Soft tissue tumors - Hemangioma

Home Chapter Home Jobs Conferences Fellowships Books

Soft tissue tumors

Benign vascular tumors

Hemangioma

Reviewer: Vijay Shankar, M.D. (see Reviewers page)
Revised: 8 February 2013, last major update November 2012
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

See variants below: capillary, cavernous, intramuscular, large vessel, pyogenic granuloma

General
=========================================================================

● Common benign tumor, particularly in childhood; some may be hamartomas
● Usually superficial (head/neck), may occur internally (1/3 in liver), malignant transformation rare
● Usually localized, but may involve large segments of body (termed angiomatosis)
● Most pediatric angiomas are present at birth and expand with growth of child, may regress at puberty

Micro description
=========================================================================

● Increased number of vessels (normal/abnormal)
● Readily recognizable vascular structures with red blood cells or transudate
● Lined by monolayer of non-atypical endothelial cells

Capillary hemangioma

General
=========================================================================

● Blood vessels resemble capillaries
● Present in skin, subcutaneous tissue, mucous membranes of lips, mouth, internal viscera
● Strawberry type is seen in juveniles in 1/200 births, may be multiple, grow in first year, fade at ages 1-3, regress by age 7 in 75%

Micro description
=========================================================================

● Closely packed spindle cells with spaces containing little blood
● Lumens may be thrombosed or organized, hemosiderin present due to rupture
● Scant fibrous stroma

Micro images
=========================================================================

Thigh

VEGFR-3–negative tumor vessels and positive normal lymphatics (Mod Pathol 2000;13:180)

Cavernous hemangioma

General
=========================================================================

● In skin, called port-wine nevus or nevus flammeus
● Present at birth, grows slowly with patient; does not regress
● In deep locations may thrombose, ulcerate, become infected; associated with thrombocytopenia, intravascular coagulation
● Associated with von Hippel Lindau disease, which has cavernous hemangiomas in cerebellum, brain stem, eye grounds
● Sinusoidal hemangiomas: cavernous hemangiomas with dilated, interconnected, thin-walled channels with occasional pseudopapillary projections

Gross description
=========================================================================

● 1-2 cm (larger than capillary), sharply defined

Micro description
=========================================================================

● Large cystically dilated vessels with thin walls
● Intravascular thrombosis or calcification is common

Micro images
=========================================================================

Various images

Intramuscular hemangioma

General
=========================================================================

● Resemble cavernous hemangiomas
● May resemble angiosarcoma due to high cellularity with mitotic figures, intraluminal papillary projections, plump endothelial cells, perineurial infiltration, but no atypia
● Also, angiosarcomas extremely uncommon in skeletal muscle

Micro images
=========================================================================

Various images

Large vessel hemangioma

General
=========================================================================

● Veins, arteries or a mixture
● May have abnormal vascular wall structure that defies classification
● Back, gluteal region, thigh; occasionally entire extremity
● Thrombosis and calcification common
● Klippel-Trenaunay syndrome: varicose veins, dysplastic cutaneous hemangiomas and soft tissue and bone hypertrophy

Pyogenic granuloma

General
=========================================================================

● Also called lobular capillary hemangioma
● Rapidly growing, exophytic red nodule, attached by a stalk to skin or gingival mucosa
● Bleeds easily, ulcerates
● 1/3 due to trauma (1-2 cm after 1-2 weeks)
● Pregnancy tumor: also called granuloma gravidarum, a pyogenic granuloma found in 1% of pregnant women, regresses after delivery

Micro images
=========================================================================

Polypoid red-brown mass

Micro description
=========================================================================

● Vessels, edema, acute and chronic inflammation
● Resembles granulation tissue

End of Soft tissue tumors > Benign vascular tumors > Hemangioma

This information is intended for physicians and related personnel, who understand that medical information is often imperfect, and must be interpreted in the context of a patient's clinical data using reasonable medical judgment. This website should not be used as a substitute for the advice of a licensed physician.

All information on this website is protected by copyright of PathologyOutlines.com, Inc. Information from third parties may also be protected by copyright. Please contact us at copyrightPathOut@gmail.com with any questions (click here for other contact information).