ocular capillary hemangioma
Introduction
Introduction to ocular capillary hemangioma Ocular capillary hemangioma is the most common benign tumor in infants and young children, also known as infantile hemangioma. In severe cases, the lesion affects the entire upper eyelid, causing diffuse swelling of the upper eyelid, which can cover the pupil, affect visual development, and cause amblyopia and strabismus. If the eyelid tumor is small, slow or static, does not affect vision or appearance, it may not be disturbed and wait for it to subside. basic knowledge The proportion of illness: 0.005%-0.006% Susceptible population: infants, the most common in early childhood Mode of infection: non-infectious Complications: capillary hemangioma
Cause
Cause of ocular capillary hemangioma
Cause:
Ocular capillary hemangioma occurs within 3 months after birth, and the subsequent 3 months grows faster, especially in those with primary eyelid skin. It can affect the entire eyelid and cheeks within 1 to 2 months. Most patients After 1 year of age, the lesion is still and has a tendency to spontaneously resolve. The symptoms and signs of the disease are related to the location and extent of the disease.
Prevention
Ocular capillary hemangioma prevention
Regular examination should be carried out during pregnancy. If the child has obvious hemangioma tendency or abnormality, especially large multiple hemangioma, artificial abortion should be performed promptly to avoid the birth of the diseased child.
Pregnant women should avoid harmful factors as far as possible, including away from smoke, alcohol, drugs, radiation, pesticides, noise, volatile harmful gases, toxic and harmful heavy metals, etc., so as not to cause genetic mutations.
Reasonable dietary habits: Maintain a light diet. Eat more fresh vegetables and aquatic products. Such as green vegetables, radishes, kelp, seaweed and so on. Should eat less meals. Fasting fat meat and animal offal, do not eat spicy onions, peppers, coffee, etc. Eat less refined sugar, honey, fruit candy, cakes, etc.
Complication
Ocular capillary hemangioma complications Complications
Eyelids develop malformations or enlargement and capillary hemangioma in other superficial parts of the body.
Symptom
Eye capillary hemangioma symptoms Common symptoms Upper ptosis eyeball displacement strabismus eyeball protrusion
Ocular capillary hemangioma occurs at most within 3 months after birth, and then grows faster in the following 3 months, especially in those with primary eyelid skin. It can affect the entire eyelid and cheeks within 1 to 2 months. After 1 year of age, the lesions are still and have a tendency to spontaneously resolve. Margileth et al. observed large numbers of children with cutaneous hemangioma. 30% of the lesions resolved spontaneously at 3 years old, 60% disappeared at 4 years old, and 76% resolved at 7 years old. Basta observation The spontaneous regression of capillary hemangioma occurring in the iliac crest is less common.
The symptoms and signs of the disease are related to the location and extent of the disease, and can be divided into three types: surface layer, deep layer and comprehensive.
The surface capillary hemangioma is limited to the dermis, which occurs within 1 month of birth, and develops rapidly in the following month. It can occur in the skin of the eyelids, and can also be found in other parts of the body. The shape of the tumor is irregular and the boundary is clear. Slightly bulging, bright red color, many small depressions on the surface, like strawberry-like, hence the name strawberry or strawberry-shaped hemangioma, the lesions are only a little bit, the larger can affect the whole eyelid and face, with fingers The pressure can be faded, and the finger will return to red after being removed. Mild abrasions and scratches can cause bleeding. In the process of self-resolving, the hemangioma becomes thinner, and normal skin or radial fading spots appear in the central part, and the appearance does not affect the appearance after spontaneous dissipation. .
Deep capillary hemangioma often invades the deep layer of the eyelid and the posterior septum. There are also a few cases where the lesion is limited to the surrounding area of the iliac crest and the central space. It occurs mostly in the medial aspect of the upper palate, with local hypertrophy or flattened bulge, and the skin or conjunctiva sees a purple-blue mass. When crying, the tumor enlarges, the tumor invades the whole eyelid, and the hypertrophy sag of the upper eyelid covers the pupil, affecting the visual development. If not treated in time, it can cause amblyopia and strabismus, the surface of the percussive tumor is smooth, and the hardness of the rubber sample is soft or soft. Sexuality, borders are unclear, blood donors still see tumors small beats, tumors occur in the first 1/3 of the iliac crest, the eyeball can be displaced downwards, the latter in the ball causes the eyeball to protrude, the tumor cells invade the extraocular muscles can affect the eye movement .
Examine
Examination of ocular capillary hemangioma
Histopathological examination: For deep lesions of the iliac crest, especially suspected rhabdomyosarcoma should be subjected to perforation or biopsy, and mature vascular endothelial cells can be seen through the suction, and the tissue block can be obtained by perforation and histopathological examination. Capillary hemangioma by capillaries The endothelial cells of the luminal wall proliferate, and the capsule is lacking in the naked eye. The substance is grayish-white granular and brittle. The microscopic findings are different due to different developmental stages. The immature tumors can be seen to accumulate vascular endothelial cells into nests. Tablets, a little interstitial, although the lesions are connected to the systemic circulation, but there is very little blood in the intervascular space. This type of tumor is called benign hemangioendothelioma. In well-differentiated lesions, piles of endothelial cells are reduced, and capillaries are increased. Long-standing tumor telangiectasia, some areas are spongy, often referred to as mixed hemangioma, under the electron microscope, visible solid cell bands, mixed bands and open vascular lumen, each vascular unit including endothelial cells, The reticular fiber sheath and the outer skin cells have phagocytic cells and denatured cell regions in the interstitial, which correspond to the spontaneous regression of clinical tumors.
1. X-ray examination and angiography in infants and young children in the rapid development of bones, although the growth of sacral capillary hemangioma is faster, it can also cause the expansion of the lateral iliac crest volume. Selective angiography can be seen in the external carotid artery, internal carotid artery or both. Blood supply, larger blood supply artery development, high density shadow in the lesion area.
Ultrasound exploration ultrasound images correspond to histological changes. Capillary hemangioma is an invasive lesion with less interstitial. B-mode ultrasound shows irregular shape and unclear boundary; interval and wall can be used as echo interface. The performance is different, the internal echoes of different strengths are compressible, the ultrasound also shows the extent and depth of tumor invasion, and Doppler ultrasound shows diffuse color blood flow and fast-flowing arterial spectrum.
3. CT scan subcutaneous capillary hemangioma shows enlargement of the eyelids and increased density, located between the eyeball and the bone wall, the contour is clear, the shape is irregular, but the boundary with the eyeball is unclear, after intravenous injection of positive contrast agent, moderate Or highly enhanced, large lesions often span several intervals, such as before the septum, around the eyelids and the central gap, manifested as invasive lesions.
4. MRI T1WI lesions showed medium signal, T2WI was high signal, and there were occasional signal streaks in the medium and high signal area, sometimes showing mixed signals or mottled.
Diagnosis
Diagnosis and differentiation of ocular capillary hemangioma
Diagnostic criteria
Comprehensive capillary hemangioma invades both the dermis and the deep layer. It has symptoms and signs common to the superficial and deep tumors. For example, the eyelids and the surrounding skin can be seen as strawberry mites, swollen eyelids, and the eyeballs are displaced and protruded. Widespread invasion, causing significant deformity of the eyelids, often makes family members fear.
The clinical diagnosis of capillary hemangioma is not difficult, mainly the shape and special color of the lesion. However, when the invasion of the iliac crest, especially the color of the eyelid, has no change, the diagnosis is difficult. At this time, ultrasound, CT and MRI are needed.
Differential diagnosis
Subcutaneous capillary hemangioma sometimes needs to be differentiated from meningeal bulging, which is difficult to distinguish clinically from rhabdomyosarcoma and often requires imaging techniques.
1. The anterior meningeal sulcus anterior meningocele is caused by the incomplete closure of the anterior cranial fossa, and the meninges and their surrounding cerebrospinal fluid are bulged through the sieve plate and the sacral cardboard bone hole to the rim. Inside the upper part, the clinical manifestation of this place is bulging forward, the color is slightly purple, can be soft and swollen, the child swells when crying, quite like capillary hemangioma, but the development is slow, no tendency to regress, often pulsating, Bone defects were seen in both X-ray and CT scans; ultrasound showed a cystic mass, and color Doppler ultrasonography revealed a lack of blood flow inside.
2. Rhabdomyosarcoma develops faster than capillary hemangioma, and continues to grow. It shows edema at the early stage, prominent eyeball, vision loss and eye movement disorder, sacral margin and hard mass, and it is incompressible, and the mass does not increase when crying. Ultrasound exploration, although it also shows low reflectivity, is rarely compressible. Although color Doppler ultrasonography has a rich blood flow inside, it is not diffuse. CT scan can be found as a solid mass and can have bone destruction.
3. The green tumor of the sputum area is a mass caused by leukocyte infiltration. The immature cells are found in the peripheral blood. The bone marrow puncture can confirm the diagnosis. For the difficulty in differential diagnosis, especially in the sputum, fine needle aspiration biopsy is often necessary. The meninges swelled back to the cerebrospinal fluid, the capillary hemangioma was a well-differentiated endothelial cell, and the rhabdomyosarcoma showed atypical cells.
4. Metastatic neuroblastoma is also a tumor that occurs in childhood. The image shows a solid tumor, extensive bone destruction, and a mass in the adrenal medulla.
