Bone hemangioma
Introduction
Introduction to bone hemangioma Bone hemangioma is a benign tumor that can occur in various parts of the body and can also occur in the bone, but the latter is far less common than hemangioma occurring in other parts. According to domestic data, the spine bone Hemangiomas account for about 3% to 8.1% of primary spinal tumors, but the clinical detection rate is low. The reason may be: bone hemangioma is benign, slow growth, early patients with asympto or mild symptoms, patients do not seek medical treatment, Therefore, it is not discovered. In patients with advanced disease, when the osteolytic destruction changes significantly, it is misdiagnosed as metastatic cancer and abandon further examination and treatment. The disease occurs in the spine and skull. The cervical spine is next to the thoracic vertebrae and lumbar vertebra The disease is common in middle-aged people around 40 years old, more women than men. basic knowledge The proportion of illness: 0.003% Susceptible people: good for men aged 10 to 30 Mode of infection: non-infectious Complications: paraplegia fracture
Cause
Cause of bone hemangioma
(1) Causes of the disease
The cause is unclear, and some may be caused by a tumor-like malformation or a hamartoma. The hemangioma is a tumor-like hyperplastic vascular tissue that is doped between the trabecular bone and is difficult to separate it separately. Divided into cavernous hemangioma and capillary hemangioma, the former is more common in the spine and skull, the latter is more common in the flat bone and long tube backbone.
(two) pathogenesis
At present, most scholars believe that it is a benign lesion composed of tumor-like hyperplasia of capillaries, cavernous vessels or venous sinus mixed with trabecular bone, some of which are tumor-like malformations or hamartomas, and the other part is A true benign tumor.
Bone hemangioma sometimes coincides with hemangioma in other areas.
Generally speaking, the tumor is located in the bone shell. The bone is generally sparse and honeycomb-shaped. There is a large, hard, unevenly distributed longitudinal callus, which is distinct from the normal bone. The tumor is dark red or grayish red, and the blood vessels are rich. The tissue is grayish red or dark red, which is very easy to bleed. The tumor makes the bones expand and thin, and rough and hardened irregular bones are common on the tumor wall.
Microscopically, the tumor is composed of sinusoids and twisted capillaries of different sizes. The tissues of cavernous hemangioma are mostly dense thin-walled dilated blood vessels, belonging to the blood vessels or venules. The blood vessels are filled with red blood cells, and the tumor edges may have In the remaining normal trabecular bone, fatty bone marrow can be seen between the tumor tissues. The blood sinus is actually a dilated thin-walled vein. Only a single layer of endothelial cells is covered, the capillaries are different in size, and the thickness is different. Fatty bone marrow stroma.
Prevention
Osteoangioma prevention
Bone hemangioma is quite sensitive to radiation. Therefore, radiation is mainly used during the treatment. When the tumor occurs in an unimportant part, such as the lower end of the ulna, the humerus or the rib, surgical resection can be considered, and the prognosis is good.
Complication
Osteoangioma complications Complications
Vertebral hemangioma invades the spinal canal and compresses the spinal cord, which can cause paraplegia. If the vertebral body pathological fracture is combined, it can produce complete paraplegia, and pathological fracture can also be combined with limb lesions.
Symptom
Symptoms of bone hemangioma Common symptoms Diffuse vascular keratosis vertebral stiffness Paraplegia spinal cord compression Fracture and dislocation
The high incidence of this disease is 10 to 30 years old, the ratio of male to female patients is about 2:1, which occurs in the spine and skull. It is rare in other bones. The incidence of vertebrae hemangioma in foreign autopsy can be as high as 11%, because most of them are asymptomatic. Therefore, there are not many patients in clinical practice. According to statistics, 15% of bone hemangioma occurs in the spine, accounting for 8% to 11% of all benign tumors of the spine, especially in the lower thoracic and upper lumbar vertebrae, mainly vertebral bodies. Attached hemangioma is rare.
Symptoms and signs: The main symptoms are local pain or swelling of the affected part, or a lump. The tumor is located in the superficial part. The pain and the mass often appear at the same time. The mass is bony stiffness, the surface skin is not changed, and there are occasional occasions when the skull is located. Sexual, generally does not produce neurological symptoms, located in the spine may have local soreness and pain, spinal stiffness, limited mobility, spinal hemangioma lesions can invade the spinal canal and the spinal cord presents progressive paraplegia, such as combined with vertebral pathological fractures can produce Complete paraplegia, such as when the hemangioma spreads from the vertebral body to the lamina and spinous processes, it may touch the mass.
Most bone hemangioma is asymptomatic, mostly unintentionally found, a small number of mild pain, slow development, mild symptoms, slow aggravation, located in the spine may have neurological symptoms and signs, mostly single, a few can be multiple, sometimes with Hemangiomas in other parts exist at the same time, most of them have typical imaging findings. Most of them can be diagnosed according to imaging findings before surgery, especially when they are located in the spine. If there is special X-ray change, diagnosis can be made. The bone hemangioma in the site is sometimes difficult to diagnose. The biopsy can be diagnosed clearly, but the biopsy is difficult to be successful. When the biopsy is performed, it may encounter uncontrollable bleeding. It is necessary to have enough mental preparation to avoid being caught off guard during surgery.
1. The patient generally has mild pain and good general condition. Because of the different parts of the tumor, the symptoms and signs are different. The patient often only has mild or discomfort in the local area. Occasionally, the X-ray film is found only. The limbs and sphincter function may have different degrees of obstacles. The reasons for the spinal cord compression may be: (1) the tumor spreads to the epidural space; (2) the affected vertebral body enlarges the spinal canal stenosis; (3) the affected vertebra The body has a fracture displacement; (4) an epidural hematoma that occurs when the aneurysm bleeds.
2. X-ray film performance: According to the site of invasion of bone hemangioma, it can be divided into vertebral body type, vertebral arch type and mixed type.
Vertebral type: The vertebral body is slightly inflated, with a typical grid-like or mesh-like image. There are many dense and clear vertical rough trabeculae in the shadow of reduced density. During the development of the tumor, the early trabecular bone is formed. Large, late formation is thinner.
Vertebral arch type: X-ray film shows that the pedicle or lamina is osteolytic, and its image is blurred or disappears, but the vertebral body and intervertebral space are normal.
Mixed type: refers to lesions invading the vertebral body and vertebral arch, in addition to the X-ray performance of the above two, there may be pathological cervical fracture and dislocation.
Examine
Examination of bone hemangioma
No relevant laboratory tests.
X-ray films of bone hemangioma have different manifestations due to different tumor sites.
1. Foliage-like or network-like bone hemangioma of all vertebrae is of this type, the affected vertebral body can be compressed or flattened to varying degrees, the lateral swell is slightly enlarged, the trabecular bone is sparse, thickened into longitudinal arrangement, or irregular bone in the lesion. Sexual intervals intersect with each other in a fence or network. In some cases, paravertebral soft tissue masses can also be seen. The lesions are usually single, with occasional involvement of 2 or 3 vertebral bodies.
2. Honeycomb or foamy bone changes the bone of the lesion is slightly dilated, the shape is irregular, and there are multiple cystic bone destruction areas of different sizes in the lesion. Radial bone needles can also appear on the edge of the lesion. Sexual cystic changes), most of the cases of jaw and long bones are of this type, and the hemangioma of the tibia is often expansive cystic changes.
3. Single large cystic bone destruction and radial bone needle skull lesions often have oval bone destruction, involving the inner and outer skull of the skull, mild bone sclerosis around, irregularly arranged trabecular bone in the destruction area, tangential position On the film, the large bone needle is perpendicular to the skull, and the foot bone hemangioma is also mostly radiation-like.
4. CT and MRI findings of vertebral hemangioma CT scan has a high degree of specificity in the diagnosis of vertebral hemangioma. The diseased vertebra has a "match bundle"-like cross-sectional change. Unlike other bone lesions, vertebral hemangioma is different. Both MRI T1 and T2 weighted images showed signal enhancement. The enhanced signals of these spots corresponded to the bone components of the lesions, while the extra-osseous lesions did not show high-intensity signals in T1-weighted images. Rotating echo techniques were used for vertebral hemangioma. The MRI examination showed that the different signal intensities of the lesions were largely determined by the varying blood flow velocity. For example, CT and MRI can be clearly seen when the aneurysm invades the spinal canal.
5. Angiography.
6. Organize biopsy.
Diagnosis
Diagnosis and diagnosis of bone hemangioma
The diagnosis is based on the patient's medical history, especially the characteristics shown by the X-ray film: the vertebral bone texture is thickened and runs vertically and is grid-like; some of the bone texture is absorbed and the mesh is saclike; the vertebral body is slightly enlarged or has different degrees of compression. The intervertebral space is normal, and when the above typical X-ray image changes, the general diagnosis is not difficult.
Spinal hemangioma may be diagnosed as spinal tuberculosis, vertebral myeloma, osteoporosis, metastases and malignant lymphoma, skull hemangioma diagnosed as meningioma and osteosarcoma, and long bone hemangioma diagnosed as giant cell tumor. Gonoma, bone cyst, aneurysmal bone cyst, non-ossifying fibroma and fibrous dysplasia, such as bone hemangioma with skin, soft tissue hemangioma, can help diagnose, and easily misdiagnosed as bone fiber dysplasia Aneurysmal bone cyst, giant cell tumor of bone, plasmacytoma, advanced stage has been misdiagnosed as metastatic cancer.
