Hemangioma overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Hemangioma was first described by Dr. Robert Liston, a British surgeon, in 1843.[1] Hemangioma may be classified according to International Society for the Study of Vascular Anomalies into six subtypes: Infantile hemangioma, congenital hemangioma, tufted angioma, spindle-cell hemangioma, epithelioid hemangioma, and lobular capillary hemangioma.[2][3] Development of hemangioma is the result of genetic mutations, overexpression of angiogenic fators and downregulation of inhibitors of angiogenesis.[4] Hemangioma may be associated with POEMS syndrome and Castleman disease. On gross pathology, spongy with vascular compartments of various sizes separated by fibrous tissue are findings of hemangioma.[4] On microscopic histopathological analysis, channels lined by benign endothelium containing red blood cells are findings of hemangioma.[5] There are no established causes for hemangioma.[6] Hemangioma must be differentiated from other diseases such as: Congenital hemangioma, kaposiform hemangioendothelioma, tufted angioma, and nevus flammeus, and pyogenic granuloma.[7] The prevalence of infantile hemangioma is estimated to be upto 10% in general population.[3] Hemangioma commonly affects infants.[6] Females are more commonly affected with hemangioma than males.[6] Common risk factors in the development of hemangioma are female gender, prematurity, low birth weight, and fair skin.[3] According to the United States Preventive Services Task Force, there is insufficient evidence to recommend routine screening for hemangioma.[8] If left untreated, 20% of patients with hemangioma may progress to develop ulceration, hemorrhage, infection, and high output cardiac failure.[9] Common complications of hemangioma include ischemia, necrosis, ulceration, and bleeding.[3]. Prognosis is generally good.Physical examination findings of superficial hemangioma include well-demarcated, flat, and erythematous red patches.[3]
Historical Perspective
Hemangioma was first described by Dr. Robert Liston, a British surgeon, in 1843.[1]
Classification
Hemangioma may be classified according to International Society for the Study of Vascular Anomalies into six subtypes: Infantile hemangioma, congenital hemangioma, tufted angioma, spindle-cell hemangioma, epithelioid hemangioma, and lobular capillary hemangioma.[2][3]
Pathophysiology
Development of hemangioma is the result of genetic mutations, overexpression of angiogenic fators and downregulation of inhibitors of angiogenesis.[4] Hemangioma may be associated with POEMS syndrome and Castleman disease. On gross pathology, spongy with vascular compartments of various sizes separated by fibrous tissue are findings of hemangioma.[4] On microscopic histopathological analysis, channels lined by benign endothelium containing red blood cells are findings of hemangioma.[5]
Causes
There are no established causes for hemangioma.[6]
Differentiating Hemangioma from other Diseases
Hemangioma must be differentiated from other diseases such as: Congenital hemangioma, kaposiform hemangioendothelioma, tufted angioma, and nevus flammeus, and pyogenic granuloma.[7]
Epidemiology and Demographics
The prevalence of infantile hemangioma is estimated to be upto 10% in general population.[3] Hemangioma commonly affects infants.[6] Females are more commonly affected with hemangioma than males.[6]
Risk Factors
Common risk factors in the development of hemangioma are female gender, prematurity, low birth weight, and fair skin.[3]
Screening
According to the United States Preventive Services Task Force, there is insufficient evidence to recommend routine screening for hemangioma.[8]
Natural History, Complications and Prognosis
If left untreated, 20% of patients with hemangioma may progress to develop ulceration, hemorrhage, infection, and high output cardiac failure.[9] Common complications of hemangioma include ischemia, necrosis, ulceration, and bleeding.[3]. Prognosis is generally good.
Diagnosis
History and symptoms
Physical Examination
Physical examination findings of superficial hemangioma include well-demarcated, flat, and erythematous red patches.[3]
Laboratory Findings
CT
MRI
Ultrasound
Ultrasound may be helpful in the diagnosis of hemangioma. Findings on ultrasound suggestive of hemangioma include fat, phleboliths or prominent vascular channels.[10]
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical therapy
The majority of cases of hemangioma are self-limited. Patients with small, stable hemangiomas in non-vital sites are treated with "wait and see" approach, whereas patients with fast growth of hemangioma are treated medically.[6]
Surgery
Primary Prevention
References
- ↑ 1.0 1.1 Liston R. Case of erectile tumour in the popliteal space.-Removal. Med Chir Trans. 1843;26:120-32.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2116921/pdf/medcht00056-0152.pdf
- ↑ 2.0 2.1 Hemangioma. Dr Tim Luijkx and Dr Donna D'Souza et al. Radiopaedia (2015). http://radiopaedia.org/articles/haemangioma. Accessed on November 12, 2015
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 Richter, Gresham T.; Friedman, Adva B. (2012). "Hemangiomas and Vascular Malformations: Current Theory and Management". International Journal of Pediatrics. 2012: 1–10. doi:10.1155/2012/645678. ISSN 1687-9740.
- ↑ 4.0 4.1 4.2 4.3 Papafragkakis, Haris; Moehlen, Martin; Garcia-Buitrago, Monica T.; Madrazo, Beatrice; Island, Eddie; Martin, Paul (2011). "A Case of a Ruptured Sclerosing Liver Hemangioma". International Journal of Hepatology. 2011: 1–5. doi:10.4061/2011/942360. ISSN 2090-3456.
- ↑ 5.0 5.1 Microscopic features of hemangioma. Librepathology (2015). http://librepathology.org/wiki/index.php/Hemangioma. Accessed on November 12, 2015
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 Zheng JW, Zhang L, Zhou Q, et al. A practical guide to treatment of infantile hemangiomas of the head and neck. Int J Clin Exp Med. 2013;6(10):851-60.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832322/?report=classic#
- ↑ 7.0 7.1 Callahan, Alison B.; Yoon, Michael K. (2012). "Infantile hemangiomas: A review". Saudi Journal of Ophthalmology. 26 (3): 283–291. doi:10.1016/j.sjopt.2012.05.004. ISSN 1319-4534.
- ↑ 8.0 8.1 Hemangioma. USPSTF. http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=hemangioma
- ↑ 9.0 9.1 Hassan, Basheir A.; Shreef, Khalid S. (2014). "Propranolol in Treatment of Huge and Complicated Infantile Hemangiomas in Egyptian Children". Dermatology Research and Practice. 2014: 1–5. doi:10.1155/2014/541810. ISSN 1687-6105.
- ↑ Ultrasound of Facial hemangioma. Dr Sinéad Culleton. Radiopaedia (2015). http://radiopaedia.org/cases/facial-haemangioma. Accessed on November 17, 2015