Capillary, Venous, and Cavernous Hemangiomas

Amitabh Srivastava, MD

Key Facts

Terminology

Benign vascular tumors composed of blood vessels lined by plump to flattened endothelial cells with no atypia

Etiology/Pathogenesis

Clinical Issues

Microscopic Pathology

Nodules of small capillary-sized vessels in lobular pattern in capillary hemangioma
Large, cystically dilated vessels filled with blood in cavernous hemangioma
Large, thick-walled veins in venous hemangioma
Lining endothelium in all lesions does not typically show atypia
Thrombosis (± Masson tumor/change), hemorrhage, and calcifications may be present
- Especially in venous and cavernous hemangiomas

Capillary hemangiomas present as small, superficial, well-circumscribed, red-purple nodules. The overlying skin is intact in this example

but may be ulcerated (especially in pyogenic granulomas).

The lobular configuration of capillary hemangiomas is apparent at low-power examination

. Multiple distinct lobules of capillaries are centered in the dermis, and the overlying skin is intact

TERMINOLOGY

Abbreviations

Synonyms

Definitions

Benign vascular tumors composed of blood vessels of various size lined by plump to flattened endothelial cells with no atypia

ETIOLOGY/PATHOGENESIS

Developmental Anomaly

CLINICAL ISSUES

Epidemiology

Age
- Depends on subtype
Gender
- Capillary and cavernous hemangiomas in adults occur more commonly in women

Site

Presentation

Natural History

Treatment

Surgical approaches
- Surgical excision is curative, but usually not necessary unless affecting vital structures
Drugs
- Glucocorticoids or interferon-α therapy for large or symptomatic juvenile hemangiomas
Watchful waiting for juvenile hemangiomas that regress with time

Prognosis