What is Hemangioma?
Hemangioma is a vascular malformation, with a benign character, which can occur in different parts of the body. This condition is characterized by a set of blood vessels that is not harmful to the individual’s health, but can cause an aesthetic discomfort to him.
This malformation is more common in the neck, face, chest and back of newborns and children, but it can also appear in other places, such as organs, muscles and bones. Normally, the hemangioma grows throughout the individual’s first year of life (which does not, in most cases, exceed 26 mm in diameter) and, as the years pass, it recedes. According to the Mayo Clinic (medical research institute in the United States), half of the hemangiomas disappear by the age of 5 and almost all by the age of 10.
About 10% to 12% of babies have the condition, being more common in those born with less than 1 kg (around 30% of births).
Hemangiomas can be classified in two different ways: the first related to the time in which it appeared and the second, according to its characterization.
In the first classification, these tumors can be congenital or childhood. Understand:
- Congenital hemangioma: happens when the tumor is found right at the moment the child is born, already fully formed. Its diagnosis can happen even before birth, through the ultrasound performed on the mother.
- Infantile hemangioma: the tumor is identified in the child’s first weeks of life and has certain very specific characteristics, such as rapid growth.
With the second classification, hemangiomas can be divided into the following types:
- Flat (capillary) hemangioma;
- Hemangioma cavernoso;
- Hemangioma fragiforme e tuberoso.
Flat (capillary) hemangioma
The most common type of the condition, the flat hemangioma is composed of several blood vessels that are normal in size and diameter, but present in a very high amount. Because of its proximity to the individual’s skin, this type of hemangioma can also be known as “Port wine stains”, as its color varies between pink and dark red.
It is classified as a congenital hemangioma and, during childhood, it is usually a flat spot, without any relief. However, in the second decade of life, some of these tumors show changes, such as darkening of the lesion, hypertrophy of the affected structures and formation of superficial nodules.
Also classified as a congenital hemangioma, the cavernous type is characterized by blood vessels that are larger and enlarged in diameter (dilated). The spaces (or “caves”) that eventually lie between the various vessels are filled with blood, which gives the tumor a certain depth. It usually appears first as a bluish swelling under the skin, that is, they are located more deeply.
Hemangioma fragiforme e tuberoso
Also known as proliferative hemangioma, this type of hemangioma can be classified as infantile, since it develops in the first weeks of the baby’s life. With the cause still undetermined, the fragiform and tuberous hemangioma has a rapid development until the age of 18 months and, at the end of this phase of progression, there is a tumor recession, which can disappear completely until the age of 12.
Some of these hemangiomas evolve so quickly and suddenly that they can directly affect the child’s health and life. Therefore, it is super important that the diagnosis of the condition is made as soon as possible, so that the appropriate treatment is carried out.
The causes of this condition are still being investigated by the scientific community, however, what is known so far, is that it originates from a malfunction of cells that participate in the vascular formation of the baby in the first weeks of pregnancy. An unexpected cell division occurs during this period and causes blood vessels to proliferate on the surface of the skin.
In addition, some hemangiomas can develop after an injury; however, it has not yet been proven whether an injury can effectively generate a hemangioma.
Hemangiomas that eventually develop in the liver may be related to estrogen sensitivity. Often, menopausal women are advised to undergo hormone replacement treatment, however, with the excessive use of hormones, stimulation of the growth of a hepatic hemangioma can occur.
Regarding the evolution of the tumor, it has the following characteristics:
- Progression from 0-4 months, with a pause between 4-6 months, and a new phase of progression between 6 and 12 months.
- Between 12 and 18 months, some areas of the tumor begin to clear, beginning the phase of its involution.
- When the initial involution occurs quickly, it maintains this rhythm and achieves spontaneous healing until the age of 5.
- In turn, when the involution is slower at the beginning, it follows the rule of 50% improvement until 5 years old, 70% until 7 and 90% until 9.
Some factors directly influence the development of a hemangioma. Therefore, people who fall within these factors are more susceptible to developing the tumor.
Caucasian (fair-skinned) people are more likely to develop the condition than those who are black or Asian.
The incidence of hemangioma is higher in females (about 3 to 1). The explanation for this fact is that girls have a greater amount of hormone in the body, which favors the failure in cell division.
Approximately 30% of hemangiomas are present at birth and the other 70% develop in the first weeks of the child’s life. Another factor that greatly influences the development of this condition is prematurity, since the cells of the vascular formation are still active in the premature child.
Hemangiomas can be cutaneous (mostly) or extracutaneous. Cutaneous skin often appears in the following regions:
- Head and neck 60%;
- Trunk 25%;
- Extremities (hands and feet) 15%.
With regard to extracutaneous hemangiomas, they can be present in these places:
- Gastrointestinal treatment;
- Central nervous system;
- Lymph nodes;
- Adrenal glands;
Among these extracutaneous hemangiomas, there are some that stand out and deserve due attention, even though they are not as common as cutaneous hemangiomas. Are they:
Hemangiomas that are located in the muscle tissue can develop at any age, however, most of the time, it occurs in young adults. Any muscle can be affected by the condition, and in these cases, flat hemangioma is the most common.
Bone and vertebral hemangioma
These hemangiomas usually occur in the skull or spine. Common in people aged between 50 and 70 years, the flat and cavernous types are the hemangiomas with the highest incidence of growing on the surface or more deeply in a bone.
Hepatic and organ hemangioma
Even though it is uncommon, hemangioma in organs can happen and, when it does, it is usually in the liver or gastrointestinal tract. Usually, this type of hemangioma is detected in routine exams, as they do not cause symptoms most of the time.
Generally, hemangiomas are painless and have a bluish red color. Most of the time, these tumors are sensitive to touch and are level with the skin or slightly elevated. Lesions located on the surface of the skin can bleed, or turn into wounds, due to the possibility of constant touch.
Hemangiomas that are not present on the skin, but in some internal organ, muscle or bone, may also show the following symptoms:
- Abdominal discomfort;
- Loss of appetite;
- Unexplained weight loss;
- Feeling of heaviness in the abdomen;
- Pain, in the case of deep hemangiomas in the muscle or bones;
- Increased bone in the case of bone hemangioma.
The specialist most suitable for making the diagnosis of a hemangioma is the dermatologist . Usually, when the condition is cutaneous, the doctor can make the diagnosis instantly, just by observing the tumor. However, when he has characteristics very similar to other types of tumors or, even when he is extracutaneous, some tests may be requested.
X-rays or Computed Tomography
Even though these tests are much more efficient in creating images of the bones, they can present a cavernous hemangioma if it has calcifications in its structure.
Able to create clear images of soft structures, such as hemangioma, magnetic resonance imaging can detect the location and extent of the tumor, as well as differentiate it from other types of vascular malformations.
When performing an angiogram, a dye is injected into the individual’s bloodstream, causing the hemangioma to appear on an x-ray image, for example.
With a sample of the tumor analyzed under a microscope, it is possible to distinguish the hemangioma from other tumors and thus have a more accurate diagnosis.
If the patient has several tumors or their symptoms are extremely worrying, the specialist may request a blood test in order to analyze their genetics.
As much as most cases of hemangioma have an involution over the years, which can practically disappear entirely, and does not require specific treatment, the condition needs constant medical monitoring. This is due to the fact that, if the tumor does not have a spontaneous cure, there are several types of treatment that can control it, in addition to improving the patient’s quality of life.
The treatments for hemangioma are divided into three aspects and, below, you will be able to better understand each one of them:
There are some pharmacological treatments for hemangioma available on the market, which are:
- Beta-blockers: when the hemangioma is superficial and small, a timolol- based gel can be applied to the area. In cases of more severe hemangiomas, the treatment should consist of the propanolol oral solution .
- Corticosteroids: for those who do not respond to treatment with beta-blockers or cannot use them, there is the option of using oral corticosteroids, application to the skin or injection into the nodule.
- Bleomycin injections : it is a super effective treatment, with a response rate of around 77%.
- Becaplermin (Regranex): gel used to treat ulcers that form on the surface of the hemangioma, however, it is important to note that it does not treat the tumor itself.
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained on this site is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
The laser option can be used to remove a hemangioma or to shrink blood vessels that may be dilated. However, it is not every type of laser treatment that will produce improvement in the tumor, as the use of inadequate equipment, or the incorrect application, can cause damage and cause irreparable sequelae.
For this reason, the treatment often recommended is Dye Laser, since its effectiveness in whitening hemangiomas is high, in addition to being safer in preserving the skin. This type of treatment is usually performed every 4 or 8 weeks. The interval between each session will be defined by the specialist according to the characteristics of the patient’s injury.
The surgical process may be the most suitable treatment if the hemangioma is of the cavernous type and is destroying the healthy tissues that surround it. For this, three options are available:
- Hemangioma removal;
- Removal of the damaged organ or area;
- Tie the main artery that supplies blood to the tumor.
In the surgical procedure itself, a general anesthesia is applied and, after performing the chosen option, some points are given which will be removed by the doctor a few weeks later.
The biggest complication of this type of treatment is the risk of bleeding. In addition, there is a high probability that the hemangioma will return, depending on the type and its original location.
As hemangioma is a lesion formed by several blood vessels, daily care must be essential. Check out some tips below:
- Keep your nails short: any scratch on a hemangioma can make you bleed. In case of bleeding from the hemangioma, press a clean cloth or tissue over it.
- Apply a thin layer of petroleum jelly over the lesion: this prevents the hemangioma from drying out.
- Use sunscreen with a high SPF: hemangiomas, when exposed to the sun, can swell and look redder. That is why protecting the region is extremely important.
- In case of infection, visit your doctor: when an infection develops in the hemangioma, treatment with antibiotics may be necessary.
- In case of ulceration, keep the area clean: washing the lesion twice a day and covering it entirely with a non-sticky dressing can be enough to cure the ulcer.
Most cases of hemangioma do not present any type of complication. However, some of them can break on the surface of the lesion, causing an ulceration. This, in turn, can be painful and bring on some problems, such as significant bleeding and infection on rare occasions.
In addition to this issue, there are also problems that may arise due to the location of the tumor:
- Hemangioma in the larynx: breathing may be impaired;
- Hemangioma close to the eye: can cause occlusion or deviation of the eye, which can lead to amblyopia (blurred vision);
- Bone hemangioma: there may be erosion of the bone.
Much of the complaints made by patients are related to appearance and how people in their social life view it. A hemangioma can cause problems with the self – esteem of its carrier, even more if it is located on the lip or nose, since they are more difficult places to treat surgically.
In view of this situation, it is important that the treatment be done as soon as possible, so that the improvement of the condition occurs spontaneously and before the school period begins a potential period for the beginning of the development of the psychological injury.
Some cases of hemangiomas are part of some dysmorphic syndromes, the most frequent being Klippel-Trenaunay Syndrome and Sturge-Weber Syndrome. Know more:
- Klippel-Trenaunay syndrome : a rare syndrome that is associated with congenital malformation of the limbs. The characteristic spot of the hemangioma varies in size and shows itself at birth. Hypertrophy of the affected limb, on the other hand, manifests itself with an increase in diameter and also in length.
- Sturge-Weber syndrome : syndrome characterized by spotting on the face (flat hemangioma) associated with intracranial vascular malformation and ocular changes.
Since hemangioma is a vascular malformation, there is no way to predict or prevent the condition. The ideal thing to do is, if the tumor develops, seek medical help as soon as possible so that it can be monitored and treated correctly.
Hemangioma is one of the most common benign childhood tumors in the population. As rare as major complications are, early diagnosis and appropriate treatment are necessary for a cure to be achieved.
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