Vascular malformations, tumors and hemangiomas

Vascular malformations, tumors and hemangiomas all refer to a variety of non-cancerous birthmarks and lesions. Boston Children's Hospital is home to internationally renowned physicians for their expertise and innovative contributions to this highly specialized field.

Hemangiomas

• Infantile hemangiomas are the most common type of vascular anomaly
• They are a benign (noncancerous) tumor
• Occur in 4 to 10 percent of infants and more frequently in premature babies
• Growths are typically noticed in the first two weeks of life
• They enlarge rapidly, outpacing the rest of the body's growth for the first year
• After infancy, they slowly regress
• Usually fully involutes (shrink) by 5 to 7 years old
• Some residual fatty tissue or thin skin may remain after involution

Vascular malformations

• Vascular malformations are benign (non-cancerous) lesions
• They are present at birth, but may not become visible for weeks or months after birth
• Unlike hemangiomas, vascular malformations do not have a growth cycle and then regress but instead continue to grow slowly throughout life.

How Children's Hospital Boson approaches vascular anomalies

The Vascular Anomalies Center at Boston Children's Hospital offers the latest diagnostic and treatment approaches, some of which were pioneered by our staff. Our team provides comprehensive consultation services to physicians and families worldwide, including referrals to local medical centers and physicians when appropriate.

The Vascular Anomalies Center (VAC) at Children's is composed of a unique interdisciplinary team of 26 physicians, representing 18 departments, who have developed sub-sub specialization in the field of vascular anomalies. Many of these physicians are internationally renowned for their expertise and innovative contributions to this highly specialized field.

What causes a hemangioma or vascular malformation?

A hemangioma is a benign (noncancerous) tumor formed by an abnormally dense group of endothelial cells (the cells that normally line the blood vessels).  The exact cause remains unknown.

Most vascular malformations are sporadic (occurring by chance), though some are inherited in a family as an autosomal dominant trait. Autosomal dominant means that one gene is necessary to express the condition, and the gene is passed from parent to child with a 50/50 risk for each pregnancy. Males and females are equally affected and there is great variability in expression of the gene. In other words, a parent may unknowingly have had a hemangioma because it faded, but your child is more severely affected. The family may not come to the attention of a geneticist until the birth of the child with a more severe condition.

What are some of the types of vascular malformation?

There are several types of vascular malformations:

• Capillary (port wine stains) always present at birth as pink or purple skin patches
• Venous often confused with a hemangioma, these malformations are soft to the touch and the color disappears when compressed. They are most commonly found on the jaw, cheek, tongue and lips
• Lymphatic formed when excess fluid accumulates within the lymphatic vessels
• Arteriovenous abnormal connections between arteries and veins, resulting in a high flow, pulsating collections of blood vessels
• Mixed - a combination of any of the other four types

What are the symptoms of a Vascular Malformations and Hemangiomas?

Hemangiomas can be superficial or deep and most commonly have the following symptoms:

• Superficial hemangiomas appear as bright red, flat or raised patches on the skin
• Deep ones growing below the surface may not have an obvious outward appearance
• Both types are usually compressible to the touch
• They most often grow in the head or neck area, but they can involve any part of the body, including major organs
• Their size is variable and while most patients only have one lesion, multiple hemangiomas can occur

Vascular malformation symptoms are highly variable and depend on the type, size and location of the malformation.  Symptoms may be absent altogether or life threatening if it’s an arteriovenous malformation (AVM).

Common arteriovenous vascular malformation symptoms include:

• Seizures
• Headaches
• Neurological problems, such as learning disorders, or ischemia, or lack of oxygen, which can affect muscle control, vision, or speech.

One patient's story: