What is Hemangioma? Do you know about Hemangioma Symptoms and Hemangioma Treatments. Hemangioma is the most common soft tissue tumors in newborns with the percentage of 5-10% in children aged less than one year. Although seen from the number of events is quite large hemangioma in children, but the pathogenesis is not fully understood, and the best treatment for hemangiomas is still controversial (Cathy, 1999).
Knowledge about the etiology, pathophysiology, classification, recognition of clinical symptoms of hemangioma, early detection of complications, and effective treatment for hemangioma, the background of the formulation of this referat.
A. Hemangioma Definition
Hemangioma is a proliferation of abnormal blood vessels and can occur in any blood vessel tissue (Anonymous, 2005).
Hemangioma is a benign vascular tumor in infants and children terlazim. Although it is possible to occur in older people, for example, is a cherry angioma senile hemangioma or a usually benign, small, red-purple papule on the skin of the elderly (Olmstead, et al., 1994; Pieter, et al., 1997; Hamzah, 1999).
B. Etiology
The cause of hemangioma is still not clear. Angiogenesis seems to have a role in the excess of blood vessels. Cytokines, such as Basic Fibroblast Growth Factor (bFGF) and Vascular Endothelial Growth Factor (VEGF), has a role in the process of angiogenesis. Increased formation of angiogenesis factors such as decreased levels of angiogenesis inhibitors such as gamma-interferon, tumor necrosis factor-beta, and transforming growth factor-beta play a role in the etiology of hemangioma (Kushner, et al., 1999; Katz, et al., 2002) .
C. Pathophysiology
Although a clear mechanism for control of growth and involution of hemangiomas is not so understandable, knowledge about the growth of abnormal blood vessels and the process of angiogenesis can be used as guidance. Vaskulogenesis shows a process in which endothelial cell precursors enhances the formation of blood vessels, considering the angiogenesis associated with development of new blood vessels in the vascular system of the body. During the proliferative phase, hemangiomas change the density of endothelial cells of small capillaries. Tues marker of angiogenesis, including proliferation of cell nuclear antigen, type IV collagenase, basic fibroblastic growth factor, vascular endothelial growth factor, urokinase, and E-selectin, can be recognized by imunokimiawi analysis (Olmstead, et al., 1994; Kushner, et al., 1999; Katz, et al., 2002).
D. Classification
Basically divided into two: hemangioma capillary hemangioma, and hemangioma cavernosa. Capillary hemangioma (superficial hemangioma) occurred in the upper skin, whereas hemangioma cavernosa occurs in the deeper skin, usually in the dermis and subcutaneous. In some cases both types of hemangioma can occur simultaneously or called mixed hemangioma (Hamzah, 1999; Lehrer, 2003).
E. Clinical manifestations
Clinical picture of the hemangioma is heterogeneous, the picture shown depending on depth, location, and degree of evolution. In newborns, the hemangioma begins with macular pale with teleangiektasis. In line with the growth of tumor proliferation picture becomes bright red, started to stand out, and noncompressible plaque. Hemangioma located in the skin is usually soft, warm period with a bluish color. Often, the hemangioma may be superficial and in the skin. Hemangioma has a diameter of several millimeters to several centimeters. Hemangioma is solid, but about 20% have an influence on infants with multiple lesions (Kushner, et al., 1999; Katz, et al., 2002; Drolet, et al., 2004).
Infants of women have a risk three times more likely to suffer hemangiomas than boys, and the incidence is increased in preterm infants. Approximately 55% of hemangiomas are found at birth, and its development during the first week of life. Formerly, hemangiomas showed early proliferative phase, involusinya slow, and mostly occur with a complete resolution. Rarely hemangiomas showed tumor growth at birth. Although the course of the disease of hemangioma is unknown, it is very difficult to predict the duration of growth and involution phase for each individual.
Superficial hemangiomas are usually reaches a maximum size of about 6-8 months, but the deeper hemangiomas may proliferate for 12-14 months. In some cases it can reach 2 years. Onset of involution is more difficult to predict, but usually depicted from the color changes from bright red to purple or grayish. Approximately 20-40% of patients had residual changes of the skin, hemangioma on the tip of the nose, lips, and parotid region involusinya usually slow and very big. Superficial hemangiomas often leave stains on the face of sikatrik (Kushner, et al., 1999; Katz, et al., 2002).
F. Diagnosis
The clinical diagnosis of hemangioma is not difficult, especially if the lesions typical picture, but in some cases the diagnosis of hemangioma can be difficult to enforce, especially in the hemangioma is located deeper (Olmstead, et al., 1994; Pieter, et al., 1997).
Diagnosis of hemangioma in addition to clinical symptoms, also can be established with another investigation. The use of imaging techniques assist in differentiating abnormalities of blood vessels from several processes that aggressive neoplasm. Ultrasound with Doppler is an effective way, since non-invasive and can show a picture of high blood flow that are characteristic of hemangioma, can thus differentiate between hemangiomas with solid tumors (Abdel-Mota'al, et al., 1996; Katz, et al., 2002).
G. Complication
Bleeding
This complication occurs most frequently compared with another complication. The cause is trauma from the outside or spontaneous rupture of blood vessel walls because of thin skin over the surface of the hemangioma, while the blood vessels beneath it continues to grow (Katz, et al., 2002).
1. Ulcer
Ulcers cause pain and increase the risk of infection, bleeding, and sikatrik. Ulcer is the result of necrosis. Ulcers can also occur due to rupture (Kushner, et al., 1999). Large cavernous hemangioma can be followed by ulceration and secondary infection (Kantor, 2004).
2. Thrombocytopenia
Rarely, usually in large hemangiomas. Formerly thought that thrombocytopenia is caused by a hyperactive spleen. It turned out later that in tissue hemangioma have experienced sekuesterisasi platelet collection (Katz, et al., 2002).
3. Impaired vision
In the periorbital region greatly increases the risk of vision problems and require more frequent monitoring. Amblyopia may be the result of blockage in the axis of vision (visual axis). Most complications that occur are hidden Astigmatism caused by pressure in the eyeball or the insistence of the tumor to retrobulbar space (Kushner, et al., 1999). Hemangioma of the eyelids can interfere with normal visual development and should be treated in the first few months of life (Office, 2004 .)
4. Psychosocial problems (Drolet, et al., 2004).
5. With a very small percentage of hemangiomas can cause airway obstruction, heart failure (Enneking, et al., 1998; Cohen, 2004).
H. Differential Diagnosis
Differential diagnosis is against other skin tumors, namely limfangioma, lipoma, and neurofibroma (Hamzah, 1999).
I. Handling
There are 2 ways of hemangioma treatment:
1. How conservative
On the natural journey will have an enlarged lesion hemangioma in the first months, then reaches a maximum and thereafter big happen spontaneously regress around the age of 12 months, the lesion continued to regress until the age of 5 years (Hamzah, 1999). Hemangioma superficial or strawberry hemangioma is often not treated. If the hemangioma is allowed to disappear, the results look normal skin (Office, 2004).
2. Active mode
Hemangiomas that require active therapy, among others, is a hemangioma that grows on vital organs, such as the eyes, ears, and throat; hemangioma who was bleeding, ulcerated hemangioma that; hemangioma who have an infection; hemangiomas are experiencing rapid growth and tissue deformity occurs (Anonymous, 2005).
2.1. Surgery
Indications:
1) There are signs that growth is too fast, for example, in a few weeks the lesions to be 3-4 times greater.
2) giant Hemangioma with thrombocytopenia.
3) There is no spontaneous regression, such diminution does not occur after 6-7 years.
Lesions located on the face, neck, hands or vulva that grow quickly, may require local excision to control it (Hamza, 1999).
2.2. Radiation
Radiation treatment in recent years are now widely abandoned because:
1) irradiation resulted in less good in children with bone growth is still very active.
2) Complications of malignancy that occurs in the long term.
3) Creation of fibrosis in the skin that is healthy that will make it difficult if action was necessary.
Although radiation is widely used in the past to treat hemangiomas, at present rarely used because of long-term complications of radiation therapy, and the fact that most will beregresi capillary hemangioma (Hamzah, 1999).
2.3. Corticosteroids
Criteria for treatment with corticosteroids are:
1) If involving one of the vital structures.
2) Growing up fast and hold cosmetics destruction.
3) The mechanical hold one orifice obstruction.
4) There is a lot of bleeding with or without thrombocytopenia.
5) It causes cardiovascular dekompensasio.
Corticosteroids are used include prednisone which resulted in hemangioma regress, which is to form strawberry, cavernosa, and mix. The dose is 20-30 mg per day orally for 2-3 weeks and slowly lowered, duration of treatment until 3 months. Therapy with corticosteroids in large doses will sometimes cause regression of lesions that grow rapidly (Hamzah, 1999).
Cavernous hemangioma that grows in the eyelid and interfere with vision are generally treated with steroid injections which reduce the size of the lesions are fast, so that development can be normal vision. Cavernous hemangiomas or mixed hemangiomas can be treated if steroids were given orally and direct injection in hemangioma (Office, 2004).
Peroral corticosteroid use in a long time can increase systemic infection, blood pressure, diabetes, stomach irritation, as well as stunted growth (Anonymous, 2005).
2.4. Drug sclerotic
Inoculation of sclerotic hemangioma lesions, for example by namor rhocate 50%, 20% quinine HCl, Na-salicylate 30%, or hypertonic NaCl solution. However, this method is often not preferred because of soreness and cause sikatrik (Hamzah, 1999).
2.5. Electrocoagulation
This method is used for spider angioma to desikasi central arteries, as well as senile hemangioma and pyogenic granuloma (Hamzah, 1999).
2.6. Freezing
Cold application by using liquid nitrogen (Hamzah, 1999).
2.7. Antibiotics
Antibiotics are given to the ulcerated hemangioma. Also performed in a sterile wound care (Anonymous, 2005).
J. Prognosis
In general, the prognosis depends on the location of the tumor, complications and good handling (Hamzah, 1999).
Hemangioma of small or superficial hemangiomas may disappear completely by itself. Large cavernous hemangioma should be evaluated by a doctor, and get the right medicine