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Definition, Pathophysiology and Etiology
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A capillary hemangioma is a benign congenital tumor, consisting of vascular tissue, which usually appears on the ocular region of an infant's face. They are widely varied in austerity, ranging from what might look like a subcutaneous pink latticework of vessels (a strong blush, maybe) to large, fleshy dark-red pockets. Their appearance and subsequent growth is unsettling, to say the least: their proliferative phase is characterized by sudden, rapid growth, and can produce a tumor the size of a golfball in anywhere between three an eight months. Following this is a period of stasis lasting from six months to a year, during which the tumor will retain its size and color. Then comes involution and the gradual disappearance. Unfortunately, however, the involutive phase can last from four to ten years, and even then there's no guarantee that the affected area will not remain abnormal to some degree, even after the tumor is gone.
Female hemangioma patients outnumber males by a ratio of three to one. Overall, one to two percent of all children are afflicted with hemangiomas: Thirty percent are apparent to some degree at birth, but always appear within the first six months of life. Children of Caucasian descent are most suceptible. Eighty three percent appear on the face and neck region; the remaining seventeen percent afflict vaious other parts of the body, both external and internal.
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Causes
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The causes of hemangioma are as of yet undetermined. For this reason, parents should not bear guilt, self-afflicted or otherwise.
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Diagnosis
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Diagnosis of capillary hemangiomas, apart from visual assessment, usually consists of some sort of imaging work. Ultrasonography, neuroimaging, CT scans, magnetic resonance imaging and angiography all help by, in a nutshell, exposing the texture and makeup of a mass which may or may not be a hemangioma.
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Dangers
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While capillary hemangiomas are benign in the sense of tumor spread, etc., their presence on the body can play host to a variety of other problems. On a purely logistical level, the bulk of an external hemangioma can interfere with breathing, eating, speaking and the like. They are prone to irritation and ulceration. It is possible that one will proliferate inside the airway, or on the brain. Additionally, the appearance of multiple hemangiomas (or hemangiomatosis) may cause lesions and bleeding inside the body. There is a risk of Kasabach-Merritt syndrome.
And there are many other risks...
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Treatment and Removal
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Treatment of hemangiomas is prescribed according to the way(s) in which the tumor affects the body - namely, where on the body the hemangioma has proliferated. Placement helps dictate courses of action and allow for consideration of the outcome, be it disfigurement, infection, etc.
Because hemangiomas are self-terminating, intervention is usually only taken if the tumor presents danger either to the sufferer's life or threatens permanent damage to any normal body tissue. As explained above, hemangioma can proliferate in the airway. Additionally, they can permanently damage the eyes. These cases would justify intervention.
Steroids, in various formulations, are typically the answer. Topical application via creams yield the slowest results, as responses may not show for several weeks. Also, they may cause changes in skin pigment and shrinkage of the skin, and because of the danger of cataract formation is not recommended for treatment of vision-threatening lesions. Steroids can also be injected at the site of a hemangioma. Injection is not administered directly into the tumor, but rather in the tissues beneath and around it. With the injection of steroids, blanching may occur as soon as two to three days, followed by involution in two to four weeks. This isn't without risk either, though; the injections can cause fat necrosis, or occlusion of the central retinal artery (presumably in cases in which the eye is threatened).
While surgical removal seems like the most obvious course of action, both incisional and laser attacks on the tumors yield questionable results. Some lasers are only effective on superficial lesions and carry a large risk of scarring; carbon dioxide lasers seem to have the most endorsements.
See (if not, node) also: Cavernous hemangioma, and the BioTech project entry under hemangioma. There are enough features in cavernous hemangiomas, distinct from capillary hemangiomas, to allow for a separate writeup. /msg me if you node it and I'll get rid of all this talking.
Sources.
- http://hemangioma.com/
- http://www.emedicine.com/oph/topic691.htm
- http://www.hopeforkids.com/body_hemangioma.html
- http://www.birthmark.org/hemangiomas.htm
- http://www.drhull.com/EncyMaster/H/hemangioma.html
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