Does fetal ultrasound show hemangioma. Hemangioma of the liver: types, signs and diagnosis using ultrasound

Hemangioma- this is a benign children's tumor, developing from the cells of the vascular tissue, and representing a volumetric neoplasm, consisting of many tiny vessels ( capillaries). The baby is either born with a hemangioma ( in 30% of cases), or it develops in the first weeks of life.

The most intensive growth is noted in the first six months of a child's life, after which the growth processes slow down or stop altogether, and the process of reverse development may begin. In more severe cases, it is possible to continue the growth of hemangioma at an older age, increase its size and germination in nearby organs and tissues, followed by their destruction. This leads to both a serious cosmetic defect and dysfunction of various organs and systems, which can have the most adverse consequences.

Hemangioma is quite common and occurs in every tenth newborn. It is three times more common in girls than in boys. The most commonly affected areas are the face, neck, and scalp ( up to 80% of all skin hemangiomas).

Interesting Facts

• The number of hemangiomas in a child can vary from one to two to several hundred.
• They occur as small hemangiomas ( 2 - 3 mm) and huge ( up to several meters in diameter).
• Hemangiomas in adults are extremely rare and are the result of their incomplete cure in childhood.
• Small hemangiomas may disappear on their own by the age of five.
• Hemangioma is characterized by the most aggressive growth among all benign tumors.

Causes of hemangioma

Fetal vessel formation

Depending on the mechanism of vascular development, there are:

• primary angiogenesis;
• secondary angiogenesis.

secondary angiogenesis
It is characterized by the growth of new blood vessels from already formed ones. This process is genetically determined and also controlled by local regulatory factors.

So, with the development of an organ and an increase in its mass, deeper sections begin to experience a lack of oxygen ( hypoxia). This triggers a number of specific intracellular processes, the result of which is the release of a special substance - vascular endothelial growth factor ( VEGF, Vascular endothelial growth factor).

This factor, acting on the endothelium of already formed vessels, activates its growth and development, as a result of which new vessels begin to form. This leads to an increase in oxygen delivered to the tissues, which inhibits the production of VEGF. Thus, angiogenesis is controlled in the later stages of fetal development and after the birth of the child.

It is important to note that fetal tissues have a pronounced ability to recover from various kinds of injuries and injuries. As a result of any, even the most minor injury ( compression, rupture of a small vessel and hemorrhage) healing processes are activated, including secondary angiogenesis with the possible subsequent development of hemangiomas.

Theories of the occurrence of hemangioma

The most plausible and scientifically substantiated are:

• stray cell theory;
• fissural ( slotted) theory;
• placental theory.

Under the influence of certain factors, this process is disrupted, as a result of which no involution of capillaries is observed, but, on the contrary, activation of their growth is noted. This can explain the birth of children with hemangioma, or its appearance in the first weeks of a child's life. It also becomes clear the possibility of the formation of this tumor in almost any tissue of the body.

fissural theory
At the initial stages of embryo development in the skull area, the so-called embryonic gaps are distinguished - the places of the future location of the sensory organs ( eyes, ear, nose) and mouth opening. At week 7, blood vessels and nerves that take part in the formation of organs grow into these cracks.

According to the fissural theory, hemangioma occurs in the fetus as a result of a violation of the development of vascular rudiments in these areas. This explains the more frequent location of these neoplasms in the area of ​​the natural openings of the face ( around the mouth, eyes, nose, ears), however, the mechanism of development of hemangiomas in other areas of the skin remains unexplained ( on the trunk and limbs) and internal organs.

placental theory
It is assumed that placental endothelial cells enter the fetal circulation and are retained in its organs and tissues. During the period of intrauterine development, maternal factors of angiogenesis inhibition do not allow vascular tissue to actively grow, however, after birth, their action ceases and intensive growth of hemangioma begins.

The mechanism of occurrence of hemangioma

Therefore, various pathological conditions leading to impaired oxygen delivery to the fetus or newborn child are potentially risk factors for the occurrence of hemangioma. These data have been confirmed by many scientific studies.

The appearance of hemangioma can contribute to:

• Multiple pregnancy. With the development of two or more fetuses in the uterus, the likelihood of having children with hemangioma is increased.

• Fetoplacental insufficiency. It is characterized by insufficient oxygen supply ( and other substances) to the fetus due to a violation of the structure or function of the placenta.

• Trauma during childbirth. When a child passes through the birth canal, the tissues of the head are compressed quite strongly, which disrupts the normal blood circulation in them. Long ( or vice versa too fast) childbirth, narrow birth canal or large size of the fetus can provoke the development of local hypoxia, followed by the formation of hemangioma in the scalp and face.

• Eclampsia. This condition develops during pregnancy or childbirth and is characterized by a pronounced rise in maternal blood pressure with possible loss of consciousness and convulsions, resulting in impaired oxygen delivery through the placenta to the fetus.

• Smoking during pregnancy. When smoking, part of the lungs is filled with tobacco smoke, as a result of which the amount of oxygen entering the body decreases. If the maternal organism is able to tolerate such a condition relatively easily, then in the fetal organism, hypoxia can cause increased growth of capillary tissue and the development of hemangioma.

• Intoxication. Exposure to various occupational hazards, as well as alcohol abuse during pregnancy, increases the risk of having a child with hemangioma.

• Mother's age. It has been scientifically proven that childbirth after 40 years of age is associated with an increased risk of various developmental anomalies in the fetus, including vascular neoplasms.

• Prematurity. Starting from 20-24 weeks of pregnancy, surfactant is produced in the lungs of the fetus - a special substance, without which lung breathing is impossible. A sufficient amount of it accumulates only by the 36th week of pregnancy, so the breathing processes in premature babies are disturbed, which leads to tissue hypoxia.

Development of a hemangioma

In the process of development of hemangioma, there are:

• A period of intense growth. It is typical for the first weeks or months after the onset of a hemangioma and, as a rule, stops by the end of the first year of life ( possible exceptions). Externally, the tumor is bright red in color, constantly increasing in diameter, as well as in height and depth. The growth rate varies within different limits - from insignificant to very pronounced ( a few millimeters a day). This period is the most dangerous in terms of the development of complications ( ulceration of the tumor, germination in neighboring organs and their destruction).

• growth stop period. In most cases, by the end of the first year of life, the growth of the vascular neoplasm stops, and up to 5-6 years it increases slightly, corresponding to the growth of the child.

• Regression period. In about 2% of cases, there is a complete spontaneous disappearance of the hemangioma. Some time after growth stops ( in months or years) the surface of the tumor becomes less bright, may ulcerate. The capillary network gradually disappears, which is replaced by either normal skin ( with small, superficially located hemangiomas), or scar tissue ( in the case of volumetric formations that grow into the deep layers of the skin and into the subcutaneous tissues).

Types of hemangiomas

Depending on the structure, there are:

• Capillary ( simple) hemangiomas. They occur in 96% of cases and are a dense capillary network of bright red or dark crimson color, rising above the surface and growing into the deep layers of the skin. This form is considered the initial stage of the development of the disease and is characterized by the intensive formation of new capillaries, prone to germination in the surrounding tissues and destruction of the latter.

• Cavernous hemangiomas. They are the result of the further development of capillary hemangiomas. In the process of growth and increase in size, as a result of capillary overflow with blood, some of them expand and rupture, followed by hemorrhage into the hemangioma tissue. The consequence of this process is the formation of small, blood-filled cavities ( cavities), the inner surface of which is lined with endothelial tissue.

• Combined hemangiomas. Combined hemangioma refers to the transitional stage from capillary to cavernous form. It is a tumor in which there is an alternation of immature capillary tissue with cavities filled with blood ( cavities). An increase in the size of the tumor occurs mainly due to the formation of new capillaries, which subsequently also undergo transformation into cavities, up to the complete replacement of the hemangioma.

• Skin hemangiomas. Occurs in 90% of cases. May be single or multiple, capillary or cavernous type.

• Hemangiomas of internal organs. Almost always accompanied by multiple hemangiomas of the skin. May vary depending on the structure and shape. Damage to the liver, spine, bones and muscles is considered the most frequent and dangerous.

What do hemangiomas look like on the skin?

Hemangioma on the skin	Detailed description	A photo
Capillary hemangioma	It is a painless volumetric formation of an elastic consistency, which rises above the surface of the skin by several millimeters. The edges are uneven, clearly demarcated from healthy skin, which is practically unchanged. The surface is bumpy, lobed, bright red or dark crimson. When pressed, the tumor may slightly fade, restoring the original color after the cessation of pressure.
Cavernous hemangioma in the face	Volumetric, painless formation, completely or partially protruding above the surface of the skin ( often the hemangioma is located deeper, and only a small part of it rises above the skin). The edges are uneven, clearly demarcated from intact skin. The surface is swollen, rough. When pressed, the formation subsides and may turn slightly pale. With the cessation of pressure, a gradual restoration of the original size and color of the tumor is noted.
Cavernous hemangioma of the leg (subcutaneous form)	The bulk of the tumor is located in deeper tissues ( in subcutaneous fat, muscle) and reach a considerable size. The affected area is enlarged ( compared to a symmetrical healthy body area). Numerous capillaries are visible on the surface of the skin. When pressed, the elastic, elastic consistency of the tumor is determined.
Combined hemangioma of the hand (cutaneous form)	It is characterized by a widespread volumetric formation of a bright red color, towering above the surface of the skin. The affected areas do not have clear boundaries, in some places the transition to the deeper layers of the skin is determined. The surface is uneven, bumpy. In some places, there are more protruding tubercles of a dark crimson color, which fall off when pressed ( cavities).

Diagnosis of hemangioma

Diagnosis and treatment of hemangiomas is carried out by a pediatric surgeon, who, if necessary, can involve other specialists.


The diagnostic process includes:

• examination by a doctor;
• instrumental research;
• laboratory research;
• advice from other experts.

Examination by a doctor

What questions will the surgeon ask?

• When did education begin?
• Does the size of the tumor change? how much and for how long)?
• Has any treatment been used and has it been effective?
• Did the child's parents, grandparents, have hemangiomas, and if so, what was their course?

• Carefully examine the neoplasms and adjacent areas.
• Examine the structure of the tumor in detail under a magnifying glass.
• Determine the consistency of the formation, the nature of the changes under pressure.
• Will change the size of the tumor to determine the intensity of growth at subsequent visits).
• Carefully examine all the skin of the child in order to identify previously undetected hemangiomas.

Instrumental Research

In the instrumental diagnosis of hemangiomas, the following are used:

• thermometry;
• thermography;
• ultrasound procedure;
• biopsy.

Thermometry
A research method that allows you to measure and compare the temperature of certain areas of the skin. For this purpose, a special device is used - a thermocouple, which is two electrodes connected to an electrical sensor. One of the electrodes is placed on the surface of the tumor, the second - on a symmetrical but unaffected area of ​​the skin. The sensor allows you to set the difference in temperature with an accuracy of 0.01ºС.

Hemangioma, representing a dense network of capillaries, is better supplied with blood than normal skin, therefore, the temperature in the area of ​​​​this tumor will be slightly higher. An increase in temperature by 0.5 - 1ºС in comparison with unaffected skin indicates the active growth of the tumor.

thermography
A safe, fast and inexpensive research method that allows you to identify areas of the skin with elevated temperature. The principle of the method is based on the same phenomena as thermometry.

The patient sits down in front of a special infrared camera, which for a certain time registers thermal radiation from the surface of the skin. After digital processing of the received information, a heat map of the study area appears on the monitor, on which warmer foci are displayed in red, and relatively cold ones in blue.

Unlike thermometry, which allows to determine the temperature only on the surface of the tumor, thermography provides more accurate information about the spread of hemangioma and allows you to more clearly define its boundaries, often located deep in the soft tissues.

Ultrasound procedure ( ultrasound)
Ultrasound examination is a safe method that has no contraindications, which allows to determine the presence of volumetric formations in the internal organs, as well as to identify the presence of cavities in skin and subcutaneous hemangiomas. Modern ultrasound machines are quite compact and easy to use, which allows you to carry out a diagnostic procedure right in the doctor's office.

The method is based on the principle of echogenicity - the ability of various tissues of the body to reflect sound waves, while the degree of reflection will be different depending on the density and composition of the tissue. The reflected waves are recorded by special sensors, and after computer processing, an image of the organ under study is formed on the monitor, reflecting the density and composition of its various structures.

Indications for ultrasound are:

• determination of the structure of the hemangioma ( cavernous or capillary);
• determination of the depth of the hemangioma;
• suspicion of hemangiomas of the internal organs ( liver, kidney, spleen and other localization).
• specification of the size of the tumor when planning a surgical operation.

• Capillary component of hemangioma. Represents small areas of medium or increased echogenicity ( a dense network of capillaries, to a greater extent than the surrounding tissues, reflects sound waves), with a heterogeneous structure and fuzzy contours.

• cavernous component. The cavity is a cavity filled with blood. The density of blood, and, consequently, its ability to reflect sound waves, is less than that of a dense capillary network, therefore, on ultrasound, caverns are defined as areas of reduced echogenicity ( against the background of a hyperechoic capillary network), round or oval, ranging in size from 0.1 to 8 - 10 millimeters.

CT scan ( CT)
A modern high-precision method that allows to detect tumors of internal organs with sizes from a few millimeters.

The essence of the method lies in the ability of tissues to absorb X-rays passing through them. To conduct the study, the patient lies on a special retractable table of a CT scanner and is placed inside the device. A special device begins to rotate around it, emitting X-rays, which, when passing through the tissues of the body, are partially absorbed by them. The degree of absorption depends on the type of tissue ( the maximum ability to absorb X-rays is observed in bone tissue, while they pass almost completely through air spaces and cavities).

The rays that have passed through the body are recorded by a special device, and after computer processing, a detailed and clear image of all organs and tissues of the area under study appears on the monitor.

It must be remembered that computed tomography is combined with the receipt of a certain dose of radiation, and therefore the appointment of this study should be strictly justified.

Indications for CT are:

• suspicion of hemangioma of the liver and other organs;
• inaccurate data on ultrasound;
• planning for surgical removal of hemangioma ( in order to clarify the size of the tumor and the involvement of neighboring organs).

• hemangioma of the liver and other internal organs). It is a formation of reduced density, round or oval in shape with uneven edges and a heterogeneous structure.

• Bone hemangioma. Since bone tissue absorbs X-rays as much as possible, its normal image on CT will be the most dense ( white color). When the hemangioma grows, the bone tissue is destroyed and replaced by a capillary network, as a result of which the density of the bones decreases, darker areas are noted in their projection, corresponding to the prevalence of the tumor. Fractures resulting from the destruction of bone tissue may be recorded.

• early childhood ( due to high radiation exposure);
• claustrophobia ( fear of confined spaces);
• presence of cancer ( possible negative impact of CT on their course);
• the presence of metal structures ( prostheses, implants) in the study area.

The principle of performing magnetic resonance imaging is the same as for CT, but instead of X-rays, the phenomenon of nuclear resonance is used, which manifests itself when the human body is placed in a strong electromagnetic field. As a result, the nuclei of atoms release a certain type of energy, which is recorded by special sensors and, after digital processing, is displayed on the monitor as an image of the internal structures of the body.

The main advantages of MRI over CT are the absence of radiation and a clearer image of the soft tissues of the body ( nerves, muscles, ligaments, blood vessels).

Indications for an MRI of the spine are:

• Suspicion of compression of the spinal cord by a tumor. Such suspicions may be caused by the presence of multiple hemangiomas on the skin in combination with gradually developing clinical symptoms of spinal cord injury ( violation of the sensitivity and motor functions of the arms, legs and other parts of the body).
• Planning surgery to remove the tumor.
• Inaccurate data with other research methods.

• Germination of hemangioma in the vertebral bodies. At the same time, their bone structure is disturbed, partially or completely replaced by capillary tissue.
• The degree of compression of the spinal cord by the tumor. A vascular formation is determined, protruding into the lumen of the spinal canal and squeezing the spinal cord, or growing into it ( in this case, the tissue of the spinal cord at the level of the lesion is not determined).
• The degree of germination of the tumor in the ligamentous apparatus of the spine.

The essence of the method is the introduction of a special contrast agent into a vein or artery, from which the tumor is supplied with blood. This procedure is carried out under the control of CT or MRI, which allows us to assess the speed and intensity of the spread of the contrast agent in the capillary network of the hemangioma.

Angiography is a rather dangerous diagnostic method, therefore, it is prescribed only in extreme cases, when it is necessary to determine the size of the tumor as accurately as possible ( when planning surgical operations in the face, head, neck).

Absolute contraindications for angiography are:

• allergy to a contrast agent;
• renal failure and/or liver failure.

Performing a biopsy is associated with certain risks, the most dangerous of which is bleeding. In addition, it is possible to confirm the diagnosis without this study, so the only reasonable indication for a biopsy is the suspicion of malignant degeneration of the hemangioma.

Early signs of malignant hemangioma can be:

• Change in the surface of the tumor violation of the usual structure, intensive growth in height and depth, ulceration or peeling.
• Consistency change - the structure becomes heterogeneous, denser areas appear.
• Color change - darker areas of brown or black appear.
• Changes in nearby skin areas - there are signs of inflammation redness, swelling, soreness, local fever).

• incisional biopsy. Most commonly used for sampling skin hemangioma. Under sterile conditions, after treatment of the tumor and surrounding tissues with ethyl alcohol, local anesthesia is performed on the area from which it is planned to take the material. A certain area of ​​the skin is excised with a scalpel, which must necessarily include the tumor tissue and the intact skin adjacent to it.

• Needle biopsy. It is most often used to collect material from internal organs ( liver, spleen, muscles and bones). Under ultrasound control, a special hollow game with sharp edges is injected directly into the tumor tissue, while both peripheral and central sections of the tumor enter the needle.

All hemangiomas removed surgically must also be sent for histological examination without fail.

Laboratory research

The most informative is the general blood test ( UAC), although its changes are nonspecific and may occur in other diseases.

Blood sampling is performed in the morning on an empty stomach. After preliminary treatment with alcohol, the skin of the ring finger is pierced with a special needle to a depth of 2-4 mm, after which several milliliters of blood are drawn into the pipette.

The characteristic changes of the UAC are:

• thrombocytopenia. A condition characterized by a decrease in the number of platelets in the blood due to their increased destruction in the hemangioma tissue, which is clinically manifested by increased bleeding of the skin and mucous membranes.

• Anemia. Decrease in the amount of hemoglobin and red blood cells in the blood. Anemia is a consequence of bleeding and hemorrhage due to thrombocytopenia.

Consultations of other specialists

The diagnostic process may involve:

• Oncologist - with suspicion of malignant degeneration of the tumor.
• Dermatologist - with ulceration of hemangiomas or in the presence of concomitant skin lesions.
• Infectionist - with the development of an infectious process in the area of ​​hemangioma.
• Hematologist - with the development of complications from the blood system ( severe thrombocytopenia and/or anemia).

Treatment of hemangiomas

This statement is due to the unpredictable and often rapid growth of the tumor, which in a relatively short time can increase several times and grow into neighboring organs and tissues. In favor of the early start of treatment is also evidenced by the data of statistical studies, according to which only 2% of skin hemangiomas undergo complete independent regression, and in more than 50% of cases visible cosmetic defects remain on the skin ( scarring).

In the treatment of hemangioma apply:

• physical methods of removal;
• surgical method of removal;
• drug therapy.

Physical methods for removing hemangiomas

Physical methods include:

• cryodestruction;
• laser irradiation;
• sclerosing therapy;
• electrocoagulation;
• close-focus radiotherapy.

The main advantages of this method are:

• high-precision destruction of tumor tissue;
• minimal damage to healthy tissues;
• relative painlessness;
• minimal risk of bleeding;
• fast recovery after the procedure.

The whole procedure takes several minutes, after which the hemangioma area is treated with a solution of potassium permanganate, and the patient can go home. Usually 2-3 sessions of cryotherapy are required with breaks of 3-5 days. After the end of treatment, the area where the hemangioma used to be should be treated with brilliant green for 7 to 10 days until a dense crust forms. Complete healing occurs within a month.

laser irradiation
A modern method for removing superficial and deeper skin hemangiomas with a diameter of up to 2 cm using a laser.

The main effects of laser radiation are:

• thermal destruction of irradiated tissues ( charring and evaporation);
• blood clotting in vessels exposed to laser ( prevents bleeding);
• stimulation of the process of restoration of normal tissue;
• prevention of scar formation.

A dense crust is formed at the site of exposure, which is independently rejected after 2-3 weeks. A small scar may form under it ( with a large size of the removed hemangioma).

Sclerotherapy
This method can be used to remove larger hemangiomas located on the skin or in internal organs. The principle of the method is based on the cauterizing and clotting ability of certain chemicals that are introduced into the tissues of the hemangioma, causing the destruction of blood vessels and caverns, followed by their replacement with scar tissue.

Currently, 70% alcohol is used for the purpose of sclerotherapy of hemangiomas. The procedure must be performed by an experienced surgeon under sterile conditions. The skin area around the hemangioma is chipped with novocaine solution ( for the purpose of pain relief), after which from 1 to 10 ml of alcohol is injected into the tumor tissue with a syringe ( depending on the size of the tumor).

After 2-3 hours, inflammation and swelling of the tissues appear at the injection site, and after 2-3 days, the hemangioma area thickens and becomes painful. The procedure is repeated several times with a break of 7-10 days. The complete disappearance of hemangioma is noted in the period from 3 months to 2 years from the end of treatment.

Electrocoagulation
The method of destruction of tumor tissue by exposure to high-frequency pulsed electric current. When current is applied to living tissues, their temperature rapidly rises to several hundred degrees, followed by destruction, charring and rejection of dead masses.

The main advantage of this method is the minimal risk of bleeding, since high temperatures lead to blood clotting in the vessels supplying the hemangioma and sclerosis ( scarring) of their lumen.

With the help of an electric knife, it is possible to remove superficial and intradermal hemangiomas, and electrocoagulation can be used as an auxiliary method in the surgical removal of a tumor.

Close-focus radiotherapy
It consists in the local effect of X-rays on the hemangioma tissue, which leads to the destruction of the tumor capillaries. X-ray therapy is rarely used as an independent method of treating hemangioma and is more often used in the preoperative period in order to reduce the size of the neoplasm, which will reduce the volume of the operation.

The impact of X-ray radiation on the body, especially for children, is associated with a number of side effects, the most dangerous of which is the possibility of developing a malignant neoplasm. In this regard, close-focus radiography is used in exceptionally rare cases when other methods of treatment are ineffective.

Surgical method of removing hemangiomas

During the operation, under general anesthesia, the entire tumor and 1-2 mm of the surrounding healthy skin are removed. When the hemangioma is located in deeper tissues and in the internal organs, the volume of the operation is determined by the size of the tumor and the degree of germination into the affected organ.

Quite often, conservative methods of treatment are used in the preoperative period ( drug therapy, radiation therapy), resulting in a decrease in the size of the tumor, which makes it possible to reduce the volume of the operation and injure nearby organs to a lesser extent ( muscles, bones).

Medical treatment of hemangiomas

However, the complete disappearance of hemangioma as a result of drug therapy alone is observed only in 1-2% of cases, so this treatment method is more often used as a preparatory stage before surgical or physical removal of the tumor.

The consequences of hemangioma

The most formidable complications of hemangioma are:

• germination and destruction of nearby organs;
• destruction of muscles, bones, spine;
• compression and/or destruction of the spinal cord ( with the development of paralysis);
• destruction of internal organs liver, kidney, spleen and other);
• ulceration of hemangioma and infection;
• malignancy;
• thrombocytopenia and anemia;
• cosmetic defect untreated hemangiomas and their scars can persist throughout life).

• the initial location of the tumor;
• the speed and nature of growth;
• time of initiation of treatment;
• the adequacy of treatment measures.

- a benign vascular formation that occurs as a result of an embryonic disorder in the development of blood vessels. Hemangioma in children has the appearance of a red, purple or cyanotic spot with a flat or raised surface above the skin; hemangiomas are prone to intensive growth and bleeding. An examination for hemangioma in children includes a consultation with a pediatric dermatologist and a surgeon, radiography of the anatomical region where the vascular tumor is located, ultrasound, angiography, and a study of the state of the blood coagulation system. Hemangioma in children can be subjected to laser or surgical removal, radiation therapy, electrocoagulation, cryotherapy, sclerotherapy, hormonal treatment, etc.

General information

Hemangioma in children is a benign tumor of vascular tissue, a vascular birthmark, a vascular malformation. In pediatrics and pediatric surgery, hemangiomas are found in 1.1-2.6% of newborns and 10% of children in the first year of life. Hemangioma is the most common benign tumor of the skin and mucous membranes in children, accounting for about 50% of all soft tissue tumors in childhood. 2-3 times more often hemangiomas occur in girls.

Despite the good quality, hemangioma in children is prone to rapid progressive growth. Growing in breadth and depth, the hemangioma can germinate and destroy the surrounding tissues; cause dysfunction of the organs of vision, hearing, respiration, etc.; become infected, ulcerate, and bleed. In addition, the presence of a hemangioma in a child is a significant cosmetic defect.

Causes of hemangioma in children

The reasons for the formation of hemangiomas in children are unknown, but numerous observations and generalization of data have made it possible to put forward a number of assumptions. In view of the fact that hemangiomas occur in infants, it is likely that a prerequisite for this is a violation of the development of blood vessels in the embryonic period of development.

In turn, a violation of vasculogenesis can occur under the influence of a pregnant woman taking certain drugs, viral diseases (influenza, SARS, etc.) during pregnancy, and adverse environmental conditions. It is possible that the appearance of vascular tumors is associated with hormonal regulation, since there is a clear gender dependence - hemangiomas occur more often in girls.

Classification of hemangioma in children

Based on morphological features, simple (capillary), cavernous, combined and mixed hemangioma in children are distinguished.

Simple hemangioma originates from capillaries; located on the surface of the skin; has clear boundaries, flat, bumpy-nodular, bumpy-flattened surface; red or purple-cyanotic color. A simple hemangioma in children turns pale when pressed on the spot, and then restores its color again.

Cavernous or cavernous hemangioma in children is located subcutaneously in the form of a tuberous nodular formation. It has a soft-elastic consistency and consists of cavities filled with blood. From above, the cavernous hemangioma is covered with unchanged or cyanotic skin. When pressing on the node, due to the outflow of blood, the hemangioma turns pale and subsides; when straining, coughing and crying of a child, it tenses up and increases in size (an erectile symptom caused by blood flow into the cavernous cavities).

Combined hemangioma in children has signs of a simple and cavernous tumor, has skin and subcutaneous parts. Clinical manifestations depend on the predominance of the capillary or cavernous component.

Mixed hemangioma in children has a complex structure and contains elements of vascular and other tissues (connective, nervous, lymphoid). Mixed-type hemangiomas include angiofibromas, angioneuromes, gemlymphangiomas, etc. Their color, consistency and appearance depend on the tissues that make up the vascular tumor.

Hemangiomas in children may be single or multiple; be small, large or extensive. In 95% of cases, a simple hemangioma is diagnosed in children. According to the course of the pathological process, hemangiomas are distinguished with rapid growth, slow growth and lack of growth.

Symptoms of hemangioma in children

In most cases, a hemangioma in a child is detected immediately after birth or in the first weeks of life; less often - during the first 2-3 months. Especially intensive growth of hemangiomas in children occurs in the first half of life; in the future, as a rule, the growth of a vascular tumor slows down.

Hemangiomas in children (in decreasing frequency) can be localized in the scalp (especially on the back of the head), face (on the eyelids, cheeks, nose), mouth, genitals, upper body, arms and legs, internal organs and bones .

Externally, a hemangioma in children is a flat or tuberous-flattened, tuberous-nodular or cavernous formation that rises above the skin. The size of the spot can vary from 1-2 mm to 10-15 cm or more in diameter: in the latter case, the hemangioma occupies a large anatomical area. Hemangioma in children has various shapes and shades (from pale pink to burgundy-bluish). With skin hemangiomas in children, temperature asymmetry is clearly expressed - the vascular formation is hotter to the touch than the surrounding intact tissues.

The growth of hemangioma occurs not only in width, but also in depth, which may be accompanied by tissue compression and dysfunction of neighboring organs. Hemangiomas in children are easily traumatized, causing the development of bleeding from the tumor, which can be difficult to stop. Other complications of hemangioma in children are ulceration and infection of the vascular tumor.

Simple hemangiomas in children may undergo spontaneous regression. In the process of spontaneous disappearance of hemangiomas, 3 stages are distinguished: until the end of the 1st year of life, early involution (from 1 to 5 years), late involution (until the end of puberty). Regression of hemangioma in children begins with the appearance of blanching areas in the center of the tumor, which gradually spread from the center to the periphery. In time, the process of spontaneous disappearance of hemangioma in children can take several years.

Diagnosis of hemangioma in children

A pediatrician, a pediatric surgeon and a pediatric dermatologist take part in the examination of children with a vascular tumor. Depending on the topography of the hemangioma, the child may need additional consultation and examination with a pediatric ophthalmologist, pediatric otolaryngologist, pediatric gynecologist, pediatric urologist, pediatric dentist and other specialists.

Physical examination techniques include examination, palpation, auscultation, determination of the area of ​​the hemangioma in a child. To identify the Kasabach-Merritt syndrome, characterized by active growth of hemangioma, thrombocytopenia and blood clotting disorders, hemostasis (coagulogram, platelet count) is examined.

In order to assess the depth of hemangioma spread in children, its anatomical and topographic features and structure, ultrasound of the skin neoplasm is performed with the measurement of blood flow velocity in the tumor parenchyma and peripheral vessels. Angiography is performed to determine the characteristics of the blood supply to hemangioma in children, angioarchitectonics and relationships with other vessels.

If it is necessary to determine the interest of surrounding tissues, radiography of a particular anatomical region (skull bones, chest, orbits, etc.) can be performed.

Treatment of hemangioma in children

Early treatment (in the first weeks and months of life) is subject to hemangiomas in children located in the head and neck, in the oral cavity, anogenital region or tending to aggressive growth (an increase in area by 2 times per week), non-regressing cavernous hemangiomas, as well as vascular formations complicated by bleeding, infection, necrosis. Expectant management is possible with simple hemangiomas in children that do not represent a serious cosmetic defect and the risk of complications; in the presence of signs of spontaneous regression of the vascular tumor. When choosing a method for treating hemangioma in children, they are guided by the principles of achieving the maximum oncological, functional and cosmetic result.

Spot and superficial hemangiomas in children can be subjected to successful electrocoagulation, cryodestruction, laser removal. Small cavernous and combined hemangiomas respond well to sclerotherapy. With a deeply located vascular tumor and the impossibility of its removal by less traumatic methods, they resort to surgical excision of the hemangioma in children within healthy tissues. It is possible to carry out embolization of a large vessel that feeds the hemangioma.

In relation to hemangiomas that have a complex anatomical localization (for example, in the region of the orbit or retrobulbar space) or occupy a large area, radiation treatment (X-ray therapy) is used. With extensive hemangiomas of the skin in children, hormonal corticosteroid therapy may be prescribed. In difficult cases (with a deep location of the hemangioma in children, a vast area of ​​damage, a complex structure and hard-to-reach localization), a combination of various methods of treatment is possible: irradiation with a microwave magnetic field plus cryodestruction; hormone therapy plus surgery or radiotherapy, etc.

Prognosis for hemangioma in children

In 6.7% of cases, hemangiomas in children progress during the first year of life, and then undergo spontaneous regression within a few years. The outcome of the reverse development of hemangioma in children may be complete disappearance with a good cosmetic result, depigmentation of the vascular tumor, its flattening or scarring. The best cosmetic effect is achieved with the spontaneous disappearance of flat hemangiomas.

The decision on the dynamic observation or treatment of hemangioma in children is made by a pediatric surgeon, therefore, in all cases, it is necessary to seek qualified help. Due to the fact that often hemangiomas in children are prone to rapid growth and various complications, in most cases an active tactic is chosen. The possibilities of modern pediatric medicine make it possible to choose the optimal method of treating hemangioma in children in order to achieve optimal functional and aesthetic results.

Thanks

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

This tumor has a number of characteristic features that distinguish it from other types of benign neoplasms. Firstly, hemangiomas almost never become malignant, that is, they do not degenerate into crayfish. Secondly, these tumors can rapidly increase in size and recur after surgical removal. The growth of hemangiomas can provoke atrophy of surrounding tissues, damage to organs with their dysfunction, as well as fatal bleeding. Therefore, despite the seemingly favorable course of hemangiomas, this tumor is not simple, and therefore represents a very urgent problem for the clinical practice of doctors of several specialties at once - surgeons, oncologists, dermatologists and therapists.

Hemangioma, localized on the skin, has the appearance of a red, purple or cyanotic spot of irregular shape and different sizes. When pressing on the tumor, it can decrease in size, however, after the cessation of the pressure, it completely restores its previous volumes within a few seconds.

Hemangioma - a general characteristic of the tumor

Hemangiomas can be localized in any tissue or organ in which there is a developed network of blood vessels. Most often, these tumors form in organs that have more blood flow than other tissues and organ structures, such as the liver, kidneys, spine, and skin. In practice, hemangiomas are most often found localized in the skin or subcutaneous tissues.

Hemangioma is the most common benign tumor formed by blood vessels. This tumor develops due to the uncontrolled growth of defective blood vessels, which are located randomly, do not perform the function of inflow and outflow of blood from tissues and organs, but form a neoplasm.

Hemangiomas almost never become malignant, that is, they do not turn into cancer. However, with prolonged or rapid, explosive growth, hemangioma is capable of destroying surrounding tissues and organs, which can eventually provoke severe complications, including death or disability and loss of function if the tumor damages vital structures. In addition, hemangiomas have another potential danger - this is the likelihood of bleeding and ulceration on its surface.

A characteristic feature of any hemangioma is its ability to spontaneous regression, that is, the tumor can pass on its own without leaving any traces. It is because of this feature that hemangiomas are not always treated, sometimes waiting for its regression for several years. However, such expectant tactics are possible only in cases where the tumor is not injured, does not bleed, does not increase in size very quickly, and is not located in the area of ​​vital organs, such as the liver, kidneys, eyes, ears, face, genitals. , buttocks, perineum, etc. In situations where the hemangioma grows rapidly, is injured, or is located next to vital organs, the functioning of which it can disrupt, a decision is made to start its treatment. The choice of treatment tactics is carried out by the doctor based on the localization of the tumor, the rate of progression, the general condition of the person and a number of other factors.

Hemangioma in children and newborns - a general characteristic

Most often, hemangiomas are congenital or appear in an infant shortly after birth (within 1 to 4 months). In the first weeks after birth, a hemangioma may be subtle, resembling a scratch or bruise. Less commonly, the tumor has the appearance of a bright red cavity or the so-called port-wine stain (a dark red area of ​​the skin). However, after a short period of time, the hemangioma can begin to grow in size very quickly, as a result of which it will become noticeable. Usually, the period of active growth of hemangioma falls on 1-10 months of a baby's life, lasting for a total of 6-10 months, after which the tumor stops increasing in size and enters the involution phase. That is, it begins to gradually decrease in size. This period of slow spontaneous involution lasts from 2 to 10 years.

Most hemangiomas are small, a few centimeters in diameter at most. Larger tumors are rare. Most often in children and newborns, hemangiomas are localized on the scalp and neck, and much less often on the buttocks, perineum, mucous membranes or internal organs. If there are 6 or more hemangiomas on the child's skin, then most likely he also has hemangiomas of the internal organs.

Skin hemangioma can be superficial, deep or mixed. A superficial tumor looks like a cluster of bright red vesicles, nodules and spots on the skin, a deep tumor looks like a protruding and soft to the touch piece of meat, painted in red-blue color.

Appeared hemangiomas spontaneously, without any treatment, disappear within a year in 10% of children. About half of all hemangiomas spontaneously involute and completely disappear by 5 years of age, 70% by 7 years, and 90% by 9 years. Signs of the onset of hemangioma involution are a change in color from bright red to dark red or gray, as well as softening and thickening of the formation. The tumor becomes colder to the touch.

Since almost all hemangiomas disappear by the age of 9-10, if the tumor does not interfere with the functioning of important organs and systems, does not ulcerate and does not bleed, it is not treated until the child reaches 10 years old, but simply observed. However, if a hemangioma disrupts the functioning of organs and systems (for example, closes the eye, is localized in the parotid region, disrupting hearing, etc.), then doctors begin its treatment in a child of any age in order to prevent severe complications associated with irreversible damage to the structure of the organ by the tumor .

After the involution of the hemangioma, completely healthy normal skin can remain at the site of its localization, which does not differ from that in any other area. However, in some cases, scars, areas of atrophy, as well as thinning of the skin and its coloration in a yellowish color can form at the site of an evolved hemangioma. Unfortunately, the same cosmetic skin changes in the hemangioma area can also form after its treatment with various surgical techniques (cauterization with a laser, liquid nitrogen, removal with a scalpel, electric current, etc.).

Photos of hemangioma in adults, children and newborns

Hemangioma of the liver (photo of the liver in section, a dark spot on the left is a hemangioma).

Causes of hemangioma

However, the most likely cause of the formation of hemangiomas are acute respiratory viral infections suffered by a woman in the first trimester of pregnancy (up to and including the 12th week of gestation). The fact is that it is during this period of pregnancy that the system of blood vessels is formed and laid in the fetus, and viral particles and their toxins can change the properties of the vascular wall. Due to such influence of viruses in a newborn or a relatively adult child, hemangiomas can form on the skin or in the internal organs.

Classification of hemangiomas

• Skin hemangiomas located in the upper layers of the skin. These tumors are the safest, so they are usually not removed, waiting for natural involution. However, if the hemangioma is located near the ear, eye, perineum or face, then it is removed because of the risk of irreversible tissue damage with the subsequent development of dysfunction of the corresponding organ.
• Hemangiomas of parenchymal organs (kidneys, liver, brain, ovaries, testicles, adrenal glands, pancreas, etc.). These hemangiomas require prompt removal in all cases, since they can be complicated by internal bleeding or damage to the organ in which they formed.
• Hemangiomas of the musculoskeletal system (joints, muscles, spine, etc.) are not as dangerous as those localized in parenchymal organs, so they are not always removed immediately after detection. Such hemangiomas begin to be treated only if they disrupt the normal development of the child's skeleton.

• Capillary hemangioma (simple) located on the skin and formed from capillaries. Such tumors are most often localized on the skin or in areas of bone growth.
• Cavernous hemangioma , located in the subcutaneous tissue and formed from larger vessels compared to capillaries. Such hemangiomas are usually localized in the area of ​​organs and tissues characterized by increased, abundant blood supply, such as the kidneys, liver and brain.
• Combined hemangioma , consisting simultaneously of two parts - capillary and cavernous. Such hemangiomas are always located on the border of the organ, so they are found on the skin, in the structures of the musculoskeletal system and in parenchymal organs. It is these hemangiomas that most often develop in adults.
• Racemose hemangioma is extremely rare and is localized on the scalp or limbs. The tumor consists of convoluted plexuses of sharply thickened blood vessels pierced by fistulas.
• Mixed hemangioma combined with other tumors, such as lymphoma, keratoma, etc.

Capillary hemangioma

Cavernous hemangioma

Combined hemangioma

This kind of hemangiomas is always localized not in the thickness of the tissues of any organ, but on its edge, in the immediate vicinity of its border. Due to this feature of localization, combined hemangiomas can be located on the skin, in the bones and on the surface of the internal organs. This hemangioma is most common in adults.

The appearance, properties and response to treatment depend on which component (capillary or cavernous) of the combined hemangioma is predominant.

Racemose hemangioma

Mixed hemangioma

The size of the vascular tumor

Symptoms

Skin hemangioma

In the area of ​​​​the skin on which the hemangioma is localized, swelling is always clearly visible and there may be an unusual color in various tones of red (red-pink, burgundy, cherry, red-crimson, red-blue, etc.). The more arteries in the hemangioma, the brighter red it is. Accordingly, the more veins, the more dark red it is, for example, cherry, burgundy, etc. If the hemangioma is located in the subcutaneous tissue, then the color of the skin above it may be normal. With physical exertion or with increased blood flow to the area where the hemangioma is located, the tumor for some time acquires a brighter color than usual. This is especially noticeable with hemangiomas on the face in children, which literally instantly become very bright against the background of crying.

The stronger the tumor grows into the skin, the more likely it is to develop any disorders associated with inadequate tissue nutrition, such as ulcers, hypertrichosis (excessive hair growth), hyperhidrosis (sweating), cracks, etc. All these violations of the integrity of the skin are complications of hemangioma and can lead to frequent and severe bleeding.

The most characteristic clinical symptoms of any skin hemangioma are pain and swelling in the area of ​​its localization. When pressing with a finger on a swollen colored area of ​​​​the skin, it subsides. However, after the cessation of pressure, the hemangioma quickly takes on its usual appearance. To the touch, the swelling may have a dense elastic or soft elastic consistency. If the consistency of the tumor is dense, then this is a favorable sign, since it means that the hemangioma is not prone to growth in the future. If the consistency of the hemangioma is soft elastic, then this means that the tumor is prone to active growth in the near future.

Pain at the beginning of the development of hemangioma is weak, occurring periodically and disturbing an adult or a child for short periods of time. In the growth phase of the tumor, when it grows into muscle tissue and nerves, the pain can be quite strong and constant. During the period when the tumor is not growing, pain may also be present constantly, due to tissue compression. In this case, the pain is combined with dysfunction of the muscles and the development of contractures in them. In addition, in the area of ​​the skin around the tumor, areas of paresthesia are possible (sensitivity disorders like sensations of goosebumps, etc.).

Hemangiomas localized in the skin during the growth period slightly increase in area. An increase in the size of the tumor usually occurs due to its germination in deep-lying tissues. If the hemangioma rapidly increases in size, then it can grow into muscles and even bones, significantly disrupting the normal functioning of the musculoskeletal system. Affecting the bones, hemangioma provokes severe osteoporosis.

If the skin hemangioma is localized in the immediate vicinity of the eyes, ears, trachea or bronchi, then squeezing the tissues of these organs, it can provoke visual, hearing, breathing and swallowing disorders.

body hemangioma

Tumors located on the body are dangerous because they can be located in places subject to constant movement and compression (for example, armpits, shoulders, etc.), as a result of which hemangiomas are complicated by bleeding, ulceration and cracks. The rapid growth of body tumors can cause them to grow into the ribs or abdominal muscles, disrupting the functioning of these body structures. And this, in turn, will adversely affect the function of breathing, proper walking, normal functioning of the abdominal organs, etc.

Hemangioma of the face, on the head and on the lip

Liver hemangioma

Spinal hemangioma

Kidney hemangioma

• Persistent uncontrolled hypertension;
• Pain in the lower back extending to the groin;
• blood in the urine (hematuria);
• General weakness;
• Low performance.

However, these symptoms accompany renal hemangioma quite rarely, most often the tumor is characterized by an asymptomatic course. A kidney tumor is usually removed surgically after detection.

Complications of hemangiomas

If the hemangioma is localized in the eye or ear area, the functioning of these organs may be disrupted, up to a complete and irreversible loss of vision and hearing. Due to the high risk of loss of vision and hearing, hemangiomas located in the area of ​​​​the eyes or ears begin to be treated without waiting for them to disappear on their own.

With the localization of hemangioma in the region of the sacrum, damage to the spinal cord is possible, which is fraught with numerous dysfunctions of the pelvic organs and intestines. Symptoms of damage to the spinal cord hemangioma are the following manifestations:

• Atrophy of the muscles of the legs;
• Incontinence of feces and urine;
• Ulcers on the soles of the feet;
• Paresis of the muscles of the legs.

Diagnostics

Hemangioma - treatment in children and adults

General principles of treatment

First, because of the high probability of spontaneous disappearance of hemangiomas within a few years, tumors that do not have a high risk of complications are usually not treated, but simply monitored for their course. Treatment of hemangioma is resorted to only in cases where the tumor can provoke severe complications (for example, it is localized on the eyelid or in the orbit of the eye, in the auricle, on the skin of the genital organs, etc.) or its presence disrupts the normal functioning of an organ or tissue . Indications for treatment is the localization of hemangiomas in the following areas of the skin:

• Hemangiomas localized around the eyes;
• Hemangiomas that disrupt normal vision;
• Hemangiomas localized near the respiratory tract (for example, on the neck, on the oropharyngeal mucosa, etc.);
• Hemangiomas localized in the respiratory tract;
• Hemangiomas on the face, if there is a risk of cosmetic defects on the skin in the future;
• Hemangiomas localized in the ears or parotid salivary glands;
• Hemangiomas with ulcerated surface.

So, the treatment of hemangioma is to reduce its size or completely remove the tumor, which is achieved using surgical or therapeutic methods, such as:
1. Surgical methods of tumor removal:

• Cryodestruction (cauterization of the tumor with liquid nitrogen);
• laser irradiation;
• Sclerosing therapy (introduction into the tumor of solutions that provoke the death of the vessels that form it);
• Close-focus X-ray therapy (tumor irradiation);
• Electrocoagulation (removal of hemangioma with electrodes);
• Removal of the tumor during a conventional surgical operation with a scalpel.

• Taking drugs containing propranolol as an active substance (Anaprilin, Inderal, Obzidan, Propranobene, Propranolol) or timolol (Okumol, Arutimol, Timadern, Timol, Niolol, etc.);
• Taking drugs from the group of corticosteroid hormones (Prednisolone, Diprospan, etc.);
• Taking drugs of the cytostatic group (Vincristine, Cyclophosphamide);
• Compression therapy (applying pressure bandages to the tumor).

Hemangioma removal (surgery)

Laser removal (laser destruction)

Cauterization (electrocoagulation)

Removal of hemangioma with liquid nitrogen (cryolysis)

The essence of cryodestruction is the effect of liquid nitrogen on the hemangioma area, which destroys the structures of the tumor. Complete removal of the tumor occurs in 1-3 sessions, after which the healing process begins at the site where the hemangioma was, during which the skin is completely restored.

However, cryodestruction can only be used to treat superficial capillary hemangiomas. If cavernous or combined hemangiomas are treated with liquid nitrogen, this can lead to the formation of ugly scars on the skin due to too deep destruction of tissues, which therefore cannot recover.

Sclerotherapy

Close-focus radiotherapy

Therapeutic methods for the treatment of hemangioma

Corticosteroids for the treatment of hemangiomas are taken in an individual dosage, calculated according to the ratio of 2-3 mg per 1 kg of body weight per day. However, taking corticosteroid hormones (Prednisolone, Diprospan) is effective in a limited number of cases (from 30 to 70%). In addition, hormone therapy causes a number of severe side effects (growth retardation, decreased immunity, increased blood pressure, etc.), so this method, as a rule, is not used on its own. As a rule, hormones are combined with the removal of hemangiomas by any surgical method.

Vincristine for the treatment of hemangiomas is taken once a week in an individual dosage, calculated as a ratio of 0.5 mg per 1 kg of body weight in children weighing more than 20 kg, and 0.025 mg per 1 kg in children weighing less than 20 kg. Cyclophosphamide is taken at a dosage of 10 mg per 1 kg of body weight daily for 10 days. Currently, Vincristine and Cyclophosphamide are rarely used to treat hemangiomas, as they cause a large number of severe side effects, including from the nervous system.

The most effective and safe therapeutic method for the treatment of hemangiomas is the use of propranolol or timolol preparations in individual dosages. This method is not registered in Russia and the CIS countries, therefore, it is practically not used in the post-Soviet space. However, in Europe and the United States, propranolol and timolol preparations were introduced into the preparations for the treatment of hemangiomas by a special decree of the relevant ministries. This decision was made based on the positive results of experimental treatment of children with hemangiomas with propranolol and timolol. Currently, among all the methods of therapy for hemangiomas (both surgical and therapeutic), it is the intake of propranolol or timolol that is the best in terms of safety / efficacy.

Propranolol is given to the child 2 times a day in an individual dosage, calculated by the ratio of 0.5 mg per 1 kg of weight. At the end of the first week of taking propranolol, the child's blood glucose and blood pressure should be determined, and an ECG should be done. If the tests are not normal, then the drug will have to be stopped and another method of treating hemangioma should be used. If all the test results are normal, then the dosage is increased to 1 mg per 1 kg and the child is given propranolol in a new dose, 2 times a day for a week. Then they donate blood again for glucose, measure pressure and do an ECG. If the tests are normal, then the dosage is increased to 2 mg per 1 kg of weight and continues to be given to the child 2 times a day for 4 weeks. On this course of therapy is considered completed. However, if necessary, it can be repeated at intervals of one month until the complete disappearance of the hemangioma.

Preparations containing timolol (eye drops or gel) lubricate the surface of the hemangioma 2 times a day for several months.

Currently, the treatment of choice for hemangioma, both in children and adults, is the use of propranolol or timolol, since it is highly effective and safe. All other methods can also be applied if necessary.

If in the process of monitoring the hemangioma, ulcers or cracks appear on its surface, then you can lubricate it with Metronidazole gel, ointments with glucocorticoids (for example, Dexamethasone, Locoid, etc.) or apply a hydrocolloid dressing (DuoDerm Extra Thin).

Hemangioma in children: description, causes, complications, diagnosis, treatment methods, answers to popular questions - video

Hemangioma of the liver and spine - treatment

Hemangioma of the liver: description, complications, methods of diagnosis and treatment - video

This is a rounded formation with delineated contours and a variety of echostructure. In the specialized literature, hemangioma is more often described as the formation of increased echogenicity.

capillary type

a) with a fairly homogeneous, weakly echoic internal structure and with delineated but intermittent contours. It occurs with a well-developed vascular network with many small cavities;

b) the echostructure is heterogeneous, sometimes the expanded vascular network is clearly visible in the form of echo-negative tracks;

c) the structure is almost echo-negative, with single signals. It is typical for large blood cavities with the presence of blood clots. Behind the dorsal wall of the tumor, a reflection effect is noted.

brain type

The structure of the hemangioma is similar to the brain tissue, has a small or large nodular structure, of different echogenicity (rare).

Cavernous type

The structure of the hemangioma is of different echogenicity; small rounded or large anechoic cavities filled with can be located.

mixed type

Part of the tumor is anechoic, consists of large fluid cavities, and the other part has a nodular structure, that is, echogenic and anechoic large signals alternate. There may be a reflection effect from the back wall.

In rare cases, hemangiomas can undergo a process of malignancy, and this process is almost impossible to differentiate sonographically, since there are no specific echographic signs of malignancy of other tumor-like formations, in particular hemangiomas.

Hemangiomas, first of all, should be differentiated from primary, from metastases, nodular hyperplasia, lipomas, etc.; a fairly long latent course, good health and good liver function indicators speak in favor of hemangioma; with the help of Doppler, it is possible to register the pulsation of the organ, which is not found in other tumors. In the final diagnosis, especially in the presence of large capillary hemangiomas, angiography helps.

Almost 10% of children are born with red, bluish or brownish spots on the skin or mucous membranes, localized in different parts of the body.

In the vast majority of cases, they turn out to be benign neoplasms, the result of the growth of the inner layer of small and medium-sized vessels (endothelium). Therefore, these formations are called angiomas or hemangiomas, that is, vascular tumors.

Skin hemangioma in children is the most common of all neoplasms, and girls are 3 times more likely to develop it than boys.

The reasons

These formations are mainly diagnosed in newborn babies and children of the first year of life, much less often their development begins in adulthood. Scientists have not yet been able to accurately determine the causes of the growth of the vascular endothelium, but, taking into account the age aspect of the manifestation of the disease, it is believed that heredity and negative factors that affect the fetus during pregnancy play a leading role.

Many negative effects during pregnancy can cause a local disturbance in the formation of a normal vascular network in the skin of an unborn child and change the course of the structural formation of capillaries, arteries and veins.

Provoke the appearance of hemangiomas on the skin of a child can also be taking medications by a woman, poor environmental conditions, acute respiratory infections or acute respiratory viral infections at any time.

early signs

The favorite localization of hemangiomas is the skin. Much less often, neoplasms are diagnosed in internal organs (, kidneys, rectum,) or bone structures.

Most often, a skin hemangioma in a child is located on the face, neck, scalp, genitals, upper body. Tumors can be small or large, single or multiple.

Depending on the structure of the neoplasm, the appearance of angiomas also differs. If the tumor is capillary, that is, consisting of overgrown capillaries, then it looks like a spot, flat or slightly raised, red, brown or red-bluish in color, turning pale when pressed.

The safest in this regard is capillary hemangioma. Being discovered at an early age of the baby, it very rarely progresses, but on the contrary, it begins to reverse development: it gradually turns pale and decreases in size. Most of these neoplasms regress within a few years after the birth of the child.

In addition, angiomas are dangerous with the possibility of injury. The damaged surface begins to bleed, ulcerate and becomes the entrance gate for infection. The subsequent inflammatory process ends with the formation of rough cicatricial formations that aggravate the aesthetic defect.

Does skin hemangioma turn into cancer?

Theoretically, any benign tumor can transform into a malignant one. Factors contributing to malignancy (malignant degeneration) are quite diverse. The starting point can be mechanical or physical injury, chemical exposure, solar radiation.

But in clinical practice, cases of the transition of hemangiomas of any type to cancer in childhood have not been registered.

Diagnostics

With skin and subcutaneous localization of vascular tumors, the diagnosis does not cause difficulties. To determine the type of neoplasm, its structure and degree of danger, the following diagnostic steps are carried out:

1. Examination of the child, determination of the number, size, shape, color of the tumor.
2. Laboratory study of blood.
3. Instrumental methods (ultrasound,).

Treatment

Treatment tactics depend on the type of hemangioma, size, localization and are individual. If the neoplasm is of the capillary type, then in many cases the doctor adheres to expectant-observational tactics. In other cases, the choice is between conservative and surgical treatment.

Of the medical methods, hormonal therapy for skin hemangioma in a child (“Prednisolone”), as well as the use of beta-blockers (“Propranolol”) are widely used.

According to the indications, cryodestruction of the tumor (liquid nitrogen) is carried out, mainly with a superficial location and any size.

Diathermoelectrocoagulation (high temperature) is performed with point forms of neoplasms of any localization.

Sclerotherapy (introduction of special agents into tumor structures) is especially effective in cavernous and combined angiomas.

Surgical excision in childhood is carried out very rarely, only when it is impossible to use other methods. It is indicated for deep germination of cellular, cavernous, combined angiomas.

It is most preferred in children, as it is painless, non-invasive and the most effective method. It has a short rehabilitation period, has no age restrictions, completely and without consequences eliminates a cosmetic defect.

Folk methods play only an auxiliary role in the treatment of this disease. Walnut juice and oak bark are used for the purpose of sclerosis, onion or garlic juice for cauterization of blood vessels.

Possible complications in the future

Hemangioma of any type, except perhaps small capillary formations that are prone to regression, must be treated. An oncologist or surgeon in each case chooses the best therapy for the child, which helps to get rid of the tumor forever.

If the skin formation is not removed in time, there is a constant risk of injury, infection or bleeding, tumor growth and aggravation of the child's psycho-emotional discomfort due to a cosmetic defect.

Forecast

Skin hemangioma in children always has a favorable prognosis for life and health. Modern methods of therapy allow achieving absolutely positive aesthetic and clinical results.