Vascular lesions: time to abandon the nomenclature of edibles!

After a long conversation discussing the management plan for a “giant cavernous hemangioma” of the liver, and although I had just recently brushed up on the subject of vascular lesions, I had to go back and look it up again. I was pretty sure the term “cavernous hemangioma” was as antiquated as “strawberry hemangioma” or “port wine stain”; the generalized agreement around me on the diagnosis made me doubts myself. Back to the books.

Sure enough, as of 25 years ago, the International Society on the Study of Vascular Lesions adopted the Mulliken system of classification, which divides vascular lesions into tumors (mainly infantile hemangiomas) and malformations (capillary, venous, lymphatic malformations etc…). This division is based on clinical and histologic characteristics; vascular tumors display endothelial proliferation and usually regress with time, while vascular malformations have a quiescent epithelium, result from dysmorphogensis of vessels, and tend to enlarge with time.

No more should the term lymphangioma, which by vertue of the –oma suffix suggests a tumor, be used to describe a lesion that is a malformation (lymphatic malformation). Nor should the term cavernous hemangioma be used to describe what could either be a deep visceral hemangioma or a venous malformation (two distinct entities, treated in very different ways).

A study by Hassanein et al reviewed articles on vascular lesions and noted a 70% incidence of incorrect nomenclature and a subsequent 20% incidence of incorrect treatment based on erroneous classification. They commented that this is probably an underestimation of the incidence of incorrect diagnosis and treatment in clinical practice, given that experts had probably edited many of these articles for accuracy.

Another reason we should continue to read, read, and read some more.

Reference:
Hassanein et al. Evaluation of terminology for vascular anomalies in current literature. Plastic and Reconstructive Surgery (2011);127(1):347