Hemangioma

• To diagnose skin hemangiomas, no special tests are used. Your doctor can diagnose them by sight during a physical examination
• Hemangiomas on the organs are usually detected as an incidental finding and are spotted during an imaging test, such as an:

1. Ultrasound
2. MRI
3. CT scan

• Almost all hemangiomas will undergo a long, slow regression, known as involution, without treatment. The end result of involution is potentially worse than the scarring that would occur with surgery
• Thus, surgical intervention is commonly indicated only if the growth of the tumor is life threatening or highly problematic from a medical or psychosocial point of view, For example, tumor growths that affect the ability of the eye to see, the ear to hear, or the passage of air in and out of the lungs are frequently candidates for surgical treatment
• Tumors that have ulcerated are also common candidates for surgical treatment
• Surgery after involution can be used to remove remaining scar tissue
• Although controversial, some plastic surgeons also recommend surgery before or during the involution process, in an attempt to minimize the final cosmetic deformity

• Hemangiomas are the most common tumor of infancy, occurring in approximately 10–12% of all white children and are nearly twice as common in premature infants
• For unknown reasons, the occurrence in children of black or Asian background is much lower, approximately 0.8–1.4%
• The tumors have been reported to be from two to six times more common in females than in males
• The great majority of these tumors are located in the head and neck, with the remaining appearing throughout the body, including internally
• At present, an estimated 60% of patients with hemangiomas require some form of corrective surgery sometime during recovery from the tumor surgery
• The remaining 40% rely on the spontaneous involution process to resolve the lesion, although complete return to normalcy is extremely rare

• The greatest risk of hemangioma excision is bleeding during the operation, as these tumors are comprised of abnormal blood vessels
• Surgeons often utilize special surgical tools to reduce this risk, including thermoscalpels (an electrically heated scapel) and electrocauteries (a tool that stops bleeding using an electrical charge)
• A second risk of the surgery is recurrence of the tumor, that is, an incomplete excision of the abnormally growing tissue
• Surgery may also result in scarring that is at least as noticeable as what would remain after involution, if not more so
• Patients and their caregivers should carefully consider this possibility when deciding to undergo surgical treatment for hemangiomas
• Other risks of the surgery are very low, and include those that accompany any surgical procedure, such as reactions to anesthesia and possible infections of the incision

• Completely normal appearance after surgery is very rare
• However, for significantly disfiguring tumors or those that impact physical function, the surgical scar may be preferable to the presence of the tumor

Morbidity and mortality resulting from this surgery is close to zero, particularly because of the new surgical techniques and tools that prevent intra-operative bleeding of the tumor.

• Several alternatives to surgical excision include observation (“watchful waiting”), treatment with steroids during the proliferation stage to shrink the tumor and speed the involution process, and laser surgery techniques to alter the appearance of the tumor
• Commonly, a combination of these treatment methods, including surgery, will be used to tailor a therapeutic approach for a patient’s particular tumor
• Hepatic Hemangioma is one of the most commonly occurring tumor that affects the liver
• There is overgrowth, found in the liver that can often lead to complications like bleeding, if left untreated
• This tumor is non-cancerous and composed of dilated blood vessel

• Hepatic hemangioma is either small or large
• Its size varies from a few millimeters to more than 20 centimeters
• Majority of hemangiomas developed in the body, are small
• The tumor is called giant hemangioma if its size exceeds 5cm. In case the liver tumor is small, treatment is not necessary as it does not cause any problem
• Symptoms in babies include anemia and development of abdominal mass
• In case a larger tumor ruptures, it will definitely cause lot of pain
• Bleeding may also occur into the abdomen
• This condition is life threatening and requires urgent medical treatment.

Following tests are performed to identify hepatic hemangioma:

• CT Scan
• MRI
• Blood Tests

In most cases, the tumor does not cause any signs of illness. However, if the hemangiomas are large, they can cause the following symptoms:

• Nausea
• Abdominal pain
• Enlargement of the liver
• Loss of appetite
• Unexplained weight loss
• A feeling of fullness in the abdomen

• Many doctors believe that it is a birth defect
• The occurrence of this tumor does not depend on the age
• In some cases, infants are diagnosed for hepatic hemangioma and the tumor becomes apparent as a life threatening lesion
• It is also commonly found in people who are between 30 and 50 years of age
• The incidence rate of this type of tumor is more in women than men
• Women are often affected with large tumors at a younger age
• Giant tumors that are more than 5 cms in size are also noticed in women

• These non-cancerous tumors can be removed surgically
• Doctors may perform liver resection to remove a large hepatic hemangioma
• Liver transplant is another option
• This type of surgery is recommended for people who have multiple hemangiomas
• In this procedure, the liver is replaced with another, that belongs to the donor
• If there is rapid growth in the tumor or spontaneous rupture then surgery (resection or transplant) is an absolute must
• Surgical procedures are safe, and the post-operative morbidity rates are also very low
• Another way to handle hepatic hemangioma is to use certain procedures that decrease the size of the large tumor

This can be achieved in any one of the following ways:

Ligation Of The Liver Artery:

• This is a surgical procedure that involves tying off the blood vessel that carries blood to the liver
• As a result, the tumor is deprived of blood which helps in decreasing its size

Embolization Of The Liver:

• This process involves blocking the blood vessels connected to the liver
• As the blood supply stops, the size of the tumor in the liver gradually reduces
• This is a minimally non-invasive procedure in which selective blood vessels are blocked by introducing a substance (emboli)
• This procedure can help shrink the tumor and reduce the pain considerably

Radiation Therapy:

• This form of treatment uses high energy beams to damage the abnormal cells in the liver
• X-rays are commonly used to get the desired result
• Depending on the size of the tumor, the doctor decides the treatment for the removal of hepatic hemongioma
• Surgery (resection or transplant) is the best and the most effective way to remove giant tumors

• Remove the lesion completely
• Set the stage for other treatments
• Correct what is left after involution
• For example, a rapidly proliferating compound hemangioma of the upper eyelid that is beginning to impair vision may be removed at an earlier point than a deep hemangioma of the back which has begun to involute
• Surgeries may be done in stages in certain cases in order to get the best cosmetic result
• Scar revisions, in particular, need to be done judiciously in young patients
• The combination of all the above modalities is very commonly used
• We may treat the superficial component of a compound hemangioma of the nasal tip with the PDL in preparation for surgery of the deep component
• Or we may treat a deep hemangioma of the orbit that is pushing on the eyeball with steroids at the same time we use the PDL for a separate superficial lesion in the same patient
• The bottom line is there are options

Treatments include:

• Steroids
• Laser therapy
• Surgery

• Steroid therapy helps to prevent the hemangioma from growing
• Steroids therapy works best during the initial stages of the hemangioma—-while it’s still growing
• This kind of treatment doesn’t help in cases where hemangioma has already reached its peak
• Steroid therapy should be avoided if possible because it can have some adverse effects, such as poor growth, hypoglycemia, hypertension, and cataracts

• Laser therapy aims to prepare hemangioma for further treatment, completely remove hemangiomas or eliminate the scarring left behind by hemangiomas
• The most commonly used laser for preparing hemangiomas for further treatments is the pulsed dye laser (PDL)
• PDL is also used to treat ulcerated hemangiomas that won’t heal with time
• Hemangiomas that have deep roots are generally treated by the YAG laser (neodymium-doped yttrium aluminum garnet)
• CO2 and Erbium lasers are used to remove hemangioma scars
• Laser therapy may sometimes be painful and lead to infections and bleeding

• Surgery can be performed on a hemangioma regardless of its stage and location
• Before a surgical procedure is performed, the physician has to consider the age, weight and medical history of the child
• In most cases, surgery is reserved for serious cases where the hemangioma starts to affect body functions or starts to grow rapidly
• Physicians may need to perform more than one surgery to completely remove the hemangioma and also make cosmetic improvements to the affected area

• Some hemangiomas can cause vascular abnormalities and malformations (such as the port wine stain)
• These malformations might require procedure other than surgery, such as sclerotherapy and embolization, which are performed by a radiologist
• There is no perfect treatment for malformations because if a malformed vessel is not removed, it can start growing even after treatment

• Aftercare for a hemangioma excision involves wound care and maintenance such as changing of bandages.