Introduction
Chen et al . (2013) asserted that Hemangioma is a condition that is characterized by the proliferation of blood vessels in a vascularized tissue. It is a condition that mainly affects infants and may manifest through a painful swelling. In other cases, it is however asymptomatic. There have been debates concerning whether the lesions that characterize hemangioma are neoplasms, vascular malformations, or hematomas. The area of the body that is mostly affected by hematomas is the subcutaneous tissue of the skin. The hemangioma of the deep tissue usually affects the skeletal muscles. The bone is also a potential site for infection with hemangioma and may either be symptomatic or asymptomatic. The discussion will analyze the etiology of the disease, the most affected group, diagnosis, signs and symptoms, and to compare and contrast hemangioma with another disease similar to it. The discussion will also highlight the genetic implications of illness and how the disease is commonly treated in the medical community.
Etiology
The etiology of the condition is not understood. However, various reasons have been put forward in an attempt to explain the cause of hemangioma. Angiogenesis, which is a process, has been implicated in the development of hemangioma. Mattassi et al . (2015) asserted that the angiogenesis leads to the formation of the vascular excess exhibited by the disease. Several factors contribute to angiogenesis, hence subsequently leading to hemangioma. Vascular endothelial growth factors and cytokines stimulate the process of angiogenesis. Inhibitors of angiogenesis such as interferon gamma have also been identified to prevent the development of hemangioma. When the angiogenic factors are in high amounts and the inhibiting factors in low amounts, the tendency to develop angiogenesis increases, hence increasing the likelihood of the development of hemangioma.
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The group that is primarily prone to the disease is the infant. They suffer from a type of the infection referred to as infantile hemangioma. They may be absent at birth, but the first symptoms appear within the first two weeks after birth. The high prevalence of the disease in the infants can be related to the angiogenesis theory during birth that originates from the embryonic mesoderm. Several stimulating factors that have a higher effect during infancy due to a weak immune system such as local growth factors, estrogens, cytokines, and hypoxia are responsible for the development of hemangioma.
Diagnosis
The diagnosis will begin with carrying out a physical exam on the patient and the physician taking their medical history. In cases where there is life threatening complications, emergency treatment is undertaken. According to Püttgen (2014), urgent treatment is also carried out in cases where the lesions have led to functional impairment, bleeding or pain. Various factors determine the method of intervention that should be taken on patients suffering from hemangioma. They include the patient's age, the stage of the lesion, size and location of the lesions, amount of skin affected, parental preference in case of a child, and the experience of the physician. The physician can take samples from the patient for further laboratory tests. The preferred samples, in this case, include blood and tissue sample for histocytopathology. A complete blood count can be done on the blood sample together with a peripheral blood film to rule out other causes of the lesions such s allergy or an underlying disease. On the other hand, a biopsy taken will be important for two reasons. First, it will be used to rule out or confirm if the lesions are cancerous. Secondly, the report can be used to assess the stage of the lesions, which will be an important indicator in determining the method of intervention used by the physician.
Other diagnostic methods that will be employed in hemangioma include the use of radiology, Magnetic Resonance Imaging (MRI), and in some other cases the use of X-rays as pointed out by Darrow et al . (2015). Imaging is mostly used in the cases of uncertain diagnosis if the physician wants to determine the extent of the lesions, or even when the response to the treatment is being monitored. The MRI particularly is used when the physician wants to evaluate the presence of complications that may arise from the lesions. Both the MRI and the radiology are used to assess the anatomy of the lesions that are as a result of the hemangioma. The Computer Tomography (CT) method is normally ordered when the lesions have affected the head, and therefore there is a reason to evaluate the extent of the injury.
Signs and Symptoms of the Disease
The symptoms of a hemangioma start out as a red flat mark on the surface of the body, and the most affected parts include the face, back, chest, and scalp. In children, it begins with a single mark that may be confused with a birth mark. Some children, however, exhibit multiple marks on their body. The red mass rapidly grows and protrudes to become a large spongy mass. They eventually develop into lesions and begin to spread throughout the body surface. The disease is characterized by other forms of complications that set in if the condition is not timely resolved. Ulceration is a common complication that is associated with the hemangioma. Ulceration leads to bleeding, pain, and the onset of secondary infections. Scarring and the prospect of permanent disfigurement can be as a result of ulceration. Bleeding, although rarely, can be a significant complication of the disease especially in ulcerated cases. Lesions and ulceration in the lips can lead to feeding impairment. Obstruction of the airways can also set in cases where the airway is ulcerated or filled with lesions. The lesions can also lead to mechanical problems on the eyes that lead to ocular complications rendering a patient visually impaired.
Genetics
The causes of hemangioma have been described to be sporadic in that it occurs only by chance. However, cases of inheritance have been postulated through research. The infections can be inherited along the family line in the form of an autosomal dominant trait. This means that each pregnancy can carry a 50/50 chance risk of passing the gene that is responsible for the condition of the child. The genes responsible for the development of the infection primarily have been identified to affect the process of angiogenesis by influencing the activating factors and preventing the hemangioma inhibiting factors. The likelihood that the disease is inherited depends on the parents. Both parents may be having the trait in a recessive form, hence increasing the chance of giving birth to a child with the infection. Also, if one parent had a dominant gene carrying the trait, the possibilities of bearing a child with the manifestation of the disease is possible.
Treatment
The hemangioma may not require a treatment if it manifests as a single swelling and it may soon go away on its own as stated by Zheng et al . (2013). Other cases, however, require treatment. Corticosteroid medication can be injected into the lesions or the swelling to reduce inflammation and stop growth. A small hemangioma that is ulcerated may be treated by beta-blockers. Laser treatment can be applied to remove the lesions or swellings caused by hemangioma. The laser treatment can be used to mitigate the redness and to promote speedy healing. According to Coulie et al . (2015), surgery can be used by the physician if the hemangioma is big and if it is located in a sensitive area. Ulcerations can be treated using a medical gel. When hemangiomas are located in the organs, they can be surgically removed, or the damaged part of the organ can be removed.
Comparison
The most probable disease that can be confused with hemangioma is cystic hygroma. The cystic hygroma also consists of lesions that are lymphatic and can arise anywhere in the body as pointed out by Prasad et al . (2015). Just like the hemangioma, they are benign and can result in disfigurement. It also affects mostly children just like the case of infantile hemangioma. Both of them are congenital infections that can cause adverse conditions on the patient. Despite their similarities, some differences can be deduced between the two diseases from a close analysis. Whereas hemangioma primarily affects the subcutaneous layer, more specifically the face and the scalp, cystic hygroma majorly affects the neck triangle regions and the armpits. In hemangioma, the lesion is usually red and does not contain any fluid. In cystic hygroma, the lesions contain a watery fluid known as lymph. The cystic hygroma is also characterized by a massive growth on the neck that is not found in hemangioma.
Conclusion
In conclusion, hemangioma is a disease that can affect people in all ages, but the prevalence is higher in infants. It mainly affects all regions of the skin such as neck, scalp, and back among others. It can be diagnosed by medical laboratory tests and other tests such as MRI, ultrasound, and the use of a CT scan. In some complication cases, it can lead to bleeding, ulceration, and effect on organs. Treatment is geared towards mitigating the adverse effects and removing the lesions. The disease that can mostly be confused to hemangioma is cystic hygroma. They have striking similarities, but on closer look, they have several major differences.
References
Chen, T. S., Eichenfield, L. F., & Friedlander, S. F. (2013). Infantile hemangiomas: an update on pathogenesis and therapy. Pediatrics , 131 (1), 99-108.
Coulie, J., Coyette, M., & Boon, L. M. (2015). Surgical Management of Infantile Hemangioma Using the Purse-String Technique: Impact on the Scar. Plastic and reconstructive surgery , 136 (4S), 156.
Darrow, D. H., Greene, A. K., Mancini, A. J., & Nopper, A. J. (2015). Diagnosis and management of infantile hemangioma. Pediatrics , 136 (4), e1060-e1104.
Mattassi, R., Loose, D. A., & Vaughn, M. (Eds.). (2015). Hemangiomas and vascular malformations: an atlas of diagnosis and treatment . Springer.
Prasad, A., Raju, S., Karthik, S., Venu, G., & Mithun, M. (2015). Adult Cystic Hygroma–A Rare Entity. Indian Journal of Mednodent and Allied Sciences , 3 (1).
Püttgen, K. B. (2014). Diagnosis and management of infantile hemangiomas. Pediatric Clinics of North America , 61 (2), 383-402.
Zheng, J. W., Zhang, L., Zhou, Q., Mai, H. M., Wang, Y. A., Fan, X. D., ... & Zhao, Y. F. (2013). A practical guide to treatment of infantile hemangiomas of the head and neck. International journal of clinical and experimental medicine , 6 (10), 851.
