferentiated are polygonal, endothelial-like, with large nuclei, deep staining, and more nuclear divisions. Multinucleoma giant cells can be seen.
Immunohistochemistry is of great significance to confirm the diagnosis and differential diagnosis. Sensitive endothelial markers, factor VIII-related antigens, CD31, CD34, etc. can be selected to help confirm the diagnosis.
