Juvenile hemangioma: A case report with an emphasis on its clinical phases (evolution and involution), and immunohistochemically distinctive physiologic differences

Abstract

Hemangiomas occupy a grey zone between hamartomatous malformations and true neoplasms. They are frequently designated and regarded as neoplasms because of their usually localized nature and mass effect. Although clearly benign, they can become very large and unsightly, and can even be fatal if they affect vital structures. They almost never become malignant, although a few documented examples of this complication are on record. A high percentage occur in children, manifesting within the first month of life. One half of these cases are in the head and neck area. Hemangiomas have been classified according to their clinical appearance and the caliber of vessel involved, namely, capillary, cavernous and venous. Capillary hemangiomas are made up of small vessels of capillary caliber. One such capillary hemangioma, the juvenile hemangioma (JH), is usually present at birth or appears during the first month and enlarges rapidly during the first few months of life (infancy), only to stop growing when the child is approximately 6 years old. We present one such JH, seen in a 3 year old male child, which appeared when the child was 2 months old. Routine histopathological (H and E) and immunohistochemical analysis (CD 34, CD 31) was done on biopsy received.

Keywords: Capillary hemangioma; infancy; juvenile hemangioma.

Figure 1

Wrinkled surface of excised lesion

Figure 2

Cream-colored gelatinous cut surface

Figure 3

Lesional area showing lobules below normal epithelium and connective tissue (H and E, 4×)

Figure 4

Plump endothelial cells lining vascular spaces with inconspicuous lumens (H and E, 10×)

Figure 5

Solid areas containing proliferation of endothelial cells (H and E, 40×)

Figure 6

CD 34 expression in lesional areas (10×)

Figure 7

CD 31 expression in lesional areas (40×)