HEMANGIOMA

By DR SHAHAB KHAN
MBBS(KHYBER MEDICAL COLLEGE)
DEMONSTRATOR PATHOLOGY at STMC
Classification of vascular tumors and tumor like
conditions
Hemangioma
◦ benign vascular tumor derived from blood vessel cell types.
◦ About 70% are present at birth which suggests that they may be hemartomas rather than true neopalsms.
◦ The skin liver and brain are common sites, but any organ may be involved.
◦ Hemangiomas are compased of well formed vascular spaces lined by endothelial cells that show no cellular
atypia.
◦ While hemangiomas typically are localized lesions confined to the head and neck, they ocassionally may be more
extensive(angiomatosis) and can arise internally. The internal are mostly found in the liver.
Histologic and clinical variants
1. Capillary Hemangiomas
2. Juvenile hemangiomas
3. Pyogenic hemangiomas
4. Cavernous hemangiomas
Capillary Hemangiomas
◦ Most common type
◦ As small as 1cm in size
◦ Lined by endothelium with scant stroma to separate it from the surrounding tissues unlike cavernous hemangioma where there
is abundant stroma.
◦ Occur in skin, subcutaneous tissues, and mucus membranes of oral cavity and lips.
◦ Also may occur in visceral organs e.g liver, spleen kidneys.
Juvenile Hemangioma
◦ Also known as strawberry hemangioma
◦ common in new borns (1 in 200 births) particularly located on their skin.
◦ They are considered a sub type of capillary hemangioma but their rapid growth post birth have made them to e classified as a
separate entity
◦ They frow rapidly for a few months but then fade by the age of 2-3 yrs. with complete regression by the age of 7 in vast
majority of cases
Pyogenic granuloma
◦ As well a subtype of capillary hemangioma that manifest as rapidly growing red pedunculated lesions on the skin, gingival or
oral mucosa.
◦ Microscopically they resemble abundant granulation tissue.
◦ They bleed easily and are often ulcerated.
◦ Rounghly ¾ of them appear after trauma(inflammatory mediators involved in the pathogenesis thus called granuloma),
reaching a size of 1-2cm with in a few weeks.
◦ Curettage and cautery usually are curative.
◦ One special type of pyogenic granuloma occurs in pregnancy called Pregnancy tumor(etiology unknown) aka Granuloma
Gravidarum.
◦ Occurs in 1% of the patients located primarily in the gingiva. These lesions regress spontaneously or rarely undergo fibrosis. Sometimes
require surgical excision.
Cavernous Hemangioma
◦ Large dilated vascular channels separated by intervening connective tissue stroma
◦ Usually found in the skin as well as in the viscera, forming a spongy mass that may reach 2-3 cm in size.
◦ The grow slowly
◦ Compared to capillary hemangiomas they are more infiltrative frequently develop in deep structures(such as liver) and do not
spontaneously regress.
◦ On histologic examination the mass is sharply demarcated but unencapsulated.
◦ Complications may arise because of them
◦ Intravascular thrombosis with associated dystrophic calcification(calcification occurring in degenerated or necrotic tissue, as in
hyalinized scars, degenerated foci in leiomyomas, and caseous nodules).
◦ Trauma and ulceration  infection

◦ They are locally destructive so surgical excision may be required in some cases.
Cont.

◦ Brain hemangiomas also are problematic, as they can cause symptoms related to compression of adjacent tissue or rupture.
◦ Cavernous hemangiomas constitute one component of Von Hippel Lindau disease in which vascular lesions are commonly
found in the cerebellum, brain stem, retina, pancreas and liver.