Hemangioma : Definition, Causes, Types, Symptoms, Diagnosis, & Treatment
Definition
- Hemangiomas are benign tumors (Hamartoma) composed of blood-filled vessels.
- Very common tumors, especially in infancy & childhood; most are present from birth and initially increase in size, but many eventually regress spontaneously.
- While hemangiomas typically are localized lesions confined to the head and neck (Most common site is skin of Face) they occasionally may be more extensive (angiomatosis) and can arise internally. Nearly one third of these internal lesions are found in the liver.
- Malignant transformation is rare.
Types
Amongst the various clinical and histologic variants, important ones are described below :-
1. Capillary hemangioma
- Most common type.
- Occur in the skin, subcutaneous tissues, and mucous membranes of the oral cavities and lips, as well as in the liver, spleen, and kidneys
Histologically,
- Well-defined but unencapsulated lobules.
- Comprised of thin-walled capillaries with scant stroma (which separeates them).
- Clinically, they appear as small or large, flat or slightly elevated, red to purple, soft and lobulated lesions, varying in size from a few millimeters to a few centimeters in diameter.
- E.g. Strawberry birthmarks and ‘port-wine mark’
- Many of the capillary haemangioma’s regress spontaneously within a few years.
2. Cavernous hemangioma
- Composed of large, dilated vascular channels.
- Compared with capillary hemangiomas, cavernous hemangiomas are more infiltrative, frequently involve deep structures, and do not spontaneously regress.
Histologically,
- Mass is sharply defined but unencapsulated
- Mass is composed of large, thin walled cavernous blood-filled vascular spaces, separated by connective tissue stroma.
- Intravascular thrombosis with associated dystrophic calcification is common.
- They may be locally destructive, so surgical excision may be required in some cases.
- More often the tumors are of little clinical significance, but they can be cosmetically troublesome and are vulnerable to traumatic ulceration and bleeding. Brain hemangiomas also are problematic, as they can cause symptoms related to compression of adjacent tissue or rupture.
- Cavernous hemangiomas constitute one component of von Hippel-Lindau disease , in which vascular lesions are commonly found in the cerebellum, brain stem, retina, pancreas, and liver.
- Cavernous haemangiomas are single or multiple, discrete or diffuse, red to blue, soft and spongy masses.
- They are often 1 to 2 cm in diameter.
- They are most common in the skin (especially of the face and neck); other sites are mucosa of the oral cavity, stomach and small intestine, and internal visceral organs like the liver and spleen.
3. Pyogenic granulomas (Haemangioma of granulation tissue type)
- Pyogenic granulomas are capillary hemangiomas that manifest as rapidly growing red pedunculated lesions (exophytic, red granulation tissue just like a nodule) on the skin, gingival, or oral mucosa. Microscopically they resemble exuberant granulation tissue. They bleed easily and are often ulcerated. Roughly a quarter of the lesions develop after trauma, reaching a size of 1 to 2 cm within a few weeks. Curettage and cautery usually are curative.
- E.g. Pregnancy tumor (granuloma gravidarum): occurs infrequently (1% of patients) in the gingiva of pregnant women and regresses after delivery.
- These lesions may spontaneously regress (especially after pregnancy) or undergo fibrosis, but occasionally require surgical excision.
- Often develops following trauma and is usually 1 to 2 cm in diameter.
Histologically,
- It shows proliferating capillaries similar to capillary haemangioma but the capillaries are separated by abundant oedema and inflammatory infiltrate, thus resembling inflammatory granulation tissue.
4. Juvenile hemangiomas (Strawberry hemangiomas)
- Juvenile hemangiomas of the newborn skin are extremely common (1 in 200 births) and can be multiple.
- These grow rapidly for a few months but then fade by the age of 1 to 3 years, with complete regression by age 7 in the vast majority of cases.
