cystic lymphangioma
Introduction
Introduction to cystic lymphangioma Cystic lymphangioma (cysticlymphangioma), also known as cystic hydromas, is a mass formed by the development of primitive lymphatic vessels. It is a congenital malformation, a hamartoma, and a borderline between tumor and deformity. . basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: difficulty swallowing
Cause
The cause of cystic lymphangioma
Causes:
Congenital malformation of lymphoid tissue, embryonic, internal jugular vein and subclavian vein junction enlargement, forming a cyst, called the cervical sac, part of the lymphatic system developed from the cervical sac, during the embryo development, if there is a part The lymphoid tissue is vagus, still retains the nature of the embryonic period, and continues to develop and enlarge. It is a cystic hydromas with a lymphatic fluid and a multi-sac sac with an endothelium.
Pathogenesis:
When the mesoderm in the embryonic venous plexus forms a primitive lymphatic sac, a misconfiguration occurs, causing the primitive lymphatic sac to fail to communicate with the venous system, leading to dysfunction of the lymphatic system, and mesoderm gap in the embryonic venous plexus. The fusion forms a large primitive lymphatic sac, which drains into the central venous system. Later, the lymphatic sac gradually degenerates or develops into a lymphatic system parallel to the vein. If the primary lymphatic sac is not connected to the venous system, cystic lymphangioma (cystic) is produced. Lymphangioma).
Because the formation of the lymphatic sac in the neck is the earliest and the largest, the cystic lymphangioma is most common in the neck. Most of the lymphangioma and hemangioma exist at birth. They are actually a congenital malformation, which is wrong. The nature of tumorigenesis is a borderline lesion between tumor and deformity. Some scholars can grow from the cystic lymphangioma to the original uninvolved part. In addition, some people also observed the formation of new tissue at the edge of the tumor, which is considered true. Tumor, however, the "invasive growth" of lymphangioma is simply the lymphatic fluid that has already existed due to mechanization or embolism, resulting in lymphatic fluid accumulation, lymphangiogenesis and lymphatic vessel dilatation mixed in the affected tissue is not a proliferative invasive lesion. It is only a lymphatic malformation. At present, most scholars believe that it is a lymphatic malformation. Due to the poor obstruction of the output channel of the lymphatic vessels, it causes proximal expansion. Later, due to inflammation or bleeding, the obstruction is further aggravated, although about 60% of the lymph nodes. Tube tumors are seen in people under 5 years of age, but quite a few also appear in adulthood.
Histopathology shows that the cystic lymphangioma contains a large lymphatic cyst, the cyst wall is thin, and there are endothelial cells. The cystic cavity is often multi-atrial, containing a pale yellow watery liquid, sometimes showing smooth muscle, usually located in the dermis. Deep, it can also extend to the subcutaneous tissue or the muscle structure of the lower layer.
Prevention
Cystic lymphangioma prevention
For this disease, there is no relevant effective method to prevent it. Early detection and early diagnosis are the key to treatment. The actual lesion range of cystic lymphangioma often exceeds the original estimate. It is often difficult to completely remove the surgery. The surgery requires careful dissection of the important nerves, blood vessels and other structures in the neck. Prevent facial nerve paralysis and lingual nerve, recurrent laryngeal nerve, and radial nerve injury, causing difficulty in breathing and hoarseness. For the remaining wall, 0.5% iodine can be applied to destroy endothelial cells to prevent recurrence.
Complication
Cystic lymphangioma complications Complications, difficulty swallowing
1. Cystic tumor infection with mild upper respiratory tract infection or local minor injury can cause cystoma infection. At this time, there may be local and systemic infection symptoms, which is difficult to control.
2. Local infection and injury of cystic hemorrhage can cause cystic hemorrhage, sudden increase of cystic tumor, and increased intracapsular tension, which may cause symptoms of tracheal and esophageal compression.
3. The cystic lymphangioma under the fascia of the trachea is extended to the mediastinum, or the hemorrhage of the cyst can cause compression of the trachea, which causes difficulty in breathing in children.
4. The cystic tumor wrapped in the pharynx can cause difficulty swallowing.
Symptom
Symptoms of cystic lymphangioma Common symptoms Cyst-like changes Internal hemorrhagic cysts Dyspnea cysts are thin and contain... Head and neck activity is limited
Most of the neck masses can be seen at birth, most of which occur in the supraclavicular fossa at the posterior margin of the sternocleidomastoid muscle (Fig. 1). The posterior triangle of the neck is a good site, and the left side is more than the right side. After extending to the clavicle, the underarm and even the mediastinum; upwards can affect the lower and lower mouth, the mass is multi-atrial, the surface of the skin is normal or pale blue due to subcutaneous fluid, soft touch, cystic feeling, a few Can also occur in the anterior triangle of the neck, the tumor protrudes from the skin, the diameter is generally 4 ~ 6cm, smooth and soft, the sense of fluctuation is obvious, no tenderness, the edge is unclear, the light transmission test is positive, can also be seen in the groin, The hip test is positive for the light transmission test. The puncture can extract the grass yellow liquid, which generally grows slowly. For example, if the infection is concurrent or intracapsular hemorrhage, the tumor can rapidly increase, and the respiratory tract and digestive tract can be compressed to have corresponding symptoms. When the water tumor is too large, The head and neck activities are restricted, the water tumors expand inward, and the throat and trachea can be compressed, causing difficulty in breathing. If the water tumor located in the anterior triangle of the neck protrudes upward into the bottom of the entrance cavity, it can affect the chewing and swallowing movement.
Water sac tumors have the potential and long-term slow growth characteristics. When the respiratory tract infection occurs, the water tumor can suddenly grow. This may be caused by the infection causing obstruction of the lymphatic vessels, causing the lymph to flow back into the cyst. Mild trauma causes internal bleeding. It also causes a sudden increase in the water tumor, which also has the characteristic of "invasive" growth along the vascular nerve, but rarely causes compression symptoms.
Examine
Examination of cystic lymphangioma
1. B-ultrasound, CT examination helps to confirm the diagnosis and understand the location and extent of the lesion.
2. The light transmission test is positive.
3. Iodine angiography of water cyst, iodine angiography before operation can help to understand the scope of the cystic tumor and its branch, which has reference value for surgical resection.
Methods: Water cysts were puncture, 10 to 15 ml of lymph fluid was withdrawn, and the same amount of contrast agent was injected, and then the film was taken. Diagnosis: Diagnosis: According to the clinical features, the diagnosis is generally difficult. The diagnosis is mainly based on the history and symptoms, because the cyst wall is thin and inside. Containing a colorless liquid, the light transmission test is positive. The puncture can pump out a liquid that is transparent and easy to coagulate. It has cholesterol crystals and has the same properties as lymph.
Diagnosis
Diagnosis and differentiation of cystic lymphangioma
According to the clinical characteristics, the general diagnosis is not difficult. The diagnosis is mainly based on the history and symptoms. Because the cyst wall is thin and contains colorless liquid, the light transmission test is positive. The puncture can pump out the liquid transparent and easy to coagulate liquid with cholesterol. Crystallized, the nature is exactly the same as lymph.
Lymphangioma is a hamartoma-like neoplasm whose occurrence is directly related to embryonic development. According to the literature, as early as during embryonic development, mesoderm fissures in the venous plexus fuse to form large primitive lymphatic sacs. If some primitive lymphatic sacs cannot communicate with the central venous system, cystic lymphoids with larger cystic spaces will be produced. Tumor; if the surrounding part of the original lymphatic sac tissue is not connected to the lymphatic system trunk, the development of cavernous lymphangioma. From the structural point of view, it is basically divided into simple (single-atrial) and spongy (multi-atrial) lymphangioma, which is also called lymphangioma when mixed with blood vessels. The above three types are more common in clinical practice.
The diagnosis of lymphangioma is not difficult, and the lymphatic tissue can be diagnosed by puncture; if it occurs on the surface of the body, it is a subcutaneous cystic mass, which is smooth and has no tenderness. The light transmission test is positive; if it is performed by B-ultrasound or CT examination, it will be more capable. Clear diagnosis. It is worth mentioning that: cavernous lymphangioma is easy to be confused with cavernous hemangioma. Careful distinction can be found that the former has a normal skin color, the latter has a purple-blue appearance, and the puncture fluid has different properties. The former is lymph, the latter. Contains blood cells.
