Infantile hemangioma - Anogenital in
Ulceration occurs in about 5% of hemangiomas, most commonly in the anogenital region. Ulcerated hemangiomas are painful, often become secondarily infected, and tend to leave a scar. Bleeding and ulceration increase concern for possible sexual abuse. However, their characteristic development in early infancy and typical regression should help differentiate them from sexual abuse. Hemangiomas with extensive ulcerative changes have been confused with perineal burns secondary to child abuse. Although genital burns are a well-recognized manifestation of child abuse, knowledge of the clinical appearance and natural course of untreated hemangiomas may help prevent misdiagnosis.
Childhood sexual abuse is a problem of epidemic proportions affecting children of all ages and economic and cultural backgrounds. Although awareness is increasing, it is often challenging to differentiate findings attributable to child abuse from those of other benign anogenital skin conditions.
D18.01 – Hemangioma of skin and subcutaneous tissue
83343001 – Infantile hemangioma
- Congenital hemangioma (CH) – Fully formed vascular tumors at birth; two types are described: rapidly involuting congenital hemangiomas (RICH) and non-involuting congenital hemangiomas (NICH). The proliferative phase in these tumors occurs in utero, and typically they do not proliferate postnatally as seen with infantile hemangiomas. CHs are characterized by hemispheric pink to purple vascular plaques with overlying telangiectasia and the characteristic peripheral rim of pallor. Both RICH and NICH may look similar; however, NICH is less impressive and flatter than RICH. Histologically, they are GLUT-1 negative, which helps to differentiate them from other hemangiomas.
- Port-wine stain – Early lesions of hemangioma may be confused with port-wine stains, which are capillary malformations present at birth. They are pink or red patches that persist throughout life and do not have the typical growth phase of hemangiomas.
- Sometimes tufted angioma and kaposiform hemangioendothelioma may mimic hemangiomas. They present as extensive brownish vascular plaques with deep fibrotic consistency.
- Infantile myofibromatosis – Fibrohistiocytic proliferations characterized by skin-colored to purple, firm to hard or rubbery nodules that are usually present in the head and neck region
- Deep hemangiomas sometimes look similar to venous malformations, which do not go through a phase of rapid proliferation. Phleboliths are often seen in venous malformations. Magnetic resonance (MR) imaging will help to differentiate these two entities.
- Cystic schwannoma
- Fibrous histiocytoma
- Vascular leiomyoma
- Kaposi sarcoma
- Sexual abuse