Hemangioma+(Benign)

-in the top skin layers (capillary hemangioma) -deeper in the skin (cavernous hemangioma) -a mixture of both
 * ​Epidemiology: || Occur most often in white infants at a rate 10-12 times more often than black or Asian infants. Females are affected more than males by a 3:1 ratio. 30% are present at birth. 70% occur a few weeks after birth. Most occur cutaneously, but can also occur in extracutaneous sites such as the liver, GI track, larynx, CNS, pancreas, gall bladder, thymus, spleen, lymph nodes, lung, urinary bladder, and adrenal glands. 2 ||
 * Etiology: || Neither the cause nor the cell of origin of hemangiomas has been elucidated. Theories abound and several lines of evidence support several divergent theories of the cell of origin, including placental tissue, endothelial progenitor cells and mesenchymal stem cells. 2,5 ||
 * Signs & Symptoms: || Hemangioma may be:

Symptoms: -A red to reddish-purple, raised sore (lesion) on the skin -A massive, raised tumor with blood vessels 4 ||
 * Diagnostic Procedures: || Hemangiomas are diagnosed by a physical examination. In the case of deep or mixed lesions, a CT or MR scan may be performed. 4 ||
 * Histology: || Infantile hemangiomas are composed of proliferating, plump endothelial cells. 2 ||
 * Lymph Node Drainage: || Benign hemangiomas do not spread from it's initial site or origination, thus lymphatic drainage does not play a significant role. ||
 * Metastatic Spread: || Hemangiomas are benign lesions that quickly proliferate and then spontaneously shrink or disappear. Majority are focal and solitary and do not spread to distant organs. 2 ||
 * Grading: || As this is a benign condition, grading/staging does not exist for this condition. However, Radiation Therapy is indicated for treatment of soft-tissue hemangiomas in surgically inaccessible or potentially dangerous sites. 6 ||
 * Staging: || As this is a benign condition, grading/staging does not exist for this condition. However, Radiation Therapy is indicated for treatment of soft-tissue hemangiomas in surgically inaccessible or potentially dangerous sites. 6 ||
 * Radiation Side Effects: || Long term side effects for infants treated with radiation for hemangiomas are at increased risk of developing breast cancer, thyroid cancer, and basal cell carcinomas later in life. 7

Accute side effects consist of erythema in the treatment field and skin irritation. 7 ||
 * Prognosis: || In a study of 38 patients treated with radiation for symptomatic vertebral hemangioma, a complete response was achieved in 58 percent, partial response in 26 percent, and no response in 16 percent of patients. 8 ||
 * Treatments: || Doses 2 to 18 Gy with complete responses expected in 35% to 40% of patials and partial responses in 45% to 50%. 1 ||
 * TD5/5: || The TD5/5 of skin in a single dose is 15-20Gy and fractionated it is 30-40Gy. 1 ||
 * Planning Photos || Former Soviet President Mikhail Gorbechev is a famous face with a port wine stain birthmark, an example of a capillary hemangioma. <span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif; font-size: 80%; vertical-align: super;">1,3

|| <span style="font-family: Arial,Helvetica,sans-serif;">**References** 1. Chao KS, Perez CA, Brady LW. //<span style="font-family: Arial,Helvetica,sans-serif;">Radiation Oncology - Management Decisions. // <span style="font-family: Arial,Helvetica,sans-serif;"> 2nd ed. Philadelphia: Lippincott, Williams & Wilkins, 2002: 677-688. 2. eMedicine. Infantile Hemangioma. []. Accessed February 15, 2010. 3. HowStuffWorks.com. Photo of Mikhail Gorbechev. []. Accessed February 15, 2010. 4. Medline Plus. Hemangioma. []. Accessed February 16, 2010. 5. eMedicine. Hemangioma. []. Accessed February 16, 2010. 6. eMedicine. Infantile Hemangioma. __http://emedicine.medscape.com/article/1083849-treatment__. Accessed February 18, 2010. 7. Haddy N, Andriamboavonjy T, Paoletti C, et al. Thyroid adenomas and carcinomas following radiotherapy for a hemangioma during infancy. //Radiotherapy & Oncology// [serial online]. November 2009;93(2):377-382. Available from: Academic Search Complete, Ipswich, MA. Accessed February 20, 2010. 8. Aksu G, Korcum A. Symptomatic Vertebral Hemangioma: Results of Radiotherapy. //Journal of Musculoskeletal Pain// [serial online]. September 2008;16(4):318-325. Available from: Academic Search Complete, Ipswich, MA. Accessed February 20, 2010.