Tumors and tumor-like processes in the vessels of the skin: causes, symptoms, diagnosis, treatment

At the heart of tumor-like processes observed in the vessels of the skin, lie embryonic dysplasias, accompanied by the cleavage of angioblastic elements, which, starting from the embryonic period, proliferate and form various kinds of hamartomas. These include the telangiectatic nevus; angiectasia of blood and lymphatic vessels of an innate or acquired character with reactive changes in vascular foam; angiokeratomes appearing in a later period of life in cotton wool of reactive changes in the epidermis: angiomas - benign vascular neoplasms with proliferation of vascular elements or of a purely capillary type, or with a partial arterial or venous component.

In addition, there are anti-ectatic malformations. Combined with various congenital disorders, such as diffuse phlebocetosis, venous stains (arachnid nevus), hemorrhagic telangiectasia (Rundu-Osler disease), and Gutchinson's serpentine ectasia.

The telangiectatic nevus exists from birth, is clinically characterized by the presence of one or more dark red or bluish-red spots, usually not protruding above the surface of the skin. There are two types of nevus: medially located mainly in the nape and the neutral part of the egg and localized laterally, usually one-sided on the face and extremities. The latter is combined with congenital disorders of other organs and tissues (leptomeningeal naevus flamrneus, Sturger-Weber Syndrome, Klippel-Trenone syndrome).

Pathomorphology. Medially located telangiectatic nevus is characterized by an expansion of the capillaries of the subpapillary dermis layer in the early period of life, whereas in lateral localization this process begins at about 10 years of age and concerns not only the subcapillary layer of the dermis but also its deeper layers, including subcutaneous fat .

Angiokeratoma is characterized by angiomatosis, accompanied by reactive changes in the epidermis (acanthosis, hyperkeratosis). WF Lever and S. Schaumhuig-Lever (1983) distinguish five types of angiokeratoma:

1. generalized systemic type - diffuse angiokeratoma Fabry, which is a hereditary impairment of metabolic processes in the body (lipidosis);
2. angiokeratoma limited non -oidal fingers Mibelli;
3. angiokeratoma of the scrotum and vulva of Fordis;
4. papular angiokeratoma and
5. angiokeratoma is limited.

Mybelli is limited clinically by the presence of small (diameter 1-5 mm or more) painless dark red or bluish, disappearing with the diascopy of cystic nodular elements, located symmetrically, mainly on the skin of the dorsal and lateral surfaces of the fingers of the upper and lower extremities, sometimes on the buttocks and other places. The surface of the element is hyperkeratotic, sometimes there are warty growths. Eruptions usually appear in the pubertal period, more often in girls with increased sensitivity to cold, accompanied by acrocyanosis, hyperhidrosis of the palms and soles, a tendency to chills and numbness of the extremities,

Pathomorphology. In the fresh elements, capillaries of the upper dermis are noted, in old foci - hyperkeratosis, acanthosis, papillomatosis. Capillaries in the dermis are sharply enlarged with perivascular lymphocytic infiltration.

Angiokeratoma of the scrotum and vulva of Fordis is characterized by the presence of multiple vascular papules with a diameter of 2 to 5 mm, the size and number of which increase with age. Fresh rashes bright red color, soft consistency, while old foci are cyanotic, with hyperkeratosis. Can be accompanied by itching and bleeding.

The solid papular antigorokeroma usually appears at a young age in the form of slightly elevated nodular elements ranging in size from 2 to 10 mm, with papular eruptions along the periphery. It is localized mainly on the lower extremities. Fresh foci are similar to those on the scrotum, the old ones are cyanotic black with a hyperkeratotic surface that resembles a malignant melanoma. In most cases, angiokeratomas of this type are solitary.

The pathomorphology of all the types of angiokeratoma described above is similar. In fresh rashes, capillaries of the upper dermis are widening, in older foci - hyperkeratosis, small acanthosis and papillomatosis, a more abrupt expansion of the capillaries around which lymphocytic infiltrates can sometimes be seen. In such cases, there are organized or organized thrombi and a more drastic expansion of the capillaries in the deep sections of the dermis and the subcutaneous fat layer.

With the papular form of angiokeratoma, there is only an expansion of the capillaries of the superficial sections of the dermis, i.e. It is in fact telangiectasia.

Angiokeratoma limited in the early stages is one or more lesions consisting of angiomas of red color, merging with each other, with an uneven hyperkeratotic surface. Sometimes they have a linear arrangement, localized mainly on the legs and feet, usually exist from birth. With age, the foci increase and new elements appear. Limited angiokeratoma can be combined with telangiectatic nevus and Klippel-Trenone syndrome.

Pathomorphology. This form is characterized by hyperkeratosis, acanthosis and papillomatosis. Sharply dilated capillaries are located near the epidermis and are sometimes enclosed in its epidermal outgrowths. Although most blood vessels are filled with blood, some of them, with thin walls, contain lymph. In the enlarged capillaries, thrombi are sometimes found. In contrast to papular angiokeratoma, in which surface telangiectasies are observed, with limited detection, the expansion of the entire vascular network of the dermis, as well as subcutaneous tissue, is observed.