Hemangioma

Hemangioma is a very common benign vascular tumour.

Hemangioma
Diagnosis in short
Capillary hemangioma. H&E stain.
LM	channels lined by benign endothelium containing RBCs
Subtypes	soft tissue (capillary, cavernous, arteriovenous, venous, intramuscular, synovial), childhood (tufted, microvenular hemangioma, glomeruloid hemangioma, epithelioid hemangioma (see angiolymphoid hyperplasia with eosinophilia‎), targetoid hemosideric hemangioma, infantile hemangioma)
LM DDx	lymphangioma, angiokeratoma, lobular capillary hemangioma (pyogenic granuloma).
IHC	CD31 +ve, D2-40 -ve, GLUT-1 +ve -- juvenile hemangioma
Site	soft tissue, skin, liver, others
Associated Dx	Castleman disease - for glomeruloid hemangioma
Syndromes	POEMS syndrome - for glomeruloid hemangioma
Prevalence	common vascular lesion
Prognosis	benign

Hemangioma
External resources
EHVSC	10172

General

• May be found in the liver.
  • Classically subcapsular.
    • May rupture and be life-threatening.

Hemangiomas to remember - if you're only going remember a few:

• Glomeruloid, infantile, caverous, capillary, arteriovenous, venous and intramuscular.

Childhood

Common childhood hemangiomas:

• Tufted - small clusters of blood vessels.
• Microvenular hemangioma.
• Glomeruloid hemangioma - associated with POEMS syndrome, Castleman disease.
• Epithelioid hemangioma - see angiolymphoid hyperplasia with eosinophilia‎.
• Targetoid hemosideric hemangioma.
• Infantile hemangioma (AKA juvenile hemangioma) - these tumours are GLUT-1 +ve. They tumours grow and then spontaneously regress.

Soft tissue

Several types are seen in soft tissue:

• Capillary.
• Cavernous.
• Arteriovenous.
• Venous.
• Intramuscular.
• Synovial.

Microscopic

Features:

• Channels lined by benign endothelium containing RBCs.

DDx:

• Lymphangioma.
• Angiokeratoma.
• Lobular capillary hemangioma (pyogenic granuloma).

Images

• 

  Capillary hemangioma - intermed. mag. (WC/Nephron)

• 

  Capillary hemangioma - very high mag. (WC/Nephron)

• 

  Cavernous liver hemangioma - intermed. mag. (WC/Nephron)

• 

  Cavernous liver hemangioma - high mag. (WC/Nephron)

• 

  Cavernous hemangioma. (WC/KGH)

• 

  Cavernous hemangioma. (WC/KGH)

www:

• Diffuse hemangioma - several images (upmc.edu).

IHC

• CD31 +ve.
• D2-40 -ve.

Juvenile hemangioma:

• GLUT-1 +ve.

Sign out

Liver Lesion, Core Biopsy:
- Cavernous hemangioma.
- NEGATIVE for malignancy.

Block letters

SUBCUTANEOUS NECK LESION, LEFT, EXCISION:
- CAVERNOUS HEMANGIOMA.
- NEGATIVE FOR MALIGNANCY.

LESION, LEFT SIDE OF FACE, EXCISION:
- CAPILLARY HEMANGIOMA.
- NEGATIVE FOR MALIGNANCY.

Micro - skin

The sections show hair-bearing skin with abundant small superficial vascular channels containing red blood cells. The endothelial cells of the vascular channels do not have atypia. No mitotic activity is appreciated. The overlying epidermis is unremarkable. Extensive solar elastosis is present. No nevus is identified.

See also

• Vascular tumours.