Pediatric Clinics of North America - CIPERJ

Pediatr Clin N Am 55 (2008) 339–355
The Role of the Hematologist/Oncologist
in the Care of Patients
with Vascular Anomalies
Denise M. Adams, MD a,b, *, Mary Sue Wentzel, RN b
a Division of Hematology/Oncology, Cincinnati Children’s Hospital Medical Center, University
of Cincinnati, MLC 7015, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
b Hemangioma and Vascular Malformation Center, Cincinnati Children’s Hospital
Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
The proper care of children who have vascular anomalies requires the expertise
of multiple pediatric specialists. In the past, there was much debate
concerning the appropriate treatment of these lesions and which specialists
needed to be involved. Many patients were evaluated by specialists who
were confused about the diagnosis and the proper medical management.
Because of the need for an interdisciplinary approach, several vascular
anomalies centers have been developed across the world. These clinics are
composed of specialists who have clinical acumen in surgery, radiology, dermatology,
hematology, oncology, pathology, neurology, ophthalmology,
cardiology, gastroenterology, and basic sciences. This comprehensive multidisciplinary
approach offers the best opportunity for children who have vascular
anomalies to obtain optimal diagnostic and therapeutic management
of these complex lesions.
A classification system for vascular anomalies first was proposed in 1982
by Mulliken and Glowacki [1]. This initial scheme distinguished hemangiomas
from vascular malformations based on clinical appearance, histopathologic
features, and biologic behavior. Hemangiomas were identified as
vascular tumors with an active growth phase, characterized by endothelial
proliferation and hypercellularity, followed by an involutional phase.
Vascular malformations were described as congenital malformations of
the vasculature derived from capillaries, veins, lymphatic vessels, or arteries
* Corresponding author. Division of Hematology/Oncology, Cincinnati Children’s
Hospital Medical Center, University of Cincinnati, MLC 7015, 3333 Burnet Avenue,
Cincinnati, OH 45229.
E-mail address: denise.adams@cchmc.org (D.M. Adams).
0031-3955/08/$ - see front matter. Published by Elsevier Inc.
doi:10.1016/j.pcl.2008.01.007
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