Morphological, genetic and clinical correlations in infantile hemangiomas and their mimics

Abstract

Infantile hemangiomas (IHs) are the most frequent pediatric benign vascular tumors, with a reported incidence of 5% to 10%. They have self-limiting evolution pattern divided into a growth phase in the first 12 months and a regression one, that may take up to 10 years. Occasionally, hemangiomas might lead to local or systemic complications, depending on their morphological characteristics. The first line of treatment is β-blockers, such as Propranolol, Timolol, Nadolol, administered either locally or systemically. Newer therapeutic strategies involving laser therapy and angiotensin-converting enzyme inhibitors are being studied, while older treatment modalities like corticosteroids, Imiquimod, Vincristine, Bleomycin and Interferon-α have become second line therapy options. Before establishing the appropriate treatment, clinical, histological, and imaging investigations are required.

Figure 1

Hemangioma: general view [Hematoxylin–Eosin (HE) staining, ×40].

Figure 2

Vascular lobules below normal epithelium (HE staining, ×40).

Figure 3

Dermis with vascular proliferation showing plump endothelial cells (HE staining, ×40).

Figure 4

Vascular spaces lined by a single layer of bland endothelial cells (HE staining, ×40)

Figure 5

Dilated vascular channels having red blood cells and lined by flat endothelial cells (HE staining, ×40).

Figure 6

Vascular channels into the deep dermis and hypodermis (HE staining, ×40).

Figure 7

Endothelial cells positive for anti-CD34 antibody (Anti-CD34 antibody immunostaining, ×40). CD34: Cluster of differentiation 34

Figure 8

Vascular channels positive for anti-α-SMA antibody (Anti-α-SMA antibody immunostaining, ×40). α-SMA: Alpha-smooth muscle actin

Figure 9

Obstructing hemangioma of the face

Figure 10

Ulcerated hemangioma of the scrotum