Angioma is the collective name of vascular tumors originating from the blood or lymphatic vessels. Angiomas can have a superficial localization (on the skin and mucous membnes), located in the muscles, internal organs (heart, lungs, uterus, liver, spleen, etc.), accompanied by bleeding of varying intensity. 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.
- Causes of angiomas
- Classification of angiomas
- Symptoms of angiomas
- Diagnosis of angiomas
- Treatment of angiomas
- Treatment prices
The term "angioma" in vascular surgery combines various anomalies of the blood (hemangioma) or lymphatic (lymphangioma) vessels. According to a number of researchers, angioma is an intermediate link between a tumor and a developmental malformation.
Angiomas can be localized in various tissues and organs, are single and multiple (angiomatosis). The morphological basis of angioma consists of dilated blood vessels or lymphatic vessels. The size and shape of angiomas vary widely; Hemangiomas have a red-blue color, lymphangiomas are colorless. More often angiomas occur in childhood, accounting for up to 70-80% of all congenital malformations in children. Angiomas are prone to progression, sometimes extremely fast. From angioma should be distinguished telangiectasias - the expansion 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). Less common are angiomas of the pharynx, lungs, eyelids and orbits, liver, bones, external genital organs, etc.
Causes of angiomas
In most cases, angiomas are congenital in nature. It is believed that the sources of angiomas are persistent fetal anastomoses between arteries and veins. Angioma increases due to the growth of the vessels of the tumor itself, which germinate and destroy surrounding tissues, like the growth of malignant tumors. The true causes of congenital angiomas are not known.
Sometimes angiomas occur after traumatic injuries or accompany other diseases (for example, cirrhosis of the liver or malignant neoplasms of internal organs).
Classification of angiomas
First of all, angiomas of blood vessels (hemangiomas) and angiomas of lymphatic vessels (lymphangiomas) are distinguished.
From a histological point of view, monomorphic and polymorphic angiomas are distinguished. Monomorphic angiomas are the true vascular formations that emanate from a particular element of the blood vessel (hemangiendothelioma, hemangioperitocytes, leiomyomas). A sign of polymorphic angioma is the combination of various elements of the vascular wall, it is possible to switch one type of tumor into another.
Types of hemangiomas
By the type of structure distinguish 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 a spot of bright red (arterial angiomas) or bluish-purple (venous angiomas). The sizes of capillary hemangiomas are different - from limited to giant. When pressing on the vascular tumor, its color pales. Capillary hemangioma is extremely rarely transformed into malignant hemangiendothelioma.
Cavernous (cavernous) hemangiomas are formed by wide spongy 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 radiologically in the thickness of the angioma can be determined angiolitis or phlebolitis - dense, globular, deformed thrombi. Cavernous hemangiomas usually have a subcutaneous location. For them, a symptom of temperature asymmetry is typical - to the touch the vascular tumor is hotter than surrounding tissues. When pressure is applied to the tumor, due to the outflow of blood, the hemangioma recedes and pales, and when strained, it strains and increases (the so-called erectile symptom caused by the influx of blood).
Branchy (ratseluznaya) hemangioma is represented by the wreath of dilated, sinuous vascular trunks. A characteristic feature of this type of angioma is the pulsation, jitter and noise determined above it, both above the aneurysm. It is rare, mainly localized on the limbs, sometimes on the face. The slightest trauma to angiomas can lead to menacing bleeding.
Combined hemangiomas combine a superficial and subcutaneous location (simple and cavernous angioma). Clinical manifestations depend on the predominance of one or another component of angioma.
Hemangiomas of a mixed structure come from vessels and other tissues (hemlymphangiomas, angiofibromas, angioneuromas, etc.).
In the form of the following types of angiomas: stellate, flat, nodular, serpiginous. Separate in a series of vascular tumors are old angiomas, representing multiple small rounded formations of pink-red color. Older angiomas appear after 40 years.
Types of lymphangiomas
Among the lymphangioma, simple, cavernous and cystic vascular formations are distinguished.
Simple lymphangiomas include enlarged tissue gaps lined with endothelium and filled with lymph. This type of angiomas develops mainly in the muscles of the tongue and lips and outwardly represents a soft, colorless tumor.
Cavernous lymphangiomas are multi-chamber cavities formed by lymphatic vessels, with thick walls of muscle and fibrous tissue.
Cystic lymphangiomas grow as a type of chillous cysts and can reach considerable dimensions. They are found in the neck, in the groin, in the mesentery of the intestines, retroperitoneal tissue. The attachment of a secondary infection can cause the formation of fistula and prolonged, exhausting patient, lymphorrhea.
Symptoms of angiomas
Clinical manifestations of angiomas depend on the type of vascular tumor, its location, size and flow characteristics. Hemangiomas are usually found soon after the birth of the child or in the first months of his life. In newborn infants, angiomas occur 3-5 times more often than in boys. In infants, a rapid increase in angiomas can be observed: for example, within 3-4 months, the dotted hemangioma can increase to several centimeters in diameter, capturing a significant surface.
Vascular tumors can be located on any part of the body; with allowance for localization, distinguish angiomas of integumentary tissues (skin, subcutaneous tissue, mucous membranes of the oral cavity and genitals), musculoskeletal system (muscles and bones), internal organs (liver, lungs, etc.). If the presence of hemangiomas of integumentary tissues is accompanied by a cosmetic defect, the hemangiomas of internal organs can lead to various kinds of disturbances of such important functions as breathing, nutrition, vision, urination, defecation.
Bony hemangiomas can be located in the spine, bones of the pelvis, skull, long tubular bones of the extremities. In bone tissue, there are more frequent cavernous angiomas, the growth of which can be accompanied by pain, skeletal deformation, pathological fractures, radicular syndrome, etc. A particular danger is represented by angiomas of the brain, which can lead to epilepsy or subarachnoid hemorrhage.
In the process of growth, ulceration and inflammation with angiomas can be noted, followed by the development of thromboses and phlebitis. The most serious complication is bleeding; when traumatizing extensive and deep angiomas, emergency surgery may be required to stop bleeding. In some cases, self-healing angiomas, associated with spontaneous thrombosis and desolation of vessels feeding the tumor, occurs. At the same time 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 primary localization is the skin and subcutaneous tissue.
Lymphangiomas are localized in places of accumulation of regional lymph nodes: on the neck, tongue, lips, cheeks, underarm and groin, mediastinum, retroperitoneum, in the area of the mesentery root. They are defined as a painful swelling, sometimes reaching a significant size. In most cases, the growth of lymphangiomas is slow, of complications, usually festering occurs.
Diagnosis of angiomas
Diagnosis of superficial angiomas in typical cases is not difficult and is based on examination and palpation data of vascular formation. The characteristic color and ability to contract with pressure are characteristic signs of angioma.
With angiomas of complex localizations, a complex of visualization studies is used. Bony hemangiomas are detected by radiography of tubular bones, spine, ribs, pelvic bones, skull. To diagnose angiomas of internal organs, angiography of the vessels of the brain, kidneys, lungs, lymphangiography, etc. is used. Ultrasound allows to determine the depth of angioma distribution, the structure and anatomo-topographic features of the tumor location, to measure the blood flow velocity in peripheral vessels and parenchyma of the hemangioma. Angiomas of the pharynx are revealed during examination of the otolaryngologist.
If suspected of lymphangioma, a diagnostic puncture is performed, which allows obtaining a transparent yellowish liquid from the tumor. 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: rapid tumor growth, the vastness of the lesion, the localization of vascular formation in the head and neck region, ulceration or bleeding, the functioning of the affected organ. Expectant tactics are justified for signs of spontaneous regression of a vascular tumor.
Surgical treatment is indicated with a deep angioma location. Surgical methods of treatment with angiomas may include dressing of leading vessels, stitching of a vascular tumor or its complete excision within healthy tissues.
Radiation therapy is used to treat angiomas of complex anatomical localizations (for example, angiomy of orbit or retrobulbar space) or simple hemangiomas of large area. With extensive angiomas of the outer covers, hormonal treatment with prednisolone is sometimes effective.
With regard to point angiomas, electrocoagulation, laser removal, cryodestruction can be used. With small but deep angiomas, sclerotherapy is applied - local injections of 70% ethyl alcohol, causing aseptic inflammation and scarring of the vascular tumor. Angiomas of internal organs after preliminary angiography can be subjected to embolization.
Angioma of the pharynx is 13% of all benign tumors of the pharynx and larynx. The tumor can be in a latent (inactive) state for many years and only then its growth begins. Angioma of the pharynx, growing from blood vessels, has a red-cyanotic, brownish-red or purple color. Most often it occurs in the palatine arch, soft palate, the root of the tongue, posterior and lateral wall of the pharynx, tonsils. Angioma of the pharynx, formed from the lymphatic vessels, is pale yellow due to the lymph filling it. It is most often localized in the lining space and on the epiglottis.
The classification of angiomyelitis, which is used by modern otolaryngology, lies in their division according to the type of vessels from which the angiomas originate, and the structure of the tumor.
Angiomas of the pharynx, growing from the blood vessels, refer to hemangiomas. In turn, they are subdivided into capillary (simple), cavernous (cavernous) and branching hemangiomas. Capillary hemangiomas are visualized as separate spots of blue-purple or red color and come from dilated capillaries. Cavernous hemangiomas have the form of nodular neoplasms of a dark blue color, covered with thinned mucosa. They consist of a multitude of blood-filled cavities. Branched hemangioma is a swelling under the mucous throats, consisting of pulsating and blood-filled vessels. When pressed on these formations, they subside, and then quickly fill with blood.
Angiomas of the pharynx, formed from the lymphatic vessels, are called lymphangiomas. Among them, simple, cavernous and cystic formations are distinguished. Simple lymphangiomas are formed from lymphatic capillaries. Cavernous lymphangiomas have a spongy structure with many lymphatic cavities filled with lymph. Cystic lymphangioma can be in the form of a single cyst or multiple cysts, sometimes merging with each other.
Symptoms of angiopathy
The small size of the pharyngeal angioma is not accompanied by any clinical symptoms and remains unnoticed. The patient begins to feel unpleasant sensations when the pharyngeal angiosphere reaches significant dimensions, which primarily affects hemangiomas. During this period, the patient begins to sense the presence of a foreign body in the throat and difficulty in the process of swallowing food or saliva. With the growth of education to the region of the vocal cords, hoarseness arises. Angiomas of the pharynx of large sizes can cause coughing and difficulty breathing.
Hemangioma often reaches considerable dimensions and is accompanied by diffuse growth in the thickness of the surrounding tissues. Even slight trauma to cavernous or cystic hemangioma can cause severe bleeding, in some cases leading to significant blood loss. Lymphangiomas, as a rule, do not reach large sizes and rarely are larger than a large pea. These throat angiomas are not dangerous in terms of bleeding.
Diagnosis of throat angiopathy
Angiopathic small pharyngeal angiomas are often an accidental diagnostic finding and are diagnosed by an otolaryngologist when examining the pharynx due to another disease (pharyngitis, tonsillitis, laryngitis, adenoids, etc.). Sufficiently large throat angiomas are accompanied by typical complaints, allowing the doctor to suspect the presence of benign education. To clarify the diagnosis it is necessary to carry out pharyngoscopy. In some cases, to eliminate the inflammatory nature of the formation or the accompanying inflammatory process in the nasopharynx, a bacteriological study of the smear from the pharynx is performed.
100% confirmation of the diagnosis of angiomy of the pharynx is a characteristic picture of the tissue structure of the neoplasm, determined by a histological examination, which is usually performed after removal of the tumor. A biopsy of angioma is not performed. In the case of hemangioma, it is dangerous bleeding, and with lymphangioma can lead to swelling of the larynx and asphyxia. Differential diagnosis of pharyngeal angioma is carried out with other benign neoplasms (fibroma, chondroma, retention cyst, papilloma, hairy pharyngeal polyp, diffuse polyposis) and pharyngeal cancer.
Treatment of throat angiomy
According to some authors, an effective way to treat angiomyoma of the pharynx is to inject 70% of alcohol into it, which causes sclerosing and reducing the size of the tumor. Other otolaryngologists use this technique only as a preoperative preparation of the patient to reduce bleeding from the hemangioma when it is removed. This method of treating throat angioma is dangerous for the development of the pharyngeal edema with spreading to the larynx and the threat of asphyxia.
Surgical endoscopic removal of pharyngeal angiomas, which have a narrow base in the form of a pedicle, is accomplished by galvanocaustic loop. If the pharyngeal angioma has a wide base, then it is removed by diathermocoagulation. Possible surgical excision of angioma, produced within unchanged tissues. Large pharyngeal angiomas located on the posterior wall of the pharynx are removed by side pharyngotomy. Radiation therapy is indicated in case of capillary or cavernous hemangiomas. It is carried out by introducing into the tumor radium preparations and leads to the sclerosis of angioma.
Prognosis of pharyngeal angiomy
Throat angiomas are benign neoplasms that are not prone to malignancy, rapid growth, destruction of surrounding tissues and recurrence. In this regard, they have a favorable prognosis both for the patient's life and for recovery as a result of adequately conducted treatment. The greatest danger is observed in the presence of cavernous hemangioma and it is associated with the possibility of profuse bleeding, which in case of large blood loss can lead to death.