Capillary Infantile Hemangiomas

Excerpt

Capillary infantile hemangiomas are the most common benign orbital neoplasms in children. Historically, they have been referred to by many names, such as infantile hemangiomas, juvenile hemangiomas, hemangioblastomas, or strawberry nevi, because of their characteristic red color. Currently, the universal vocabulary of capillary hemangioma is followed. A fast development phase and spontaneous involution distinguish them.

John Mulliken and Julie Glowacki initially classified these vascular anomalies as angiomas in a study published in 1982. They were thought to be proliferating lesions with an independent life cycle. However, these classifications have undergone several revisions. Capillary infantile hemangiomas have been reclassified as benign vascular neoplasms under the revised International Society for the Study of Vascular Anomalies (ISSVA). According to this classification, capillary infantile hemangiomas are benign neoplasms, which are true tumors that arise de novo and undergo clonal proliferation and growth that is out of proportion to the patient. These lesions have a predictable life cycle and most often do not require any treatment without complications.

Although they can develop anywhere on the body, capillary infantile hemangiomas most frequently occur in the head and neck region, accounting for up to 60% of cases. These tumors are made up of anastomosing capillary-sized blood vessels with endothelial cells lining them and pericytes supporting them. Deeper lesions can appear bluish from deoxygenated blood, while superficial lesions have bright red nodules. Most infant hemangiomas are isolated lesions, while some, eg, hepatic hemangiomas, may have several lesions that indicate systemic involvement. Capillary infantile hemangiomas typically show symptoms in the first few weeks of life. They usually multiply quickly over the next 3 to 12 months and progressively enlarge. Following this, capillary infantile hemangiomas start a gradual involution process that causes the lesion to shrink and usually leaves behind leftover fibrotic or fatty tissue. While most lesions resolve independently, they might result in telangiectasia or residual scarring. Hemangiomas can occasionally result in issues that call for medical attention.