Benign+Hemangioma

Hemangiomas are tangled masses of blood vessels. They are the most common benign tumors in infants and commonly will dissipate by the fifth year of life. 1 In Caucasian infants, roughly four to ten percent of infants will be born with at least one hemangioma. 1 There is also a higher incidence in female infants as opposed to male infants. 1 Hemangiomas are rare in the Asian population and even more rare in African Americans. 1 || Recent research has shown that hemangiomas arise from stem cells within the body. 1 They are not hereditary; and there are no known medications, foods, or other activity that gives rise to hemangiomas more than another. 1 The truly just occur only by chance. || Cutaneous hemangioma is a common condition that occurs in infants and often times goes away without treatments. These lesions are usually red, blue or a combination of both and are painless. 2 These lesions can appear on the skin, lips or inside the mouth and are soft. 2 There are 3 main types of benign hemangiomas: Superficial, Deep and Congenital. Superficial hemangiomas are the most common type and appear as a bright red spot. Sometimes it can be raised or have a distinct texture. With these cases, the spot usually fades by age 7. Specifically with cutaneous lesions, they can become sore and bleed if injured and rubbed against. 2 Deep hemangioma can appear more like a deep bruise. These cases are usually not diagnosed until 2-4 months old and the texture appears more raised. 2 Congenital hemangioma appear at birth and can be quite large. Depending on the type, the area can shrink over the course of the first year or remain completely intact until treatment. 2 || Since the lesions appear at birth and don’t go away until the infant is a few months old, the diagnosis of hemangioma can be relatively simple. For most cases, treatment is not urgent and most pediatricians tell parents to observe the lesion and watch for changes. In cases where it is difficult to diagnose, an ultrasound is performed to provide a confirmed diagnosis. 3 An MRI or CT scan may be necessary if the extent of the lesion is unknown or very large. 3 In the worst of cases, a biopsy may be performed to determine malignancy. 3 The children are awake during ultrasound, sedated during a CT scan and under general anesthesia for an MRI or biopsy. 3 || Cutaneous hemangiomas are identified as raised lesions that are benign neoplastic proliferation of vascular endothelial cells. 4 Simplistic classification schema of hemangioma: 4,5 Refined classification schema of hemangioma: 5 No Lymph node drainage. 5 || Since cutaneous hemangiomas are benign, they cannot spread or metastasis like malignant tumors do. 6 || There is no grading system for cutaneous hemangiomas. || 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. 7 || 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. 8 || Most disappear without treatments. 50 % of lesions disappear by the age of 5 and almost all disappear by the age of 10. 9 || Superficial or “strawberry” hemangiomas may not be treated. They often go away on their own, the appearance of the skin returns to normal. In some cases, a laser may be used to remove the small vessels.
 * **Epidemiolgy:** || Brandon
 * **Etiology:** || Brandon
 * **Signs & Symptoms:** || Ashley
 * **Diagnostic Procedures:** || Ashley
 * **Histology:** || Amanuel
 * Capillary hemangiomas also known as superficial hemangiomas - small vessel
 * Cavernous hemangiomas also known as deep hemangiomas – large vessel
 * Mixed hemangiomas
 * Capillary hemangioma, including juvenile
 * Cavernous hemangioma
 * Venous hemangioma
 * Arteriovenous hemangioma
 * Epithelioid hemangioma
 * <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif; line-height: 1.5;">Hemangioma of granulation tissue
 * <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif; line-height: 1.5;">Miscellaneous hemangioma of deep soft tissue [including synovial and intramuscular hemangiomas] ||
 * **Lymph node drainage:** || <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">Amanuel
 * **Metastatic spread:** || Lindsey
 * **Grading:** || Lindsey
 * **Staging:** || Kevin
 * **Radiation side effects:** || Kevin
 * **Prognosis:** || Jenn
 * **Treatments:** || Jenn

Cavernous hemangiomas that involve the eyelid and block vision can be treated with lasers or steroid injections to shrink the mass. Large cavernous hemangiomas or mixed may be treated with steroids either as oral medicines or injections into the hemangioma. 9 || No Radiation treatment is done in this case. ||
 * **TD 5/5:** || Rachel
 * **References:** || # Hemangiomas. Boston Children’s Hospital. Web site. []. Accessed July 9, 2013.
 * 1) Hemangiomas. Boston Children’s Hospital Web site. []. Accessed July 1, 2013.
 * 2) Diagnosis of Hemangiomas. Cincinnati Children’s Hospital Web site. []. Updated November 2012. Accessed July 2, 2013.
 * 3) <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">Wirth FA, Lowitt MH. Diagnosis and treatment of cutaneous vascular lesions. http://www.aafp.org/afp/1998/0215/p765.html. Accessed July 8, 2013.
 * 4) <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">Kistler BJ, Gellman H. Orthopedic surgery for hemangioma workup. http://emedicine.medscape.com/article/1255694-workup#a0723. Accessed July 8, 2013.
 * 5) Understanding cancer series. National Cancer Institute Web Site. http://www.cancer.gov/cancertopics/understandingcancer/cancer/page9. Accessed on July 9, 2013.
 * 6) Cancer staging/ grading. Available at: []. Accessed on July 9, 2013.
 * 7) Chao KS, Perez CA, Brady LW. //Radiation Oncology - Management Decisions//. 3rd ed. Philadelphia: Lippincott, Williams & Wilkins, 2011: 785-786.
 * 8) Hemangioma. Availble at: []. Accessed on July 11, 2013. ||

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