Hemangioma

DEFINITION:
Hemangiomas are simply a collection of extra blood vessels in the skin. They may have different appearances depending on the depth of the increased numbers of blood vessels.

A hemangioma is a benign self involuting tumour of endothelial cells (the cells that line blood vessels) Haemangiomas of infancy They are connected to the circulatory system and filled with blood. The appearance depends location. If they are on the surface of the skin the look like a ripe strawberry, if they are just under the skin the present as a bluish swelling. Sometimes they grow in internal organs such as the liver or larynx. In most cases, hemangiomas will disappear over time. They are formed either during gestation or most commonly they are not present at birth but appear during the first few weeks of life. They are often misdiagnosed, initially, as a scratch or bruise but the diagnosis becomes obvious with further growth. Typically at the earliest phase in a superficial lesion one will see a bluish red area with obvious blood vessels and surrounding pallor. Sometimes they present as a flat red or pink area. Hemangiomas are the most common childhood tumor occurring in approximately ten percent of Caucasians, and are less prevalent in other races. Females are three to five times more likely to have hemangiomas than males. They are also more common in twin pregnancies. Approximately eighty percent are located on the face and neck, with the next most prevalent location being the liver. Although hemangiomas are benign, some serious complications can occur.

Before considering the hemangioma it is important to understand that there have been recent changes in the terminology used to define vascular anomalies (abnormal lumps made up of blood vessels). The term hemangioma was originally used to describe any vascular tumour both present around birth or appearing later in life. Mulliken et al separated these conditions into a family of self involuting tumours (growing lesions that eventually disappear) from the family of malformations (enlarged or abormal vessels present at birth and essentially permanent. The importance of this separation is that allows us to differentiate early in life between lesions that will resolve versus those that are permanent. Examples of permanent malformations include Port-wine stains (capillary vascular malformation) and masses of abnormal swollen veins (venous malformations).Hemangiomas and Vascular Malformations in Infants and Children: A Classification Based on Endothelial Characteristics. Unfortunately many textbooks and dictionaries are not up to date creating great confusion.
…………....You may click to see the pictures

Types:
1.Strawberry Hemangioma is an abnormal collection of blood vessels in the skin characterized by a bright red color and well-defined border.

2.A Deep or Cavernous Hemangioma is a large, collection of blood vessels beneath the skin surface characterized by a soft, bluish, or skin colored mass.

3.A Combined Hemangioma is a combination of a deep and superficial (strawberry) hemangioma.

There are two types of liver hemangioma: cavernous and hemangioendothelioma. Hemangioendotheliomata are generally seen only in children.Click learn about cavernous hemangioma,

HOW COMMON ARE THEY?

Hemangiomas are one of the most common birthmarks in newborns. Most hemangiomas are not present at birth but develop within the first few weeks to months of life. They are found in up to 10 percent of babies by the age of one.

……..capillary_haemangioma.jpg………..hemangioma3.jpg

CAUSES:
The cause of hemangioma is currently unknown; however, several studies have suggested the importance of estrogen signaling in hemangioma proliferation. In 2007, a paper from the Stanford Children’s Surgical Laboratory revealed that localized soft tissue hypoxia coupled with increased circulating estrogen after birth may be the stimulus. There is also a hypothesis presented by researchers at Harvard and the University of Arkansas that maternal placenta embolizes to the fetal dermis during gestation resulting in hemangiomagenesis, yet Duke researchers conducted genetic analyses of small nucleotide polymorphisms in hemangioma tissue compared to the mother’s DNA that contradicted this notion. More research is required in order to fully understand the explosive nature of hemangioma growth which will hopefully yield targeted therapeutics to treat its most complicated presentations.
In very rare instances they may run in families, but in general they are not inherited. For a parent with a child with this birthmark, there is no increased risk of having a subsequent child with a hemangioma. Hemangiomas are more common in girl babies than boys. They are also more commonly seen in premature infants.
TYPICAL GROWTH PATTERN OF HEMANGIOMAS:

Age of Child..………..Hemangiomas
Birth………………… often not present or noticeable
1-2 months……… becomes noticeable
1-6 months……… grows most rapidly
12-18………………. months begins to shrink (involute)


WHEN WILL THEY GO AWAY?

Hemangiomas usually involute (shrink away) in time. 30% of hemangiomas will resolve by 3 years of age 50% by 5 years of age, and 80%-90% by 9 years of age. Over one-half of hemangiomas heal with an excellent cosmetic result without treatment.

COMPLICATIONS:

The vast majority of hemangiomas are not associated with complications. Hemangiomas may break down on the surface to form ulcers. If the ulceration is deep, significant bleeding may rarely occur. Ulceration on the diaper area can be painful and problematic.

If a hemangioma develops in the larynx, breathing can be compromised. A hemangioma can grow and block one of the eyes, causing an occlusion amblyopia. Very rarely, extremely large hemangiomas can cause high-output heart failure due to the amount of blood that must be pumped to excess blood vessels. Lesions adjacent to bone can also cause erosion of the bone.

The most frequent complaints about hemangiomas, however, stem from psychosocial complications: the condition can affect a person’s appearance and can provoke attention and malicious reactions from others. Particular problems occur if the lip or nose is involved, as distortion can be difficult to treat surgically.

Some hemangiomas can cause significant problems, however. Scenarios that may be more complicated and require treatment include:

1) Involvement of a vital organ, like the eye or ear, or windpipe
2) Bleeding
3) Ulceration
4) Crusting or infection
5) Rapid growth and deformity of the surrounding tissues

Hemangiomas in certain areas may have a higher risk of complications. These areas include the face (especially nose and lips), body folds, and groin. Hemangiomas in certain locations, which affect function, or are complicated by infection or ulceration, may be treated with laser, medication, or injections. If any worrisome signs appear such as these listed above, please contact your physician.

TREATMENT:

Most hemangiomas disappear without treatment, leaving minimal or no visible marks. Large hemangiomas can leave visible skin changes secondary to severe stretching of the skin or damage to surface texture. When hemangiomas interfere with vision, breathing, or threaten significant cosmetic injury, they are usually treated. The mainstay of treatment is oral corticosteroid therapy. Other drugs such as interferon or vincristine are sometimes considered if the corticosteroids do not work. If this fails, surgical removal often becomes necessary. Blockage of the airway will often require a tracheostomy to be performed (insertion of an external airway through the front of the neck into the trachea below the level of the obstruction). Smaller raised lesions are sometimes treated with injection of corticosteroid directly into the lesion. Pulsed dye laser can be useful for very early flat superficial lesions if they appear in cosmetically significant areas or for those lesions that leave residual surface blood vessels in the case of incomplete resolution. Unfortunately raised lesions or lesions under the skin do not respond to laser.

Ulceration will usually heal with topical medication and special dressings under medical supervision. Sometimes pulsed dye laser can be used to accelerate healing.

HEMANGIOMAS THAT NEED TREATMENT:
Some hemangiomas can cause significant problems, however. Scenarios that may be more complicated and require treatment include:

1) Involvement of a vital organ, like the eye or ear, or windpipe
2) Bleeding
3) Ulceration
4) Crusting or infection
5) Rapid growth and deformity of the surrounding tissues

Hemangiomas in certain areas may have a higher risk of complications. These areas include the face (especially nose and lips), body folds, and groin. Hemangiomas in certain locations, which affect function, or are complicated by infection or ulceration, may be treated with laser, medication, or injections. If any worrisome signs appear such as these listed above, please contact your physician.

Before treatment>.hemangioma41.jpg.After treatment>hemangioma51.jpg

Pulsed Dye Laser Treatment and Cortisone

Before treatment>hemangioma6.jpg...After treatment>hemangioma7.jpg

In many instances no treatment will be indicated. If treatment is needed, however, it may include:

Cortisone: Injected into the hemangioma or given orally by mouth. If given orally for prolonged periods has side effects including increased risk of systemic infection, high blood pressure, diabetes, increased appetite, stomach irritation, growth suppression, etc.

Pulsed Dye Laser Therapy: This therapy treats the superficial blood vessels best. If this treatment is recommended it is usually reserved for the superficial component of hemangioma, characterized by a flat, red lesion. It is usually administered in a series of laser treatments spaced 2-4 weeks apart.

Antibiotics: If the hemangioma is infected and open it may be treated with a short course of antibiotics and daily wound cleansing.

Alpha Interferon: This therapy is limited to the most severe and potentially life threatening hemangiomas. It involves administering systemic medication via daily shots, usually into the leg, for several months. It is usually given to the baby by the parents under physician direction and supervision. This therapy has serious potential side effects including neurologic effects, blood abnormalities and others.

Surgical removal: In rare instances, hemangiomas may be surgically removed especially if they are not likely to resolve spontaneously or lead to significant tissue distortion and deformation.

PROGNOSIS:
Hemangiomas go through three stages of development and decay:

1.In the proliferation stage, a hemangioma grows very quickly. This stage can last up to twelve months.

2.In the rest stage, there is very little change in a hemangioma’s appearance. This usually lasts until the infant is one to two years old.

3.In the involution phase, a hemangioma finally begins to diminish in size. Fifty percent of lesions will have disappeared by age five with the vast majority gone by puberty.

DISCLAIMER : This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

RESOURCES:

http://en.wikipedia.org/wiki/Hemangioma

http://childrensspecialists.com/body.cfm?id=498

http://cpmcnet.columbia.edu/dept/gi/hemangioma.html

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