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Published byCecilia Park Modified over 6 years ago
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Haemangioma Its benign endothelial tumor of blood vessels.
-common skin lesion. -1% newborn,10% infant. -60% =head. - female/male=3/1. -Grow rapidly in first year then slowly involute.70% at years. -80% solitary lesion &20%are multiple(viscera).
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Classification Mullikan classify haemangioma into 2 groups:
1- vascular tumor: - rapid growth. -involutes ,leaving fibrosed skin +fat deposition. -increase endothelia cell activity. - increase number of mast cells. - capillary. 2-vascular malformation: -not regress with time. - not hyper cellular. -flat mature endothelium. - not proliferative. -cavernous
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Clinical appearance -depend on the depth &growth phase.
-early lesion as strawberry ,elevated ,irregular. - size= small red elevated mark to huge tumor . - Deep lesion = blue or skin color. - on examination: comprisable but slowly refill . - Difficult to differentiate between cavernous and capillary haemangioma. -Microscopically: dilated vascular spaces within dermis and subcutaneous tissue.
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Rapid growth result from :
- canalization. - proliferation of angioblast. Regression result from: 1- thrombosis. 2- sclerosis. 3-infarction. - Most complications occur during proliferative phase.
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Location In addition to size &complications it dictate the urgency of treatment? 1- periorbital lesion visual obstruction ambylopi a & sometimes visual impairment. 2- nasal opening obstruction apnea in neonates. 3- external auditory meatus conductive hearing loss.
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History 1- proliferating phase:
- a small sot appear several weeks after birth. - grow rapidly for several months(8-12). 2- plateau phase : - size not increase or decrease up to 2 years. 3- involution phase: - started at 2-3 years . - disappears by 5-7 years; - leaving a patch of pale flaccid skin( fibro fatty tissue)
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Complications 1-superficial ulceration: -common.
- my cause necrosis and bleeding. - Can be treated by dressing & systemic antibiotics. - Large ulcer need aggressive treatment. 2- bleeding : can stop with compression or fibrin glue. 3- infection: -blood born. - May cause septicemia or local necrosis. - Treated by antibiotics.
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4-Kassabach-meritt syndrome:
-large size haemangiom secondary to traped platelets. - thrombocytopenia , coagulopatthy and hemolytic anemia. -growth phase
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Its characterized by 1-Rapid increase in the swelling of haemangiom. 2-Tens and shining of overlying skin. 3-Surrounding area of ecchymosis and pitichia. 4-Bleeding tendency. Laboratory finding : 1-Dicreas platelet count (thrombocytopenia) 2-Dissimination intravascular coagulation 3-Decrease plasma fibrinogen 4-Prolong blooding time 5-Atteration in factor V,VIII,prothrombin time and thrombin time
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5-Larg visceral lesion or multiple lesion can cause congestive heart failure secondary to shunting of blood. 6- functional impairment.
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Treatment Factors affects the mode of intervention :
In general most lesions treated non surgically . Factors affects the mode of intervention : 1-Site : eyelid or medial cantus treated by local injection of steroid 2- Size : big perineal haemangioma can be treated by diverting colostomy 3-Multiplicity : multiple lesion need systemic steroid 4-Presence of complications
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Emergency treatment confind for life threatinig haemangioma
Example: 1- Massive liver enlargement 2-Conjestive heart failure high out put 3-Hearing or vision loss 4-Airway obstruction
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Treatment options 1- Active are intervention with close monitoring
2- Waiting involution of tumor 3- Laser therapy which may cause edema and later scaring 4- Intra lesion cortico steroid 5- Interferon 6- Excisional surgery 7- Systemic cortico steroid 8- Other drugs like bleomycin, cyclophosphamide.
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indication in proliferative phase in infancy
Surgery indication in proliferative phase in infancy 1-Visual or subglottic obstruction 2-Compression of eye globe 3-Bleeding 4-Ulceration 5-Lesion with high risk of searing Indication in involution phase 1-befer school age 2-Post ulcerative searing or residual skin 3-For cosmetic purposes
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Any Questions
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