Vascular tumors hemangioma angioma lymphangioma – signs diagnosis treatment

The term “angioma” in vascular surgery combines various kinds of anomalies of blood (hemangiomas) or lymphatic (lymphangiomas) vessels. According to some researchers, angioma is an intermediate link between a tumor and a malformation.

Angiomas can be localized in various tissues and organs, are single and multiple (angiomatosis). The morphological basis of angioma is made up of dilated blood or lymph vessels. The size and shape of angiomas vary widely; hemangiomas are red-blue in color, lymphangiomas are colorless. More often angiomas are found in childhood, accounting for up to 70-80% of all congenital neoplasms in children. Angiomas are prone to progression, sometimes extremely fast. From angioma, telangiectasias should be distinguished – expansion of blood vessels with the presence of arteriovenous aneurysms.

Angiomas are located mainly on the upper half of the body, including the head and neck (up to 80% of cases). Angiomas of the pharynx, lungs, eyelids and orbits, liver, bones, external genitalia, etc. are less common.

Lymphangioma is a fairly rare pathology. According to various sources, it makes up 1,3-10,6% of cases of all vascular tumors (in childhood – up to 25%), occurs with a frequency of 1 in 20-250 thousand admissions to surgical hospitals. Lymphatic malformations take the second place among the soft tissue formations of the maxillofacial region.

Usually they are detected in newborns and infants (90% of cases), less often in the first 2–3 years of a child’s life, but they can be diagnosed even in utero or much later in adulthood. Gender statistics are contradictory: while some researchers report the predominant development of superficial lymphangiomas in women, others observe pathology 3 times more often among men.

Pathogenesis

The mechanisms of development of lymphangioma are not well understood. The main pathological process, many researchers call the association of lymphatic tanks in the deep subcutaneous space. They are separated from the normal vasculature, but communicate with the surface capillaries through vertical dilated channels. Presumably, the cisterns originate from a primitive lymphatic sac, unable to unite with the rest of the lymphatic system in embryogenesis.

Hypertrophic muscle fibers lining the sequestered areas support rhythmic contractions of the wall, which leads to increased pressure with dilatation of the channels ascending to the skin. Around the altered lymphatic vessels of the superficial and deep parts of the dermis, processes of fibrosis occur, the epidermis undergoes acanthosis, papillomatosis, hyperkeratosis. Some variants of lymphangiomas are accompanied by pronounced infiltrative growth, but without tissue destruction. Tumors do not give metastases.

Complications

Despite the benign nature, lymphangioma is considered a potentially dangerous formation. Large vascular anomalies in the neck and head area of ​​the fetus block its exit through the birth canal of the mother, compress and displace adjacent structures. Diffuse lesions of the bottom of the oral cavity can cause respiratory distress, up to asphyxiation, inability to eat. Malformations of the orbital zone lead to visual impairment, and localized in the abdominal cavity are accompanied by intestinal obstruction, sometimes torn.

Superficial lymphangiomas are easily injured and bleed, inflamed angio-dysplasias in the cervical-facial zone can become a source of serious infectious complications. A higher risk of developing epithelioid hemangioendothelioma and lymphangiosarcoma in patients is reported. That is, the lymphatic anomaly is not just a cosmetic defect – it can lead to severe functional disorders and cause conditions that pose a real threat to life.

Prognosis and prevention

Lymphangiomas are benign lymphatic malformations, not true tumors. But acquiring large sizes, they are able to provoke functional disorders and lead to the development of life-threatening conditions. Timely correction makes the prognosis favorable, although the risk of relapse still exists.

Causes of angiomas

In most cases, angiomas are congenital in nature. Persistent fetal anastomoses between arteries and veins are thought to be sources of angiomas. An increase in angioma occurs due to the proliferation of the vessels of the tumor itself, which germinate and destroy 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).

IV. An. Arrangements and forms

1)
dystopia) unilateral (thoracic,
lumbar, iliac, pelvic) b)
cross

2)
kidney fusion a) one-sided (Z)
b) bilateral: – symmetrical (horseshoe,
biscuit) – asymmetric (L,
S)

V.
An. Structures 1)
dysplastic kidney2)
multicystosis 3)
polycystic disease4)
solitary cysts5)
cup-medular an.: a)
megacalixb)
polymegacalixv)
spongy kidney

1)
unilateral lesions (multilocular,
multicystic, solitary, pelvic,
perinephric)

2)
bilateral (multicystosis, polycystic
spongy kidney).

VI.
Combined en. Kidney 1)
with PMR2)
with infravesicular obstruction

3)
1 2 4) with an. other organs and systems (genital,
SS, musculoskeletal, digestive).

Agenesis
kidneys
Unilateral renal agenesis associated
with no nephroblastoma formation
one side. In this case, as a rule,
missing appropriate
ureter, underdevelopment is noted
half of the bladder and often
genital apparatus. However increased
load contributes to the disease
solitary kidney pyelonephritis, lithiasis
and etc.

Clinic
and diagnostics.
Suspected solitary kidney arises
with palpation of increased painless
kidneys, however, a diagnosis can be made
based on in-depth
X-ray examination
(excretory urography, chromocystoscopy,
renal angiography). With urography
the appearance of contrast on the side of aplasia
is absent.

Incremental
bud. Education
additional kidney associated with budding
site of metanephrogenic blastema,
moreover, it often forms near
main, higher or lower
her. Additional (third) kidney significantly
less than normal but has normal
anatomical structure. Blood supply
it is separately due to arteries extending
from the aorta.

The ureter usually flows into
a bladder with an independent mouth
but can be ectopied or reported
with the ureter of the main kidney. Clinic
and diagnostics.
Clinical relevance
kidney acquires only with ectopia
ureteral orifice (constant
urinary incontinence) or its defeat
due to inflammatory, tumor
or other pathological process.

Dystopia
the kidneys. Under
this name understands the unusual
location of the kidneys due to violation
in embryogenesis of their ascension process.
Since
ascension and rotation processes
interconnected, dystopic kidney
turned outward, while lower
dystopia, the more ventrally located
pelvis.

Distopted
the kidney often has a loose type
blood supply, its vessels are short and
limit the mobility of the kidney.
Functional state of the dystopian
kidneys are usually reduced. Kidney like
usually has a lobed structure. The form
it can be the most diverse –
oval, pear-shaped, flattened and
wrong.

Distinguish
high dystopia, low and cross.
high dystopia applies intrathoracic
bud. With intrathoracic dystopia, the kidney
usually part of the diaphragmatic
hernias. The ureter is elongated, flows into
bladder, artery departs from
thoracic aorta.
low dystopia are lumbar,
iliac and pelvic.

RџSЂRё
lumbar dystopia slightly rotated
anterior to the pelvis is at
IV lumbar vertebra. Renal artery
usually moves above aortic bifurcation.
The kidney is shifted to a limited extent.
dystopia is characterized by more
pronounced rotation of the pelvis anteriorly
and its location at the level Lv – S1.

Renal arteries are usually
multiple, depart from the general
iliac artery or aorta in place
bifurcation. Mobility of the kidney with
a change in body position
no. pelvic
the kidney is located in the midline
under aortic bifurcation, behind and
slightly above the bladder. Vessels
kidneys are usually loose type, are
branches of the common iliac or various
pelvic arteries.

Cross
dystopia is characterized by displacement
kidneys contralaterally. Moreover, how
as a rule, both buds fuse, forming
S- or L-shaped kidney. Ureter,
draining a dystopian kidney
flows into the bladder on an ordinary
location. The vessels that feed the kidneys depart
lower than normal sipsy
or contralateral side.

Clinic
and diagnostics.
Clinical dystopia
the picture is due to abnormal
location of the organ. Leading symptom
is the pain arising from a change
body position, physical stress,
flatulence. With cross dystopia
pain is usually localized in the iliac
areas and radiates to the inguinal region
opposite side.

Since
a dystopic kidney is affected
pathological process
(hydronephrotic transformation,
calculosis, pyelonephritis) significantly
more often than usually located, often
symptoms of indicated
diseases. Intrathoracic dystopia
clinical manifestations and data
radiography survey can simulate
tumor of the mediastinum.

With lumbar
and iliac dystopia, the kidney is palpated
in the form of a painful sedentary
education. Dystopia is usually detected.
with excretory urography, and in case of
a sharp decline in kidney function –
retrograde pyelography. Celebrate
characteristic signs of dystopia: rotation
and unusual localization of the kidney with
limited mobility.

Often
difficulties in differential
diagnosis of lumbar and iliac
dystopia and nephroptosis, especially in cases
the so-called fixed
nephroptosis, which, like dystopian
kidney, characterized by low localization
and low mobility of the kidney. However on
urograms with fixed nephroptosis
medial location can be noted
pelvis and convoluted long ureter.

Sometimes distinguish between these conditions
only renal angiography helps
revealing short vascular pedicle
with dystopia and elongated – with
nephroptosis. Treatment.
Relation to dystopia of the kidney as much as possible
conservative. Operation usually
produce with dystopia complicated
hydronephrosis or calculosis.

Horseshoe
bud. At
this abnormality of the kidney fused lower
or upper ends, renal parenchyma
looks like a horseshoe. Occurrence of anomalies
associated with a violation of the climbing process
and kidney rotation. Horseshoe kidney
located lower than usual, the pelvis
fused kidneys directed anteriorly or
laterally.

Blood supply is usually
carried by multiple arteries,
departing from the abdominal aorta or its
branches.
Clinic and diagnosis.
Main clinical symptom
horseshoe kidney is a symptom
Roving, which is
the occurrence of pain during extension
torso. The appearance of a pain attack
associated with vascular compression and
aortic plexus isthmus of the kidney.

Often the pain is vague
character and is accompanied by dyspeptic
phenomena. horseshoe-shaped
the kidney can be identified by deep
palpations of the abdomen in the form of a dense
sedentary education.
X-ray with good preparation
intestines, the kidney looks like a horseshoe,
convex down or up.

The contours of the kidney are most clearly identified.
with angiography in the phase of the nephrogram.
horseshoe-shaped excretory urograms
kidney is characterized by rotation
pyelocaliceal system and change
angle made by longitudinal axes
fused kidneys. Shadows of the ureters
outline a “flower vase”: moving away
from the pelvis, the ureters diverge into
side, then along the way to the bladder
gradually getting closer.
Treatment.

Galetoid
bud. Flat oval
level education
Promontory or below. This anomaly
formed as a result of intergrowth
two kidneys at both ends before starting
their rotation. Blood supply biscuit
kidneys carried by multiple
vessels departing from bifurcation
aorta and randomly piercing
renal parenchyma.

Asymmetric
forms of fusion.
They are characterized by a combination of kidneys.
opposite ends. When
S- and I-shaped kidney longitudinal axis
fused kidneys are parallel, and the axis
kidneys forming an L-shaped kidney,
perpendicular to each other. Pelvis
S-shaped kidneys facing opposite
side, more often towards the vertebral
pillar.

I-shaped kidney occurs in
the result of dystopia of one kidney,
more often right, in the opposite direction.
In this case, the kidneys grow together, forming
single post renal parenchyma with
pelvis located medially.
Fused ectopic kidneys may
squeeze neighboring organs and large
vessels causing intermittent ischemia
and the occurrence of pain. Diagnostics.

Aplasia
kidney under
aplasia of the kidney should be understood as severe
the degree of underdevelopment of her parenchyma,
often combined with a lack of
ureter. There are two forms of aplasia
kidneys – large and small. At the first
kidney shaped lump
fibrolipomatous tissue and small
cysts. Nephrons are not detected,
there is no isolate ureter.

The second form of aplasia is characterized by
the presence of fibrocystic mass with a small
the number of functioning nephrons.
The ureter is thinned, has a mouth, but
often does not reach the renal parenchyma,
ending blindly.
Clinic and diagnosis.
Clinically Applied Kidney
nothing manifests itself and is diagnosed
in diseases of the contralateral
kidney.

Some patients present
complaints of pain in the side or abdomen that
associated with compression of nerve endings
proliferating fibrous tissue or
enlarging cysts.
aplasia of the kidney is based on data
radiological and instrumental
research methods. On the overview
radiograph in rare cases on
spot applazirovannye kidneys are found
cysts with calcified walls.

On
background of air introduced retroperitoneally,
aplated kidney with good
bowel preparation is visible
on the tomograms in the form of a small lump.
aortography going to applauded
arteries are not detected in the kidney.
should be differentiated
from non-functioning kidney, agenesis
and kidney hypoplasia.

the ureter is absent either
– represented by fibrous strand or
ends blindly, there is hematrophy
urinary triangle, testicle
missing or not omitted. Differential
diagnosis helps cystoscopy,
revealing with aplasia of the kidney in half
cases of the mouth of the corresponding
Ureter. Hypoplastic
the kidney is distinguished from aplasia
functioning (albeit in a reduced
volume) parenchyma, ureter,
walkable all over, and
vascular pedicle visualization with
aortography.
Treatment.

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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