Vascular Anomalies

Dr. Shahzad Hussain

BDS, FCPS (Resident)
Nishtar Institute Of Dentistry, Multan
SNDENTALCARE.Co
 Outline
 What are Vascular Anomalies?
 Hemangioma
 Rendu Osler Weber Disease
 Sturge Weber syndrome
 Lymphangioma
 Cystic Hygroma
 Basic Cell biology

• On basis of cell kinetics, there are two

major types of vascular anomalies:
• Hemangiomas: lesions demonstrating
endothelial hyperplasia.
• Vascular Malformations : lesions with
normal endothelial turnover.
Classification
 Hemangioma
• The word "hemangioma" comes from the
Greek haema-, "blood"; angeio , "vessel";
-oma , "tumor".
• A hemangioma is a benign and usually self-involuting
tumor of the endothelial cells that line blood vessels,
and is characterised by increased number of normal
or abnormal vessels filled with blood.
• May be present at Birth or arise during early childhood.
 Hemangioma
• Mostly within Skin
• May be relatively large, covering large skin,
Which are termed as birthmarks.
• Mostly invoulate by the time of puberty.
• Those hemangiomas that do not invoulate are
called hemartomas.
How we Classify Hemangioma?
 Capillary Hemangioma
• occur in superficial layer of skin.
• most common type of hemangioma.
• made up of small capillaries that are normal
in size and diameter, but high in number.
• Because of their proximity to the surface of
the skin, capillary hemangiomas are
typically brighter red in color.
 Cavernous Hemangioma
• In contrast with a capillary hemangioma,
a cavernous hemangioma is made up of
larger blood vessels that are dilated.
• The blood vessels are not as closely
packed as in a capillary hemangioma
• the spaces (or "caverns") between them
are filled with blood
 Intra Muscular Hemangioma

• Arise any where in the soft tissue of head &

neck
• Spongy Texture on palpation
• Usually deep seated
• Seen on the tongue and lips
 Clinical Features Of Hemangioma
• Usually raised
• Often Multinoduler
• No sex prediction
• Blenching on compression
• May Arise in any site but most commonly arise
in tongue
 Anteriovenous Malformation
• Occur in head & neck
• Central Mandibular
• 1: more in female Childs
• 2: painless, slow expansion
• 3:bruit on auscultation
• 4:spontanious hemorrhage on aspiration or prick.
• 5: small Multilocular radiolucency termed as worm
hole
• 6: Rarely subjected to biopsy due to excessive bleeding.
• Diagnosed with imaging studies such as Doppler
angiography or time-lapse angiography.
 Port wine Stain

• Unique type of hemangioma

• Usually unilateral
• Follow One, two or All division of trigeminal
nerve.
• Purplish, Diffuse, Maccular and sharply
demarcated from the adjacent skin.
 True Hemangioma
• Benign vascular tumor
• Under capillary or venous pressure
• Identical to ordinary hemangioma of Soft
tissues
• May Expand the bone
• Multilocular appearance
• No detectable Bruit
 Histopathology
• Hemangioma are characterized by
Multiple small capillary channel
( Capillary Hemangioma) or Large
tortuous dilated (cavernous
hemangioma) vascular spaces packed
with erythrocytes.
Micro-photograph of the capillary hemangioma, showing
multiple vessels with RBCs occluding the lumen and
inflammatory cells uniformly distributed
Capillary Hemangioma (Histopathology)

• Closely packed endothelial lined channels

typify the capillary Hemangioma.
• Fibrous Stroma not present.
• Well formed capillaries present throughout
but there may be a foci of prolifirating
endothelial cells that does not make a lumen.
• DD: Pyogenic granuloma
 Cavernous Hemangioma (Histopathology)

• Large, irregular shaped, dilated endothelial

lined channels of variable size that are
separated by mature fibrous stroma and
contain large aggregates of erythrocytes.
• Lack a muscular coat as a rule!!
• Central hemangiomas are of cavernous
type.
Histopathology
 Treatment
• Left untreated in childhood
• Cosmetic reasons may require surgical
removal.
• Sclerosing agents
•Multilocular
Radiolucency that
yield blood upon
aspiration ?? DD?
• 1: Central Hemangioma
• 2:Anurysmal bone Cyst
• 3:Central AV malformation
• Treatment of choice is induced embolization
admisntered through feeder vessels.
• Bilateral vascular supply may further complicate
the treatment plan.
• Tooth extraction may cause death due to excessive
bleeding
 HEREDITARY HEMORRHAGIC
TELANGIECTASIA
(Rendu Osler Weber disease)
• Autosomal dominant trait
• Thought to be due to mutations in
Transferring Growth Factor (TGF)-beta
signaling
Clinical features
Telangiectasia
Epistaxis
GI bleeding
 Basic Mechanism

post-capillary venules get enlarge and

connect to enlarging arterioles, thus
forming direct arteriolar-venular
connections
 Sturge-Weber syndrome
(encephalotrigeminal
angiomatosis)
• Syndrome characterized by
• 1:Intracranial Hemangioma(Parralle
Radiopaque Lines termed as TRAMLINE
CALCIFICATIONS)
• 2: Epilepsy
• 3: Port wine Stain
 LYMPHANGIOMA

• Lymphangiomas are benign tumours of lymphatic

vessels

• shows as a focal superficial lesion in the oral cavity

and as a massive diffuse lesion of the neck (cystic

Hygroma)
 Features
• Arise during childhood
• No sex prediction
• Two major types in the head & neck region
• 1: Self limiting in the oral cavity
• 2: Cystic hygroma in the lateral neck in
 Clinical Features
• Oral mucosal in the tongues of child
• May invoulate or persist at puberty
• Racemose appearing grape like cluster which
is yellowish and soft.
• Lips are second most common site.
 Treatment of lymphangioma

• Various methods have been reported for the

treatment of Lymphangiomas.

Procedures such as

• 1)Surgical excision

• 2)Radiation therapy,

• 3)Cryotherapy,
 Histopathology
• Stratifi ed squamous epithelium of tongue beneath
which dilated lymphatic vessels filled with lymph are
seen along with chronic inflamatory cells
 CYSTIC HYGROMA
•  known as cystic lymphangioma
• macrocystic lymphatic malformation
• congenital multiloculated lymphatic lesion
• can arise anywhere
• classically found in the left posterior triangle
of the neck and armpits. This is the most
common form of lymphangioma.
Cystic Hygroma