Benign+Hemangioma

Using a more refined classification schema, Enzinger and Weiss divide localized hemangiomas into 7 categories, as follows: Cells within a hemangioma can be stained for factor VIII; positivity indicates that the cells are endothelial. Recently, each of 3 suggested phases of hemangioma development (proliferative, involuting, and involuted) has been defined histochemically and immunohistochemically by a group in New Zealand.[4] Both CD31 and von Willebrand factor stain vascular endothelial cells in tumors of each phase. Proliferating cell nuclear antigen was predominant in the proliferative and involuting hemangiomas, but negligible in the involuting phase. Mast cells were identified predominately in the involuting phase hemangiomas. Vascular endothelial growth factor was identified primarily during the proliferative phase. Basic fibroblast growth factor was identified during the proliferative and early involuting phases. While these studies generally are not necessary for diagnosis, they provide insight into the biology and development of hemangioma.[4] Electron microscopy can be used to identify Weibel-Palade bodies. Weibel-Palade bodies are rod-shaped, 0.1-0.3 microns in length, and contain parallel tubules that localize factor VIII-associated antigen. They are relatively specific to endothelial cells.[4]
 * **Epidemiolgy:** || Hemangiomas are the most common benign tumor of childhood tumors. It is estimated that 10% to 12% of children are affected within the first year of life. Female are more affected than males at rates of 3-5:1. These benign tumors seem to be more common in Caucasians. [1] The tumors seem to spontaneously regress and disappear in a patient’s fifth year of life. [2] ||
 * **Etiology:** || What causes cutaneous hemangiomas in not clearly understood. An autosomal transmission, with or without other vascular malformations, is presumed. [1] Cavernous hemangiomas of the liver are a congenital abnormality. [2] ||
 * **Signs & Symptoms:** || * Reddish/purple change in skin, in some cases a lesion may be present[2]
 * Raised tumor with involved blood vessels if presented under the skin.
 * These tumors and involve both top layers of the skin and deeper (capillary/cavernous hemanigomas) ||
 * **Diagnostic Procedures:** || * For superficial hemangiomas a physical examination may be done by physician
 * For tumors that are deeper seated (liver, larynx, intestines) a CT or MRI may be done to evaluate the growth or possible involvement to other organs to be used as a comparison for future evaluation due to the likely hood of the tumor shrinking. ||
 * **Histology:** || Hemangiomas may have a spectrum of histologic findings.In a simplistic classification schema, hemangiomas can be divided into capillary (small vessel), cavernous (large vessel), and mixed types.[4] Capillary hemangiomas have abundant vessels approximately 10-100 microns in diameter with walls 1-3 cells thick.[4] The vessels tend to run in parallel. There is a single layer of endothelial cells with no shedding and no anaplasia. Cavernous hemangiomas have a similar appearance, but the lumina are bigger. A cellular type also has been described in which a much higher number of cells are present, distinct lumina are still identifiable, and no shedding or anaplasia is seen. There may be smaller areas within a cellular type that resemble capillary hemangiomas.[4]
 * Capillary hemangioma, including juvenile
 * Cavernous hemangioma
 * Venous hemangioma
 * Arteriovenous hemangioma (racemose hemangioma)
 * Epithelioid hemangioma
 * Hemangioma of granulation tissue
 * Miscellaneous hemangiomas of deep soft tissue (including many of the hemangiomas important to orthopedists, specifically synovial and intramuscular hemangiomas)

|| Cavernous hemangiomas that include the eyelid and block vision are treated with steroid injections or laser treatments. [5] In the past they used to treat these lesions with doses of radium in surface applicators. Use of radiation therapy has stopped because of the late effects of radiation therapy in a developing child; and also because they consider the treatment unnecessary. [2] []. ||
 * **Lymph node drainage:** || No lymph node drainage.[4] ||
 * **Metastatic spread:** || Hemangiomas are benign lesions with increased numbers of blood vessels.[4] They can affect numerous tissue types (individually or in combination), including skin, subcutaneous tissue, viscera, muscle, synovium, and bone, but they do not spread to avascular tissue such as cartilage.[4] ||
 * **Grading:** || Grading involves analyzing the cellular structure of a lesion to determine the abnormality and rate of growth of the tissues envolved . A tumors grade effects the decision to treat or not and what options may be available for the patient. Grading also effect the predicted prognosis of the patient. Since a benign diagnosis is not cancerous, grading is not available.[3] ||
 * **Staging:** || Staging describes the extent or severity of the tumor and spread. This included the primary tumor site, size, nodal involvement, cell grade, and metastasis. Benign lesions are not cancerous and no staging is available.[3] ||
 * **Radiation side effects:** || Depending on the site of a hemangioma on the skin, care must be taken to not dose areas that are sensitive to radiation since hemangiomas are benign and are usually considered unnessesary to treat. These areas include the thyroid, bone, eyes, and breast tissues. [2] ||
 * **Prognosis:** || The prognosis is great for hemangiomas. Most lesions regress naturally, 50% disappear by the patient’s fifth year, and 90% by age 9 without any treatment. [5] ||
 * **Treatments:** || Usually superficial or “strawberry" hemangiomas are not treated. When they resolve on their own the patient will have normal looking skin. Sometimes they are treated with lasers to remove the small vessels. [5]
 * **TD 5/5:** || No radiation treatment is necessary. ||
 * **References:** || # Hemangiomas and Vascular Malformations. Department for Plastic and Reconstructive Surgery. Medical University of Vienna. [|http://www.meduniwien.ac.at/haemangiom/index.php?lang=en&page=1#2]. Accessed June 27, 2012
 * 1) Chao KS, Perez CA, Brady LW. Radiation Oncology: Management Decisions. Philadelphia, PA: Lippincott Williams & Wilkins; 2002.
 * 2) //Cancer staging/ grading.// Available at: []. Accessed on July 2,2012.
 * 3) Reference: Katz, Danielle A. Orthopedic Surgery for Hemangioma Workup. Medscape Reference. September 29, 2010. Available at: [|http://emedicine.medscape.com/article/1255694-workup#a0723]. Accessed on: July, 3, 2012.
 * 4) Hemangioma. Medline Plus. Available at: []. Accessed on July 2, 2012. ||

Back to Week 7