Hemangioma. Questions & Answers. Dmitriy Romanov

      ISBN 978-5-4498-5733-0

      Created with Ridero smart publishing system

      Dear readers

      Here you have a book that is intended first of all for parents whose children suffer from infant hemangiomas. We hope that it will be interesting to doctors as well who come across this disease in their practice. This book presents parents questions which they ask while doctor appointments. Our book does not replace full-time examinations and is not a guide to action and self-medication.

      Remember that only a doctor prescribes any treatment!

      The basis of the books is 7 years of experience with patients having vascular disease. More than 15 000 children were treated during this period. Maybe someone will recognize pictures they sent to us or those we made during the treatment. We have selected the most demonstrative cases, as well as clinical examples to present answers to your questions in the best possible way.

      We are grateful to everybody who helped us, as well as to those people who did not throw a spanner in our work and who made it difficult and forced us to look for a way out of temporary difficulties. Thank you all so much!

      Special thanks to the medical staff: cardiologists, anesthetists, pediatricians, ophthalmologists and, of course, our nurses. Special thanks to Olga Nikolaevna Metelkova and Svetlana Anatolyevna Troitskaya, thanks to whom we managed to develop this direction: to found a department, and then a Center for the treatment of children with vascular pathology.

      Authors

      Introduction

      1. What is infantile hemangioma?

      Infant (“infantile”) hemangioma (infantile hemangioma) is a benign vascular tumor that develops from the endothelial tissue. Its outstanding feature is the probability of appearance in infants during their first months of life and the ability to involute during following years.

      Superficial infantile hemangioma in the left zygomatic region.

      Сombined infantile hemangioma in the forehead.

      2. Is hemangioma a tumor?

      According to the classification of the International Society for the Study of Vascular Anomalies (International Society for the Study of Vascular Anomalies – ISSVA) infantile hemangiomas are vascular tumors. They are characterized by the uncontrolled growth due to endothelium cells division. It is impossible to determine exactly when and how big hemangioma will grow.

      3. Can a hemangioma become malignant?

      No. Infantile hemangioma is a benign vascular tumor. She does not show signs of malignancy.

      4. What is endothelium?

      Endothelium is a layer of thickened cells of mesenchymal origin, lining the inner walls of blood and lymphatic vessels, as well as of the heart. It provides contraction and expansion of blood vessels, growth of new blood vessels (angiogenesis), coagulation, and also carries respiratory and nutrient metabolism.

      Difference Between Mesothelium and Endothelium

      5. What is mesenchyme?

      This is a generic term defining population of primitive tissue layer cells that have certain concordance, but will produce different tissue cells in the future (blood cells, connective and muscular tissue cells etc.)

      I. Classification

      1.1. What classification of vascular abnormalities is common today?

      Classification of International Society for the Study of Vascular Anomalies is applied currently worldwide (ISSVA) (Table 1).

      Table 1. Classification of International Society for the Study of Vascular Anomalies

      Vascular Tumors

      Benign:

      · infantile hemangioma;

      · congenital hemangioma (RICH, NICH, PICH);

      · tufted angioma;

      · spindle cell angioma;

      · spindle cell angioma;

      · pyogenic granuloma;

      · other.

      · pyogenic granuloma;

      · other.

      Less aggressive or related tumors:

      · Kaposiform hemangioendothelioma;

      · retiform hemangioendothelioma;

      · papillary intralymphatic angioendothelioma (PILA);

      · Dabska tumor;

      · complex hemangioendothelioma;

      · Kaposi sarcoma;

      · other.

      Malignant:

      · epithelioid hemangioendothelioma;

      · angiosarcoma;

      · other

      _{* Complex malformations: CVM – capillary-venous malformation; CLM – capillary-lymphatic malformation; LVM – lymphatic-venous malformation; CLVM – capillary-lymphatic-venous malformation; CAVM – capillary-arteriovenous malformation; CLAVM – capillary-lymphatic-arteriovenous malformation.}

      1.2. Infantile hemangioma and cavernous (capillary) hemangioma are the same thing?

      Obsolete terms “cavernous”, “capillary”, “cliff-like” hemangioma, “strawberry congenital mark” etc are used currently. International Society for the Study of Vascular Anomalies (ISSVA) developed classification in 2014 which is recommended for use while determining vascular abnormalities (Table 1). Incorrect terms use makes diagnosis more complicated and confuse communication between doctors. For example, term “capillary hemangioma” might be used for infantile hemangioma, as well as Kaposiform hemangioendothelioma (Table 2).

      Table 2. Incorrect terminology used to describe vascular abnormalities.

      1.3. What are types of hemangiomas?

      Infantile hemangiomas are divided into following types currently:

      – superficial (pathological proliferation of blood vessels is determined only on the surface of the skin);

      – deep (pathological proliferation of blood vessels is determined in the full-thickness skin and subcutaneous tissue, without skin signs);

      – combined (combination of superficial and deep).

      Deep infantile hemangioma in the back.

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