Dear Editor,
I read with interest the article by Akhlaghpoor et al [1] entitled “Transarterial Bleomycin–Lipiodol Embolization (B/LE) for Symptomatic Giant Hepatic Hemangioma.” However, I would like to comment on the term “hemangioma,” as the treated lesions obviously are not hemangiomas.
The word “hemangioma” has been used for decades and unfortunately still is widely used in everyday practice to describe several lesions, which are nowadays known to be distinct pathological entities [2].
Suitable terms, that should be applied in this regard, are defined by the International Society for the Study of Vascular Anomalies (ISSVA) and summarized in its classification for vascular anomalies, recently updated in May 2018.
Experts of the ISSVA and others assume that liver or hepatic “hemangioma” in adult is in fact not a hemangioma at all, but rather a slow-flow vascular malformation, more precisely a venous malformation [2,3,4,5]. These lesions are histopathologically composed of malformed vessels, are glucose transporter 1 (GLUT 1) negative and do not undergo mitosis, and thus are vascular malformations [6].
A standardized nomenclature is critical for scientific communication and patient management, and utilizing the ISSVA approach for classification of vascular lesions is strongly recommended, not only for skin or soft tissue, but also for bone and viscera.
It is long overdue to put an end to the general incorrect use of the term “hemangioma,” also and in particular within the radiological community.
References
Akhlaghpoor S, Torkian P, Golzarian J. Transarterial bleomycin–lipiodol embolization (B/LE) for symptomatic giant hepatic hemangioma. J Cardiovasc Interv Radiol. 2018. https://doi.org/10.1007/s00270-018-2010-4.
Lowe LH, Marchant TC, Rivard DC, Scherbel AJ. Vascular malformations: classification and terminology the radiologist needs to know. Semin Roentgenol. 2012;47(2):106–17. https://doi.org/10.1053/j.ro.2011.11.002.
Mulliken JB, Burrows PE, Fishman SJ. Treatment of visceral vascular tumors. In: Mulliken JB, Burrows PE, Fishman SJ, editors. Mulliken and Young’s vascular anomalies: hemangiomas and malformations. 2nd ed. Oxford: University Press; 2013.
Kassarjian A, Zurakowski D, Dubois J, Paltiel HJ, Fishman SJ, Burrows PE. Infantile hepatic hemangiomas: clinical and imaging findings and their correlation with therapy. AJR Am J Roentgenol. 2004;182(3):785–95.
Behravesh S, Yakes W, Gupta N, Naidu S, Chong BW, Khademhosseini A, Oklu R. Venous malformations: clinical diagnosis and treatment. Cardiovasc Diagn Ther. 2016;6(6):557–69. https://doi.org/10.21037/cdt.2016.11.10.
Kollipara R, Dinneen L, Rentas KE, Saettele MR, Patel SA, Rivard DC, Lowe LH. Current classification and terminology of pediatric vascular anomalies. Am J Roentgenol. 2013;201:1124–35. https://doi.org/10.2214/AJR.12.105.
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Rott, G. Don’t Call It “Hemangioma”. Cardiovasc Intervent Radiol 42, 159 (2019). https://doi.org/10.1007/s00270-018-2025-x
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DOI: https://doi.org/10.1007/s00270-018-2025-x