choroidal hemangioma
Introduction
Introduction to choroidal hemangioma Choroidal hemangioma (choroidalhemangioma) is a benign, vascular, hamartomaous lesion. Most are cavernous hemangioma, and capillary hemangioma is extremely rare. It usually occurs between the ages of 10 and 20. It can exist alone or as part of a craniofacial hemangioma, often with glaucoma. Histologically, these tumors are spongy, with up to 90% of the retinal detachment under the microscope. basic knowledge The proportion of illness: the incidence rate is about 0.001% - 0.03% Susceptible people: no special people Mode of infection: non-infectious Complications: retinal detachment glaucoma
Cause
Chronic hemangioma
Cause of the disease (80%):
The cause of choroidal hemangioma is unknown. Because it occurs in the posterior pole, it is presumed to be related to the posterior ciliary artery. Choroidal hemangioma is a hamartoma formed by congenital vascular malformation. The lesion mainly occupies the choroid and the middle vascular layer, while the capillary is not involved. The blood vessels are composed of blood vessels of different sizes, no tumor capsule, and no endothelial cells in the inner wall of the blood vessel. Hyperplasia, no smooth muscle on the wall.
Prevention
Choroidal hemangioma prevention
Understanding the risk factors of tumors and formulating corresponding prevention and treatment strategies can reduce the risk of cancer. The focus of cancer prevention and treatment work we are currently facing should first focus on and improve those factors closely related to our lives, such as smoking cessation, reasonable diet, and regular exercise. And reduce weight. Appropriate exercise, enhance physical fitness and improve your disease resistance. Anyone who follows these simple and reasonable lifestyles can reduce their chances of developing cancer.
Complication
Choroidal hemangioma complications Complications, retinal detachment, glaucoma
Retinal detachment, retinal cystic degeneration and secondary glaucoma.
Symptom
Chronic hemangioma symptoms common symptoms fundus changes visual deformity visual impairment edema visual field defect
Diffuse choroidal angiomatosis
Because there are often facial hemangioma and conjunctival vasodilation of the conjunctiva and sclera in the affected side, more early ophthalmologic examination, found that the fundus changes more than 10 years old, facial and skin hemangioma more along the side of the trigeminal nerve distribution, a small number of patients Bilateral distribution, some patients have leptomeningeal angiomatosis at the same time, 50% of patients with facial and cutaneous hemangioma with diffuse choroidal hemangioma (Sturge-Weber syndrome), a small number of patients with small hemangioma And conventional fundus examination is difficult to find, the typical patient's pupil area presents a bright orange-yellow reflection, and the posterior pole of the fundus appears as a broad flat and borderless tomato color thickening, and the corresponding retina is due to degeneration and fat-bearing brown The phagocytic or pigment epithelial cells invade, resembling retinitis pigmentosa, extensive low-level exudative retinal detachment, retinal blood vessels multi-expansion and distortion, if accompanied by glaucoma, the enlarged proportion of optic disc cup to disk ratio, late lesions Causes complicated cataract, iris redness, glaucoma and so on.
2. Isolated choroidal angiomatosis
Without facial, eye or other body lesions, occurs in young adults, the average age of diagnosis is nearly 40 years old, vision loss or visual distortion is a common cause of treatment, long-term patients with central dark spots, sector defects or even half-field Defects, the tumor is mostly located in the posterior pole, 96% in the equator, 86% within 3mm from the macula, 42% partially or completely under the macula, the size of the tumor varies from 3 to 18mm, the average is 7mm, the bulge is 1~7mm Etc., an average of 3mm, the tumor is orange-red bulge, the boundary is clear, the pigment epithelium or hyperplasia on the surface of the tumor is pigmented, or the metaplastic is yellow-white fibrous tissue, the retina of the tumor is diversified, or mild edema, if located The macular area can be misdiagnosed as central serous chorioretinopathy, or cystic degeneration. The cystic degeneration merges into retinal cleft palate. Early exudative retinal detachment is mostly confined to the vicinity of the tumor. Later retinal detachment is widely observed. The retina is obviously bulged, even after reaching the lens, the tumor adjacent to the optic disc can cause optic nerve ischemic changes, and then the corresponding visual field defect occurs, such as Side visual field loss, the natural history of tumor increases slowly but gradually increase retinopathy.
Examine
Examination of choroidal hemangioma
Histopathological findings: Choroidal hemangioma is composed of blood vessels of different sizes. The blood vessel wall is a layer of endothelial cells. The lumen is different in size, and there is a gap between the blood vessel walls. The vascular morphology of choroidal hemangioma can be divided into 3 type:
1. Capillary type: composed of capillaries, consisting only of a layer of endothelial cells, the morphology of endothelial cells is normal, no hyperplasia, no basement membrane and smooth muscle tissue, no loose edema inside the wall The quality of the tissues, mainly pigment cells and fibroblasts, but not as dense as those of cavernous hemangioma, the cells showed no obvious abnormalities and hyperplasia.
2. Spongy vasculature: The tissue consists of lumens of different sizes, but mainly composed of larger vascular lumens, some of which have small lumens and thin blood vessel walls. They consist of only one layer of endothelial cells, and no basement membrane or smooth muscle. Tissue, endothelial cells are normal in morphology, no hyperplasia is found, and there is a very thin interstitial tissue between the walls. The composition is mainly a choroidal matrix that is extruded into a lamellar structure, which is characterized by densely packed pigment cells, but pigment cells. No hyperplasia, more common in isolated hemangioma.
3. Hybrid type: It is composed of two types of blood vessels, capillary type and cavernous vascular type. It is more common in diffuse choroidal hemangioma. The blood in the hemangioma is mainly red blood cells, occasionally polymorphonuclear leukocytes and eosinophils. The blood in the lumen is less, which may be related to the compression of the tumor. In the diffuse hemangioma, the thickness of the choroid is 4 to 5 times normal, and there is no obvious boundary with the adjacent choroid, but the isolated hemangioma and the surrounding choroid There are obvious boundaries between the formation of compressed choroidal melanocytes and choroidal lamina. Due to the influence of hemangioma, various changes can occur, and different degrees of pathological changes occur in the retinal tissue on the surface of the tumor, firstly on the surface of the hemangioma and There is a certain extent of retinal tissue in the vicinity of the retina, a large amount of fibrinous exudation under the detached retina, and retinal tissue also undergoes different degrees of degeneration. In the light, the outer retina has obvious cystic degeneration, and the capsule is filled with proteinous exudation. , resulting in thickening of the retina, ganglion cell layer with varying degrees of atrophy, ganglion cells, internal and external plates The layers also shrank to varying degrees. In the most severe cases, the normal tissue structure of the retina disappeared completely, and all were replaced by glial tissue and connective tissue. The retinal pigment epithelium (RPE) also showed hyperplasia or atrophy, and there was a drusen under the RPE. There is a part where ossified tissue is present, and the glass film is often destroyed.
Diagnosis
Diagnosis and diagnosis of choroidal hemangioma
diagnosis
According to the clinical manifestations, the results of ophthalmoscopy, frontal mirror and three-sided mirror examination are clear.
Differential diagnosis
It is mainly the clinical identification of isolated choroidal hemangioma and choroidal melanoma with less pigment content. In recent years, most choroidal hemangiomas have been correctly diagnosed due to the application of B-ultrasound, indirect ophthalmoscopy and fluorescein angiography. There are still very few cases in the clinic because the secondary retinal detachment, neovascular glaucoma, eye pain and other symptoms are misdiagnosed as choroidal melanoma and lead to eyeball removal.
In addition, it should be differentiated from choroidal metastasis, choroidal osteoma, central serous chorioretinopathy, age-related macular degeneration, and posterior scleritis. Diffuse choroidal hemangioma is often associated with facial vascular disease. Tumor or central nervous system hemangioma, so its clinical identification is relatively easy.
