- Pediatric Annals
- August 2012 - Volume 41 · Issue 8: 1-7
CME Educational Objectives
1. Compare and contrast infantile hemangiomas with other vascular anomalies that may be confused clinically.
2. Briefly review associated signs or syndromes found in the context of certain vascular anomalies.
3. Describe the vascular anomalies classification system according to the International Society for the Study of Vascular Anomalies (ISSVA), highlighting the differences between vascular tumors, such as infantile hemangiomas, and vascular malformations.
Infantile hemangiomas are the most common benign vascular tumor in infancy but may mimic many other types of vascular anomalies. In many cases, the appearance, time of onset, growth pattern, and consistency of infantile hemangiomas make the diagnosis straightforward (see “Pathogenesis of Infantile Hemangiomas” on p. 321). However, many other vascular lesions can appear quite similar to infantile hemangiomas, especially early in life, and at times this makes the correct diagnosis challenging.
In order to distinguish among vascular anomalies, it is important to understand their current classification into vascular tumors and vascular malformations. Biologically, vascular tumors are caused by endothelial cell proliferation, whereas vascular malformations are composed of aberrant blood vessels with normal turnover rate due to errors in embryogenesis.1 Vascular tumors include congenital hemangiomas, infantile hemangiomas, tufted angiomas, kaposiform hemangioendotheliomas, pyogenic granulomas, and hemangiopericytomas. Whereas infantile hemangiomas have a predictable life cycle, other vascular tumors vary both in onset and growth pattern.
Vascular malformations are divided by type of vessel and speed of blood flow through the vessel, and they include capillary, venous, lymphatic, arteriovenous, and mixed malformations containing two or more of the above-mentioned vessel types. Many vascular malformations are combined and may occasionally coexist with other vascular tumors. Unlike infantile hemangiomas, vascular malformations are often fully present at birth and grow proportionally with patients as they get older. Most vascular malformations do not fade but instead become more prominent and occasionally thicker with time. Some vascular malformations do not present until later in life. Cytologic markers, along with radiologic imaging, often help to delineate vascular tumors and malformations when needed.
Marissa J. Perman, MD, is a Pediatric Dermatology Fellow, The Children’s Hospital of Philadelphia. Leslie Castelo-Soccio, MD, PhD, is an Attending Physician, The Children’s Hospital of Philadelphia. Melinda Jen, MD, is an Attending Physician, The Children’s Hospital of Philadelphia.
Address correspondence to: Marissa J. Perman, The Children’s Hospital of Philadelphia, 3550 Market St., 2nd Floor, Philadelphia, PA 19104; fax: 215-590-4948; email: Permanm@email.chop.edu.
Disclosure: The authors have no relevant financial relationships to disclose.