The issues of “self-transition” of infantile hemangiomas are actively discussed by both doctors and parents of patients. Information circulating in the media, pseudo-scientific and scientific literature varies greatly. The figures for self-regression (self-resolution) of hemangiomas vary from 8 to 100%.

With this article, we want to answer most questions, based on the results of international research and data presented in the fundamental guide to vascular pathology Hemangiomas and Malformations. Second Edition. Edited by John B. Mulliken, Patricia E. Burrows, and Steven J. Fishman

Involution of infantile hemangiomas.

The growth of hemangiomas stops by the end of the first year of life. Subsequent years the formation develops in proportion to the child’s growth and after years there follows a slow involution, the process of independent passage of the hemangioma.

The development of hemangioma follows a certain pattern, graphically characterized by a dome-shaped graph (see figure). This curve characterizes the life (biological) cycle of infant hemangiomas. The appearance and beginning of the development of hemangiomas is determined by the first month of a child’s life; almost all children are born without any visible skin manifestations. The peak of development occurs at 4-5 months of a child’s life, followed by a period of plateau (growth stabilization) and after the first year a process of regression and withering of education is observed. Although some hemangiomas continue to grow after 1 year of life (Bandling-Bennett et al. 2008).

The processes of active development (proliferation) and involution (the process of passage) are not clear phases in the life cycle of infant hemangiomas. The processes of apoptosis (the natural process of “disassembling” pathological tissue) begin to prevail only after 1 year of life. But this process may be uneven in the same formation, for example, in some cases, involution processes may begin in the center of the formation, and proliferation processes (active growth) may actively occur at the periphery of the formation.

Immunohistochemical studies have shown that the final growth processes of infantile hemangiomas continue until the child is 4-5 years old (Mulliken and Glowacki 1982). The maximum process of apoptosis is achieved at the age of 2 years (Raison et al. 1998).

A combination of involution processes in the center with active proliferation processes along the periphery of infantile hemangioma.

One of the signs of the beginning of regression of infant hemangioma is a change in its color from bright crimson to lavender. The surface of the hemangioma is covered with a grayish membrane, and upon closer examination you can see tiny white spots. The hemangioma becomes softer, less tense, the skin on the hemangioma becomes wrinkled. Hemangiomas become less hot, bleeding and ulcerations stop bothering the child. The processes of involution of infant hemangioma begin, as a rule, from the middle of the formation and spread to the periphery.

The process of involution of infantile hemangioma in the upper third of the thigh on the right.

When a hemangioma appears, parents quite often note the child’s anxiety and pain when touching the hemangioma. With the period of development of involution, hemangiomas become less painful, and the child becomes less capricious. Many parents notice that despite the passage of hemangiomas, they swell when crying, straining, or when the temperature rises and take on their previous appearance when everything returns to normal. There is currently no reliable assessment of changes in blood flow in hemangiomas. The most reliable data on a decrease in blood flow in a hemangioma during an ultrasound examination with Doppler sonography can be determined only at 2-3 years of age, although in the majority of cases, pathological blood flow in the vessels feeding the hemangioma may persist at an older age.

The process of involution of infantile hemangioma in the area of ​​the right forearm. Residual elements of hemangioma, telangiectasia, and areas of healthy skin are noted.

The process of involution continues from 1 year of life to 5-7 years. Hemangiomas change color by the age of 5 years. Early clinical studies of the development of hemangiomas showed that complete resolution occurred in more than 50% of children by 5 years, and in more than 70% of children by 7 years, with continued improvement by 10-12 years. (Lister 1938, Pratt 1953, Simpson 1959, Bowers et al. 1960). Subsequent studies of children with hemangiomas showed that 80% of hemangiomas had not completely involuted (“gone”) by 6 years of age and resulted in significant defects (Finn et al. 1983).

The involution of infantile hemangiomas is not influenced by gender, race, location of the tumor, its size, period of active growth, or morphological data (Bowers et al. 1960, Finn et al. 1983). The current idea that large hemangiomas are less likely to regress than small tumors has been refuted by studies that have shown that tumor size does not affect the rate or extent of involution, and there is no relationship between the final outcome of involution and age (Simpson , 1959, Bowers et al. 1960).

The involution processes are identical for all types of hemangiomas (superficial or deep). Prematurity does not affect the timing of involution. An interesting point of this study is that with hemangiomatosis (multiple hemangiomas), the process of involution occurs faster, by 2-3 years.

It was also noted that involution processes occur most slowly in the area of ​​the nose and lips (Bowers et al. 1960). A possible explanation for this circumstance can be considered that during the process of involution, more fibro-adipose tissue is formed in this area. As a result, it may appear that infantile hemangiomas heal more slowly in these areas.

If infant hemangioma continues to grow when the child is more than 1 year old and there is no response to drug therapy, this formation requires a biopsy or complete removal for histological examination.

As a result of involution, virtually healthy skin is restored in 50% of children with infantile hemangiomas (Finn et al. 1960). Quite often, residual atrophy, telangiectasias (dilated capillaries, capillary “stars”), and discolored skin are observed. In the presence of a large, voluminous growth of infantile hemangioma, as a result of involution, stretched, dough-like skin is formed.

The result of drug-induced involution of an infantile hemangioma in the back. As a result, a fairly large amount of fibrous and fatty tissue remained. Wrinkled, deformed and atrophic skin covered with superficial telangiectasias is detected. Veins are visible through thinned areas of skin.

After the involution of a convex tumor with clear boundaries, draining veins may become visible through the skin, which may make the area appear blue. If ulceration occurs during the active development of the hemangioma, then as a result the area of ​​ulceration will become a pale scar, and restoration of the skin in this area is impossible. An interesting observation is the tendency for acne or teenage acne to appear on the skin of involuted hemangioma.

Convex hemangiomas of any size typically result in a fibrofatty residue. Deep infantile hemangiomas, without cutaneous manifestations, can completely regress without leaving any cosmetic skin changes.

Hemangiomas in the scalp area, as a result of active development, can injure hair follicles, which can subsequently lead to reduced hair density in this area.

Periorbital hemangiomas often lead to proptosis, blepharoptosis, and imbalance of the eyeball muscles.

The result of hemangioma growing into the orbit. There is a displacement of the eyeball.

Hemangiomas at the nasal tip expand the lower lateral cartilages and leave a fatty residue, resulting in a spherical enlargement of the nasal tip.

Hemangiomas in the lip area often cause local hypertrophy (enlargement), erasure of the red border of the lip, and sometimes lead to discoloration of the red border.

The result of the growth of hemangioma in the upper lip. The shape is disturbed, the red border in the area of ​​the hemangioma is not differentiated. Not only cosmetic, but also functional disorders are determined - it is difficult for the child to eat.

In most cases, the main problem that arises in a child as a result of the independent involution of infantile hemangioma becomes cosmetic defects of varying severity, which subsequently require certain surgical or dermatological procedures to eliminate them. Another important factor is the child’s social adaptation in the children’s group; the presence of cosmetic defects leads to problems in communication and attitude towards a child with hemangioma. In the near future, we will devote a separate article to this topic.

I thank Ksenia Sofenko for her assistance in translation.

Adapted translation of the book “Mulliken and Young’s Vascular Anomalies: Hemangiomas and Malformations”

// November 16, 2014

First of all, it is necessary to take into account that consultation on the Internet cannot replace a full medical examination and dynamic observation of a doctor.
In this situation, the most important step is to carry out a differential diagnosis between hemangioma and vascular malformation, on which the choice of the correct treatment tactics depends. The medical history you described: noticed swelling at 3.5 months; up to 8 months the tumor increased in size; and from 8 to 11 months it practically did not change (only increased by 3 mm), in our opinion, it fits more into the classic version of the course of hemangioma: the tumor was discovered after birth, there was a period of tumor growth, and now the size has stabilized. Unlike hemangiomas, vascular malformations, like congenital malformations of blood vessels, appear from birth and most often increase in proportion to the child’s growth (very slowly). However, the localization of your son’s tumor deep in the soft tissues makes it difficult to initially assess the size of the pathological process and does not exclude the presence of a vascular malformation. There are good laboratory tests that can help identify hemangioma, but this diagnostic method is applicable only during the growth phase of the tumor. Considering the different clinical course of hemangiomas and vascular malformations, dynamic observation in this case can be used as a method of differential diagnosis. Involution of hemangiomas occurs on average from one year of a child’s life and lasts about 6 years. By being observed by your doctors, with regular ultrasound monitoring, you can assess changes in the volume of the tumor.
As for the clinical case described by Dr. Mikhail Valerievich Zhitny, this is an extreme option that cannot prove the validity of surgical treatment of all types of vascular anomalies. In this situation, there was no follow-up and I agree with my colleague that treatment should have been carried out much earlier. However, we also have opposite clinical observations, when unjustified aggressive treatment of hemangiomas in children at an early age subsequently led to serious aesthetic defects, the correction of which required complex plastic and reconstructive surgeries.
I agree with my colleague that until now one of the main obstacles to the development of the field of medicine involved in the study of anomalies of vascular development is confusion in terminology. The fact is that doctors most often confuse hemangiomas and angiodysplasias (vascular malformations), although their biological classification was proposed back in 1982 (Mulliken JB, Glowacki J. Hemangiomas and vascular malformations in infants and children: A classification based on endothelial characteristics Plast Reconstr Surg 1982;69:412–422. If we talk about hemangiomas, these are endothelial benign vascular tumors and their structure depends little on whether the tumor is located on the skin or under the skin. The division of hemangiomas into cavernous and capillary (classification by S.D. Ternovsky, 1959) in practice leads to confusion, since the doctor often associates cavernous hemangioma with a vascular malformation, which entails the choice of erroneous treatment tactics.

Stage III – late evolution (end of puberty).

Cavernous tumor is located under the skin in the form of a nodular formation, consisting of cavities of varying sizes filled with blood. It has a soft elastic consistency and bluish color. As the tumor grows, the color changes to blue-purple. Such hemangiomas are most often found in newborn infants. When they scream or cough, the tumor becomes more filled with blood, protruding. If you press on it, due to the outflow of blood it turns pale and collapses.

From 1 to 3% of newborns are born with hemangiomas; in 10% of children, vascular tumors are detected during the first year of life. One of the rarest tumors is bone hemangioma, accounting for up to 1% of the total number of all benign bone tumors. Liver hemangioma is diagnosed in 7% of the adult healthy population, and in women 3 to 6 times more often than in men.

Combined hemangiomas may look like a simple vascular tumor or like a cavernous one, depending on the predominance of one or the other tissue.

Diagnosis of hemangiomas

a) Ultrasound in combination with Dopplerography of the hemangioma itself or the abdominal organs if it is internally localized;

c) radiography of the spine, pelvic bones, skull, and so on.

b) puncture of the hemangioma followed by morphological examination.

Treatment of hemangiomas

Laser therapy. Coagulation of overgrown vessels with laser.

Diathermoelectrocoagulation. Used for small pinpoint vascular formations. The essence of the method is cauterization of blood vessels with electric current.

Cryodestruction– removal of vascular growth with liquid nitrogen.

Sclerosis using injections with a special sclerosing agent.

Hormone therapy. Used to stop the growth of hemangioma in children.

Operation. Surgical removal is indicated for internal hemangiomas that cannot be removed otherwise.

All about hemangiomas in newborns

Infantile hemangioma is a benign tumor that is formed from small and large blood vessels. Due to disturbances in the formation of blood vessels in the prenatal period, hemangiomas in newborns begin to appear after birth. The neoplasm most often has a skin localization (in 80% of cases) in the form of a pale or bright burgundy spot, but it can also have another location: internal organs, bones, muscles. The structure of the tumor is a small thickening with uneven edges, consisting of normal and atypical cells.

Immediately after the birth of a child, you can notice spots on the skin that show maximum growth activity in the first six months. Hemangioma occurs in 10% of newborns, several times more often in girls. After the 1st year of life, the growth of the tumor slows down and its involution occurs - gradual disappearance. By the age of five, 50% of hemangiomas disappear, and by the age of seven – up to 70% (early involution). Since hemangioma is a hormone-sensitive tumor, its complete suppression occurs at puberty (late involution).

Why does hemangioma occur?

Reasons

The true causes of these tumors are still unknown. It is assumed that the triggering factors in their development may be:

• ARVI in the mother during pregnancy at 3–6 weeks, when the cardiovascular system is developing in the fetus;
• Rhesus – conflict in the mother during pregnancy;
• taking medications, alcohol, or smoking during pregnancy;
• hormonal disorders in a pregnant woman or child;
• poor environmental conditions;
• burdened heredity.

Types of hemangiomas

Depending on the structure and level of location, the following types of hemangiomas are distinguished:

Cavernous hemangioma

Cavernous hemangioma is a tumor formed by dilated vessels and cavities filled with arterial or venous blood. It is often located in the skin, but does not penetrate deeply, so it is easily amenable to local therapy. It has a soft structure to the touch.

This type of tumor is also found in organs with a rich blood supply: liver, spleen, kidneys, adrenal glands, lungs and brain.

Cavernous hemangioma in a newborn in the liver is considered very dangerous. In most cases, it makes itself felt only when complications occur or is accidentally diagnosed, since it exists in the body asymptomatically. In case of injury, a hemangioma can rupture, and the resulting hemorrhage under the liver capsule or into the abdominal cavity leads to death in 80% or more cases.

The spleen is a very well vascularized organ, therefore hemorrhages in it due to rupture of hemangiomas are the most dangerous because they are profuse in nature.

Brain cavernous hemangioma is one of the most insidious tumors. Despite its benign quality, its ruptures lead to intracerebral or subarachnoid hemorrhages, which entails deep coma or death.

Capillary hemangioma

Capillary (simple) hemangioma is formed from the vessels of the dermis and never affects the underlying layers of the skin (with the exception of the combined type of hemangioma). The structure is like capillary vessels intertwined into a ball. The tumor protrudes slightly above the surface of the skin and rarely produces hemorrhages. As a rule, she small size, about 1 cm in diameter. A tumor is considered more favorable the paler its color - this indicates its involutional development.

Combined hemangioma

Combined hemangioma is represented by simple and cavernous parts and is insidious in that it is often mistaken for a capillary tumor, while its cavernous part can be dangerous.

A mixed tumor occurs when, along with a vascular neoplasm, tumor cells of connective, nervous or other tissues are present.

Hemangiomas in newborns located on the eyelid, oral mucosa, in the auricle or on the tip of the nose can cause hearing, vision or breathing problems.

Video

Diagnosis and treatment methods for hemangioma

Choice therapeutic measures depends on the results of diagnostic studies of hemangioma. First of all, the doctor must differentiate the tumor from other diseases. It may be squamous cell carcinoma or glomus angioma. Hemangioma is sometimes similar to vascular malformations, some forms of nevi and cysts, and pyogenic granuloma.

Once the diagnosis is made, decisions about subsequent treatment are made depending on the progression of the tumor.

During the period up to the 1st month (newborn period), surgical intervention is excluded. The “behavior” of the hemangioma is monitored. If the tumor does not change in size and color, then before visiting the kindergarten it is simply observed by a specialist. If it increases, disrupts the functioning of organs or poses a threat to life, then measures are taken to remove it. As a rule, such operations are prescribed to a child aged 3 months, six months or 1 year.

Hemangiomas are treated in the following ways:

• Surgical treatment includes complete or partial excision of the tumor and is indicated for its rapid progression, provided that the operation does not cause a serious cosmetic defect and does not disrupt the functioning of organs. Surgical treatment is preferred in case of large tumors, but then after resection it becomes necessary to take a donor flap of skin from another part of the body. This is especially true when treating hemangioma on the scalp or eyelid. In children, such operations are performed only in exceptional cases with parallel blood transfusion, under general or local anesthesia.
• Conservative treatment:
  • Cryotherapy (carbon dioxide snow): applied to small hemangiomas (2-2.5 cm). Snow is applied to the site of the tumor, covering up to 0.5 cm of healthy tissue. After this, a depressed surface is formed, which soon swells, turning into a bubble. Then a crust forms, which disappears after two weeks.
  • Injection treatment with a sclerosing effect on the tumor vessels, after which connective tissue is formed in its place. For injection, 70% alcohol and a solution of quinine - urethane are used. With several injections, an infiltration ridge is formed, first around the tumor, then in its center. The procedure is repeated once a week after the swelling disappears. This method is used when surgical treatment is impossible due to the difficult localization of the tumor: eyelid, oral mucosa.
  • Electrocoagulation is used to treat small (no more than 5 mm) capillary, cavernous and stellate hemangiomas, as well as to remove remaining parts of the tumor after other procedures. Under the influence of an electric current, the tumor tissue coagulates, after which a crust forms, which goes away on its own over time.
  • Radiation therapy is used in the treatment of subcutaneous cavernous hemangiomas or tumors localized to internal organs. Radiotherapy has a negative effect on the entire body, so it is not used for hemangiomas in newborns. Radiation therapy is prescribed exclusively after 6 months.

Video

Complications of hemangioma

In addition to the fact that hemangiomas can cause hemorrhages or disrupt the functioning of organs, they also contribute to the formation of blood clots in the tumor cavity. Because of this, the consumption of platelets in the body increases, which leads to a deterioration in blood clotting. This characterizes the Kasabach-Merritt symptom complex, a disease of newborns and children under one year old with large hemangioma.

If the tumor is located in traumatic areas or in the genital area, it often undergoes ulceration.

Hemangioma in newborns is most often limited to a cosmetic defect or goes away completely. But, nevertheless, the presence of a tumor in a child obliges parents to provide the child with systematic observation by a specialist.

Video

Hemangioma is now very common among children. This did not escape us either. Immediately after birth, I noticed a red spot on my daughter’s forehead. The doctor said that in most children this goes away without a trace with age. I, of course, worried a lot about this. But, literally, a year later it completely disappeared. So it's not so scary!

My daughter is already 17 years old, and the red spot on her forehead still hasn’t gone away. So how about someone….

You have a spot, but my niece has a bump near her elbow, quite large for her size.

The daughter was born without a single spot, after about two

week, a small red dot appeared on the head in the area of ​​the soft spot, which by one and a half months had grown to almost a centimeter in circumference, became very bright and lumpy (photo 1).

We were very worried, we took our daughter to many doctors, and they all diagnosed him with hemangioma. Some said to cut, some not to touch.

A very good surgeon advised treatment with anipriline.

My wife and I decided not to rush and wait at our own risk.

We are now 1.3 years old, the hemangioma has almost disappeared (photo 2).

Decide for yourself what to do!

The hemangioma appeared on the cheek after the maternity hospital, and at 2 months it began to actively grow. At 4 months We went to the regional clinical hospital in Dnepropetrovsk for 3 days, took propronalol 3 times a day. Then we take anaprilin at home (calculated by weight) and go for control once a month. Now the child is 8 months old. - still on the tablets, the tumor is not visible at all, barely pink spots are visible. Satisfied.

In rare cases, hemangiomas can affect the arteries, forming in the form of large formations with many cavities that interfere with the normal functioning of the circulatory system.

Hello, my baby has a hemangioma. After discharge approximately 2 weeks. We are now five months old. I burned it for two months. The injection took 4 months. Hemangioma was the same as before. Swollen with a ball. Now I don’t know what to do? Hemangioma right on the neck. Doctors are afraid to operate. Close to carotid artery. Help me, what should I do please 😢

Hello! Help, who has encountered this!

The child was born immediately covered with hemongioma. The whole body except the head. What to do?

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How dangerous is a vascular tumor - hemangioma?

There are many tumor-like formations of a benign or malignant nature, differing in structure, structure and tissues from which they are formed. For example, hemangiomas grow from vascular tissues.

Description of what a hemangioma is?

Such formations belong to non-cancerous tumor processes caused by venous abnormalities of congenital origin. Such a tumor can grow in any place that has a vascular network.

Causes of occurrence in children and adults

There is no reliable information about the provoking factors of hemangioma in adults and children, although there are many assumptions and hypotheses that explain the factors and mechanisms of formation of certain tumor processes.

It has been absolutely proven that there is no connection between mutations and the development of education. The generally accepted theory of the onset of hemangioma is considered to be a viral-infectious factor that occurs at the time of pregnancy before the 12th week.

The bottom line is that during the first trimester the formation of the circulatory system occurs, and the toxic effect of viruses leads to the formation of intraorganic or superficial hemangiomas already in infancy or in adulthood.

The picture shows a flat hemangioma of the facial skin in a newborn baby

In adults, such tumor processes are activated due to a traumatic factor or as a result of a thrombus-forming process.

There are several types of hemangioma. Depending on the location of the tumor, they are divided into:

1. Skin formations, which are characterized by location in the superficial epidermal layers. Similar tumor formations belong to the harmless hemangiosal varieties, which is why, as a rule, they are not touched. Although if you are close to visual or auditory organs, on the face, back or perineum, removal is necessary to avoid irreversible changes and dysfunction of nearby organs;
2. Musculoskeletal formations arising on the spine, muscle or joint tissues. These tumors are slightly more severe, but not so severe that they need to be removed immediately after detection. As a rule, surgical measures are started when a hemangioma of this nature becomes the culprit of problems with the skeletal formation of children;
3. Parenchymal hemangiotic processes are concentrated in the testicles, bladder, hepatic, adrenal or renal, cerebral or pancreatic parenchyma. Such tumors require immediate removal, because they are fraught with intraorganic lesions or bleeding.

In accordance with the histological structure, hemangiomas are classified according to morphological characteristics into such varieties as simple or capillary tumor, combined, venous or mixed formations, etc.

In addition, hemangioma can be senile and infantile. The infantile form of hemangioma is most common in newborn girls and is usually located in the head or neck area. Externally, infantile hemangioma looks like a reddish spot that disappears autonomously by approximately 7-9 years.

Senile hemangiomas are also called senile hemangiomas. Such formations look like crimson-red bumps that are mistaken for moles. But with a mole, senile hemangioma has structural differences, because the hemangiosal tumor consists of venous structures.

Capillary

This hemangiosal form is considered one of the most common tumor processes. Capillary hemangioma is characterized by a shallow location in the upper epithelial layers. The structure of the tumor is represented by a cluster of many wall-connected and intertwined capillaries. Such formations have a predisposition to penetrating germination.

Such tumors are located mainly on the head and neck. They can occupy large areas, causing cosmetic discomfort to the patient.

Photo of capillary hemangioma on the scalp

When pressure is applied to such a hemangioma, a rapidly passing blanching of the tumor is observed. This is an asymmetrical spot with jagged edges, having a purplish-bluish or reddish-pink tint. Such tumors are prone to ulceration, although they hardly undergo malignancy.

Cavernous

Such a tumor is concentrated in subcutaneous tissue, forming from larger vessels than the capillary form of formation. It looks like a protruding purple swelling formed from a venous collection. Cavernous hemangioma can grow only into subcutaneous tissue, and internal organs or muscle tissue are very rarely affected. Found on the skin of the thighs and buttocks.

Photo of a cavernous hemangioma on a child’s neck

Such formations may be diffuse or limited in nature. Diffuse hemangiomas have blurred edges and occupy a large area in the form of multiple formations of different sizes. Limited tumors are distinguished by clear demarcation from other zones.

Combined

Hemangiomas of a combined nature are a cavernous-capillary mixture; such formations are located under the skin in the tissue and in the epidermal layers. Hemangioma forms on intraorganic surfaces, on the bones of the skull, frontal bone or skin. This tumor is most specific for adult patients.

Racemotic

This variety is relatively rare. Racemotic hemangioma is also called branched. Most often, such neoplasms are located on the extremities and scalp. They consist of twisting and intertwining blood vessels. Experts usually consider such a neoplasm as a cavernous hemangioma.

Mixed

A similar term means a tumor consisting of vascular, nervous, lymphoid and connective tissues. The group of such formations includes angioneuromas, angiofibromas, gemlinfangiomas and other tumors. The clinical data of such formations are determined by the type of predominant tissue.

Venous

Venous hemangioma is often called a tumor of the senile lips or venous lake because this formation is usually found on the face of older people. Experts suggest that UV radiation has an important influence on the development of such tumors.

Externally, venous hemangioma looks like a soft dark purple or bluish papule with a diameter of no more than a centimeter. Typically this formation is located on the lower lip.

The photo clearly shows what a venous hemangioma of the skin looks like in an adult

The tumor only causes cosmetic discomfort. When pressed, venous hemangioma takes on an almost colorless appearance, because it has a thin-walled cavity structure and is filled with blood.

Vascular tumor size

The parameters of hemangioma vary depending on the type of tumor formation. There are venous tumors several millimeters or centimeters in size.

Symptoms and localization

The clinical picture of vascular hemangiomas depends on many factors such as age criteria, the location of the hemangioma and the depth of its infiltration into the tissue.

Skin hemangioma

Such a venous tumor is located on any part of the body, therefore symptomatic manifestations do not depend on whether the tumor is located on facial zone or on the gluteal. In general, the neoplasm can be characterized by the following features:

• On the surface of the skin there is a slight elevation, which can be any shade of red (from light pink to purple). The shading hemangiosal characteristics are influenced by the number of vessels that make up the tumor;
• As tumors infiltrate deep into the skin, various types of pathological changes caused by insufficient blood supply to tissues - increased hairiness or ulcerations, microcracks or hypersweating. Any of these signs can cause hemangioma bleeding;
• At the location of the tumor, there is slight swelling of the surrounding tissues and pain;
• When pressed, the formation has a dense consistency, which indicates the absence of a tendency to malignancy. A soft structure indicates a predisposition to increase in size in the near future;
• Around the hemangioma, paresthesia areas may form, where numbness or pins and needles are felt.

The clinical picture of vascular tumors of the body is almost identical to skin tumors. Its symptoms are also associated with a red, swollen formation that causes painful discomfort.

Such formations can be localized in areas where they will be injured (shoulder area, armpits, mammary glands, fingers, belt, etc.). Such damage is fraught with disruption of the integrity of the tumor, cracks, bleeding and the formation of ulcers on their surface.

If the formation is rapidly growing, then it may undergo infiltration into the ribs and muscle tissue, which will lead to disturbances in these organs.

On the face, head, leg, lip and nose

Such localization of vascular tumors is observed quite often in clinical practice. The main symptoms of such formations are swelling, a reddish tint, and pain in the area of ​​the tumor.

Photo of a vascular hemangioma on the lip of an adult

Such localization is dangerous due to the excessively close location of the formations relative to the most important organs such as the brain, eye orbits, ears, eyelids, etc.

Liver

Usually similar localization of hemangioma for a long time remains unnoticed, developing asymptomatically. Typically, hepatic hemangioma and gallbladder are detected accidentally during ultrasound, MRI or CT scan of the liver. This type of tumor is more often found in older women.

Spine

The presence of a vertebral hemangioma is indicated by intractable pain in the back and is not eliminated by other traditional methods such as rubbing with ointment or massage. Painful symptoms are localized in an area similar to the location of the hemangioma. The therapeutic approach is individual and determined by the doctor.

Kidneys

Renal localization of vascular tumors is very rare. Such hemangiomas are congenital, but are found in adult children. Education increases in accordance with the growth of children, which provokes a bright expression clinical symptoms like:

• Lumbar pain radiating to the groin;
• Colic;
• Uncontrollable hypertension;
• Hyperthermia;
• Hematuric signs;
• Weakness and rapid fatigue.

Brain

Cerebral hemangioma is characterized by nausea and vomiting, spontaneous dizziness, various headaches, and weakness of muscle tissue.

Also, patients with cerebral hemangioma may complain of extraneous sounds in the ears, head, seizures of an epileptic or convulsive nature, frequent fainting and paralysis of some parts of the body.

During pregnancy

If a pregnant woman is diagnosed with a hepatic hemangioma, the woman needs to be regularly monitored by a specialist, because such vascular tumors are prone to rapid growth during pregnancy.

This fact is explained by increased general blood circulation and increased estrogen levels.

Therefore, during pregnancy, the patient should be monitored by an appropriate specialist, noting changes in the condition of the hemangioma.

How dangerous is the disease?

Vascular formations are dangerous for their development serious complications such as ulcerations, bleeding, trophic ulcers. If the tumor is located near any important organs (for example, the larynx and lungs), then complications affect them, causing functional disorders.

Diagnostics

Diagnostic processes usually do not take much time and do not cause any difficulties, because in most cases the hemangioma is located on the skin surface. And it will not be difficult for an experienced dermatologist to determine the nature of the formation. Internal tumors are detected by MRI, CT or ultrasound.

General principles of treatment

The same therapeutic approach is applied to patients of any age, depending only on the location and properties of the hemangioma. If the tumor does not belong to the group with a high risk of complications, then it is monitored, because such tumors are prone to self-limitation.

1. When located near the eyes or with a negative effect on vision;
2. If there are ulcerations;
3. When the tumor is located in the respiratory system or in close proximity to it, etc.

Among the conservative methods used:

• Taking drugs based on propranolol or timolol - Propranobene, Anaprilin or Timaderne, Timol, etc.;
• Prescription of cytostatic agents - Cyclophosphamide or Vincristine;
• Corticosteroid therapy - Diprospan, Prednisolone, etc.;
• Pressure bandages on hemangioma.

Among surgical techniques, it is especially common laser removal, cryodestruction, administration of sclerosing drugs, radiation therapy, electrocoagulation or traditional excision.

Folk remedies for kidney formation

Among folk remedies, the following methods are quite popular:

1. Lubricating the tumor with freshly squeezed celandine juice. Course – 2 weeks;
2. Wetting the hemangioma with a solution of copper sulfate (1 tbsp per glass of water). Course – 10 days;
3. Daily compresses with kombucha. Course – 3 weeks.

How to get rid of a tumor in the spleen

Traditional treatment for hemangioma localized in the spleen involves splenectomy, leading to absolute recovery.

How to treat diseases on the tongue

Tongue hemangioma can be treated in several ways:

• Cauterization;
• Laser treatment;
• Cryotherapy;
• Sclerosis;
• Traditional surgical removal.

In most clinical cases, hemangioma on the tongue does not cause concern.

Can the tumor go away on its own?

With childhood growth and development, the reverse development of hemangioma with its subsequent self-removal is possible. If the cavernous tumor is not prone to growth, it can go away by about 5-7 years of age, so it is better to choose a wait-and-see approach in such a clinical case. If the tumor begins to grow rapidly, then it is necessary surgical treatment.

Which doctor should I contact?

Therapeutic tactics are selected by specialists: pediatrician, surgeon, dermatologist, etc.

This video will explain the reasons for the development of hemangioma and its treatment:

Hemangioma in newborns

In this article, we will look at what hemangioma is in newborns, how often it occurs, how hemangioma is diagnosed and treated in newborns, and what dangers there are in the presence of hemangioma.

What is hemangioma in newborns

Hemangioma in newborns is benign education(tumor), in which changes occur in the structure of blood vessels (the structure is damaged). As a rule, the structure of blood vessels in the area of ​​hemangioma is disrupted even before the birth of the child (during the embryonic period). Hemangiomas usually look like vascular dots, or dots that have merged into one spot. The color of the hemangioma can vary from pink to dark burgundy (depending on which vessels are affected), it can be purple or, conversely, bluish.

To the touch, the spot may be flat or lumpy (depending on the type of hemangioma). The size of a hemangioma can be completely different, from 1-2 mm to more than cm. The shape can be approximately regular, with clear boundaries, or it can be completely irregular (like a spot with processes). It can be located both externally and internally, under the skin or inside organs (different types of hemangiomas).

Superficial hemangiomas (flat, tuberous-flattened and tuberous-nodular, more on them later) affect the skin 2-4 mm deep; there may be areas of deeper damage. Subcutaneous hemangiomas are blood-filled cavities that extend more than a few millimeters from the surface of the skin. Hemangioma can be either one spot or multiple spots.

Hemangioma, main signs

• When you press on it with your finger, the hemangioma turns pale and then gains color again.
• When the child cries, screams, or is generally stressed, the color (saturation) of the hemangioma may change; as a rule, the color becomes darker.
• The skin temperature in the area of ​​the hemangioma may be increased.
• It can be in the form of a spot of any size.
• It can be flat or convex, lumpy.
• Hemangioma consists of the same cells that make up the inner surface of blood vessels.
• It can increase in size (both in breadth and depth).
• This benign tumor has the fastest growth rate (if it grows).

Types of hemangiomas in newborns

Based on appearance and location, the following varieties are distinguished.

• Flat hemangioma.
• Tuberous-flattened hemangioma.
• Tuberous nodular hemangioma.

These three types are superficial simple hemangiomas, are pink, red, or blue-burgundy in color, affect the outer part of the skin, and grow inward only a few millimeters. Their surface may be completely smooth, may partially protrude above the skin, or may contain nodules.

It can be both superficial and subcutaneous. Superficial is a cavity with blood and is visible on the surface of the skin. Subcutaneous - located under the skin and looks like a tumor. It may be visible on the surface of the skin (a bluish tint to the skin), but it may not be visible, and the skin above it remains unchanged.

In addition to these forms, there are also combined forms of hemangiomas.

At what age does hemangioma most often appear?

Hemangioma can occur before the baby is born and is visible immediately after birth.

May appear between 1 and 2 months of age (more often during the first 2-3 weeks of life). But there are cases of hemangiomas occurring before the age of one year (these cases are rare).

Where does hemangioma occur in newborns?

• Most often, hemangiomas affect the head area. They can be located on the scalp, on the mucous membranes of the mouth, eyes, nose, and cheeks.
• Hemangiomas also often affect the mucous and skin parts of the genital organs.
• Hemangiomas can be located on any part of the body: arms, legs, abdomen, back, etc.
• Hemangiomas can affect the internal granules, bones, and soft tissues.

Hemangioma in newborns, causes

The causes of hemangiomas in children are not fully known. There are several main reasons that doctors cite, but they are quite vague, rather, they are theories.

• Unfavorable environmental conditions, harmful factors V environment during pregnancy.
• Diseases suffered by the pregnant woman (and reaction to medications). As a rule, this is an acute respiratory infection in the first 8 weeks of pregnancy.
• Hormonal changes in the body of a pregnant woman.

As you can see, there are no clear reasons. For some reason, it turns out that in certain moment the cells of the inner surface of the blood vessels are misplaced and transform into a benign tumor. As a rule, this occurs at the stage of pregnancy when the cardiovascular system of the fetus is formed (from the third to the eighth week of pregnancy).

• A common cause (besides those listed above) is considered to be tissue hypoxia, a lack of oxygen in the tissues.

Factors that make hemangioma more likely to occur

Despite the fact that doctors have not yet identified clear causes of hemangiomas, there are factors that increase the risk of occurrence. Let's bring them.

• Multiple pregnancy.
• Mom's age (older).
• Low birth weight of the baby (less than 2900 g for a full-term pregnancy).
• Premature pregnancy. Due to the fact that there is not enough surfactant (a substance for normal breathing) in the baby’s lungs, conditions of hypoxia may occur, and this can provoke the appearance of hemangioma.
• A sharp increase in blood pressure (eclampsia) during pregnancy.
• Placental insufficiency, in which the function of the placenta, which is responsible for providing the fetus with oxygen, is impaired.
• Injuries during childbirth. Too fast rapid labor, or vice versa, prolonged labor, cases of severe compression of the fetus. At this time, a state of local hypoxia occurs in places of compression, and this can provoke the appearance of hemangioma.
• Smoking during pregnancy. This factor “works” in the same way as placental insufficiency. The fetus does not have enough oxygen, since the mother’s lungs are periodically filled with smoke.

Statistics on the appearance of hemangioma in newborns

Hemangioma is the most common benign tumor. On average, according to statistics, it can occur in every 10th child. More common in girls than boys. On average, there is 1 boy for every 3 girls with hemangioma.

The most common are simple (flat, tuberous-flat and tuberous-nodular) hemangiomas. This is about 70% of all cases. The least common are hemangiomas of internal organs and bones. This is only 0.5% of all cases.

Hemangioma in newborns, treatment

There are cases when hemangioma is treated immediately, they are listed in the paragraph below. These cases, according to statistics, account for about 10% of all cases. In all other cases, a wait-and-see approach is recommended. You need to understand that small (especially superficial) hemangiomas quite often go away on their own, without treatment.

It is important to note the psychological aspect of the occurrence of hemangioma. It may not be a case that requires urgent treatment, but it can severely traumatize both the growing child and the parents. The child will be “looked at askance”; children may refuse to play with him or tease him. In these cases, a decision may be made to treat the hemangioma, even if it is not dangerous (and, perhaps, would disappear on its own with age).

Which doctor should see and diagnose hemangioma?

The following specialists may be needed to diagnose and monitor hemangioma in a child.

Depending on the location of the hemangioma, consultation with the following specialists may be necessary.

• Pediatric ophthalmologist.
• Pediatric gynecologist.
• Children's ENT.
• Pediatric urologist.
• Pediatric dentist.

In case of complications in the development of hemangioma, consultations with the following specialists may be necessary.

• Oncologist (if malignancy is suspected).
• Infectious disease specialist (for infection of the hemangioma area).
• Hematologist, a specialist in blood diseases (for complications associated with the circulatory system (for example, anemia or thrombocytopenia).

Diagnosis of hemangioma

The following procedures may be performed to diagnose hemangioma.

Medical examination. During the examination, the doctor (pediatric surgeon) finds out the history of the occurrence and development of the tumor. When it appeared, how it grew. In addition, he will measure its size, find out its structure, and the nature of changes in the tumor when pressed.

Instrumental research. This group of studies is needed to identify internal hemangiomas (organs, tissues, bones), as well as when planning surgery to remove the tumor. Instrumental studies may include:

• thermometry;
• thermography;
• ultrasound examination;
• computed tomography;
• magnetic resonance imaging;
• angiography;
• biopsy.

Laboratory tests (usually a general blood test).

Consultations with related medical specialists, the main ones are listed above (gynecologist, ENT, etc.).

Hemangioma development process (phases)

As already mentioned, hemangioma appears, most often, in the first weeks of a child’s life. After its appearance, it can grow rapidly (up to about six months). Your maximum size hemangioma, as a rule, reaches the age of one year. Then regression and resorption of the hemangioma often begins, which can last up to 5-7 or 12 years.

In connection with the patterns of development, the phases of development of hemangioma are distinguished.

• First phase of development. The appearance of a small, relatively light, sometimes pinkish spot.
• Second phase of development. The spot begins to become increasingly red and may resemble a scratch.
• Third phase of development. Hemangioma rapidly grows in size (sometimes doubling in size in a week).
• Fourth phase of development. The spot acquires a purple edge, the destruction of the subcutaneous layer begins and the hemangioma grows inward.
• Fifth phase of development. It is characterized by growth cessation (usually by the child’s age, and up to 5-6 years it may increase slightly).
• Sixth phase of development. Tumor regression. The surface becomes less bright, is partially replaced by healthy skin, and may be partially replaced by scar tissue. Complete disappearance of the tumor (without any cosmetic defects at all) is observed in approximately 2 cases out of 10.

How does a hemangioma pass (disappear)

Many hemangiomas resolve without treatment. This is especially true for small flat hemangiomas. This course of events is called spontaneous disappearance (spontaneous regression) of the hemangioma. As a rule, such age periods are typical for such spontaneous disappearance.

• Until the end of the first year of life.
• From one to five or six years.
• Until the end of the child's puberty.

With spontaneous disappearance, the following visual phenomena are observed.

• The appearance of light areas in the area of ​​the hemangioma, as a rule, first in the center, and then “spread” to the edges.
• A convex hemangioma may become progressively flatter.
• Hemangioma can be replaced by scar tissue.

You need to understand that the hemangioma may disappear, but cosmetic effect may be different. It may “go away without a trace,” or it may become scarred, and then it will be necessary to cosmetically correct the scar tissue. It may not go away completely, and then it will need to be corrected.

It should be noted that cavernous and combined hemangiomas practically do not go away on their own.

When is it necessary (required) to treat hemangioma in newborns?

• Hemangiomas in the mucosal area (eyes, nose).
• Hemangiomas in the labia or anus.
• Hemangiomas on the face.
• Sometimes hemangiomas in the neck area.
• Hemangiomas that grow rapidly (approximately double in 7-10 days).
• Hemangiomas on the inner surface of the cheeks and in the mouth (palate, tongue).
• Any hemangioma, anywhere, with signs of infection, bleeding or necrosis.
• When signs of tumor malignancy appear.

Signs of malignancy of hemangioma

• Changes in the quality of the surface tissue of the tumor, changes in the usual tissue structure, sudden growth in breadth, height or depth. The appearance of ulcers, the appearance of peeling.
• Change in the usual consistency (composition) of the tumor. The appearance of denser, nodular areas.
• Discoloration, appearance of dark, black and brown areas.
• Changes in the surrounding skin, inflammation, swelling, pain, fever).

Why is hemangioma dangerous in newborns?

• Hemangioma grows into internal organs and destroys them.
• Damage and destruction of muscles and bones.
• Damage or compression of the spinal cord (can lead to paralysis).
• The appearance of ulcers and the penetration of infections into the area of ​​the hemangioma.
• Malignancy.
• Cosmetic defects for life.
• Anemia (anemia) - a decrease in the concentration of hemoglobin in the blood, a decrease in the number of red blood cells.
• Thrombocytopenia is a condition associated with a low platelet count and difficulty stopping bleeding.

Removal of hemangioma in newborns

When choosing a specific removal method, the following factors will be important:

• Tumor size.
• Location of the hemangioma.
• A type of hemangioma.

The following groups of methods can be distinguished.

Physical removal methods

• Cryodestruction - freezing of hemangioma tissue (usually with liquid nitrogen). After freezing, the tissue is rejected. Used for superficial or shallowly located tumors.
• Laser irradiation is a modern and most aesthetically justified method of removing hemangioma. The risk of bleeding is minimal, since the blood in the vessels is sintered by the laser. The treated tissues do not form scars, which achieves the desired cosmetic effect.
• Sclerosing therapy - a method involves the introduction of special chemical solutions (for example, alcohol) into the hemangioma tissue, which cauterize the vessels and act as a clotting agent.
• Electrocoagulation - the effect on hemangioma of high-frequency pulse current. This method removes both superficial and internal hemangiomas, and can also prepare the hemangioma for surgery. The big advantage of this method is that the blood vessels become scarred when exposed to electricity, the blood becomes caked, and the risk of bleeding is lower.
• Close-focus radiotherapy – local effect on hemangioma tissue x-rays. Often used as an additional method before surgery.

Surgical method of removal

It is used for small tumors located in places where a scar will not have cosmetic value. It is also used to remove internal tumors that have grown into organs and tissues. Surgical removal itself is often combined with other methods of treating the tumor (medications and physical methods discussed above).

Drug therapy

Drug treatment slows down the growth of hemangioma and can reduce its size. But medications cannot completely remove hemangioma. Therefore, medication is used as an additional method, for example, in preparation for removal surgery.

Dear moms and dads! If your child has a hemangioma, it is very important to consider three main points.

• On the one hand, do not miss the deterioration in its development, observe it carefully (both independently and with a specialist).
• On the other hand, it is important to be patient if the doctor advises so, and the hemangioma may go away on its own. You understand that exposing a child to unnecessary stress during removal is not the best thing if there is a chance of complete disappearance without intervention.
• And on the third hand, it is also not worth exposing the child to negative psychological influences (if the age is already more than a year, and the hemangioma is in a visible place, and they literally “point the finger” at the child). If you need to wait at the cost of psychological discomfort and trauma to the child, then it is better not to wait but to remove the hemangioma.

And, most importantly, do not use any self-medication. Although this is a benign tumor, it is a tumor, and self-medication is dangerous.

Thank you

Hemangioma is a benign vascular tumor that develops as a result of congenital anomaly blood vessels. Hemangioma can form in any organ or tissue that has a branched and wide network of blood vessels, for example, in the skin, liver, kidneys, spine, etc.

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 Cancer. Secondly, these tumors can quickly 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 current problem for the clinical practice of doctors of several specialties at once - surgeons, oncologists, dermatologists and therapists.

Hemangioma, localized on the skin, looks like a red, purple or bluish spot of irregular shape and different sizes. When pressing on the tumor, it may decrease in size, but after stopping the pressure, it completely restores its previous volume within a few seconds.

Hemangioma - general characteristics of the tumor

Various diseases and anomalies of blood vessels are widespread, very diverse and therefore can be either small in size and volume lesions in the form of spots on the skin, or large formations localized in any part of the human body, including in internal organs that are not are simply dangerous, but represent a life-threatening condition.

Hemangiomas can be localized in any tissue or organ that has a developed network of blood vessels. Most often, these tumors form in organs that have greater blood flow than other tissues and organ structures, such as the liver, kidneys, spine and skin. In practice, the most common hemangiomas are 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 arranged randomly, do not function as the 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 can destroy surrounding tissues and organs, which can ultimately cause 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 the formation of ulcers on its surface.

A characteristic feature of any hemangioma is its ability to undergo spontaneous regression, that is, the tumor can go away on its own without leaving any traces. It is because of this feature that hemangiomas are not always treated, sometimes waiting several years for their regression. However, such a wait-and-see approach is only possible 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, for example, the liver, kidneys, eyes, ears, face, genitals , buttocks, perineum, etc. In situations where the hemangioma is growing rapidly, is injured, or is located next to vital organs, the functioning of which it can disrupt, a decision is made to begin treatment. The choice of treatment tactics is made by the doctor based on the location of the tumor, the rate of progression, general condition person and a number of other factors.

Hemangioma in children and newborns - general characteristics

These tumors are detected in approximately 10% of newborns, and in girls 4 times more often than in boys. In addition, hemangiomas are more common in premature infants compared to full-term infants, and the risk of tumor is inversely proportional to the infant's body weight. That is, the greater the body weight of the newborn, the lower his risk of hemangioma.

Most often, hemangiomas are congenital or appear in an infant soon after birth (within 1 to 4 months). In the first weeks after birth, the hemangioma may be subtle, resembling a scratch or bruise. Less commonly, the tumor appears as a bright red cavity or a so-called “port wine stain” (a dark red area of ​​skin). However, after a short period of time, the hemangioma can begin to grow very quickly in size, as a result of which it becomes noticeable. Typically, the period of active growth of hemangioma occurs between 1 and 10 months of a baby’s life, lasting generally for 6 to 10 months, after which the tumor stops growing 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 maximum of a few centimeters in diameter. More extensive tumors are quite 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 a child’s skin, then most likely he also has hemangiomas of internal organs.

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

Hemangiomas that appear 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 9–10 years of age, if the tumor does not interfere with the functioning of important organs and systems, does not ulcerate or bleed, it is not treated until the child reaches 10 years of age, but simply observed. However, if the hemangioma disrupts the functioning of organs and systems (for example, it closes the eye, is localized in the parotid region, impairing 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 organ structure by the tumor .

After the involution of a hemangioma, completely healthy normal skin may remain at the site of its localization, no different from that in any other area. However, in some cases, scars, areas of atrophy, as well as thinning of the skin and its yellowish color may form at the site of the evolved hemangioma. Unfortunately, the same cosmetic changes in the skin in the area of ​​hemangioma can also form after its treatment with various surgical techniques (cauterization with laser, liquid nitrogen, removal with a scalpel, electric current, etc.).

Photos of hemangiomas in adults, children and newborns

Hemangiomas of various sizes and structures, localized on the skin.

Liver hemangioma (sectional photo of the liver, dark spot on the left - hemangioma).

Causes of hemangioma

At present, the exact causes of the development of hemangiomas have not been identified; doctors and scientists only have theories that explain one or another aspect of the occurrence and formation of the tumor. No specific mutations have been identified in the human genome that could cause the development of hemangiomas.

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

Classification of hemangiomas

Currently, there are several classifications of hemangiomas that take them into account various properties and characteristics. First of all, hemangiomas are divided into the following types depending on location:

• Cutaneous hemangiomas , localized in the upper layers of the skin. These tumors are the safest, so, as a rule, they are not removed, waiting for natural involution. However, if the hemangioma is located near the ear, eye, perineum or face, then it is removed due to the risk of irreversible tissue damage with 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.

This classification of hemangiomas is rather theoretical, since it is not always determined and reflects all the nuances of the severity of the condition of a child or adult. Therefore, practitioners prefer to use another classification - morphological, taking into account the structure of hemangiomas, and, consequently, the likely severity of their course:

• Capillary hemangioma (simple) , located on the skin and formed from capillaries. Such tumors are most often localized on the skin or in bone growth areas.
• Cavernous hemangioma , located in the subcutaneous tissue and formed from larger vessels compared to capillaries. Such hemangiomas are usually localized in areas of organs and tissues characterized by an 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 at 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.
• Racemotic hemangioma It is extremely rare and is localized on the scalp or extremities. The tumor consists of convoluted plexuses of sharply thickened blood vessels, penetrated by fistulas.
• Mixed hemangioma combined with other tumors, such as lymphoma, keratoma, etc.

Let's look at a brief description of each morphological type of hemangioma.

Capillary hemangioma

Capillary hemangioma develops in 3 people out of 1000. The tumor is a flat spot on the skin or on the surface of an internal organ, colored red-pink. Over time, the color of the spot becomes darker and it becomes red-purple in color. During the growth phase, the spot may become convex with a bumpy surface. The tumor is formed by dilated and blood-filled capillaries. If a simple hemangioma is located on the eyelid, then it must be removed, since otherwise it can provoke glaucoma with loss of vision in one eye. But in principle, capillary hemangiomas localized on the back of the head, on the forehead or on the eyelids usually disappear spontaneously within 1 to 3 years.

Cavernous hemangioma

Cavernous hemangioma is always localized in the subcutaneous tissue, so on the surface of the skin it is visible as a convex bluish formation. Such a hemangioma consists of a large number of dilated blood vessels and the cavities formed by them, which are filled with blood and connected to each other by numerous anastomoses (vascular bridges). During the growth period, such hemangiomas grow only into the skin and subcutaneous tissue, and underlying tissues, such as muscles, bones or internal organs, are extremely rarely affected. Cavernous tumors can be of varying sizes, single or multiple. Depending on their location on the skin or in internal organs, cavernous hemangiomas are divided into limited and diffuse. Limited ones are localized in a strictly defined area, without spreading beyond its boundaries. But diffuse hemangiomas do not have a clear boundary and are located over a fairly large area in the form of numerous formations of various sizes - from very small to quite large.

Combined hemangioma

Combined hemangioma consists of two parts - capillary and cavernous, and therefore is located simultaneously in the skin and subcutaneous tissue. That is, the capillary part of the combined hemangioma is located on the skin, and the cavernous part is in the subcutaneous tissue.

This type of hemangiomas is always localized not in the thickness of the tissues of any organ, but on its edge, in close proximity to its border. Due to this localization feature, combined hemangiomas can be located on the skin, in the bones and on the surface of 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 hemangiomas is predominant.

Racemotic hemangioma

Racemotic hemangioma is usually localized on the scalp, arms or legs, and consists of convoluted, thick-walled and sharply dilated blood vessels. A section of a hemangioma shows serpentine plexuses of thick and dilated vessels filled with blood. This type of hemangiomas is not always isolated, but is more often classified as cavernous.

Mixed hemangioma

Mixed hemangioma consists of elements of a vascular tumor, as well as lymphoid, nervous or connective tissue. This type of hemangiomas includes angiofibromas, angioneuromas, hemlymphangiomas, etc. The external signs of tumors and their clinical manifestations can be different, since they are determined by the types of tissues that form them and their relationship with each other. This type of neoplasm is rarely classified as hemangiomas proper due to the complexity of the structure and the very diverse clinical picture, and therefore practicing doctors prefer to consider them as a separate, independent pathology, which has some features of a vascular tumor.

Vascular tumor size

Hemangioma can have different sizes - from a few millimeters to tens of centimeters in diameter. If the tumor is not round, then its size is considered to be the greatest length from any one edge to the other.

Symptoms

Clinical signs of hemangiomas can be different, since they depend on the age, size, depth of tumor growth in the tissue, as well as the location of the tumor. Therefore, we will consider the clinical manifestations of hemangiomas of different localizations separately to avoid confusion.

Skin hemangioma

Skin hemangioma can be localized on any part of the skin - on the head, on the limbs, on the torso, on the buttocks, on the external genitalia, etc. Regardless of the exact location, all skin hemangiomas manifest the same clinical symptoms.

In the area of ​​the skin where the hemangioma is localized, swelling is always clearly visible and may be unusually colored in various shades of red (red-pink, burgundy, cherry, red-raspberry, red-blue, etc.). The more arteries there are in a hemangioma, the brighter red it is. Accordingly, the more veins, the darker 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 stress or increased blood flow to the area where the hemangioma is located, the tumor temporarily becomes brighter in color than usual. This is especially noticeable with hemangiomas on the face of children, which literally instantly become very bright against the background of crying.

How stronger tumor the skin grows, the more likely it is to develop any disorders associated with insufficient tissue nutrition, such as ulcers, hypertrichosis ( overgrowth hair), hyperhidrosis (sweating), cracks, etc. All these violations of skin integrity 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 you press your finger on the swollen, colored area of ​​skin, it goes away. However, after the pressure stops, the hemangioma quickly takes on its normal 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 and elastic, this means that the tumor is prone to active growth in the near future.

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

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

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

Body hemangioma

Hemangioma of the body manifests itself with the same clinical symptoms as a tumor localized on the skin. That is, a hemangioma of the body is characterized by swelling, pain and coloration of the skin in various shades of red in the area of ​​its localization.

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. Fast growth tumors of the body can cause them to grow into the ribs or abdominal muscles, disrupting the functioning of these body structures. And this, in turn, will have a detrimental effect on breathing function, proper walking, normal functioning of the abdominal organs, etc.

Hemangioma of the face, head and lip

Hemangioma of the face, on the head and on the lip is recorded quite often. The tumor can be localized on any part of the surface of the skull - on the nose, on the lips, on the cheeks, on the forehead, on the temples, on the eyelids, on the back of the head, near auricle, under hair, etc. The main clinical symptoms of hemangiomas of the face, head and lips, like any other skin hemangiomas, are pain, swelling and coloration of the skin in shades of red. The danger of tumors on the face and head is due to the fact that they are in close proximity to many important organs, such as eyes, ears, brain, etc. Therefore, hemangiomas on the face and head are treated with the utmost attention and caution, carefully monitoring their growth and ensuring that the tumor does not put too much pressure on important organs, irreversibly impairing their functions.

Liver hemangioma

Liver hemangioma, as a rule, is asymptomatic, that is, nothing bothers the person. Such tumors are usually an incidental finding during ultrasound examination, as well as computed tomography or magnetic resonance imaging. Liver hemangioma usually occurs in people 30–50 years old, mainly in women. This tumor is usually removed surgically after detection.

Spinal hemangioma

Spinal hemangioma is characterized by the presence of constant back pain, which is not relieved by taking drugs from the NSAID group (Ketorol, Ketonal, Ibuprofen, Nimesulide, Xefocam, etc.) and is not relieved by massage or applying various ointments and gels with a distracting or anti-inflammatory effect (for example, Voltaren, Finalgon, Dolgit, Capsicam, etc.). Hemangioma can imitate attacks of osteochondrosis, herniated intervertebral discs and other diseases of the spine due to compression of tissues and disruption of their functions. The localization of pain and discomfort usually corresponds to the part of the spinal column in which the hemangioma is located. For example, if the hemangioma is located in the lumbar region, then the lower back will hurt, etc. The spinal hemangioma can be removed or left and its progress observed. Therapeutic tactics are determined by the doctor individually for each individual, taking into account all the nuances of the disease and the general condition of the patient.

Kidney hemangioma

Renal hemangioma is extremely rare. This tumor is congenital, but it is often discovered much later. During the period of active growth of the child, the tumor also begins to rapidly increase in size, squeezing the kidney tissue and disrupting its functioning, which provokes the appearance of a number of clinical symptoms. Signs of renal hemangioma are the following symptoms:

• Persistent uncontrolled hypertension;
• Pain in the lower back, spreading 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. Kidney tumors are usually removed surgically once detected.

Complications of hemangiomas

Complications of hemangiomas are bleeding, ulceration of their surface, formation of cracks and trophic ulcers on the skin in the immediate vicinity of the tumor. In addition, when the hemangioma is localized near any important organs, its complications include disturbances in the functioning of these anatomical structures arising due to tissue compression. So, if the hemangioma is localized on the face or neck, it can compress the trachea and cause breathing difficulties. Usually, when the trachea is compressed by a hemangioma, the child develops a painful cough, cyanosis and hoarseness.

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

When the hemangioma is localized in the sacral area, damage to the spinal cord is possible, which is fraught with numerous dysfunctions pelvic organs and intestines. Symptoms of spinal cord damage by hemangioma are the following:

• Leg muscle atrophy;
• Fecal and urinary incontinence;
• Ulcers on the soles of the feet;
• Leg muscle paresis.

Hemangiomas localized in internal organs may be complicated heavy bleeding, which exhaust a person, provoke anemia, loss of strength, etc.

Diagnostics

Diagnosis of cutaneous hemangioma is not difficult, since it is clearly visible, and the doctor can examine the formation with the naked eye. That is why the diagnosis of cutaneous hemangiomas involves examining the formation by a doctor. Magnetic resonance or computed tomography is used to identify hemangiomas of internal organs.

Hemangioma - treatment in children and adults

General principles of treatment

The principles of tumor therapy do not depend on the person’s age, but are determined solely by its properties and location. Therefore, treatment of hemangiomas in children and adults is carried out in exactly the same way, using the same techniques.

First, due to the high probability of spontaneous disappearance of hemangiomas within several years, tumors that do not have a high risk of complications are usually not treated, but simply monitored for their course. Hemangioma treatment is resorted to only in cases where the tumor can cause severe complications (for example, it is localized on the eyelid or in the orbit of the eye, in the area of ​​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 are localization of hemangiomas in the following areas of the skin:

• Hemangiomas localized around the eyes;
• Hemangiomas that interfere with normal vision;
• Hemangiomas localized near the respiratory tract (for example, on the neck, on the mucous membrane of the oropharynx, 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 area of ​​the ears or parotid salivary glands;
• Hemangiomas with an ulcerated surface.

If the hemangioma was simply observed, and at some point in time the tumor began to become complicated, then in this case passive tactics are replaced with active ones and treatment of the disease begins. In other words, treatment of hemangioma can be started at any time if it appears high risk complications.

So, treatment of hemangioma consists of reducing its size or completely removing the tumor, which is achieved using surgical or therapeutic methods, such as:
1. Surgical methods for tumor removal:

• Cryodestruction (cauterization of the tumor with liquid nitrogen);
• Laser irradiation;
• Sclerosing therapy (introduction of solutions into the tumor that provoke the death of the vessels that form it);
• Close-focus radiotherapy (tumor irradiation);
• Electrocoagulation (removal of hemangioma using electrodes);
• Removal of the tumor during routine surgery using a scalpel.

2. Therapeutic methods for treating hemangioma:

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

Let's take a closer look at all the therapeutic and surgical methods of treating hemangiomas.

Removal of hemangioma (surgery)

The operation is performed under general anesthesia. During the intervention, the doctor removes the entire hemangioma, as well as 1.5 - 2 cm of surrounding tissue. This method is traumatic and ineffective, since in 50–60% of cases, after surgical removal, the hemangioma reappears on some adjacent area of ​​the skin and begins to grow very quickly. Therefore, at present, surgical treatment is used only for hemangiomas localized in internal organs, and skin tumors are removed by other methods.

Laser removal (laser destruction)

Removal of hemangioma with a laser (laser destruction) is also suitable only for the capillary type of tumors. Cavernous or combined hemangiomas cannot be removed with a laser, as this will lead to too deep tissue damage and scarring. Laser therapy for simple skin hemangioma, as well as cryodestruction, can be carried out at any time, including during the period of active tumor growth.

Cauterization (electrocoagulation)

This method of removing various pathological tissues is usually familiar to women who experience cervical erosion. The fact is that diathermocoagulation of cervical erosion (so-called “cauterization”) is the same as electrocoagulation of hemangioma. That is, during electrocoagulation, under the influence of electric current, the structures of the tumor are destroyed, after which normal healthy skin grows in its place. Electrocoagulation can be used for any type of hemangioma, however, when treating cavernous tumors, scar formation is possible due to the fact that it is necessary to destroy tissue to a considerable depth.

Removal of hemangioma with liquid nitrogen (cryodestruction)

Currently, this is the most commonly used method for the removal of capillary cutaneous hemangiomas. Cryodestruction can be used at any time, regardless of what phase the hemangioma is in. That is, burning with liquid nitrogen can be carried out during the period of active tumor growth.

The essence of cryodestruction is the exposure of the hemangioma area to liquid nitrogen, which destroys the tumor structures. Complete removal The tumor occurs in 1 to 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 tissue destruction, which as a result cannot recover.

Sclerosing therapy

Sclerosing therapy for hemangiomas is an injection into the tumor various solutions, which cause the death of its constituent blood vessels with their subsequent transformation into connective tissue. That is, under the influence of sclerosing therapy, the hemangioma turns into an ordinary connective tissue cord under the skin. However, if the hemangioma was quite large or treatment was started in the growth phase, then after sclerotherapy the tumor may not completely disappear, but decrease in size and stop active growth. Sterile alcohol is used as the main sclerosing solution, which is injected into the tumor along with Novocaine, which relieves any pain. Sclerosing therapy is effective for deep hemangiomas.

Close focus X-ray therapy

Close-focus radiotherapy involves irradiating the tumor with X-rays. The method is very effective and is often used to treat deep hemangiomas.

Therapeutic methods for treating hemangioma

Compression therapy is the safest and effective enough to be used for any type of hemangioma, including complicated ones, if it is located in an area where a pressure bandage can be applied. Treatment consists of applying compression bandages to the hemangioma, which are left in place for a certain period of time. After 1 – 2 months, the hemangioma significantly decreases in size or completely disappears.

Corticosteroids for the treatment of hemangiomas are taken in an individual dosage, calculated at a ratio of 2 - 3 mg per 1 kg of body weight per day. However, taking corticosteroid hormones (Prednisolone, Diprospana) 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 independently. As a rule, taking hormones is combined with the removal of hemangiomas by some surgical method.

Vincristine for the treatment of hemangiomas is taken once a week in an individual dosage, calculated at the 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 because they cause a large number of severe side effects, including those affecting the nervous system.

The most effective and safe therapeutic method for treating hemangiomas is the use of propranolol or timolol 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 USA, the drugs propranolol and timolol, by special decree of the relevant ministries, were introduced into the treatment of hemangiomas. This decision was made based on the positive results of experimental treatment of children with hemangiomas with propranolol and timolol. Currently, among all methods of treatment for hemangiomas (both surgical and therapeutic), it is the use of propranolol or timolol that is the best in terms of safety/efficacy ratio.

Propranolol is given to the child 2 times a day in an individual dosage, calculated at the ratio of 0.5 mg per 1 kg of weight. At the end of the first week of taking propranolol, blood glucose levels should be determined and blood pressure in the child, and do an ECG. If the tests are not normal, then you will have to stop taking the drug and use another method of treating hemangioma. If all 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 blood pressure and do an ECG. If the tests are normal, then the dosage is increased to 2 mg per 1 kg of weight and continued to be given to the child 2 times a day for 4 weeks. At this point, the course of therapy is considered completed. However, if necessary, it can be repeated at intervals of one month until the hemangioma completely disappears.

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

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

If, during the process of observing the hemangioma, ulcers or cracks appear on its surface, then you can lubricate it with Metronidazole gel, ointments with glucocorticoids (for example, Dexamethasone, Lokoid, 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

Hemangiomas of this localization, just like skin ones, may require treatment or observation. After detecting a hemangioma in the liver or spine, doctors perform computed tomography or magnetic resonance imaging at intervals of 1 to 2 weeks, with which they look to see if the tumor is growing. If the study reveals that the hemangioma is actively growing, then treatment should be immediately carried out, which consists of surgical removal of the tumor followed by taking glucocorticoids or propranolol. If the hemangioma does not grow, then the person is left under observation, monitoring his condition at least once a month, since there is a high probability of the tumor disappearing on its own.

Liver hemangioma: description, complications, methods of diagnosis and treatment - video

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

The most intensive growth is observed 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, the hemangioma may continue to grow at an older age, increase in size and grow into nearby organs and tissues with their subsequent destruction. This leads to both a serious cosmetic defect and disruption of the functions of various organs and systems, which can have the most unfavorable consequences.

Hemangioma is quite common and occurs in every tenth newborn. It appears three times more often 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 or two to several hundred.
• They occur as small hemangiomas ( 2 – 3 mm), and huge ( up to several meters in diameter).
• Hemangiomas in adults are detected extremely rarely and are a consequence 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

Today, science does not have a clear opinion about the causes of hemangioma. It is known that the development of this tumor is associated with a disruption of the process of vascular formation during the period of intrauterine development of the fetus.

Formation of fetal vessels

During the growth of the fetus in the womb, the first blood vessels begin to form at the end of the 3rd week of embryo development from a special embryonic tissue - mesenchyme. This process is called angiogenesis.

Depending on the mechanism of vascular development, there are:

• primary angiogenesis;
• secondary angiogenesis.

Primary angiogenesis
Characterized by the formation of primary capillaries ( the smallest and thinnest blood vessels) directly from the mesenchyme. This type of vascular formation is characteristic only of the early period embryonic development. Primary capillaries do not contain blood and consist of a single layer of endothelial cells ( in the adult body, endothelial cells line the inner surface of blood vessels).

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

Thus, with the development of an organ and an increase in its mass, the deeper sections begin to lack oxygen ( hypoxia). This triggers a number of specific intracellular processes, which result in 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. In this way, angiogenesis is controlled in later stages of fetal development and after birth.

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

Theories of hemangioma occurrence

Today, there are more than a dozen theories trying to explain the mechanisms of the appearance and development of hemangiomas, but none of them is able to independently cover all aspects of this disease.

The most plausible and scientifically substantiated are:

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

Lost Cell Theory
The most modern and scientifically substantiated theory, according to which hemangioma occurs as a result of a violation of the development of capillaries from the mesenchyme. During embryogenesis, accumulations of immature blood vessels form in organs ( capillaries), which then turn into veins and arteries. After the formation of an organ, a certain amount of unused immature vascular tissue may remain in it, disappearing over time.

Under the influence of certain factors, this process is disrupted, as a result of which involution of capillaries is not 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 that this tumor can form in almost any tissue of the body.

Fissural theory
At the initial stages of embryo development, the so-called embryonic clefts are distinguished in the area of ​​the skull - 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 gaps.

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

Placental theory
It is assumed that endothelial cells of the placenta enter the bloodstream of the fetus and are retained in its organs and tissues. During the period of intrauterine development, maternal factors inhibiting angiogenesis do not allow the vascular tissue to actively grow, however, after birth, their effect ceases and intensive growth of hemangioma begins.

Mechanism of occurrence of hemangioma

Despite the diversity of theories, what they have in common is the presence of immature embryonic vascular tissue in the skin and other organs, where it should not normally be present. However, this is not enough for the development of hemangioma. The main factor that triggers the process of capillary growth and tumor formation is tissue hypoxia ( lack of oxygen).

Consequently, 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 be promoted by:

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

• Fetoplacental insufficiency. Characterized by insufficient oxygen delivery ( and other substances) to the fetus due to a violation of the structure or function of the placenta.

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

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

• 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 body is able to tolerate this condition relatively easily, then in the fetal body 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 is associated with an increased risk of various developmental anomalies in the fetus, including vascular neoplasms.

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

Development of hemangioma

A distinctive feature of these neoplasms is their clear staged progression.

In the process of development of hemangiomas, they are distinguished:

• A period of intense growth. Characteristic of the first weeks or months after the onset of hemangioma and, as a rule, stops by the end of the first year of life ( exceptions are possible). Externally, the tumor is bright red in color, constantly increasing in diameter, as well as in height and depth. The growth rate varies within varying 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 into neighboring organs and their destruction).

• Period of growth cessation. In most cases, by the end of the first year of life, the growth of the vascular neoplasm stops, and until the age of 5–6 years it increases slightly, corresponding to the growth of the child.

• Period of reverse development. In approximately 2% of cases, complete spontaneous disappearance of the hemangioma is observed. Some time after growth stops ( in months or years) the surface of the tumor becomes less bright and may ulcerate. The capillary network gradually disappears, which is replaced either normal skin (for small, superficially located hemangiomas), or scar tissue ( in the case of voluminous formations growing into the deep layers of the skin and subcutaneous tissues).

Types of hemangiomas

Depending on the nature of growth, structure and location of the hemangioma, the method of its treatment is chosen, therefore, when making a diagnosis, it is also necessary to determine the type of tumor.

Depending on the structure there are:

• Capillary ( simple) hemangiomas. They occur in 96% of cases and represent 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 initial stage development of the disease and is characterized by the intensive formation of new capillaries, prone to sprouting into the surrounding tissues and destroying them.

• Cavernous hemangiomas. They are the result of further development of capillary hemangiomas. In the process of growth and increase in size, as a result of capillaries overflowing 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 ( cavern), the inner surface of which is lined with endothelial tissue.

• Combined hemangiomas. Combined hemangioma is classified as a 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 ( caverns). The increase in tumor size occurs mainly due to the formation of new capillaries, which subsequently also undergo transformation into cavities, up to complete replacement of the hemangioma.

Depending on the location there are:

• Skin hemangiomas. Occurs in 90% of cases. They can 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 structure and shape. Damage to the liver, spine, bones and muscles is considered the most common and dangerous.

What do hemangiomas look like on the skin?

Hemangiomas can affect any part of the skin, but are most often observed in the face, neck and scalp. Their appearance varies depending on the structure.

Hemangioma on the skin	Detailed description	Photo
Capillary hemangioma	It is a painless volumetric formation of elastic consistency, rising 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 lumpy, lobed, bright red or dark crimson in color. When pressure is applied, the tumor may turn slightly pale, restoring its original color after the pressure is removed.
Cavernous hemangioma in the facial area	Volumetric, painless formation, fully 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 and rough. When pressed, the formation collapses and may turn slightly pale. When the pressure stops, there is a gradual restoration of the original size and color of the tumor.
Cavernous hemangioma of the leg (subcutaneous form)	The bulk of the tumor is located in deeper tissues ( in subcutaneous fat, in muscles) and reaches significant sizes. The affected area is enlarged ( in comparison with a symmetrical healthy area of ​​the body). 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, voluminous formation of bright red color, rising above the surface of the skin. The affected areas do not have clear boundaries; in some places there is a transition to deeper layers of the skin. The surface is uneven, bumpy. In some places there are more protruding tubercles of a dark crimson color, which collapse when pressed ( caverns).

Diagnosis of hemangioma

Despite the fact that hemangioma is a benign tumor, its rapid growth can be accompanied by a serious cosmetic defect ( when located in the face, head, neck). In addition, when located in internal organs, this neoplasm can lead to their destruction, posing a danger to human health and even life.

The 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 studies;
• laboratory tests;
• consultations with other specialists.

Examination by a doctor

If at birth or in the first weeks of life a red spot is found on the child’s skin, rapidly increasing in size, you should consult a doctor as soon as possible, since hemangiomas are often characterized by very rapid, destructive growth.

What questions will the surgeon ask?

• When did education appear?
• Does the size of the tumor change ( how much and over what period of time)?
• Was any treatment used and was it effective?
• Did the child’s parents or grandparents have hemangiomas, and if so, what was their course?

What examination will the doctor perform at the first visit?

• Carefully examine the tumors and surrounding areas.
• Examine the structure of the tumor in detail under a magnifying glass.
• Determines the consistency of the formation, the nature of changes when pressed.
• 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 studies

Usually, there are no difficulties in diagnosing hemangioma, and the diagnosis is made based on a survey and careful examination. Instrumental methods diagnostics are used to identify lesions of internal organs, as well as when planning surgical removal of a tumor.

In the instrumental diagnosis of hemangiomas the following are used:

• thermometry;
• thermography;
• ultrasound examination;
• 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 consists of two electrodes connected to an electrical sensor. One of the electrodes is installed on the surface of the tumor, the second - on a symmetrical but unaffected area of ​​the skin. The sensor allows you to determine the difference in temperature with an accuracy of 0.01ºС.

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

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

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

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

The method is based on the principle of echogenicity - the ability of various body tissues to reflect sound waves, and the degree of reflection will vary 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 hemangioma ( cavernous or capillary);
• determining the depth of the hemangioma;
• suspicion of hemangiomas of internal organs ( liver, kidney, spleen and other localization).
• clarification of tumor size when planning surgery.

Ultrasound can detect:

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

• Cavernous component. A cavern 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, cavities are defined as areas of reduced echogenicity ( against the background of a hyperechoic capillary network), round or oval in shape, ranging in size from 0.1 to 8 - 10 millimeters.

Based on ultrasound data, it can be assumed that there is a hemangioma in the internal organ, but additional research is required to establish a final diagnosis.

Computed tomography ( CT)
A modern, high-precision method that allows you to identify tumors of internal organs ranging in size from several 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 the computed tomograph 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 passing 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 performing a computed tomography scan is combined with receiving a certain dose of radiation, and therefore the purpose of this study must be strictly justified.

Indications for CT scanning are:

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

Using CT you can determine:

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

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

Contraindications to CT scanning are:

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

Magnetic resonance imaging of the spine ( MRI)
A modern, highly accurate diagnostic method that allows a detailed examination of the structure of the spine and spinal cord. Performing an MRI is absolutely safe and harmless; the only contraindication is the presence of metal parts in the human body ( implants, prostheses).

The principle of magnetic resonance imaging is the same as in 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 atomic nuclei are released certain type energy, which is recorded by special sensors, and after digital processing is presented 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 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 ( disturbance of sensitivity and motor functions arms, legs and other parts of the body).
• Planning surgery to remove a tumor.
• Inaccurate data with other research methods.

MRI of the spine can reveal:

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

Angiography
This method allows you to most accurately determine the structure and size of the hemangioma and assess the involvement of neighboring organs and tissues.

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

Angiography is quite dangerous method diagnostics, 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 contrast agent;
• renal failure and/or liver failure.

Biopsy
This study includes intravital sampling of body tissues for the purpose of subsequent examination under a microscope of their structure and cellular composition.

Performing a biopsy comes with certain risks, the most dangerous of which is bleeding. In addition, the diagnosis can be confirmed without this study, so the only justified indication for a biopsy is the suspicion of malignant degeneration of the hemangioma.

Early signs of malignancy of hemangioma may be:

• Change in tumor surface – disruption of the usual structure, intensive growth in height and depth, ulceration or peeling.
• Change in consistency – the structure becomes heterogeneous, denser areas appear.
• Color change - Darker brown or black areas appear.
• Changes in nearby skin areas - signs of inflammation appear ( redness, swelling, pain, local fever).

Depending on the technique for taking material, there are:

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

• Needle biopsy. More often used to collect material from internal organs ( liver, spleen, muscles and bones). Under ultrasound control, a special hollow game with sharp edges is inserted directly into the tumor tissue, while both peripheral and central departments neoplasms.

Histological examination
Material obtained from biopsy ( biopsy), is placed in a sterile tube and sent to the laboratory, where, after special processing and staining, a microscopic examination of the structure and cellular composition of the tumor is performed, and a comparison is made with undamaged areas of the skin.

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

Laboratory research

Laboratory research methods are not very informative in the process of diagnosing hemangiomas and are more often used to identify complications of the disease, as well as to monitor the patient’s condition during treatment.

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

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

Characteristic changes in 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 increased bleeding 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 hemorrhages caused by thrombocytopenia.

Consultations with other specialists

To help make a diagnosis, as well as in the event of various complications of hemangioma, the pediatric surgeon may need to consult specialists from other fields of medicine.

The diagnostic process may involve:

• Oncologist – if malignant degeneration of the tumor is suspected.
• Dermatologist – with ulceration of hemangiomas or in the presence of concomitant skin lesions.
• Infectious disease specialist – 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

Previously, a wait-and-see approach was recommended for hemangiomas in children, but recent research data suggests the opposite - the earlier treatment of the disease begins, the fewer complications and residual effects may develop.

This statement is due to the unpredictable and often rapid growth of the tumor, which is relatively short terms can increase several times and grow into neighboring organs and tissues. Evidence also supports early treatment statistical research, according to which only 2% of skin hemangiomas undergo complete independent reverse development, and in more than 50% of cases visible cosmetic defects remain on the skin ( scarring).

In the treatment of hemangiomas the following is used:

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

Physical methods for removing hemangiomas

This group includes methods of physical impact on hemangioma tissue, resulting in its destruction and subsequent removal.

Physical methods include:

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

Cryodestruction
It is used to remove superficial or shallowly located skin hemangiomas, the size of which does not exceed 2 cm in diameter. The essence of the method is to expose the tumor to liquid nitrogen, the temperature of which is -196ºС. In this case, the tumor tissue is frozen, killed and rejected, followed by replacement with normal tissue. Removal of large tumors can lead to the formation of extensive scars, which represent a serious cosmetic defect.

The main advantages of this method are:

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

The cryodestruction procedure itself is safe, almost painless, and can be performed in a doctor's office. The patient sits in a chair, after which a special mold is applied to the area of ​​the hemangioma, completely surrounding the boundaries of the tumor. This mold is filled with liquid nitrogen, while the patient may experience a slight burning sensation for the first few seconds.

The whole procedure takes a few minutes, after which the area of ​​the hemangioma is treated with a solution of potassium permanganate, and the patient can go home. Usually 2 – 3 cryotherapy sessions are required with breaks of 3 – 5 days. After treatment is completed, the area where the hemangioma used to be must 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 of removing superficial and deeper skin hemangiomas with a diameter of up to 2 cm using a laser.

Main effects 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.

The technique of performing the procedure is quite simple, but at the same time, it must be performed by an experienced specialist, as it is associated with certain risks ( possible damage to healthy tissue). After local anesthesia, the hemangioma area is exposed for several minutes to a laser beam, the diameter of which is selected depending on the size of the tumor ( the beam should not hit intact skin).

A dense crust forms at the site of exposure, which peels off on its own after 2 to 3 weeks. A small scar may form underneath ( with large sizes of the removed hemangioma).

Sclerosing therapy
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 coagulating ability of certain chemicals that are introduced into the hemangioma tissue, causing the destruction of blood vessels and cavities, followed by their replacement with scar tissue.

Currently, 70% alcohol is used to harden hemangiomas. The procedure must be performed by an experienced surgeon under sterile conditions. The area of ​​skin around the hemangioma is injected with a solution of novocaine ( for the purpose of pain relief), after which 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 tissue swelling appears at the injection site, and after 2 - 3 days the area of ​​the hemangioma thickens and becomes painful. The procedure is repeated several times with a break of 7–10 days. Complete disappearance of hemangioma is observed in the period from 3 months to 2 years from the end of treatment.

Electrocoagulation
A method of destroying tumor tissue through exposure to high-frequency pulsed electric current. When living tissue is exposed to current, its temperature rapidly increases 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 feeding the hemangioma and sclerosis ( scarring) their lumen.

Using an electric knife, superficial and intradermal hemangiomas can be removed, and electrocoagulation can be used as an auxiliary method for surgical tumor removal.

Close focus X-ray therapy
It consists of 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 to reduce the size of the tumor, which will reduce the volume of surgery.

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

Surgical method for removing hemangiomas

As an independent treatment method, it is used for small superficial skin formations located in areas of the body where postoperative scar less significant in cosmetic terms ( in men in the back, legs).

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

Quite often, conservative treatment methods are used in the preoperative period ( drug therapy, radiation therapy), which results in a reduction in tumor size, which reduces the volume of surgery and causes less injury to nearby organs ( muscles, bones).

Drug treatment of hemangiomas

Until recently, drug therapy was practically not used in the treatment of hemangiomas. However, scientific research recent years found that some drugs have a beneficial effect on the course of the disease, slowing down the growth process and reducing the size of the tumor.

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

Name of the medication	Mechanism of action	Directions for use and doses
Propranolol	The drug blocks certain vascular receptors ( B2-adrenergic receptors), which affects hemangioma. The action of propranolol is due to: constriction of blood vessels of hemangiomas ( as a result of blocking the action of vasodilating factors); decrease in the formation of vascular endothelial growth factor ( VEGF); stimulation of the process of destruction of hemangioma capillaries and their replacement with scar tissue.	Taken orally. The initial dose is 1 mg per kilogram of body weight per day, divided into two doses ( morning and evening). If there is no effect ( manifested in slowing down the growth of hemangioma and reducing its size) the dose can be increased to 3 mg/kg/day. The course of treatment is from 6 months. During treatment, it is necessary to monitor the performance of the cardiovascular system weekly ( measure blood pressure, heart rate, conduct an electrocardiogram).
Prednisolone	Steroid hormonal drug, the effect of which is due to the activation of the formation of scar tissue in the area of ​​the hemangioma. As a result, the capillaries are compressed, blood flow through them stops, they become empty and destroyed, replaced by scar tissue. The effects of prednisolone are: slowing down the growth of hemangioma; reduction in the size of the hemangioma.	Taken orally after meals with a glass of water. First 6 weeks – dose 5 mg per kilogram of body weight, 1 time per day. Next 6 weeks - dose 2 mg per kilogram of body weight, 1 time per day. Next 6 weeks - dose 4 mg per kilogram of body weight, every other day. Discontinuation of the drug should be done slowly, gradually reducing the dose to avoid adverse reactions and relapse ( reappearance) hemangiomas.
Vincristine	Antitumor drug, the action of which is due to the blocking of cell division processes, as a result of which the growth of hemangioma slows down and stops. The drug has a lot of side effects, and therefore is prescribed only when other medications are ineffective.	It is administered intravenously, once a week, at a dose of 0.05 - 1 mg per square meter of body surface. During treatment, it is necessary to regularly monitor the composition of peripheral blood ( carry out a general blood test at least 2 times a month).

Consequences of hemangioma

If treatment of hemangioma is started incorrectly and untimely, a number of complications can develop that pose a threat to human health and life.

The most serious 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, kidneys, spleen and others);
• ulceration of hemangioma and infection;
• malignancy;
• thrombocytopenia and anemia;
• cosmetic defect ( untreated hemangiomas and their scars can persist throughout life).

The prognosis for hemangioma is determined by:

• original location of the tumor;
• speed and nature of growth;
• time of start of treatment;
• adequacy of treatment measures.

With a timely diagnosis, timely and correct treatment tactics, the prognosis is favorable - complete disappearance of the hemangioma is noted without any visible skin defects.