Hemangioma - frequent benign vascular lesions.
Despite the possibility of self-healing and stop hemangioma growth, followed by the disappearance, continued its course still remains unpredictable.
Classification
- Simple hemangioma - located on the surface of the skin;
- Cavernous hemangioma - located under the skin;
- Combined hemangioma - is subcutaneous and cutaneous portion;
- Mixed hemangioma - consists of different tissues.
The symptoms of hemangioma
Simple hemangiomas are red or blue-purple color, are located superficially, clearly demarcated, affect the skin and a few millimeters of subcutaneous fat layer, growing mainly to the sides. Hemangiomas smooth surface, at least - is uneven, sometimes slightly protruding above the skin. When pressed hemangioma blanch, but then again regain their color.
Cavernous hemangiomas are located under the skin in the form of a limited nodular formation, soft-elastic consistency and consist of different sized cavities, cavities filled with blood. Cavernous hemangiomas appear as tumor formation, covered with intact skin, or cyanotic, with an increase in tumor vascular skin becomes bluish-purple color. When pressed hemangioma collapses and pales (due to blood flow), and weeping, coughing and crying child increases and strained (as a result of blood flow).
Combined hemangiomas are a combination of surface and subcutaneous forms (simple and cavernous). Appear depending on the combination and the predominance of one or another part of the tumor vasculature.
Mixed hemangiomas consist of tumor cells originating from the vessels and other tissues (connective, nerve, etc.). Appearance, color and texture are determined by members of the vascular tissue of the tumor.
Photo: site of the Department of dermatology Tomsk Military Medical Institute
Girls hemangiomas occur 2-3 times more often than boys.
Typically, they are found immediately after birth and much less - for the first two months of life.
A favorite location of hemangiomas is the area of the head and neck. Very rare localization in the head and neck is the parotid region.
Hemangiomas may be single or multiple.
A feature of hemangiomas in the perineum and external genitalia is their tendency to frequent ulcerate, which leads to self-healing of the tumor.
Diagnostics
Diagnosis is performed hemangiomas a surgeon using the following techniques:
- inspection
- laboratory diagnosis
- Ultrasound examination (determination of the depth and spread of the tumor formation volume calculation; determined location particular structure of the tumor, measuring blood flow velocity in blood vessels).
- Angiography (required for examination of patients with a wide and deep hemangiomas)
hemangioma treatment
hemangioma treatment in most cases should be started as soon as possible, immediately after diagnosis. The most effective treatment in the first weeks and months of life.
Surgical treatment is indicated in deep-seated vascular hemangiomas, when it is possible to remove education as a whole, within the healthy tissue, with no significant cosmetic damage. Operative treatment should be used in cases where the use of other therapies seems obviously ineffective. Treatment success was achieved in 90% of cases. Postoperative complications are rare.
Subject to radiation treatment of hemangioma complex locations, primarily those areas where other treatments can not be used, for example the region of the orbit. Radiation therapy has been shown for the simple hemangiomas large area. Irradiation is carried out individual fractions at intervals of 2-4 weeks to 2-6 months until the disappearance of hemangioma. This method of treatment is relatively complicated, and the effect occurs over a relatively long time.
Diatermoelektrokoagulyatsii (cauterization) to be only small, dot hemangiomas in cases where the tumor is located in areas that are inaccessible to other treatment. Electrocoagulation extensive and deep formations should not be used. In some patients, after electrocoagulation cosmetic defects observed.
Sclerosing treatment is indicated with small, deep-seated vascular hemangiomas complex location, especially in the treatment of small cavernous and combined forms of the face and the tip nose. 70% alcohol is used for injection. When combined hemangiomas first carried cryogenic or microwave treatment for cryogenic destruction of the surface of the tumor and then sclerotherapy. The disadvantages of sclerotherapy are pain and duration of treatment. The advantage of injection therapy to other conservative therapies lies in its simplicity.
One of the methods of treatment of extensive hemangiomas integument in children is a hormonal treatment. It is carried hormone prednisone. The daily dosage of prednisolone tablets divided into two stages: at 6 o'clock in the morning the child receives 2/3 the dose in the 9 o'clock - 1/3 dose. The drug is taken through the day without tapering. Duration of treatment - 28 days. If necessary, after 6-8 weeks, repeat the treatment. This method stops the growth of tumor vasculature. Hemangiomas follow-up care after other methods of hormonal therapy can solve cosmetic problems.
The widespread use of low-temperature exposure associated with the use of special apparatus and freezing systems, thus extending the capabilities of the method. Due to such important properties as painless, no bleeding and appreciable overall response of the body - a cryogenic method is widely distributed in the treatment of hemangiomas. Cryogenic treatment is required for all ordinary hemangioma small area, any location and at any age child. For therapeutic modality applied hardware cryogenic method wherein a liquid nitrogen is used as cooling agent. The optimal duration of cryotherapy - 20-25 seconds for hemangiomas, which are located on the skin, and 7-10 seconds for the hemangiomas, which are located in the mucous membranes. Cryoexposure total area should not exceed 10 cm2.
the most appropriate to use cryogenic method for simple hemangiomas.
In the treatment of hemangiomas simple large area hormone and radiation therapy are the methods of choice.
When cavernous and combined forms are most effective sclerosing, surgical and microwave cryogenic techniques.
At extensive and deep hemangiomas parotid region effectively comprehensive treatment that includes mandatory embolization angiogram and hemangioma.
Course and prognosis
For hemangiomas in most cases benign. Modern methods of treatment allow to choose the optimal treatment option for a particular patient. Cosmetic defects after treatment, as a rule, are absent or unimportant.
