Chapter 51: Vascular Tumors and Vascular Oncosurgery

INTRODUCTION

Vascular tumors describe tumors that encompass a vascular origin that reflect at soft-tissue growth formed from blood vessels. The tumors can develop on any part of the body; they are classified into benign and malignant. Vascular anomalies represent a group of disorders with a wide spectrum entity from a simple “birthmark” to life-threatening conditions. The International Society for the Study of Vascular Anomalies (ISSVA) classified these anomalies into two main categories: vascular tumors and vascular malformation.¹ The main difference between the two types is the proliferation of endothelium, which is observed in the vascular tumor but not in malformation. This section will outline benign (mainly infantile hemangioma [HI], congenital hemangioma, and kaposiform hemangioendothelioma KHE) and malignant vascular tumors by tumor types, diagnosis, and surgical management.

ISSVA classified the vascular tumors into three main categories: benign, locally aggressive or borderline, and malignant. Table 51-1 represents the subtypes for each category.²

Vascular oncosurgery describes the discipline of surgical therapy for tumors of or closely involving vascular structures. It is an area of interest and challenge to many in the field due to the multidisciplinary nature of the practice and the developing referral circles of cases that essentially involve vascular therapists.

BENIGN VASCULAR TUMORS

Benign vascular tumors account for noncancerous tumors, with hemangiomas expounding on the most common form of the tumor.

Infantile Hemangioma (IH)

Incidence and Epidemiology

Infantile hemangiomas (IHs) are the most common benign vascular tumors, estimated to occur in 4% to 5% of newborns.³ They are more common in females, non-Hispanic white patients, and premature infants.⁴ Up to this date, there is no genetic mutations on the X chromosome have been reported. However, the increased incidence among females is thought to be related to early parents seeking medical advice in the dermatology clinic for cosmetic concerns when female newborns are affected. Finally, the early withdrawal of placental antiangiogenic factors is strongly related to IH’s high incidence among premature infants.⁵

Biology

Although the exact mechanism that causes the initial proliferation of blood vessels followed by involution of the vascular component of ...