Pediatric hemangioma
Introduction
Introduction to pediatric hemangioma Pediatric hemangioma occurs at birth or within three months to six months after birth, often occurs in the head, face and neck, affecting the baby's appearance, generally growing more quickly in 2-8 months, causing parents' concerns. Parents' patience and close coordination with the doctor can sometimes be cured without treatment. However, dangerous infantile hemangiomas, such as the eyes, throat, and limb ends, need special attention. The disease is a benign tumor that originates in the blood vessels of the skin and occurs mostly in infants or children. More common in the head and neck skin, but mucous membranes, liver, brain and muscles can also occur, often found at birth or shortly after birth, with the most common red spotted plaque in the occipital region. basic knowledge The proportion of illness: 0.31% Susceptible people: children Mode of infection: non-infectious Complications: hearing impairment
Cause
Pediatric hemangioma etiology
Gene mutation (35%)
During the development of human embryos, especially in the early stage of vascular tissue differentiation, due to the small-scale misconfiguration of the control gene segments, the tissue differentiation of specific parts is abnormal and develops into hemangioma.
Mechanical damage (30%)
In the early embryonic period (8-December), the embryonic tissue is mechanically damaged. Local tissue hemorrhage causes some hematopoietic stem cells to be distributed to other embryonic characteristic cells, some of which differentiate into blood vessel-like tissues and eventually form hemangiomas.
Pathological change
The structure of strawberry hemangioma and capillary spongy mixed tumor is almost the same under light and electron microscopy. A large number of capillaries, venules and venules form vascular plexus, and endothelial cells proliferate actively. Under electron microscope, endothelial cells are flat. Or elliptical, with a continuous multi-layered basement membrane around the endothelial cells, with a large number of mast cells during the growth phase and stationary phase, wine stains, orange-red spots and cavernous hemangioma and vascular hemangioma The underlying structure is quite different, but the ultrastructure of endothelial cells is basically the same. The endothelial cells of the three are flat, small in size, and the cytoplasmic organelles are underdeveloped. Only a small amount of mitochondria, endoplasmic reticulum, etc. are seen, and even absent.
Prevention
Pediatric hemangioma prevention
1. Avoid harmful substances (promoting factors)
It is able to help us avoid or minimize exposure to harmful substances.
Some related factors of tumorigenesis are prevented before the onset, and many cancers can be prevented before they are formed. A report in the United States in 1988 compared the international malignant tumors in detail and proposed many external factors of known malignant tumors. In principle, it can be prevented, that is, about 80% of malignant tumors can be prevented by simple lifestyle changes, and traced back. In 1969, Dr. Higginson's research concluded that 90% of malignant tumors are caused by environmental factors," "Environmental factors", "lifestyle" refers to the air we breathe, the water we drink, the food we choose to make, the habits of activities, and social relationships.
2. Improve the body's immunity against tumors
Can help to strengthen and strengthen the body's immune system and cancer.
The focus of our current cancer prevention efforts should first focus on and improve those factors that are closely related to our lives, such as quitting smoking, eating properly, exercising regularly, and losing weight. Anyone who follows these simple and reasonable lifestyles can Reduce the chance of cancer.
The most important thing to improve the function of the immune system is: diet, exercise and control troubles. Healthy lifestyle choices can help us stay away from cancer. Maintaining good emotional state and proper physical exercise can keep the body's immune system at its best. Tumors and prevention of other diseases are equally beneficial. Other studies have shown that appropriate activities not only enhance the body's immune system, but also reduce the incidence of colon cancer by increasing the peristalsis of the human intestinal system. Here we mainly understand the diet in preventing tumorigenesis. Some questions.
Human epidemiology and animal studies have shown that vitamin A plays an important role in reducing the risk of cancer. Vitamin A supports normal mucosa and vision. It directly or indirectly participates in most of the body's tissue functions. Vitamin A is present in animal tissues. In the liver, whole eggs and whole milk, the plant is in the form of -carotene and carotenoids, which can be converted into vitamin A in the human body. Excessive intake of vitamin A can cause adverse reactions in the body and -carrot This is not the case with carotenoids, and the low vitamin A content in the blood increases the risk of malignant tumors. Studies have shown that those with low levels of vitamin A intake in the blood increase the likelihood of lung cancer, while those with low blood levels in smokers Levels of vitamin A ingestors have the potential to double lung cancer. Vitamin A and its mixture can help remove free radicals in the body (free radicals can cause damage to genetic material), and secondly stimulate the immune system and help differentiate cells in the body. Ordered tissue (while the tumor is characterized by disorder), some theories suggest that vitamin A can help early carcinogens Invasion mutated cells become reversed the occurrence of the normal growth of cells.
In addition, some studies suggest that supplementation with -carotene alone does not reduce the risk of cancer, but rather increases the incidence of lung cancer. However, when -carotene binds to vitamin C, E and other antitoxin substances, its protective effect. It is shown, because it can increase free radicals in the body when it is consumed by itself. In addition, there are interactions between different vitamins. Both human and mouse studies have shown that the use of -carotene can reduce 40% of vitamins in the body. At E-level, a safer strategy is to eat different foods to maintain a balanced vitamin to protect against cancer, as some protective factors have not been discovered so far.
Vitamin C, E is another anti-tumor substance that prevents the harm of carcinogens such as nitrosamines in food. Vitamin C protects sperm from genetic damage and reduces the risk of leukemia, kidney cancer and brain tumors in their offspring. Vitamin E can reduce the risk of skin cancer. Vitamin E has the same anti-tumor effect as vitamin C. It is a scavenger that protects against toxins and scavenges free radicals. The combination of vitamins A, C and E protects the body against toxins. Better than applying it alone.
At present, research on phytochemistry has attracted widespread attention. Phytochemistry is a chemical found in plants, including vitamins and other substances found in plants. Thousands of plant chemicals have been found, many of which have anticancer properties. The protective mechanism of these chemicals not only reduces the activity of carcinogens but also enhances the body's immunity against carcinogens. Most plants provide antioxidant activity that exceeds the protective effects of vitamins A, C, and E, such as a cup of cabbage. Contains 50mg of vitamin C and 13U of vitamin E, but its antioxidant activity is equivalent to the antioxidant activity of 800mg of vitamin C and 1100u of vitamin E. It can be inferred that the antioxidant effect in fruits and vegetables is far better than what we know. The effect of vitamins is strong, and no doubt natural plant products will help prevent cancer in the future.
Complication
Pediatric hemangioma complications Complications, hearing impairment
1, causing hearing impairment: the onset of hemangioma can also cause hearing loss in patients, parotid hemangioma can completely block the external auditory canal and affect hearing, but will not affect the development of the child.
2, causing visual impairment: visual impairment is a common complication in hemangioma, because periorbital hemangioma can block the line of sight, it will lead to cost amblyopia. Even if the line of sight is unaffected, the upper hemangioma can cause astigmatism. Periorbital or intraorbital hemangioma can cause axial destruction, astigmatism, and myopia, leading to disuse amblyopia. Disuse of amblyopia is one of the common causes of blindness.
3, causing bleeding: because the tumor of the hemangioma is easily affected by external influences and rupture and bleeding, with the increase of age, due to the child's movement, hemangioma is most vulnerable to trauma and cause serious bleeding, especially the lesion Superficial. Hemangioma hemorrhage is not controlled by dressing or pressurization like other traumatic bleeding. Ulcerative hemangioma has a tendency to spontaneously erupt, causing bleeding after a minor trauma.
4, causing ulcers: common complications of hemangioma are ulcers, the incidence rate is about 5%, in the rapid proliferative phase or in the special anatomical parts (upper lip, upper chest, perianal or perineal) is most likely to occur.
Symptom
Pediatric hemangioma symptoms Common symptoms Hemorrhagic tendency Tinnitus vascular murmur varicose veins spider erythematosus
Hemangiomas can grow in any part of the body, but are more common in the skin and subcutaneous tissues, followed by oral mucosa and muscles, bones, liver, spleen, and intracranial, while the digestive tract, kidney, heart, and lungs are rare.
Capillary hemangioma
(1) neonatal spotted sputum: also known as capillary hemangioma (capillary hemangioma), is a pale red or blue epidermal discoloration, usually located in the back of the midline of the head, neck or ankle, existed at birth, generally It gradually disappears on its own within a few months without treatment.
(2) intradermal capillary hemangioma: There are three clinical variants, which are found after birth. It is characterized by mature endothelial cell tissue-type capillaries in the dermis, and many areas located in the distribution of sensory nerves, such as the trigeminal nerve.
1 orange-red spot: it is a patch from orange-red to rust-colored, flat and not higher than the surface of the skin, mostly in the forehead, upper eyelids, nostrils, pillows, etc., the pressure can fade, does not disappear naturally, drying method , freezing method and rubbing method or X-ray irradiation, are invalid, generally do not need treatment, if necessary, can be covered with cosmetics, occasionally removed.
2 wine stains: dark purple, born at the time, rarely extended, facial wine stains may be associated with intracranial hemangioma, namely Sturge-Weber syndrome, in recent years, foreign countries often use surgical treatment, such as large area, can Staging surgery, and skin grafting, surgery should be carried out before the age of 5, so as not to have a psychological impact on children.
3 spider mites: also known as stellate hemangioma, which is characterized by a small number of radially dilated intradermal capillaries from a subcutaneous central small artery. The shape resembles a spider, which occurs in the face, arms, hands and upper torso, and oppresses the center. The spider mites can disappear, and if they do not naturally disappear, the center of the tumor can be punctured with a red needle under a magnifying glass, and the effect is better.
(3) Strawberry-shaped capillary hemangioma: also known as juvenile capillary hemangioma, may disappear completely or partially, usually appear shortly after birth, the tumor is often higher than the skin, bright red, lobulated, shaped like a strawberry, good to face , scalp and neck, no significant changes in compression, generally gradually disappear in 1 to 4 years old, can also be used surgery, freezing, hardener, low voltage, short-distance radiotherapy and other methods.
2. Capillary cavernous hemangioma and cavernous hemangioma
(1) Capillary cavernous hemangioma (also known as mixed hemangioma), also known as mixed hemangioma, usually existing at birth, mainly in the face and neck, the tumor can reach a large volume, growing rapidly in the first 6 months It is invasive, but it can still subside naturally, but it will not shrink completely. Therefore, active treatment measures such as hormone therapy, freezing and radiotherapy should be taken.
(2) cavernous hemangioma (angio cavernoma): it is formed by a large number of blood-filled cavities or sinuses. There is an endothelial cell layer on the wall of the cavity. The cavity is separated by fibrous connective tissue, and the tumor grows in the subcutaneous tissue. Muscle, can occur in any part of the body, with limbs, torso more common, touch like a sponge-like feeling, flat or uneven, compression can be trapped, may automatically shrink, but will not completely disappear, currently for cavernous hemangioma The effective treatments are mainly surgery and hormone therapy.
3. Vascular hemangioma
Less common, for hemangioma containing small arteries and small vein anastomosis, occurs in the scalp or extremities, subcutaneous can distort blood vessels, vascular pulsation, increased skin temperature, auscultation can be heard and vascular murmurs, can be severe Pain, and can cause tinnitus, this hemangioma will not disappear automatically, it should be treated early, for limited hemangioma racemosum, only surgical treatment, tumor is too large, can be staged surgery, if necessary skin grafting.
4. Tumorous syndrome
Tumorous syndrome refers to a certain type of hemangioma clinically, which is regularly accompanied by other pathological conditions, and forms several independent pathological entities or syndromes.
(1) Hereditary hemorrhagic vasodilatation: mainly manifested by telangiectasia of the skin and mucous membranes, with significant bleeding tendency. Pathological sections show that the expanded capillary wall is thin, often only one layer of endothelial cells, directly in the outward Below the epidermis, the capillary hemangioma is often multiple, flat or slightly protruding from the skin, irregular shape, occurs in the back of the hand and nasal mucosa, finger pressure can be pale, easy to bleed, treatment can use hormone or electrocoagulation.
(2) Sturge-Weber syndrome: facial wine stains combined with intracranial hemangioma (Sturge-Weber syndrome), so the facial wine stains should be carefully observed and examined, such as the first branch of the trigeminal nerve The skin of the area is an important part of the concurrent Sturge-Weber syndrome. This syndrome has no root treatment, often accompanied by epilepsy and mental retardation.
(3) Ma Fuxi syndrome: no hereditary, completely normal at birth, and gradually unilateral cartilage dysplasia, resulting in bilateral limb development imbalance.
(4) Lindau-(Feng) Hippel syndrome: single or multiple hemangiomas that grow in the cerebellum, brainstem, spinal cord, retina, liver, etc., accompanied by pancreas, kidney, adrenal cysts or adenomas, Although the scope of the tumor is wide, it is benign.
(5) Klippel-Trenaunay syndrome: mainly manifested as limb soft tissue and bone hyperglycemia, subcutaneous varices, skin hemangioma, the incidence of men and women is not much difference, there is no standard treatment, most scholars advocate conservative treatment of light, Surgical treatment in severe cases or complications.
Examine
Pediatric hemangioma examination
General laboratory results have no specific findings.
With the manifestations of tinnitus, epilepsy, etc., you can do brain CT, angiography and other tests. Other syndromes are based on clinical selection of B-ultrasound, X-ray and other corresponding examinations.
1. Appearance characteristics of the tumor (wine spot or bayberry, etc.).
2. Fading or shrinking.
3. Positive position test, percussion and venous stone, puncture and extraction of whole blood (sponge type), sputum pulsation, auscultation, murmur, compression of the blood supply artery and murmur disappeared (vine-like).
4. Angiography shows contrast agent concentration or vascular malformation.
5. Histopathological examination confirmed the diagnosis.
Diagnosis
Diagnosis and diagnosis of pediatric hemangioma
Diagnosis can be based on clinical performance and related examinations.
Differential diagnosis
Different from glomus tumor, angiosarcoma, etc., its characteristics are as follows:
1. glomus tumor: refers to the sharp painful mass in the toenail bed and its vicinity. It is especially painful when it is stimulated by cold. It is located in the lower jaw. It can be seen that the toenail is locally raised and the surface may be light red, purple or slightly dark. Do not let touch.
2. Angiosarcoma: less common, the tumor is nodular, painless, purple red, superficially easy to hemorrhage and ulceration, microscopically seen numerous disordered tumor blood vessels, tumor cells proliferate in the basement membrane, It can be attached to the inner wall of the blood vessel to form a nodular protrusion in the lumen. The tumor cells are mostly fusiform. The undifferentiated are polygonal, endothelium-like, nuclear, deep-stained, and more nuclear division. Polynuclear giant cells can be seen. .
Immunohistochemistry is of great significance for the diagnosis and differential diagnosis. Sensitive endothelium markers, VIII-related antigens, CD31, CD34, etc. can be selected to help diagnose.
