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Hemangioma

Hemangioma is a benign tumor, usually in the shape of a ball, but sometimes a flatter mat, formed by a collection of excess blood vessels in an area. Because blood vessel cells are usually transparent in thin smooth muscle cells, hemangiomas are usually the color of the blood that runs through them. If the blood has a lot of oxygen, or is more arterial, the color is usually bright red. If the color is dark, the blood is usually low in oxygen, venous or possibly stagnated. more...

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Hemangiomas are relatively common in newborns, and tend to disappear without treatment. The appearance of the tumor may be mistaken for a sign of physical abuse.

Types

Hemangiomas are often classified by the size of the vessel affected. For example:

  • Capillary hemangioma (or "capillary nevus hemangioma", or "superficial hemangioma")
  • Cavernous hemangioma (or "deep hemangioma") -- large vessels

Hemangiomas are mostly commonly cited as a skin related abnormality. However, various types of Hemangiomas can occur within the body. Common internal occurrences of hemangiomas include the liver, among other organs (Cavernous Hemangioma).

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Hemangioma of the parotid - Pathology Clinic
From Ear, Nose & Throat Journal, 11/1/02 by Lester D.R. Thompson

Hemangiomas are benign tumors of endothelial cell origin (benign hemangioendotheliomas). They are the most common salivary gland tumor in children younger than 1 year of age, accounting for 90% of cases. Hemangiomas in adults are uncommon. The characteristic features of hemangiomas are the rapid enlargement of a unilateral (usually on the left), compressible, bluish mass shortly after birth, particularly in girls. Hemangiomas are not associated with any syndrome.

Macroscopically, these tumors are lobular, dark, and as large as 8 cm in maximum dimension. Histologically, they are characterized by an unencapsulated intralobular growth with replacement of salivary gland acini by capillary-sized vessels (vessels without muscle walls). These vessels are marked by compressed vascular lumina and increased cellularity (figure 1). The cellularity can be so great that it obscures the vascular lumina altogether. The capillaries are lined with two or more layers of spindle-shaped endothelial cells that feature ample eosinophilic cytoplasm (figure 2). Their nuclei contain clear nuclear chromatin (vesicular nuclei; open chromatin). Mitotic figures are frequent, but atypical forms are not seen. Vascular arborization and anastomoses are not observed. Although peri- and intraneural invasion can be seen, it is not an indicator of tumor behavior. A reticulin stain outlines the vessels in which the endothelial cells proliferate. The vascular origin of the neoplasm is confirmed by positive factor VIII-related antigen, CD34, or CD31 immunohistochemical reactions. Whereas lymphangioma is included in the differential diagnosis, separation from malignant hemangioendothelioma or angiosarcoma is more important. Anastomosing vascular channels lined with remarkably atypical endothelial cells herald angiosarcoma, which is rare in infants.

Although complete surgical excision has been advocated, a conservative wait-and-see approach provides an opportunity for spontaneous regression and an overall decrease in size. Malignant transformation does not occur. If surgery is needed later in childhood, there will be a lower likelihood of possible facial nerve damage.

Suggested reading

Lack EE, Upton MP. Histopathologic review of salivary gland tumors in childhood. Arch Otolaryngol Head Neck Surg 1988;114:898-906.

From the Department of Endocrine and Otorhinolaryngic-Head and Neck Pathology, Armed Forces Institute of Pathology, Washington, D.C.

COPYRIGHT 2002 Medquest Communications, LLC
COPYRIGHT 2002 Gale Group

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