Hemangioma – Causes, Symptoms and Treatment
A hemangioma is a benign vascular tumor made up of an overgrowth of blood vessels. It is most common in infants and typically resolves on its own over time.
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A hemangioma is a benign vascular tumor made up of an overgrowth of blood vessels. It is most common in infants and typically resolves on its own over time.
What is a Hemangioma?
A hemangioma is a benign (non-cancerous) tumor consisting of an abnormal accumulation of blood vessels. It is the most common benign tumor in childhood and occurs most frequently in newborns and infants. Hemangiomas can develop on the skin, in internal organs such as the liver, or in the brain. Although they initially grow, they typically regress partially or completely during childhood without requiring treatment.
Causes
The exact cause of hemangioma formation is not yet fully understood. The following factors are currently discussed:
- Genetic predisposition: A familial clustering has been observed in some cases.
- Prematurity: Premature infants have a higher risk of developing hemangiomas.
- Female sex: Girls are affected approximately three times more often than boys.
- Disturbances in vascular development: Dysregulation in the growth of endothelial cells (the cells lining blood vessels) plays a role.
- Placental factors: Certain placental changes have also been proposed as a contributing cause.
Types of Hemangiomas
Infantile Hemangioma
The infantile hemangioma is the most common form. It appears in the first weeks of life, grows rapidly during the first months, and begins to involute after the first year. In approximately 50% of children it has completely resolved by age five, and in 70% by age seven.
Capillary Hemangioma
This type is located near the surface of the skin and appears as a bright red, raised lesion, which is why it is commonly referred to as a strawberry mark or strawberry hemangioma.
Cavernous Hemangioma
The cavernous hemangioma lies deeper within the tissue, appears bluish, and feels soft and spongy. It can occur in the skin as well as in internal organs such as the liver or brain.
Congenital Hemangioma
This rare form is fully developed at birth and behaves differently from infantile hemangiomas. It either involutes very rapidly (RICH - Rapidly Involuting Congenital Hemangioma) or persists permanently (NICH - Non-Involuting Congenital Hemangioma).
Symptoms
Most hemangiomas do not cause any discomfort. However, depending on location and size, the following symptoms may occur:
- Visible red or bluish skin change
- Swelling or thickening of the affected tissue
- Tendency to bleed in superficial hemangiomas
- Ulceration in rapidly growing hemangiomas
- Visual disturbances or breathing difficulties if hemangiomas develop near the eyes or airways
- Organ displacement symptoms in large internal hemangiomas
Diagnosis
The diagnosis of a hemangioma is usually made clinically based on its appearance. If needed, the following investigations may be used:
- Ultrasound (sonography): To assess the location, size, and blood flow of the hemangioma.
- MRI (Magnetic Resonance Imaging): For deep-seated or internal hemangiomas to obtain a detailed image.
- Biopsy: In rare cases to distinguish from malignant tumors.
Treatment
Most hemangiomas do not require treatment as they spontaneously regress. Treatment is necessary when:
- the hemangioma affects vital structures (eyes, airways),
- ulceration, bleeding, or infection occurs,
- it causes significant cosmetic impairment.
Medical Therapy
Propranolol (a beta-blocker) is now the standard treatment for infantile hemangiomas requiring intervention. It inhibits growth and accelerates regression. Timolol gel can be used as an alternative for superficial hemangiomas.
Laser Treatment
The pulsed dye laser is primarily used for flat, superficial hemangiomas and can treat residual redness and changes following regression.
Surgical Removal
Surgery may be considered for very large hemangiomas, those with complications, or for cosmetically bothersome residual changes after involution.
Corticosteroids
Corticosteroids were formerly used to inhibit growth. This approach is now less commonly used due to side effects and has largely been replaced by propranolol.
Prognosis
The prognosis for infantile hemangiomas is generally very good. Most resolve completely without leaving scars or permanent changes. Complications are rare but can occur with large or unfavorably located hemangiomas. Regular follow-up with a pediatrician or dermatologist is recommended.
References
- Hoeger PH et al. - Guideline on the Diagnosis and Treatment of Hemangiomas in Childhood. AWMF Guideline No. 006-100 (2016).
- Leaute-Labreze C et al. - Propranolol for Severe Hemangiomas of Infancy. New England Journal of Medicine, 2008; 358(24): 2649-2651.
- Wassef M et al. - Vascular Anomalies Classification: Recommendations From the International Society for the Study of Vascular Anomalies. Pediatrics, 2015; 136(1): e203-e214.
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