What are Vascular Anomalies? Hemangioma Rendu Osler Weber Disease Sturge Weber syndrome Lymphangioma Cystic Hygroma Hemangiomas: lesions demonstrating endothelial hyperplasia. Vascular Malformations : lesions with normal endothelial turnover. 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.

1. Vascular Anomalies
Dr. Shahzad Hussain
BDS, FCPS (Resident)
Nishtar Institute Of Dentistry, Multan
SNDENTALCARE.Co

2. Outline
 What are Vascular Anomalies?
 Hemangioma
 Rendu Osler Weber Disease
 Sturge Weber syndrome
 Lymphangioma
 Cystic Hygroma

3. 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.

4. Classification

5. 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.

6. 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.

8. How we Classify Hemangioma?

9. 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.

12. 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

14. 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

15. 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

16. 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.

17. 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.

18. 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

19. Histopathology
• Hemangioma are characterized by
Multiple small capillary channel (
Capillary Hemangioma) or Large tortuous
dilated (cavernous hemangioma)
vascular spaces packed with
erythrocytes.

20. Micro-photograph of the capillary hemangioma, showing
multiple vessels with RBCs occluding the lumen and
inflammatory cells uniformly distributed

21. 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

22. 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.

23. Histopathology

24. Treatment
• Left untreated in childhood
• Cosmetic reasons may require surgical
removal.
• Sclerosing agents

25. •Multilocular
Radiolucency that
yield blood upon
aspiration ?? DD?

26. • 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

27. HEREDITARY HEMORRHAGIC
TELANGIECTASIA
(Rendu Osler Weber disease)
• Autosomal dominant trait
• Thought to be due to mutations in
Transferring Growth Factor (TGF)-beta
signaling

28. Clinical features

29. Telangiectasia

30. Epistaxis

31. GI bleeding

32. Basic Mechanism
post-capillary venules get enlarge and
connect to enlarging arterioles, thus
forming direct arteriolar-venular
connections

33. Sturge-Weber syndrome
(encephalotrigeminal angiomatosis)
• Syndrome characterized by
• 1:Intracranial Hemangioma(Parralle
Radiopaque Lines termed as TRAMLINE
CALCIFICATIONS)
• 2: Epilepsy
• 3: Port wine Stain

36. 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)

37. 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

38. 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.

41. Treatment of lymphangioma
• Various methods have been reported for the
treatment of Lymphangiomas.
Procedures such as
• 1)Surgical excision
• 2)Radiation therapy,
• 3)Cryotherapy,

42. Histopathology
• Stratifi ed squamous epithelium of tongue beneath
which dilated lymphatic vessels filled with lymph are
seen along with chronic inflamatory cells

43. 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.

44. Cystic Hygroma