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Hemangioma: Review of Literature Tarun Ahuja, Nitin Jaggi, Amit Kalra, Kanishka Bansal, Shiv Prasad Sharma

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Hemangioma: Review of Literature Tarun Ahuja, Nitin Jaggi, Amit Kalra, Kanishka Bansal, Shiv Prasad Sharma 10.5005/jp-journals-10024-1440 TarunREVIEW Ahuja A etR TICLEal Hemangioma: Review of Literature Tarun Ahuja, Nitin Jaggi, Amit Kalra, Kanishka Bansal, Shiv Prasad Sharma ABSTRACT deep, compound) and the management of residual deformity. The therapeutic modalities currently available surgery Hemangiomas are tumors identified by rapid endothelial cell alone or in combination with endovascular embolization, proliferation in early infancy, followed by involution over time. All 1-3 other abnormalities are malformations resulting from anomalous intralesional injection of sclerosing agents, lasers, development of vascular plexuses. The malformations have systemic steroids. a normal endothelial cell growth cycle that affects the veins, the capillaries or the lymphatics and they do not involute. CLASSIFICATION OF HEMANGIOMAS Hemangiomas are the most common tumors of infancy and are characterized by a proliferating and involuting phase. They are Classifying vascular neoplasms has always been a challenge. seen more commonly in whites than in blacks, more in females Until recently, most classification of these neoplasms was than in males in a ratio of 3:1. based on a mixture of clinical, radiological and pathological Keywords: Hemangiomas, Tumor, Vascular malformations. features, and there was little agreement on histopathologic How to cite this article: Ahuja T, Jaggi N, Kalra A, Bansal K, classification. Some of the most accepted classifications are as: Sharma SP. Hemangioma: Review of Literature. J Contemp I. Blood vessels and lymphatics by David I Abramson Dent Pract 2013;14(5):1000-1007. follows (1962)63 Source of support: Nil • Capillary hemangioma (strawberry mark) Conflict of interest: None declared • Cavernous hemangioma • Mixed cavernous and capillary angioma INTRODUCTION • Hypertrophic or angioblastic hemangioma Hemangioma is the most common tumor in infants • Racemose hemangioma (10-12%) and the head and neck region is the most commonly • Port-wine stain or nevus vinosus involved site (60%). Most lesions are solitary (80%), and • Spider angioma (nevus araneus) girls are more affected than boys (3:1).4 Most hemangiomas • Nevus flammeus (DeMorgan’s spot) are found within the soft tissues (mucosa, skin and muscle) • Systemic hemangiomatosis or hemangioma unislateris, and only a small percentage of cases occur intraoseously. infectious hemangioma, pyogenic granuloma Hemangiomas usually appear soon after birth (though • Special regional hemangiomas of the brain, tongue, up to 30% may be present at birth), typically proliferate gastrointestinal tract, liver, skeletal muscle and bone. during the first year of life and then involute during the • Congenital neurocutaneous syndromes associated with childhood years (up to 12 years). The terms capillary and angiomatosis. cavernous hemangioma are out of date and the lesions are i. Von Recklinghausen’s neurofibromatosis with more appropriately described according to the depth of the angiomatosis lesion as superficial, deep and compound hemangioma. ii. Bourneville’s syndrome with tuberous sclerosis The natural history of hemangiomas should influence iii. Sturge-Weber’s disease (encephalofacial the timing and type of intervention. Benign neglect is often angiomatosis) advocated but can be unacceptable given the natural history iv. Lindau-Von Hippels disease (hemangiomatosis of of these lesions. A useful approach to the management retina and cerebellum). of hemangiomas can be based on the stage of the lesion II. Classification by Shafer et al (1993): (proliferative or involutive phase), type of lesion (superficial, • Capillary hemangioma 1000 JCDP Hemangioma: Review of Literature • Cavernous hemangioma REVIEW RESULTS • Angioblastic or hypertrophichemangioma Historical Perspective • Racemose hemangioma • Diffuse systemic hemangioma First case of hemangioma was documented by Liston (1843). • Metastasizing hemangioma Later in 1867, Virchow described the first case of vertebral • Nevus vinosus or port-wine stain hemangioma. In the 1940s, Kasabach and Merritt described • Hereditary hemorrhagic telngiectasis a 2-month-old male infant who had thrombocytopenic III. WHO classification of soft tissue tumors by Ivan purpura and a ‘giant capillary hemangioma’ on his left (1996)64: thigh. Thereafter, the double eponym ‘Kasabach-Merritt • Benign syndrome’ came to be used for hemangioma with platelet • Papillary endothelial hyperplasia trapping.11 The theory that, hemangiomas are neoplasms, • Hemangioma was strongly supported by the study of Mulliken and • Capillary hemangioma GIowacki (1982). In 1982, Mulliken and Glowacki proposed • Cavernous hemangioma a binary classification system for vascular anomalies based • Venous hemangioma on pathologic features.12 • Epithelial hemangioma (angiolymphoid hyperplasia, Later Douglas Marchuk (2001) in their study defined histiocytoid hemangioma) hemangioma as a benign tumor that exhibits an early and • Pyogenic granuloma (granulation tissue type rapid proliferation phase during the first year of life, and hemangioma) is characterized by endothelial and pericytic hyperplasia, • Acquired tufted hemangioma (angioblastoma) followed by a slower but steady involution phase that • Lymphangioma may last for years. Another definition came from Richard. • Lymphangiomyoma, lymphangiomyomatosis, J Antaya (2002) who defined hemangiomas as benign angiomatosis, lymphangiomatosis vascular neoplasms that have a characteristic clinical IV. CIassification of vascular tumors by Christopher DM course with early proliferation followed by spontaneous 65 Fletcher (2003) : involution and were the most common tumors of infancy. • Hemangioma Recently in 2004, DanieIle A Katz defined hemangioma as • Capillary hemangioma an abnormal proliferation of blood vessels that may occur in • Variants any vascularized tissue and that considerable debate exists • Tufted angioma as to whether these lesions are neoplasms, hamartomas or • Verrucous hemangioma vascular malformations. • Cherry angioma • Lobular hemangioma DEMOGRAPHICS • Cavernous hemangioma • Variants Age • Sinusoidal hemangioma The first intradermal hemangioma was identified by • Arteriovenous hemangioma Edgerton MT, Heibert JM (1978) and they stated that it • Variants is frequently present at birth.13 Walter, John Brahn (1979) • Superficial (cirsoid aneurysm) reported that hemangiomas are usually present at birth or • Deep else appear soon afterward.14 In 1985, Marcus Connelly • Microvenular hemangioma reported in his study that the average age of 46 patients • Targetoid hemosederotic hemangioma (hobnail with hemangiomas was 58 years and the range was from hemangioma) 17 to 78 years. There was no difference in the age between • Epitheloid hemangioma (angiolymphoid hyperplasia men and women.15 Wolf (1985) was of the opinion that with eosinophilia) intramuscular hemangiomas of the head and neck are most • Venous hemangioma commonly present in the third decade of life. Thomas • Spindle cell hemangioendothelioma Fitzpatrick (1987) reported that capillary hemangiomas are • Deep hemangiomas first noted shortly after birth. He also stated that granuloma • Variants pyogenicum may occur at any age.16 Yih (1989) stated that • Intramuscular, synovial, neural, nodal the peak incidence of central hemangiomas of the jaws is • Angiomatosis in the second decade of life. Harry L Arnold Jr et al (1990) The Journal of Contemporary Dental Practice, September-October 2013;14(5):1000-1007 1001 Tarun Ahuja et al were of the opinion that hemangiomas might be present at musculature of the trunk and extremities. Intramuscular birth, which they observed in 38% of their cases.17 James hemangiomas are uncommon tumors in the head and neck L Rossiter (1991) reported that hemangiomas are the most region, with the masseter muscle representing the most common benign tumors of infancy.18 Bruckner and Anna L common site of involvement.30 In 1993, Rossitert et al et al (2003) stated that hemangiomas of infancy can occur stated that 14 to 22% of intramuscular hemangiomas occur in l.1% to 2.6% of term neonates and their frequency is in the head and neck region.30 Infantile hemangiomas estimated to be as high as 10 to 12% within the first year occur anywhere on the skin, but the head and neck is the of life.19 Mark A Crowe et al (2003) reported that pyogenic most commonly affected, followed by the trunk and limbs. granuloma is more common in the first 5 years of life. Rosai Hemangiomas may involve mucous membranes of the oral Ackerman (2004) was of the opinion that a high percentage and genital regions. Microvenular hemangioma affects of capillary hemangiomas were seen in children and many of the upper limbs, particularly the forearms, but lesions on them were present at birth.20 The peak incidence of central the trunk, face and lower limbs have also been reported.31 vascular malformations of the jaws is in the second decade of Neville et al (2002) observed that hemangiomas occur life.23 Intramuscular vascular malformation of the head and more frequently in the head and neck region.32 In the study, the neck most commonly present in the third decade of life.24 Richard J Antaya (2002) was of the opinion that 60% of cutaneous hemangiomas occur in the head and neck, 25% Sex on the trunk and 15% on the extremities. Hemangiomas Lister WA et al (1938) found that capillary hemangioma can also occur in extracutaneous sites, including the liver, affected females slightly more than males.21 gastrointestinal tract, central nervous system, pancreas, gall Barret (2000) observed that arteriovenous
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