HEMANGIOMA

By Deden Sura Agung

Hemangioma is a lesion that growth can be predicted, these lesions can be evoluted, and also aimed at vascular lesions found in adults who do not experience regression and sometimes experienced progression. The origins of the terminology on the basis of the appearance of abnormalities and maternal impressions, such as strawberry hemangiomas, cherry angiomas, port-wine stains and salmon patches. Virchow then make a histopathological classification of the first, divided into three: angioma simplex, angioma cavernosum, and angioma racemosim, and ambiguous terminology is still survive in the modern medical books until now. Diagnosis for these lesions is really not easy to do because naming of the description of ambiguous and not appropriate proficiency level, therefore, clinical correlation is needed to make a final diagnosis.

CLASSIFICATION

Mulliken and Glowacki in 1982 proposed a classification system for vascular birthmarks that connects the history of the emergence of these birthmarks and physical examination with the cellular picture. They divided the vascular lesions of infancy and the kids into two major types: hemangiomas, with endothelial hyperplasia, and malformations, with normal endothelial changes. The key of the terminology is the word "oma" is derived from the Greek language, which was originally meaning "a lump or tumor". When this suffix is used for a term that describes lesions that grow from the cell proliferation. Most of hemangioma during infancy did not appear at birth but appear postnatally. Grew rapidly during the first year (proliferative phase), slowed, then regresses spontaneously in childhood (involuting phase), and then stabilized (involuted phase).
Histologically, proliferative phase has the character of an increase in mitotic activity, whereas in apoptotic phase of involution occurs, fibrosis occurs slowly and infiiltrasi fat. While the vascular malformation is a wrong morphogenesis that appear at 40-10 weeks in intrauterine life. Most of the vascular malformations appear at birth, or not appear at birth but appear a year later. If it has appeared it will continue to grow in proportion with the growth of the patient, however, rapid growth can grow due to trauma, hormonal changes, thrombosis, infection, or surgical intervention. In histology, vascular malformations have kareakteristik canal dilated, with an abnormal vascular wall, and endothelial quiet. There are classifies hemangiomas as follows: Superficial, Deep, Mixed, based on the location of the skin and subcutaneous tissue. It would be more appropriate terminology for these two disorders based on the use classification of vascular anomalies.

FREQUENCY
Eighty percent growth as a single tumor, 20% multiple. Hemangiomas appear more in women than in men, with a ratio of 3-5:1. Incidence is more on baby as much as 10-12% were white, and about 22% found in premature infants weighing less than 1000 grams.

PATHOPHYSIOLOGY
Hemangioma is a vascular network consisting of endothelial cells to proliferate. Proliferation is not regular at first, but over time become a regular form blood vessels in the form of lobules with lumen containing blood cells. Growth properties of endothelial cells is benign and has a thin basal membrane.

Proliferation is slowed and eventually stopped. The hypothesis of Takahashi stated that in the last trimester of pregnancy, the fetus is formed in the immature endothelial cells with pericyte is also immature, have the ability to perform limited proliferation began at age 8 months to 18 months of the first period of life after being born so there was hemangioma. During the proliferative activity of the endothelium occurs influx of a number of mast cells (as a proliferative stimulus endothelium) and tissue inhibitors of metalloproteinase (TIMP or tissue growth inhibitors). Endothelium proliferation returned to normal after stopping the proliferation phase (involution).

RESULT AND PROGNOSIS

Most hemangiomas occur during the early months of life, proliferates and peaked at age 1 year, and after it undergoes involution slowly. 50% experienced a complete involution by age 5 years. Seventy percent at age 7 years, and continued improvement until the age of 10-12 years. The exception of congenital hemangioma, which appear at birth usually regresses by age 1 year. Unlike vascular malformations, hemangiomas rarely cause distortion of the bones and excess growth except for a large facial hemangioma.