Benign vascular tumours
- Lesion
Most vascular growths are benign: red birthmarks that shrink, bleeding nodules on gums and fingers, lymph-filled cysts and painful nail-bed lumps.
What it is
Vascular tumours range from benign haemangiomas, through intermediate (borderline) tumours that recur and rarely spread, to malignant angiosarcoma. Haemangiomas are the commonest tumours of infancy; capillary, juvenile (strawberry), cavernous and lobular capillary (pyogenic granuloma) types differ in vessel size and behaviour. Lymphangiomas are the lymphatic counterpart. The glomus tumour arises from modified smooth-muscle cells of the glomus body and is painful. Bacillary angiomatosis is an infection by Bartonella in immunocompromised people that mimics a vascular tumour.
Structure
- Capillary haemangioma: lobules of thin-walled capillaries lined by flat endothelium; strawberry haemangioma is cellular early and fibroses as it regresses.
- Cavernous haemangioma: large blood-filled spaces lined by endothelium with thin fibrous walls; may thrombose and calcify.
- Pyogenic granuloma: lobular capillaries in edematous stroma, often ulcerated with inflammation like granulation tissue.
- Lymphangioma: thin-walled lymphatic spaces with protein-rich fluid, lymphoid aggregates in the stroma.
- Glomus tumour: nests of uniform round cells with central nuclei around vessels, smooth-muscle actin positive.
- Bacillary angiomatosis: capillary proliferation with plump endothelium, neutrophils, nuclear dust and clumps of bacteria.
Vascular tumours by behaviour
| Group | Examples | Behaviour |
|---|---|---|
| Benign | Capillary, juvenile and cavernous haemangioma; pyogenic granuloma; lymphangioma; glomus tumour | Do not spread; some regress |
| Reactive, tumour-like | Bacillary angiomatosis, granulation tissue | Resolve when the cause is treated |
| Intermediate (borderline) | Kaposi sarcoma, some haemangioendotheliomas | Recur locally, metastasise rarely |
| Malignant | Angiosarcoma, epithelioid haemangioendothelioma | Invasive, metastasise |
| Useful markers | CD31, CD34, ERG (endothelium); D2-40 (lymphatics); GLUT1 in infantile haemangioma | Confirm endothelial origin |
Clinical notes
- Large infantile haemangiomas near the eye or airway need treatment; most others are observed as they regress.
- Many haemangiomas of the liver are found by chance on imaging and need no treatment.
Test yourself
Think of the answer, then tap the question to see it.
What usually happens to a juvenile (strawberry) haemangioma?
It grows rapidly in the first months of life and then regresses in most children by school age.
Which stain shows the bacteria of bacillary angiomatosis?
The Warthin–Starry silver stain (Bartonella organisms).
Where does a glomus tumour typically occur, and what is the symptom?
Under the fingernail (distal digit); it causes severe pain, often triggered by cold or pressure.
Connections
Microorganisms1
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Hemangioma: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2025); Childhood Vascular Tumors Treatment (PDQ®)–Health Professional Version (National Cancer Institute, 2025).
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Representative model, for educational purposes only.