CURRENT CONCEPTS IN THE PATHOGENESIS AND MANAGEMENT OF VASCULAR LESIONS - A BRIEF REVIEW
- Oral & Maxillofacial Pathology, Dental Surgeon, Chanditala Rural Hospital, Hooghly, West Bengal.
- Oral & Maxillofacial Pathology, Senior lecturer, Ambedkar Institute of Dental Sciences & Hospital, Patna.
- Abstract
- Keywords
- References
- How to Cite This Article
- Corresponding Author
Hemangiomas are considered to be benign tumors of infancy which show a rapid growth phase marked by endothelial cell proliferation, followed by gradual involution. On the other hand, vascular malformations are structural anomalies of blood vessels without endothelial cell proliferation. The pathophysiology of these lesions is still shroud in mystery. One etiologic hypothesis speculates that cells are “embolized” from the placenta. Another suggests that hemangiomas result from somatic mutations in a gene mediating endothelial cell proliferation. Recent data suggest an endothelial progenitor cell as the source of origin of the tumors. It has been speculated that hypoxia, either systemically (e.g., due to placental insufficiency) or in a specific “niche” area of poorly perfused tissue stimulates endothelial progenitor cells to proliferate inappropriately. The fetal endothelial cell precursor cells, possess specific histochemical markers (GLUT-1, Lewis Y Antigen, merosin), similar to those on placental blood vessels. Abnormal levels of matrix metalloproteinases (MMP-9) and proangiogenic factors (VEGF, b-FGF, and TGF-beta 1) play a crucial role. Genetic errors in growth factor receptors have also been shown to affect development of hemangiomas. Recent discoveries concerning hemangioma pathogenesis provide both an improved understanding and more optimal approach to workup and management like corticosteroid or propranolol therapy. Important detrimental associations can be seen with hemangioma, such as significant structural anomalies. Standards of care have dramatically changed evaluation and management of hemangiomas.Herein, we have briefly discussed the factors that contribute to the formation of hemangiomas and vascular malformations in general along with their management.
- Mulliken, J., and Glowacki, J. 1982. Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Reconstr. Surg. 69:412–420.
- N. Haggstrom, B. A. Drolet, E. Baselga et al., “Prospective study of infantile hemangiomas: demographic, prenatal, and perinatal characteristics,” Journal of Pediatrics, vol. 150, no. 3, pp. 291–294, 2007.
- Mulliken, J., and Young, A.E. 1988. Vascular birthmarks hemangiomas and vascular malformations. B. Saunders Co. Philadelphia, Pennsylvania, USA. 24–37.
- E. North, M. Waner, and M. C. Brodsky, “Are infantile hemangiomas of placental origin?” Ophthalmology, vol. 109, no. 4, pp. 633–634, 2002.
- Enjolras O, Mulliken JB, Boon LM, Wassef M, Kozakewich HP, Burrows PE. Noninvoluting congenital hemangioma: a rare cutaneous vascular anomaly. Plast Reconstr Surg. 2001;107(7):1647–1654
- Frieden IJ. Infantile hemangioma research: looking backward and forward. J Invest Dermatol. 2011;131(12):2345–2348
- C. Chang, A. N. Haggstrom, B. A. Drolet et al., “Growth characteristics of infantile hemangiomas: implications for management,” Pediatrics, vol. 122, no. 2, pp. 360–367, 2008.
- Mihm MC Jr, Nelson JS. Hypothesis: the metastatic niche theory can elucidate infantile hemangioma development. J Cutan Pathol. 2010;37(suppl 1):83–87
- Yu Y, Flint AF, Mulliken JB, Wu JK, Bischoff J. Endothelial progenitor cells in infantile hemangioma. Blood. 2004;103(4):1373– 1375
- Barnés CM, Huang S, Kaipainen A, et al. Evidence by molecular profiling for a placental origin of infantile hemangioma. Proc Natl Acad Sci U S A. 2005;102(52):19097–19102
- Chang, D. Most, S. Bresnick et al., “Proliferative hemangiomas: analysis of cytokine gene expression and angiogenesis,” Plastic and Reconstructive Surgery, vol. 103, no. 1, pp. 1–9, 1999.
- Drolet BA, Frieden IJ. Characteristics of infantile hemangiomas as clues to pathogenesis: does hypoxia connect the dots? Arch Dermatol. 2010;146(11):1295–1299
- North PE, Waner M, Mizeracki A, Mihm MC Jr. GLUT1: a newly discovered immunohistochemical marker for juvenile hemangiomas. Hum Pathol. 2000;31(1):11–22
- Berard, M., et al. 1997. Vascular endothelial growth factor confers a growth advantage in vitro and in vivo to stromal cells cultured from neonatal Am. J. Pathol. 150:1315–1326.
- Waner M, North PE, Scherer KA, Frieden IJ, Waner A, Mihm MC Jr. The nonrandom distribution of facial hemangiomas. Arch Dermatol. 2003; 139(7):869–875.
- Pittman KM, Losken HW, Kleinman ME, et al. No evidence for maternal- fetal microchimerism in infantile hemangioma: a molecular genetics J Invest Dermatol. 2006; 126(11):2533–2538
- Boye, E., et al. 2001. Clonality and altered behavior of endothelial cells from hemangiomas. Clin. Invest. 107:745–752
- Takahashi K, Mulliken JB, Kozakewich HP, Rogers RA, Folkman J, Ezekowitz RA. Cellular markers that distinguish the phases of hemangioma during infancy and childhood. J Clin Invest. 1994; 93(6):2357–2364
- Praveen V, Vidavalur R, Rosenkrantz TS, Hussain N. Infantile hemangiomas and retinopathy of prematurity: possible association. Pediatrics. 2009; 123(3). Available at: pediatrics.org/cgi/content /full/123/3/e484
- Mobasheri A, Richardson S, Mobasheri R, Shakibaei M, Hoyland JA. Hypoxia inducible factor-1 and facilitative glucose transporters GLUT1 and GLUT3: putative molecular components of the oxygen and glucose sensing apparatus in articular chondrocytes. Histol Histopathol. 2005; 20(4):1327–1338
- Jinnin M, Medici D, Park L, et al. Suppress NFAT-dependent VEGFR1 expression and constitutive VEGFR signaling in infantile hemangioma. Nat Med. 2008; 14 (11):1236–1246
- Greenberger S, Boscolo E, Adini I, Mulliken JB, Bischoff J. Corticosteroid Suppression of VEGF-A in infantile hemangioma-derived stem cells. N Engl J Med. 2010; 362(11): 1005–1013
- Kleinman ME, Tepper OM, Capla JM, et al. Increased circulating AC133+ CD34+ endothelial progenitor cells in children with hemangioma. Lymphat Res Biol. 2003; 1(4): 301–307.
- Ritter MR, Dorrell MI, Edmonds J, Friedlander SF, Friedlander M. Insulin- like growth factor 2 and potential regulators of hemangioma growth and involution identified by large-scale expression analysis. Proc Natl Acad Sci USA. 2002; 99(11):7455–7460
- Peichev M, Naiyer AJ, Pereira D, et al. Expression of VEGFR-2 and AC133 by circulating human CD34 (+) cells identifies a population of functional endothelial precursors. Blood. 2000; 95(3):952–958
- Marx Robert E, Stern D- Oral and Maxillofacial Pathology; A Rationale for Diagnosis and Treatment-Second Edition.]
- Razon, M.J., Kraling, B.M., Mulliken, J.B., and Bischoff, J. 1998. Increased apoptosis coincides with onset of involution in infantile hemangioma. Microcirculation. 5:189–195.
- Leonardi-Bee J, Batta K, O’Brien C, Bath- Hextall FJ. Interventions for infantile haemangiomas (strawberry birthmarks) of the skin. Cochrane Database Syst Rev. 2011; (5):CD006545
- Infantile Hemangiomas: An Update on Pathogenesis and TherapyDOI: 1542/peds.2012-1128 Pediatrics 2013; 131; 99; originally published online December 24, 2012; Tina S. Chen, Lawrence F. Eichenfield and Sheila Fallon Friedlander
- Léauté-Labrèze C, Dumas de la Roque E, Hubiche T, Boralevi F, Thambo JB, Taïeb A. Propranolol for severe hemangiomas of infancy. N Engl J Med. 2008; 358(24):2649–2651
- Sans V, de la Roque ED, Berge J, et al. Propranolol for severe infantile Hemangiomas: follow-up report. Pediatrics. 2009; 124 (3). Available at: pediatrics.org/cgi/content/full/124/3/e423
- Marsciani A, Pericoli R, Alaggio R, Brisigotti M, Vergine G. Massive response of severe infantile hepatic hemangioma to propanolol. Pediatr Blood Cancer. 2010; 54(1): 176
- Ezekowitz RA, Mulliken JB, Folkman J. Interferon alfa-2a therapy for life- threatening hemangiomas of infancy. N Engl J Med. 1992; 326(22):1456–146
- Greenberger S, Yuan S, Walsh LA, et al. Rapamycin suppresses self-renewal and vasculogenic potential of stem cells isolated from infantile hemangioma. J Invest Dermatol. 2011; 131(12):2467–2476
- Ni N, Guo S, Langer P. Current concepts in the management of periocular infantile (capillary) hemangioma. Curr Opin Ophthalmol. 2011; 22(5):419– 425
- Pathogenesis of hemangioma-Douglas A. Marchuk. Department of Genetics, Box 3175, Duke University Medical Center, Durham, North Carolina 27710, USA. Phone: (919) 684-3290; Fax: (919) 681-9193; E-mail: march004@mc.duke.edu.
- Visser, T. Fitzjohn, and S. T. Tan, “Surgical management of arteriovenous malformation,” Journal of Plastic, Reconstructive and Aesthetic Surgery, vol. 64, no. 3, pp. 283–291, 2011.
Snehanjan Sarangi M. D. S and Debanjali Mukherjee M. D. S. (2017); CURRENT CONCEPTS IN THE PATHOGENESIS AND MANAGEMENT OF VASCULAR LESIONS - A BRIEF REVIEW, Int. J. of Adv. Res., 5 (02), 1469-1475, ISSN 2320-5407. DOI URL: https://dx.doi.org/10.21474/IJAR01/3302
Dental Surgeon, Chanditala Rural Hospital, Hooghly,West Bengal.






