Capillary Hemangioma

Childhood tumours are rare, but amongst them, {the} most common benign tumour is a capillary haemangioma. It is seen around {the} orbit of {the} eye, and is 3 times more common in women than in men. It accounts for 10% of all forms of haemangioma.

In this article, we shall take a brief look at this clinical condition.

Pathological considerations

A capillary haemangioma is essentially overgrowth of normal blood vessel tissues where it should not be. If one were to look at these under a microscope, it would be evident that it consists of a mixture of cells (called endothelial cells) and blood vessels. Early lesions have more cells, while advanced lesions have a lot of capillaries in {the} form of lobules. As they get more advanced, {the} capillary walls become thickened and fibrosed, resulting in occlusion of {the} vessels.

The most common site where capillary haemangioma are found is {the} upper eyelid. It might just involve {the} surface of {the} skin, but can extend to {the} tissues beneath it all {the} way to {the} orbital cavity.

Clinical signs and symptoms

Capillary haemangioma are clinically evident within {the} originally 6 months after birth. A third of {the} cases are seen at birth, and over 9 out of 10 cases are seen by 6 months. Lesions that involve just {the} skin (also called cutaneous haemangioma) appear as a red, elevated nodule, while lesions that extend under {the} skin (subcutaneous lesions) are darker. In advanced cases involving {the} orbit, {the} eyeball might protrude out. This is called proptosis.

Haemangiomas on {the} upper eyelid tend to push {the} eyelid downwards, causing a droopy eyelid (called ptosis). Patients complain of blurred vision which occurs due to change in corneal shape, astigmatism and squinting (strabismus).

On pressing gently, {the} haemangioma can change colour and have a sponge-like texture. It is visibly evident on examination.

Diagnosis

Diagnosis is primarily clinical, but imaging might be performed for further evaluation. Ultrasound can help ascertain {the} depth of involvement. CT scans can demonstrate blood flow into {the} lesion. MRI scans are also useful.

Treatment

The natural course of capillary hemangiomas is an initial growth phase followed by a regression phase. Most lesions tend to undergo involution by {the} age of 8. Treatments are offered if there is visual impairment or infection.

Medical treatment involves {the} use of steroids, taken as tablets or injected directly into {the} lesion. However, {the} long term use of steroids has a number of side effects such as osteoporosis and weight gain. In addition steroid injections can affect blood flow to {the} retina and affect {the} local skin.

Treatments that alter body immunity have also been used, but with limited efficacy. Adverse effects are high and benefits can take a long time to show.

New treatment includes {the} use of beta blocker Propranolol. This drug is often used to manage high blood pressure, but it has found to help reverse visual problems with haemangiomas. It acts by reducing {the} amount of growth factors that stimulate haemangioma growth, reducing {the} blood supply and stimulating cell death within {the} lesion. Side effects are a few, and {the} drug must be avoided if a patient has asthma.

Surgical treatment includes laser photocoagulation for skin lesions, and entire removal with surgery for deeper lesions. Blocking off {the} blood supply to {the} lesion using a procedure called embolisation is also useful.

Finally, any associated medical conditions that form parts of different syndromes need to be managed as well.

Conclusion

Capillary haemangioma are {the} most common benign tumour of {the} orbit. Diagnosis is straightforward, but treatments seem to be limited. Surgery appears to be {the} better option when compared to medical therapy.

 

 

Procedures
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