Vascular Anomalies, Malformations & Tumours

Vascular Anomalies, Malformations & Tumours

Vascular anomalies can be classified as malformations or tumours. This article details their pathology and classification systems


Summary Card

Classifications
ISSVA system based on the work by Mulliken and Glowacki.
High-flow vs Low-flow

Vascular Tumours
Vasoproliferate disorders that do not grow in proportion to the patient. They can be benign, borderless or malignant.

Vascular Malformations
Structural abnormalities that grow in proportion to the patient. They can be simple, combined or associated with other conditions.



Classification of Vascular Anomalies


Key Point

The International Society for the Study of Vascular Anomalies (ISSVA) developed a classification system based on the seminal work by Mulliken and Glowacki.

The ISSVA revised its classification system in 2018. It is now the standard system used for classification, communication, and documentation. It is seen in the table below.

Classification of Vascular Tumours and Malformations

Other classification systems have been published. For example

  1. Fishman1: patterns of flow (fast vs slow)
  2. Mulliken and Glowacki2: endothelial properties (hemangiomas have proliferative endothelium, vascular malformations have stable endothelium)
  3. Jackson3: clinical, histologic, and vascular flow

High and Low Flow Vascular Malformations

🤭
Tip: any malformation with arterial involvement is "high-flow".


Vascular Tumours


Key Point

Vascular tumours are vasoproliferative disorders with increased endothelial cell tumours. They do not grow in proportion with the patient. Infantile haemangioma is the commonest type.


Vascular tumours are vasoproliferative disorders with increased endothelial cell tumours. They do not grow in proportion with the patient. These can be benign, locally aggressive or malignant.

The types of vascular tumours are illustrated in the table below.

Types of Vascular Tumours

😎
Fun Fact: An infantile haemangioma is the commonest tumour in infancy. 


Vascular Malformations


Key Point

Vascular malformations are "structural abnormalities". The grow in proportion to the patient. They can be related to other systemic anomalies.


Vascular malformations are "structural abnormalities". The grow in proportion to the patient. These can be simple, combined, or named in relation to a vessel.  

The types of simple and combined vascular malformations are illustrated in the table below.

Vascular abnormalities can be linked to other abnormalities in the body. These include:

  • Sturge-Weber Syndrome: capillary malformation of the trigeminal nerve
  • Parkes-Weber Syndrome
  • Klippel-Trenaunay Syndrome


References

  1. Fishman, S.J., and Mulliken, J.B.Vascular anomalies: A primer for pediatricians. Pediatr. Clin. North Am. 45: 1455, 1998.
  2. Mulliken, J. B., and Glowacki, J. Hemangiomas and vascular malformations in infants and children: A classification based on endothelial characteristics. Plast. Reconstr. Surg. 69: 412, 1982.
  3. Jackson, I. T., Carreno, R., Potparic, Z., et al. Hemangiomas, vascular malformations, and lymphovenous malformations: Classification and

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