Correspondence
Synovial Hemangioma
N Engl J Med 1999; 341:2019December 23, 1999
- Article
To the Editor:
Hemangiomas and structural malformations of the vasculature are distinct entities that have different biologic features and require different therapeutic approaches.1 This distinction was nicely stated in the review of hemangiomas in children by Drolet and colleagues.2 In addition, these authors point out that the term “cavernous hemangioma” is confusing because it has been used to describe hemangiomas as well as structural anomalies. Thus, I was surprised by the images of a synovial hemangioma by Macdonald and Gollish (July 29 issue).3 The vascular tumor depicted is a typical example of a vascular malformation and not of a hemangioma or a cavernous hemangioma, as the authors state. Vascular malformations should be distinguished from hemangiomas of infancy.
3 ReferencesCharlotte M. Niemeyer, M.D.
University Children's Hospital Freiburg, D-79106 Freiburg, Germany1
Mulliken JB ,Glowacki J . Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg 1982;69:412-422
CrossRef | Web of Science | Medline2
Drolet BA ,Esterly NB ,Frieden IJ . Hemangiomas in children. N Engl J Med 1999;341:173-181
Full Text | Web of Science | Medline3
Macdonald D ,Gollish J . Synovial hemangioma. N Engl J Med 1999;341:336-336
Full Text | Web of Science | Medline
Author/Editor Response
The authors reply:
To the Editor: The origin and classification of vascular lesions remain controversial.1,2 The system cited by Niemeyer is one approach,3 but it is not universally accepted. We favor an approach in which a hemangioma is defined as a benign (nonreactive) process marked by an increase in the number of vessels, which may appear histologically “normal” or “abnormal.”3 In a large series of cases of synovial hemangioma, Devaney et al. noted the histologic overlap between reactive, hamartomatous lesions and true neoplasms of vascular tissue.4 They concluded that the finding of large, cavernous spaces (the histologic finding in our patient) can be interpreted as evidence of a hemangioma and not a reactive lesion. Like Devaney et al., we do not attempt to distinguish vascular malformations from true benign neoplasms on histologic grounds, one of the three criteria advocated by Mulliken and Glowacki.3 It would be impossible to use their other two criteria — the findings on physical examination at birth and the growth characteristics of the lesion. Although our patient had a history of trauma to his knee, this circumstance is unusual, and only 3 of the 20 patients in the series described by Devaney et al. had a history of trauma, making it an unlikely cause of such a vascular proliferation. Perhaps a neutral term, such as “benign vascular lesion,” would encompass all these theories, but until a consensus is reached, hemangioma remains a term of convenience and not one imputing the condition to a pathogenic mechanism.
4 ReferencesDenis Macdonald, M.D.
Jeffrey Gollish, M.D.
Orthopedic and Arthritic Institute, Toronto, ON M4N 3M5, Canada1
Vigorita V. Synovial tumors — benign. In: Orthopaedic pathology. Philadelphia: Lippincott Williams & Wilkins, 1999:544-5.
2
Benign tumors and tumor-like conditions of blood vessels. In: Enziger FM, Weiss SW. Soft tissue tumors. 3rd ed. St. Louis: C.V. Mosby, 1995:579-626.
3
Mulliken JB ,Glowacki J . Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg 1982;69:412-422
CrossRef | Web of Science | Medline4
Devaney K ,Vinh TN ,Sweet DE . Synovial hemangioma: a report of 20 cases with differential diagnostic considerations. Hum Pathol 1993;24:737-745
CrossRef | Web of Science | Medline
- Citing Articles (1)
Citing Articles
1
Xiao-Ming Ying, Peng Wang, Ben-Shun Yao, Hai-Yang Gu, Quan-Zhen Xu. (2011) Hematuria after Orthopedic Tuina: A Case Report and Brief Review of Literature. Evidence-Based Complementary and Alternative Medicine 2011, 1-3
CrossRef
