12/03/2026
Hemangioma
Angiomas and Vascular Tumors According to the International Society for the Study of Vascular Anomalies, angiomas are subclassified into hemangiomas and vascular malformations.45 Hemangiomas are considered to be endothelial proliferations; vascular malformations are considered to be developmental anomalies. Hemangiomas are the most common parotid gland tumor of infants. Three types may occur: hemangioendotheliomas and cavernous and capillary hemangiomas. The former two account for the vast majority of hemangiomas. The histological type, however, is of minor importance for therapy. Although there is a tendency of spontaneous regression, active treatment usually is recommended today because of possible rapid growth with infiltration of healthy tissue. Hemangiomas in general can be treated by excision, cryosurgery, or percutaneous or interstitial laser therapy or conservatively according to the size and location of the lesion. Since 2008, the first line treatment option of hemangiomas especially in deep tissue layers with considerable surgical morbidity like the parotid gland is propranolol (Figure 46-7).46 Vascular malformations are subclassified into high- or lowf low lesions. According to the vascular structure and hemodynamics, low-flow lesions can be classified into capillary, venous, or lymphatic malformations. The clinical diagnosis is conf irmed by color-coded duplex ultrasonography and MRI. Digital subtraction angiography is indicated as part of the treatment planning in high-flow malformations. In patients with venous malformations, percutaneous sclerotherapy is the first choice, sometimes combined with surgical reduction. In patients with arteriovenous malformations, transarterial embolization before radical surgical excision of the nidus is required. Lymphatic malformations most commonly are located in or near the parotid gland. Paraglandular extension may occur frequently. Acute inflammation of the lymphangioma often leads to rapid enlargement and pain. The lymphangioma congenitum cysticum colli may infiltrate the neck area extensively and often requires early surgery. Treatment options include surgical reduction or removal if possible. Hemangiopericytoma is an uncommon vascular tumor that was described first by Stout and Murray.47 Hemangiopericytoma still is recognized as a benign tumor. The differentiation between benign and malignant hemangiopericytomas, however, can be derived only from the clinical course. To date, the tumor must be classified as more malignant.
