A. CONNECTIVE TISSUE TUMORS 1. 1-1(rm It yio »? a I-Ilmnangiomata are the most frequent forms of tumors found in children. They are made up of blood-vessels in irregular construction, and they arise and grow by new-formation and exuberance of the vessels.
Etiology and Pathologic divides these into hem angioma simplex, angioma cavernosum, and angioma racemosum.
The hwmanyioma simplex lies in the skin, and is usually formed by a convolution of capillaries. It is sometimes separated from the sur rounding tissues as by a membrane, but much more frequently it sends out sprouts in all directions, which burrow into the tissues, destroying them, and spreads rather rapidly with malignant tendencies.
Ribbert believes their origin is due to disturbances of development. A small, circumscribed capillary region with its own artery and vein develops independently, without its being kept hack by the tension in the tissues surrounding it. We frequently observe them near original clefts—near the mouth or the eyebrows (combination with other con genital anomalies).
When they are confined to the skin, they form the well-known "strawberry-marks." As long as these are on the level with the skin they will only deserve cosmetic consideration. As soon, however, as they grow above the level of the skin, or send their lobes into the deeper tissues, then they begin to assume a malignant character.
When they are only in the subcutaneous connective tissue, without attacking the skin, they will form bluish, soft and easily expressed tumors which slimy underneath the skin and come nearer to the second type—that of the angioma ca•ernosum.
The angioma cavernoslon contains cavities which are filled with blood, in which thrombosis and calcification are of frequent occurrence. Their most frequent location is on the cheek, on the scalp, and on the ear (Fig. I ST).
In the tongue they may cause a form of macroglossia (see Congenital Diseases of the Face, p. 36).
On the forehead they sometimes appear under the skin as convolu tions of veins, which form shallow excavations in the skull by their pressure which can be felt through the thin skin.
In excitement these formations swell the same as natural corpora cavernosa (tumour erectile, Frohlich).
The arterial racemose angiomata are much rarer. These are recog nized by the convoluted, frequently dilated arteries which stand out like corkscrews and pulsate. These are especially malignant owing to their unlimited growth.
Angiomata may also be observed in muscles (long dorsal muscles), where they spread rapidly by the formation of sprouts and nests (muscle angiomata).
The course of angiomata differs a great deal, from the benign straw berry-marks to the malignant spreading cavernous and racemose angio mats and their combination with sarcomatous formations, and we cannot draw a sharp line between the different phases.
Every angioma may at times grow and become malignant. We can only speak of a spontaneous cure in so far as infection of angiomata may easily arise from injury of the thin surface and then suppuration sets in, so that the consequent formation of scars will compress the angioma; usually, however, sonic portions are left over, from which the angioma may redevelop.
The symptoms of angiomata depend entirely upon their location.
The diagnosis can be made at once from the color and shape, which are superficial and include the skin. Cavernous angiomata may be emptied of their blood by pressure, but will refill at once to their former size as soon as we release the pressure.
In deep angiomata, their differentiation from lipomata may be difficult (bluish and shining appearance of the skin, compressibility). The racemose angioma is so characteristic in appearance (pulsation) that it can easily he discerned from the superficially similar neuroma plexiforme.
The treatment of angiomata must be as radical as possible. It is best to circumcise the tumor within the healthy tissues, on account of their occasional malignity.