Update on the classification of hemangioma

Abstract

Despite the fact that a biological classification of congenital vascular tumors and malformations was first published in 1982 by Mulliken and Glowacki, significant confusion still prevails due to the indiscriminate and interchangeable use of the terms hemangioma and vascular malformation. Hemangiomas are true neoplasms of endothelial cells and should be differentiated from vascular malformations which are localized defects of vascular morphogenesis. On an analysis of various scientific articles and latest edition of medical text books an inappropriate use of various terms for vascular lesions was found, contributing further towards the confusion. The widely accepted International Society for the Study of Vascular Anomalies (ISSVA) classification differentiates lesions with proliferative endothelium from lesions with structural anomalies and has been very helpful in standardizing the terminologies. In addition to overcoming obstacles in communication when describing a vascular lesion, it is important that we adhere to the correct terminology, as the therapeutic guidelines, management and follow-up of these lesions differ.

Low Flow Venous Malformation Lesion Presented with Medial Canthal Swelling Simulating Swelling of the Lacrimal Sac Origin : A Case Report

“…There are different sites where vascular malformation can present, in which head and neck region is the most common (60%), followed by the trunk (25%) and the extremities (15%). (6) In our patient, the presentation was unusual and it was thought to be a case of chronic dacryocystitis because of the site of the mass, in which he was treated by a physician outside our hospital with an oral antibiotic. When the patient presented to our clinic, we noticed that the mass was pulsating and synchronized with the radial artery pulse.…”

Three Case Reports of Simple Vascular Malformations: Inappropriate, Perplexing and Interchangeable Use of Nosology by Clinicians and Pathologists

“…The Greek suffix 'oma' means cellular tumoral proliferation and thus the term hemangioma should never be used for describing VMs which are developmental anomalies [1,[6][7][8][9][10][11]. Hemangiomas are usually not present at birth, arise by 8 wk.…”

“…of life, exhibits a rapid proliferative phase to develop into a raised rubbery bright- red tumour mass, and is followed by a involutive phase. 90% of hemangiomas disappear by the age of 9 yr. by involution [7][8][9][10][11][12][13]. Growth and expansion of VMs unlike hemangioma is by distension and hypertrophy (rather than hyperplasia), and usually do not show a growth phase.…”

“…Their etiopathogenesis are not properly understood, though advances made in molecular genetics have improved our insight with the discovery of several inherited mutations [4,5]. The International Society for the Study of Vascular Anomalies (ISSVA) updated April 2014 classification differentiates vascular lesions with proliferative endothelium (vascular tumours) ( Table 1) from structural anomalies (vascular malformations) ( Table 2) [6][7][8][9]. An interactive portable document format of ISSVA classification is available at www.issva.org [accessed 23 April 2016].…”

“…They persist throughout life and grow slowly with the person's biological growth [1][2][3][4][5]. Unfortunately 50% of the VMs are diagnosed and termed incorrectly as hemangioma because of lack of update and knowledge of these lesion among clinicians and since it is often impossible to differentiate clinically and histopathologically a malformation from a neoplasm [6][7][8][9]. The goal of this article is to serve as a guide for clinicians, pathologists and researchers on arriving at the right term while diagnosing and reporting VMs.…”