Type	Hemangioma	Vascular malformations
1. Definition	Hamartoma endothelial cell proliferation	Errors in blood vessel morphogenesis
2. Elements	Increased number of capillaries/ sinusoidal spaces	Mix of arteries, veins and capillaries
3. Classification	– Superficial (capillary) – Deep (cavernous) – Compound (both)	1. Simple lesion a) Low flow: – Capillary malformation – Venous malformation – Lymphatic malformation (Lymphangioma) b) High flow: – Arterial malformation 2. Combined lesions – AV malformation – Lymphovenous malformation
4. Growth	Rapid congenital growth	Grows with patient
5. Boundaries	Circumscribed, rarely affecting bone	Poorly circumscribed, may affect bone
6. Thrill & bruit	No	May have
7. Involution (shrink)	Spontaneously Responds to oral steroids	Does not involute
8. Resection	Persistent lesions resectable	Difficult – surgical hemorrhage
9. Recurrence	Uncommon	Common

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Hemangioma

Clinical:

• Purple, flat/nodular lesion – blanch on pressure
• Painless swelling
• Resorb overlying bone
• Bleeds
• Loosens teeth

Associated syndromes:

• Sturge Weber syndrome
• Rendu Osler Weber syndrome

Diagnosis: Angiogram hemangioma – in head and neck, inject radiopaque material into external carotid artery

Radiology:

• Well circumscribed radiolucency
• Unilocular or multilocular (honeycomb appearance)

Histology:

• Fibrous connective tissue network – contains endothelial lined capillaries containing RCB
• Sinusoids with endothelial cells

NB:

1. Infantile hemangioma

• Superficial overlying patch of redness
• Appears weeks/months after birth
• Natural course:
  • 1. Proliferate – first year
  • 2. Involuting – few years
  • 3. Involuted – most resolved by age 10

2. Congenital hemangioma

• Present at birth – blue/gray hue with pale halo

• RICH – Rapidly involuting congenital hemangioma
  • Reach maximum size by birth and involute within 12-18 months
• NICH – Non involuting congenital hemangioma
  • Continue to grow in size in proportion to patient and do not involute
• PICH – Partially involuting congenital hemangioma
  • Evolve from RICH to persistent NICH like lesions

• Complications: Ulceration, bleeding, infection, obstruct/displace organs

Management:

1. Watchful neglect – if congenital, most involute
2. Surgical excision – contraindicated in large lesions
   • Need for surgery: Trauma, hemorrhage, ulceration, 2ry infection, psychosocial effect
3. Laser therapy
4. Pharmacologic – steroids, propranolol, vincristine
5. Sclerotherapy – induction of fibrosis to control bleeding with absolute (95%) alcohol and then surgical removal
   • Sclerosants: Doxycycline, bleomycin, OK-432, sodium tetradecyl sulphate
6. Embolic therapy
7. Cryotherapy