Hemangiomas : Pathology,Pathogenesis,Types of Hemangiomas ,Clinical features,Diagnosis and Treatment

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Hemangiomas: Pathology,Pathogenesis,Types of Hemangiomas ,Clinical features, Diagnosis and Treatment

Vascular lesions of infants and children are classified into two major types: tumors and vascular malformations .Infantile hemangiomas are the most common vascular tumors . Other examples of vascular tumors include pyogenic granuloma, kaposiform hemangioendothelioma, and tufted angioma. So-called rapidly involuting (RICH) and non-involuting (NICH) "congenital" hemangiomas appear histopathologically to be hybrids showing features of both vascular tumor and malformation. Because cases of RICH evolving into NICH have been reported, it has been suggested that these two entities lie within the same spectrum.
• Hemangiomas are the most common tumors of infancy. The true incidence of infantile hemangiomas is unknown. Although they are classically said to occur in up to 10 percent of Caucasian infants, 4 to 5 percent is probably a better estimate. Infantile hemangiomas are generally noticed within the first few days to months of life . Although most hemangiomas occur sporadically, familial transmission in an autosomal dominant fashion has been reported. In one series of 136 patients/families, 34 percent had a family history of infantile hemangiomas, most often in first-degree relatives

Epidemiology

• The majority of hemangiomas are not clinically evident at birth but become apparent within the first days to months of life. Some newborns have a premonitory cutaneous mark, such as a patch of telangiectasia’s with surrounding pallor (secondary to vasoconstriction) at the hemangioma site. Early lesions may be so subtle as to go unrecognized and may be mistaken for a scratch or bruise. Less commonly, a hemangioma may appear initially as a bright red patch resembling a port-wine stain.
• The majority of lesions are solitary, but multiple lesions occur in up to 20 percent of infants and are especially common among multiple births. Hemangiomas have a predilection for the head and neck, although they can occur anywhere in the skin, mucous membranes, or internal organs. Hemangiomas range in size from a few millimeters to many centimeters in diameter. They may be superficial, deep, or combined (compound hemangioma).

Clinical features

• The superficial presentation is most common and consists of a bright red papule, nodule, or plaque raised above clinically normal skin. Superficial hemangiomas have been called "strawberry" or "capillary" hemangiomas, but superficial hemangioma is the preferred term, since not all superficial hemangiomas have the "strawberry" appearance, and not all strawberry-like lesions are hemangiomas .

• The deep, or subcutaneous, hemangioma is typically a raised, skin-colored nodule, which often has a bluish hue with or without central telangiectatic patch. Purely deep hemangiomas are less common. They have been called "cavernous" hemangiomas, a term that is also erroneously used to describe venous malformations and thus is best avoided.
• Combined hemangiomas are common and contain both superficial and deep components.

Complication

• Most cutaneous hemangiomas are uncomplicated and require no intervention. However, some lesions may ulcerate, leading to pain, bleeding, scarring, and/or infection. Other lesions may cause functional impairment during, and/or disfigurement after, the proliferative phase
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