Hemangiomas: Differential Diagnosis, Pathophysiology, and Treatment

Differential diagnosis

A mature hemangioma that has undergone the various stages of growth is difficult to confuse with other lesions. Telangiectatic hemangiomas can be confused with vascular malformations and deep hemangiomas may be mistaken with lymphatic malformation. The clinical course of the lesion will simplify the differential.

Pathophysiology

Hemangiomas are benign, proliferative tumors of the capillary endothelium that are associated with an overabundance of mast cells. These mast cells decrease as the tumor regresses.

Treatment

Hemangiomas should be treated if they are associated with complications such as high-output cardiac failure, obstruction of vital function, ulceration, infection, facial location or diaper area to decrease the chances of ulceration or blockage of the urethra or anus. The mainstay of treatment for hemangiomas has always been glucocorticoids by mouth with 30% to 60% responding. For hemangiomas that do not respond to glucocorticoids, interferon alpha-2a has been demonstrated to be effective. However, because of the numerous and toxic side effects of interferon alpha-2a, it should be reserved for life-threatening hemangiomas unresponsive to glucocorticoids. More recently the vascular-specific pulsed dye laser has been helpful in the treatment of superficial, ulcerated hemangiomas, however there is an increased risk for scarring with laser treatement. Laser can also be used as an adjunct to glucocorticoid therapy.

Superficial hemangioma

Ulcerated hemangioma