Classification, diagnosis and treatment of hemangiomas

Hemangiomas are known by many names and are classified in different ways, which leads to confusion in clinical treatment. In recent years, according to the biological characteristics of tumor endothelial cells and the anatomical structure of tissues, hemangiomas are divided into 2 major categories: hemangiomas (also known as infantile hemangiomas) and vascular malformations. Vascular malformations are further classified into micro venous malformations (including midline micro venous malformations and micro venous malformations of 2 types), lymphatic vascular malformations (also divided into microcystic malformations and macrocystic malformations of 2 types), venous malformations, arteriovenous malformations, and mixed malformations (including venous – lymphatic malformations and venous – micro venous malformations of 2 types) with different pathogenesis and therapeutic methods. lymphatic malformations and venous-microvenous malformations), with different pathogenesis, clinical manifestations, and treatment approaches. Hemangiomas (also known as infantile hemangiomas) are characterized by proliferation of vascular endothelial cells and are the most common congenital tumors in infants and children, including superficial, deep, and mixed types. 60% of hemangiomas occur in the head and neck region, trunk (25%), and limbs (15%). It is more common in females and manifests in 3 distinct clinical stages, namely, rapid proliferative stage (0-1 year old), regressive stage (1-5 years old), and complete regressive stage (5-10 years old). Congenital hemangioma is a special type of hemangioma in infants and children, which is characterized by its presence at birth and completed growth; a few are detected during fetal ultrasonography. It consists of 2 subtypes, the nonregressive congenital hemangioma and the rapidly regressing congenital hemangioma. The diagnosis of hemangioma can be made on the basis of history and clinical examination in most cases. Two questions should be answered during the history taking: when the lesion was first detected; and what is the growth rate of the lesion, and whether there is rapid growth and regression. The treatment of hemangioma should mainly depend on the location, depth (superficial, deep, mixed), scope and size of the lesion, staging (proliferative stage, regressive stage), whether there are functional disorders and the expectation of the child’s family. At present, the main treatment methods for hemangioma are as follows: 1. Waiting for observation: it is suitable for the hemangioma in the regression stage or the non-important parts with small volume, or the proliferative stage hemangioma in the growth stabilization period, which has not caused important impact on the aesthetics and function. During the observation period, objective methods such as digital photographs or precise measurements should be used to monitor the growth of hemangiomas. 2.Therapy of freezing: It has been used for the treatment of superficial hemangioma and achieved certain effect. Because of its negative effects, it is now rarely used in the treatment of hemangioma, especially cutaneous hemangioma. 3.Laser treatment: because of the limited penetrating power of laser, it is mainly applied to the treatment of early and superficial hemangioma. When the lesion continues to increase in the process of laser treatment, auxiliary drug treatment should be considered. 4.Oral medication: it is suitable for the treatment of generalized multiple hemangioma and fast proliferating hemangioma. Xindean is safe and effective in the treatment of proliferative hemangioma, and has become the first-line drug in the treatment of hemangioma in various parts of the body. 5.Local topical application: It is mainly used in the treatment of small and medium-sized superficial hemangiomas. Its main advantages are convenient, controllable and small local irritation. Commonly used drugs are Thimerosal ophthalmic solution or imiquimod cream. 6. Intratumor injection: mainly applicable to the more limited small-scale hemangioma. For patients with poor effect of laser treatment or oral drug treatment, or those who have been in the period of regression, the commonly used drugs are hormone leveling, yangmyeon or polyglutamyl alcohol. 7.Nuclide dressing: 90 strontium (90Sr) dressing can be used for the treatment of early, proliferative superficial hemangioma, the operation is simple. However, after the dressing treatment, local scarring or abnormal pigmentation can be left behind. 8.Interventional therapy: commonly used in visceral hemangioma, such as hepatic hemangioma. For hemangiomas in trunk and limbs, which are mostly huge or severe, the indications should be strictly controlled. 9.Surgical treatment: surgical resection needs to strictly control the indications, and except for a few cases, it is not the first choice of treatment for hemangioma at present. 10.Compression therapy: it is mainly applicable to the auxiliary treatment of hemangioma in the limbs, trunk, breast and other parts which are easy to place elastic air bags. The method is economical and practical, without trauma and adverse reaction.