LYMPHANGIOMA

From Big Medical Encyclopedia

LYMPHANGIOMA (lymphangioma; lat. lympha pure water, moisture + grech, angeion a vessel + - oma) — the benign tumor developing from absorbent vessels. In most cases L. it is found in children in the first year of life, but can meet at any age. According to many authors, it is intermediate between a tumor and a malformation. L. has limited growth, is not exposed to a malignancy.

Preferential localization of L. — skin, hypodermic cellulose. In some cases L. can develop in fabrics of language, a liver, spleen, kidneys, and also in cellulose of a mediastinum and retroperitoneal space.

On a structure of L. divide on capillary, cavernous and cystous.

Capillary L. is located on a face (an upper lip and cheeks) more often. Externally it represents the swelling covered with not changed skin; border of L. difficult opredelima, consistence more elastic, than surrounding cellulose. In the diameter capillary L. seldom exceeds 2 — 3 cm.

Microscopic picture of a capillary lymphangioma: 1 — expanded gleams of the lymphatic capillaries covered by an endothelium; 2 — a fibrous stroma of a tumor with focal accumulations of lymphoid cells; x 150.

At microscopic examination capillary L. represents network expanded and gyrose limf, the capillaries covered by an endothelium (fig). The stroma of a tumor consists of fibrous fabric, edges sometimes contains accumulations of lymphoid cells.

Cavernous (cavernous) L. has an appearance of the tumoral nodes soft to the touch covered with not changed skin and the affected areas causing sharp deformation. In some cases L. sprouts skin, forming the thin-walled bubbles with a diameter up to 0,5 cm filled with a lymph on its surface. On a face cavernous L. affects cheeks and parotid area; on a trunk it is located in hypodermic cellulose, preferential side and perednebokovy surface of a thorax. On top and bottom extremities cavernous L. tends to the growth directed on length of an extremity. Microscopically cavernous L. consists of the small cavities which are reported among themselves and covered by an endothelium; also separate large cavities meet, in to-rykh proteinaceous weight with single uniform elements of blood is found. Layers of connecting fabric, making as if a framework of a tumor, are located between cavities and almost always contain the separate centers of infiltration by lymphoid cells.

Cystous L., according to various authors, makes 60% of all L. also meets preferential in the locations limf, nodes. More than in half of cases cystous L. is located in the field of internal and outside triangles of a neck. The second for the frequency of defeat is axillary area. Cystous L. represents soft hemispherical painless formation of the big sizes, as a rule, not soldered to skin. Coloring of skin over a tumor is usually not changed and is only in some cases slightly cyanotic. Cystous L. consists sometimes of one, is more often from several reported or isolated large cavities. Their inner surface is covered by an endothelium, the gleam is filled a milk look with contents or transparent serous liquid with impurity of a detritis. In walls of cavities, thickness to-rykh in some cases reaches 1 — 3 mm at the remains of fatty and smooth muscle tissue meet the centers of infiltration by lymphoid cells, and also blood vessels and nerves. At a puncture and removal of contents the tumor decreases in volume, however further again gets a former form and the sizes at the expense of fluid accumulation.

At an inflammation the palpation of a tumor is painful; suppuration of cystous cavities is in some cases possible.

Bystry increase in sizes cystous L., especially at an arrangement on a neck and in a mediastinum, at newborn children leads to sharp difficulty of breath and swallowing.

Diagnosis cystous L. in typical cases does not cause difficulties. At the differential diagnosis with other myagkotkanny tumors make its puncture. At an arrangement of L. in a mediastinum, retroperitoneal space and in hypodermic cellulose apply X-ray inspection: the tumor has the irregular, so-called oblakovidny shape, accurate contours and heterogeneous structure; the cavities making it are reported among themselves by channels of various caliber.

Treatment operational, sclerosing or combined. Operational treatment consists in radical removal of all tumor and if it is impossible, then at a distance its greatest part. Single-step operational removal is carried out at L. any structure, having accurate contours and located no more than in two anatomic areas. At tumors of a cystous structure, fascinating more than two anatomic areas, it is reasonable to make step-by-step removal. At children in the absence of urgent indications operational treatment is carried usually out at the end of the 1st year of life; at localization of L. the big sizes on a neck or in a mediastinum, followed difficulty of breath or swallowing, showed an urgent operative measure.

Sclerosing therapy is carried out with the purpose to cause an aseptic inflammation with the subsequent fibrosis of fabric L. 70 or 96% alcohol, solution quinine-urethane and other drugs are for this purpose used (see. Hemangioma ).

At localization of L of a .n the person with growing into the next fabrics sclerosing therapy is method of the choice and is most effective at children aged till 1 year.

The combined treatment consists in preliminary carrying out several courses sclerosing therapies with the subsequent excision of the struck fabric. It is used at extensive L. persons and necks, napr, the part of a tumor which is located on a neck is removed in the operational way, and the sites extending to the person are exposed sclerosing therapies.

Forecast after radical treatment favorable.



Bibliography: Clinical oncology, under the editorship of H. N. Blochina and B. E. Peterson, t. 1, page 413, M., 1979; M and l and N and A. P. Klinik's N and treatment of hypodermic lymphangiomas at children's age, in book: Sovr, probl. onkol., under the editorship of A. I. Rakov, etc., century 1, page 184, L., 1969; The Guide to pathoanatomical diagnosis of tumors of the person, under the editorship of N - A. Krayevsky and A. V. Smolyannikov, M., 1976; T e r e-sh and N and 3. L. and Odabashyan A. L. Cystous lymphangiomas of the person and neck and their sparing treatment, Stomatology, t. 54, K * 1, page 42, 1975; Briccoli A. e. and. Gli emolinfoangiomi mediastinici, Arch. Chir, torace cardiovasc., v. 28, p. 175, 1974; Germain H. e. a. Lymphangiome kystique du mesent^re, J. Radiol. Electro]., t. 51, p. 755, 1970; Hafner E., K u f-f e r F. u. F u with h s W. A. Lymphangiogra-phische Befunde bei der Knochenlymphan-giomatose. Radiol, clin. biol., Bd 41, S. 246, 1972,


G. A. Fedoreev.

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