Soft tissue
Vascular - normal / benign
Venous hemangioma

Author: Jian-Hua Qiao, M.D., FCAP (see Authors page)

Revised: 17 July 2017, last major update July 2017

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Venous hemangioma [title]

Cite this page: Venous hemangioma. PathologyOutlines.com website. http://pathologyoutlines.com/topic/softtissuevenoushemangioma.html. Accessed November 22nd, 2017.
Definition / general
  • Also called venous malformation (VM)
  • Rare slow growing benign tumor of aberrant and ectatic venous connections
  • Vascular anomalies, including venous hemangiomas, are congenital lesions of abnormal vascular development
Essential features
  • Mainly present in adults
  • Tumor present in the subcutaneous or deep soft tissues with predilection for the limbs
  • Also present as a long standing slow growing tumor
  • Rapid growth may occur during puberty, pregnancy or traumatic injury
  • Calcifications can be seen in these tumors due to phleboliths (calcified thrombi)
  • Deep seated tumor is difficult to excise and can recur locally but subcutaneous tumors do not show a tendency to recur
Terminology
  • Venous hemangioma / venous malformation
Epidemiology
  • Incidence ~ 1 in 10,000
  • Most occur sporadically
  • Both men and women are affected
Sites
  • Mostly in adult limbs
Pathophysiology
  • Aberrant venous connections lead to venous congestion, thrombosis, phlebolith formation and gradual expansion of these lesions
Etiology
  • Vascular / venous malformation
  • Inherited forms of venous hemangiomas are autosomal dominant disorders and have been localized to chromosome 9p
  • Mutation of angiopoetin receptor gene TIE2 / TEK was recently discovered in multiple sporadic venous hemangiomas
Clinical features
  • Visible at birth but presents as a deep mass
  • Overlying skin may appear normal or possess a bluish discoloration
  • With more cutaneous involvement, the lesions appear darker blue or purple
Diagnosis
  • Calcifications can be seen in the radiological examinations due to phleboliths (calcified thrombi) within venous hemangiomas
  • MRI is the imaging modality of choice for diagnosing venous hemangioma; it offers superior delineation of the disease, which is necessary for treatment planning
Laboratory
  • D dimer may be elevated and a marker of disease
Radiology description
  • Radiographic studies, angiogram and MRI
Prognostic factors
  • Deep seated tumor is difficult to excise and can recur locally
  • Subcutaneous tumors do not show a tendency to recur
Treatment
  • Different treatment modalities based on size, location and patient age, including periodic observation, embolization, sclerotherapy, radiofrequency ablation and wide surgical excision
Gross description
  • Hemorrhagic cutaneous or deep soft tissue mass with ill defined and dilated vessels
Microscopic (histologic) description
  • Typically consists of closely packed thick walled vessels, which are variably dilated and commonly display thrombosis with occasionally formation of phleboliths (calcified thrombi)
  • Vein valves are present
  • Occasional hemosiderin interposition can be seen in vessel walls
Microscopic (histologic) images

Images hosted on PathOut server:

Images contributed by Jian-Hua Qiao, M.D., FCAP

Low power

High power

Mural thrombus formation

Large laminated thrombus

Thrombus with proliferation of fibroblasts

Focal hemosiderin deposition

Board review question #1
Which statements are true about venous hemangioma:

  1. It can grow rapidly during pregnancy
  2. The deep soft tissue tumor can be entirely excised without recurrence
  3. The tumor can be found in subcutaneous tissue or deep soft tissue
  4. Venous hemangioma is a slow growing tumor


  1. (1,3,4)
  2. (1,4)
  3. (2,3)
  4. (1,2,3,4)
Board review answer #1
A. (All but 2 are correct; 2 is wrong, since deep seated tumors are difficult to excise and can recur locally)