Hemangioma. Questions & Answers. Dmitry V. Romanov

      Hemangioma

      Questions & Answers

      Dmitry V. Romanov

      © Dmitry V. Romanov, 2025

      ISBN 978-5-0065-3725-5

      Created with Ridero smart publishing system

      Dear readers!

      The book “Hemangioma” is written for medical students, doctors of various specialties who encounter this disease in their practice, as well as for interested parents of young patients. This book is not a guide to self-treatment and self-diagnosis. The book talks about modern approaches and views on this pathology and emphasizes that infant hemangiomas are a serious problem of the present time. Considering the complexity of this disease, infant hemangiomas should be treated with due attention and professionalism.

      Important: treatment can only be prescribed by a doctor!*

      Author

      Dmitry V. Romanov

      Director and founder of the “Center for Vascular Pathology” (Moscow) clinic, pediatric surgeon, laser treatment specialist, interventional radiologist.

      Specialist advice is required.

      Contents

      Preface

      Infantile hemangiomas have become a very common pathology in recent years, with almost every hundredth infant suffering from this disease. And if just 5—7 years ago the problem of diagnosis and treatment was extremely urgent, now many specialists are able not only to correctly diagnose, but also to perform the necessary treatment. But, unfortunately, there are not enough such specialists yet. Our Center for Vascular Pathology is the leading clinic in Russia for the treatment of vascular pathology in children and adults. This book contains and updates the main questions that arise not only among specialists, but also among any medical doctors who encounter this pathology. The book reflects modern views on the medical aspects of this problem. My personal experience of working with patients with vascular pathology since 2011, the experience of my colleagues and our Center for Vascular Pathology are reflected in this publication.

      In working on this publication I was assisted by: Bryleeva Anastasia Aleksandrovna, Rakhimov Amriddin Ravshanovich, Denisevich Svetlana Sergeevna.

      I express my deep gratitude to Postevaya Alina Anatolyevna for preparing and editing the material for the book.

      April 12, 2022

      Dmitry V. Romanov

      There are no manuals in Russian medical literature that would cover the problem of treating vascular tumors in sufficient detail. Individual chapters and small sections of general manuals are clearly insufficient for a practicing physician, and articles scattered across the pages of periodicals, usually treating one of the many methods of treatment, are unable to give the reader an idea of all aspects of the problem. Thus, the latter is deprived of the opportunity to compare and choose one or another method in each specific case.

      S.A. Kholdin

      “Hemangiomas and their treatment”

      1935

      Introduction

      1. What is an infantile hemangioma?

      Infantile hemangioma is a benign vascular tumor that is formed in utero and develops in the first weeks after birth. Distinctive features of the tumor are active growth in the first months of life and the ability to involution over the following years.

      Fig. 1 Infantile hemangioma in the knee area.

      Fig. 2 Infantile hemangioma in the parietal region.

      2. Why infantile hemangioma and not children’s hemangioma?

      In English literature, hemangiomas are referred to as infantile hemangioma, the literal translation is “children’s hemangioma” or “infantile hemangioma”, but the words “children’s” and “infantile” do not reflect the essence of the disease, the disease occurs in the period of “infancy” – early childhood up to one year.

      The phrase “infantile hemangioma” most fully describes the time of development and the essence of the disease, so we will use and consider it correct to use the term – “infantile hemangioma”.

      3. Is hemangioma a tumor?

      The term “hemangioma” (from the Greek haima – blood, angeion – vessel and -oma ending denotes the names of tumors) is a benign tumor of blood vessels. According to the classification of the International Society for the Study of Vascular Anomalies (ISSVA), infantile hemangiomas are classified as vascular tumors. The conducted immunohistochemical studies confirm the fact of the individuality of this nosological unit and the tumor-like nature of the disease.

      4. Can infantile hemangioma become malignant?

      Infantile hemangioma is a benign vascular tumor. It cannot become malignant over time, or with surgical, laser, or other treatments.

      5. What tissue does hemangioma grow from?

      Infantile hemangioma is formed embryonically from hemogenic epithelium, which, under the influence of certain factors, first develops into mesenchymal stem cells and endothelial progenitor cells, then into pericytes and endothelial cells, from which abnormal blood vessels are subsequently formed.

      6. What is endothelium?

      Endothelium is a single-layered sheet of flat cells of mesenchymal origin lining the inner surface of blood and lymphatic vessels, and the chambers of the heart. Endothelial cells perform many functions of the vascular system, such as: vasoconstriction and vasodilation, control of blood pressure; regulation of blood clotting components, namely thrombin and fibrin; angiogenesis (formation of new blood vessels).

      Fig. 3 Capillary endothelium under electron microscopy.

      7. What are pericytes?

      Pericyte (from the ancient Greek περι- – around, near and κύτος – cell), or Rouget cell, is a branched cell of connective tissue.

      Pericytes are part of the walls of small blood vessels, including capillaries.

      Fig. 4 Pericytes on the vessel surface.

      8. What is angiogenesis?

      Angiogenesis is the process of formation of new blood vessels in an organ or tissue, leading to the reorganization of the primary capillary network, which is reduced to a simpler and more distinct system of capillaries, arteries and veins. Normally, angiogenesis processes in the body occur with moderate intensity and are activated only during the regeneration of damaged tissues, the formation of blood clots, the elimination of inflammation, the formation of a scar and similar recovery processes.

      Vasculogenesis is the process of formation of blood vessels from endothelial progenitor cells (EPCs), which differentiate into endothelial cells, forming new vessels. This form of vessel formation is characteristic of the embryonic period, when the formation of the primary vascular plexus occurs.

      I. Classification

      1.1. What is the current classification of vascular anomalies?

      The