They usually appear on the skin as a red birthmark, which is the most common type of tumor in infants.
People with multiple skin hemangiomas are more likely than people with a single skin tumor to have an internal hemangioma. Most people with internal hemangiomas do not have any outward signs of it, however.
While skin hemangiomas are childhood problems, internal hemangiomas usually affect adults. They do not usually get found until the body is scanned for some other reason. Adults often carry these internal lumps without realizing it.
When these growths occur inside the body, they most often affect the liver. This large organ has many roles.
Many internal organs can have hemangiomas. The two that have been studied the most are the liver and the brain.
Most internal hemangiomas can be found on the liver. They are often small and don't cause symptoms.
Most internal hemangiomas affect the liver.
They are usually small and do not produce any symptoms.
Some larger liver hemangiomas can give problems, however. If they are bigger than 4 centimeters (about 1.6 inches) across, they may cause discomfort or a feeling of fullness in the stomach.
More rarely, symptoms can include weight loss, nausea, and feeling full sooner when eating. If the tumor bleeds or has an associated blood clot, there may be pain.
Vascular tumors are rare in the brain. Brain tumors overall are uncommon, and brain hemangiomas are a small proportion of these.
Two types of hemangioma affect the brain:
- Hemangioblastoma - about 2 percent of all the tumors that start in the brain are hemangiomas. These usually affect the lowest parts of the brain: the brain stem and cerebellum.
- Hemangiopericytomas are less common and develop in the coverings of the brain or spinal cord, the meninges. This is the same part that becomes inflamed in meningitis.
Hemangioblastomas are slow-growing harmless tumors. Like the hemangiomas that affect other organs or the skin, they form from overgrowth of the cells that make up the inside layer of blood vessels.
Hemangioblastomas are seen more often in people who have von Hippel-Lindau disease, a genetic disorder passed down through families. In addition to many with this disease having hemangiomas in the brain, the disorder can also produce hemangiomas in the back of the eye. There is also more risk of pancreatic and kidney cysts with von Hippel-Lindau disease.
Hemangiopericytomas are different. They are rarer, higher-grade tumors that are thought to form from an overgrowth of the cells that surround blood vessels in the meninges. They can eventually spread to other parts of the body.
While they are uncommon overall, internal hemangiomas are seen most often in the liver. As a result, there is good information about diagnosis and treatment for hemangiomas in this area. There is also good information about brain hemangiomas.
Internal hemangiomas are usually found by chance with scans for other conditions.
Medical research on other internal hemangiomas is much less advanced or detailed than that for hemangiomas in the skin. Medical guidance for external hemangiomas is well developed.
Many internal hemangiomas are described in medical journals as "case reports" - descriptions from doctors who have dealt with one or two cases.
Hemangiomas that affect the food pipe from the mouth to the stomach, known as esophageal hemangiomas, are very rare. In 2010, one case report of such a hemangioma cited figures from New York Medical College. Among almost 20,000 autopsies done there across a decade, only three cases of esophageal hemangioma were found.
For the woman's case described in this report, the details covered the particular experience of diagnosis and surgery for the lump in the food pipe. The 28-year-old patient recovered fully.
Internal hemangiomas are rare overall, and they rarely cause problems. They are usually discovered by chance when the body is scanned for some other reason.
Whether the scan accidentally finds a hemangioma or imaging is ordered to investigate symptoms caused by one, the tests are the same. A doctor may be able to feel a lump in some cases, and an internal hemangioma could be found via any of these tests:
- X-rays, including plain ones, or the detailed computer build-up of X-ray pictures produced by CT (computed tomography) scans
- MRI (magnetic resonance imaging) scans, which are more likely to be able to see the soft lumps of hemangioma
- Angiogram, an X-ray scan that shows up a dye injected into the blood vessels to highlight the hemangioma
Most internal hemangiomas that are discovered or investigated do not need treatment.
When these benign tumors do need treatment, the approach taken by doctors will be similar to that for any other benign lump.
They are only removed if they press on an organ or affect how the body works. If this occurs, they may be removed by surgery. If they cause pain, this may be another reason for operating.
For these less common internal hemangiomas that do need treatment:
Internal hemangiomas are only removed if they press on an organ or begin to affect how the body works.
- Brain hemangiomas are removed by surgery, but a form of focused radiation may be added if it is not completely removed.
- Liver hemangiomas are only removed when the symptoms give particular trouble, or the benign tumor is getting bigger at a quicker rate.
- Large liver hemangiomas in babies can lead to danger for the heart because of an effect on blood vessels. Steroids, heart drugs, surgical removal, and, rarely, radical liver surgery will be considered.
Unlike other benign growths that do not come back once removed by surgery, some hemangiomas do grow back.
A drug that is used for particularly troublesome skin hemangiomas in young children has not been approved for treating internal hemangiomas.
Some children who have been treated for multiple skin hemangiomas have had internal hemangiomas that were also treated by the drug called propranolol. More research will be needed before the drug is used for internal hemangiomas that are not linked to skin lesions.Written by Markus MacGill