Beck Daniel O, Gosain Arun K
Cleveland, Ohio From the Department of Plastic Surgery, Rainbow Babies and Children's Hospital of Case Western Reserve University.
Plast Reconstr Surg. 2009 Jun;123(6):181e-191e. doi: 10.1097/PRS.0b013e3181a65c59.
After studying this article, the participant should be able to: (1) Define what is meant by either a classic (infantile) or atypical hemangioma and understand the natural history of each. (2) Identify the common phenotypic, histologic, and radiographic findings of a hemangioma. (3) Know the potential complications associated with hemangiomas. (4) Outline the options available to treat a hemangioma.
Hemangiomas represent the most common tumors of infancy. These lesions maintain unique patterns of growth, sequelae, and therapeutic modalities from other vascular birthmarks. Until recently, however, classification schemes based on historical phenotypic observations often complicated diagnosis and proper medical management.
Mulliken and Glowacki redefined the identification of these lesions by correlating clinical, histological, and autoradiographical data from a series of patients with vascular marks. A formal classification was officially adopted by the International Society for the Study of Vascular Anomalies in 1996 to structure a clinically relevant classification system.
Under the adopted parameters, hemangiomas are classified as a subset of vascular tumors and delineated from vascular malformations. Generally, a hemangioma experiences a phase of rapid growth and expansion followed by slow, but steady, regression. The life cycle can be divided into the proliferating phase, involuting phase, and involuted phase, with each distinct in its time course and histological, radiographic, and molecular findings. Rarely, hemangiomas with an atypical presentation arise, and the clinician must be aware of their existence to avoid incorrect intervention and to prepare for possible life-threatening sequelae.
The frequency of vascular marks in the general population makes it likely that a plastic surgeon will be involved in treatment of an affected patient at some point in his or her career. The goal of this article is to distinguish hemangiomas from other vascular marks by highlighting their presentation, possible complications, and common treatment modalities to aid diagnosis and therapeutic planning for this common vascular tumor.
在学习本文后，参与者应能够：（1）定义典型（婴儿型）或非典型血管瘤的含义，并了解每种血管瘤的自然病程。（2）识别血管瘤常见的表型、组织学和影像学表现。（3）了解与血管瘤相关的潜在并发症。（4）概述治疗血管瘤的可用选项。
血管瘤是婴儿期最常见的肿瘤。这些病变在生长模式、后遗症和治疗方式上与其他血管性胎记有所不同。然而，直到最近，基于历史表型观察的分类方案常常使诊断和恰当的医疗管理变得复杂。
Mulliken和Glowacki通过关联一系列有血管胎记患者的临床、组织学和放射自显影数据，重新定义了这些病变的识别方法。1996年，国际血管畸形研究学会正式采用了一种正式分类，以构建一个具有临床相关性的分类系统。
在采用的参数下，血管瘤被归类为血管肿瘤的一个子集，并与血管畸形区分开来。一般来说，血管瘤经历一个快速生长和扩张阶段，随后是缓慢但稳定的消退。其生命周期可分为增殖期、消退期和消退完成期，每个阶段在时间进程、组织学、影像学和分子表现上都有所不同。很少会出现表现不典型的血管瘤，临床医生必须意识到它们的存在，以避免错误干预，并为可能危及生命的后遗症做好准备。
普通人群中血管胎记的发生率使得整形外科医生在其职业生涯的某个阶段很可能会参与到对受影响患者的治疗中。本文的目的是通过强调血管瘤的表现、可能的并发症和常见治疗方式，将其与其他血管胎记区分开来，以辅助对这种常见血管肿瘤的诊断和治疗规划。
