Lecture notes for medical students

1. Tips on using my ppt.
1. You can freely download, edit, modify and put your
name etc.
2. Don’t be concerned about number of slides. Half the
slides are blanks except for the title.
3. First show the blank slides (eg. Aetiology ) > Ask
students what they already know about ethology of
today's topic. > Then show next slide which enumerates
aetiologies.
4. At the end rerun the show – show blank> ask questions >
show next slide.
5. This will be an ACTIVE LEARNING SESSION x
three revisions.
6. Good for self study also.
7. See notes for bibliography.

2. Learning Objectives

3. Learning Objectives
1. Introduction & History
2. Relevant Anatomy, Physiology
3. Aetiology
4. Pathophysiology
5. Pathology
6. Classification
7. Clinical Features
8. Investigations
9. Management
10. Prevention
11. Guidelines
12. Take home messages

4. Introduction & History.
•

5. Cutaneous Vascular Lesions
• Infantile hemangioma.
• Coloured Naevus/ Vascular birthmarks
– Portwine stain
– Salmon patch
– Capillary haemangioma (strawberry naevus)
• AV Malformations
• Aneurysm
• Pyogenic granuloma

6. Cutaneous Vascular Lesions
• Popularily known as Hemangioma
• Infantile hemangiomas are benign
vascular neoplasms that have a
characteristic clinical course marked by
early proliferation and followed by
spontaneous involution.
• Hemangiomas are the most common tumors
of infancy and usually are medically
insignificant.

7. Aetiology

8. Aetiology
• Idiopathic
• Congenital/ Genetic
• Nutritional Deficiency/excess
• Traumatic
• Infections /Infestation
• Autoimmune
• Neoplastic (Benign/Malignant)
• Degenerative / lifestyle
• Iatrogenic
• Psychosomatic
• Poisoning/ Toxins/ Drug induced

9. Etiology
• Congenital
• Traumatic
• Infections /Infestations
• Neoplastic (Benign/Malignant)
• Degenerative

10. Etiology
• Congenital
• Traumatic
• Infections /Infestations
• Neoplastic Benign
• Degenerative

11. Pathophysiology

12. Pathophysiology
• Infantile hemangiomas are composed of
proliferating, plump endothelial cells.
• Limited basement membrane structure
• Early in proliferation, the cells are in
disarray, but, with time, they form vascular
spaces and channels replete with blood
cells.

13. Pathophysiology
• Hemangiomas assume a lobular architecture
as proliferation slows and ends.
• Mast cells appear to affect this process of
involution.

14. Clinical Features
•

15. Clinical Features
• Frequency of cutaneous hemangiomas at
particular sites is as follows:
– Head and neck - 60%
– Trunk - 25%
– Extremities - 15%

16. Clinical Features
• Eighty percent of infantile hemangiomas
are focal and solitary.
• Hemangiomas also can occur in
extracutaneous sites, including the liver,
gastrointestinal tract, larynx, CNS,
pancreas, gall bladder, thymus, spleen,
lymph nodes, lung, urinary bladder, and
adrenal glands.

17. Clinical Features
• Cutaneous hemangiomas progress
sequentially through the following stages:
– Blanching of the involved skin
– Occasionally (especially with lip and buttock
lesions), a shallow ulceration
– Fine telangiectasias
– A red or crimson macule or papule, often
surrounded by a faint halo of vascular
blanching

18. Clinical Features
• Early rapid growth followed by slow
involution, as follows -
– Rapid growth during the neonatal period (birth
to 4 wk) is the historical hallmark of infantile
hemagiomas
– The hemangioma becomes elevated and dome
shaped, lobulated, plaquelike, tumoral, or any
combination of these morphologies
– The most growth occurs during the first 4-6
months of life
– Proliferation slows considerably between 6-12
months of life

19. Clinical Features:Involution
– Complete involution in 50% of infantile
hemangiomas by age 5 years and 70% by age 7
years
– Complete involution may take an additional 3-5
years in the remainder

20. Clinical Features:Complications
• Occasionally infantile hemangiomas may
– impinge on vital structures,
– ulcerate,
– bleed,
– cause high-output cardiac failure
– significant structural abnormalities or
disfigurement.

21. Clinical Features:Complications
• Rarely, a cutaneous infantile hemangioma
may be associated with one or more
underlying congenital anomalies:
– Sturge-Weber Syndrome.
– PHACE Syndrome
– PELVIS Syndrome

27. Investigations

28. Investigations
• Laboratory Studies
– Routine
– Special
• Imaging Studies
• Tissue diagnosis
– Cytology
• FNAC
– Histology
– Germ line Testing and Molecular Analysis
• Diagnostic Laparotomy.

29. Diagnostic Studies
Imaging Studies

30. Diagnostic Studies
Imaging Studies
• X-Ray
• USG
• CT
• Angiography
• MRI
• Endoscopy
• Nuclear scan

31. Magnetic resonance imaging
(MRI)
With or without Gadolinium contrast-
• Delineate the location and extent of
cutaneous and extracutaneous hemangiomas
• Differentiate proliferating hemangiomas
from other high-flow vascular lesions (eg,
arteriovenous malformations)

32. Ultrasonography:
• Can help differentiate hemangiomas from
other deep dermal or subcutaneous
structures, (eg, cysts, lymph nodes)
• Cannot fully evaluate the magnitude and
extent of the hemangioma
• High vessel density (>5 vessels/cm 2) and
high peak arterial Doppler shift (>2 kHz)
are sensitive and specific for infantile
hemangiomas, as compared with other soft
tissue masses.

33. Diagnostic Studies

34. Diagnostic Studies
• Biopsy
• Small parts USG
• MRI

35. Differential Diagnosis

36. D/D
• Infantile hemangioma.
• Coloured Naevus/ Vascular birthmarks
– Portwine stain
– Salmon patch
– Capillary haemangioma (strawberry naevus)
• AV Malformations
• Aneurysm
• Pyogenic granuloma

37. Management

38. Management
• The vast majority of infantile hemangiomas
do not require any medical or surgical
intervention.
Treatment options for clinically significant
hemangiomas include the following:
• Laser surgery
• Surgical excision
• Medication

39. Non Operative Therapy

40. Pharmacologic treatment
• Corticosteroids can slow the growth and
decrease the size of proliferating infantile
hemangiomas
• Oral corticosteroids preferred over
intralesional injection

41. Pharmacologic treatment
• Propranolol has become the treatment of
choice for disfiguring or functionally
significant hemangiomas .

42. Minimally invasive Therapy

43. LaserTherapy
• Flashlamp-pumped pulsed-dye laser most
widely used
• Pulsed-dye laser surgery effective for
treating ulcerated hemangiomas and thin
superficial hemangiomas
• Lasers used especially on areas likely to
result in significant functional or
psychological impact eg, fingers, eyes, lips,
nasal tip, ears, face
•

44. Laser Therapy
• Many ulcerated hemangiomas respond with
decreased pain , rapid reepithelialization,
and hastened involution
• Laser treatments generally performed every
2-4 weeks until complete healing results
• Scarring or residual skin changes may occur
• Laser treatment may worsen ulceration,
particularly of deep or combined superficial
and deep lesions

45. Operative Therapy

46. Operative Therapy
• Not uncommonly used for correction of
cutaneous defects from involuted
hemangiomas
• Specially trained surgeons needed for
surgical excision of proliferating
hemangiomas because of the risk of
hemorrhage and damage to vital structures
• Early excision may save life, preserve
vision, or eliminate a cosmetically
disfiguring lesion.

47. Get this ppt in mobile
1. Download Microsoft
PowerPoint from play
store.
2. Open Google assistant
3. Open Google lens.
4. Scan qr code from
next slide.

48. Get this ppt in mobile

49. Get my ppt collection
• https://www.slideshare.net/drpradeeppande/
edit_my_uploads
• https://www.dropbox.com/sh/x600md3cvj8
5woy/AACVMHuQtvHvl_K8ehc3ltkEa?dl
=0
• https://www.facebook.com/doctorpradeeppa
nde/?ref=pages_you_manage