Re: [MOL] LILLIAN [01637] Medicine On Line


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Re: [MOL] LILLIAN



Sandy:  Expect to see me Saturday, need an address.  If it is all right with
you, one of my daughters will be driving me over to Savannah?  Looking
forward to our meeting there pal.  I could be wrong; but what I am reading
on Hemangioma's they tend to be benign.....Whew!  That was a relief huh?
Also included are the treatments used for said mentioned.  Good luck, keep
me informed and best you get a second opinion.....love, lillian

Hemangioma

Tend to be small, focal lesions with increased echogenicity
larger masses may cause nausea and vomiting
Vascular tumors
More common in women than men
Most common benign liver mass

Hemangiomas are tumors made-up of dilated blood vessels that usually appear
shortly... 03/27/97

Congenital Malformations

Hemangiomas



This child was born with a hemangioma vascular growth on the top of her
skull. Traditionally hemangiomas are dealt with by letting them involute,
that is, regress slowly over several years. In this particular case, the
parents were very distraught because the tumor was bleeding too much, was
getting infected, and producing a bad smell. We decided to proceed with
removal of the tumor and closure of the scalp. The child now looks normal,
is free of the pain, free of the bleeding, and free of the odor-causing
infection.

Hemangiomas are benign vascular anomalies which may occur in various areas
throughout the body with 50% being located in the head and neck. Vascular
anomalies are the most common head and neck tumor in infancy and childhood
with hemangiomas and lymphatic malformations comprising the majority of
these lesions.

Classification

Although the classification systems vary for vascular tumors, Mulliken's
scheme divides hemangiomas into two categories, capillary and cavernous.
Capillary hemangiomas are the most common with an incidence of 1-1.5% in
infants. They are characterized by raised, circumscribed, red lesions that
are often lobulated. On histology, they are composed of small thin-walled
vessels of capillary size that are lined by single layer of flattened or
plump endothelial cells and surrounded by discontinuous layer of pericytes
and reticular fibers. .In general, they are low flow lesions. Cavernous
hemangiomas on the other hand can be high flow lesions, and they consist of
deep, irregular, dermal blood-filled channels. They typically impart a
purple-blue hue to the overlying skin. They are comprised of tangles of
thin-walled cavernous vessels or sinusoids that are separated by a scanty
connective tissue stroma. Further classification includes a mixed hemangioma
containing both components which may be more common than the pure cavernous
lesions.

Clinical Course

Hemangiomas are usually not present at birth but are antedated by a pale,
well-circumscribed flat area that may contain some central telangiectasia.
The actual hemangioma will appear within the first month and will continue
to increase in size for the next 3-8 months. A stable phase of relatively no
growth then occurs over the next 6-12 months followed by slow involution of
the tumor by ages 5-7 years. They can occur just about anywhere in the head
and neck, but are more common in the parotid, lip, oral cavity, perinasal
region, and larynx or subglottis. The complications of these lesions are
ulceration, infection, bleeding, compression syndromes (airway compromise),
thrombocytopenia, and even high output cardiac failure. Psychiatric problems
are not uncommon given the sever cosmetic deformities that are associated
with facial tumors.

Treatment

There is no uniformly accepted treatment of head and neck hemangiomas. The
various modalities of therapy are dependent upon the age of the patient, the
site and size of the lesion, and the hemodynamic flow of the hemangioma. It
is important to note that congenital lesions typically regress while adult
onset lesions do not. The treatment options include: observation, steroids,
embolization, cryotherapy, sclerotherapy, antifibrinolytic agents, radiation
therapy, laser photocoagulation, surgery with or without preoperative
embolization, or any combination of the above.

Observation is encouraged in uncomplicated cases given the natural
regression with onset in infancy, but intervention should be considered with
lesions that threaten function.

Steroids may act to increase the sensitivity of the hemangioma to
circulating vasoconstrictors, but the overall mechanism is unclear. Dosing
can range from 20 to 40 mg per day and have been continued from 2 weeks to
17 months. The various side effects of prolonged steroid therapy are many
and must be considered when following a patient on steroid therapy.

Other modalities such as antifibrinolytic agents, cryotherapy, and
sclerotherapy have shown variable efficacy in reducing the size of the
hemangioma and are not generally considered as first line therapies.
Radiation therapy has fallen out of favor because of its potential to
disrupt growth and induce malignancies.

Laser Treatment

The use of the laser to treat hemangiomas by photocoagulation or excision
has become popular with the advent of new laser technology. The argon laser
emits a blue-green light that is absorbed by hemoglobin as well as melanin,
and has only a few millimeters of penetration. It is therefore more useful
for superficial lesions, and may cause skin pigmentation changes as a result
of its effects on melanin containing cells. The copper vapor laser emits a
light that is selectively absorbed by hemoglobin and thus it has reportedly
less effects on the skin. Its range of penetration is similar to that of the
argon laser and so is limited to use with superficial lesions. The CO2 laser
has minimal tissue penetration (.2-.5mm) and therefore is a valuable tool
for subglottic hemangiomas where limited penetration will protect the nearby
esophagus and great vessels. The Nd-YAG laser has low tissue absorption and
thus deeper penetration (5-7mm), and it is also preferentially absorbed by
pigmented soft tissue. These characteristics make it especially useful for
the deeper cavernous or mixed hemangiomas. The YAG laser can also be
transformed into a hemostatic excisional tool by utilizing the scalpel tip
adaptor.

Surgery

Surgical excision appears the most effective treatment and often results in
complete cure. It is reserved for small lesions that fail to regress or the
larger lesions that compromise function or cause severe cosmetic deformity.
Superselective embolization is recommended pre-operatively in order to
reduce the complications of bleeding that can occur. The use of the laser as
a pre-operative coagulator can also be utilized in conjunction with surgical
excision.

Summary

Hemangiomas are common tumors of the head and neck. The majority of
congenital lesions will regress spontaneously, whereas adult onset lesions
will persist. There are many options for treatment when a lesion fails to
regress or compromises function. In general, surgical excision with a
combination of embolization or laser photocoagulation pre-operatively is the
treatment of choice.




-----Original Message-----
From: SandizHere@AOL.COM <SandizHere@AOL.COM>
To: mol-cancer@lists.meds.com <mol-cancer@lists.meds.com>
Date: Monday, March 29, 1999 5:04 PM
Subject: Re: [MOL] LILLIAN


>Lillian,
>So glad to see you back on.  Did your daughter give you my message?  Would
>love to meet you this week-end sometime while I am in Savannah for Easter.
We
>are having a birthday party for my 2 year old on saturday and you are
invitied
>to come over if you like.
>
>I also want to know if you have any information on hemangioma?  My doctor
told
>me today that I have this in my neck - C6 vertabrae and it is
pre-cancerous.
>I am not at all sure of what he is talking about.  I will also be having a
>bone scan.
>
>Thanks,
>Sandi
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