title: Cellular markers that distinguish the phases of hemangioma during infancy and childhood.
abstract: Hemangiomas, localized tumors of blood vessels, appear in approximately 10-12% of Caucasian infants. These lesions are characterized by a rapid proliferation of capillaries for the first year (proliferating phase), followed by slow, inevitable, regression of the tumor over the ensuing 1-5 yr (involuting phase), and continual improvement until 6-12 yr of age (involuted phase). To delineate the clinically observed growth phases of hemangiomas at a cellular level, we undertook an immunohistochemical analysis using nine independent markers. The proliferating phase was defined by high expression of proliferating cell nuclear antigen, type IV collagenase, and vascular endothelial growth factor. Elevated expression of the tissue inhibitor of metalloproteinase, TIMP 1, an inhibitor of new blood vessel formation, was observed exclusively in the involuting phase. High expression of basic fibroblast growth factor (bFGF) and urokinase was present in the proliferating and involuting phases. There was coexpression of bFGF and endothelial phenotypic markers CD31 and von Willebrand factor in the proliferating phase. These results provide an objective basis for staging hemangiomas and may be used to evaluate pharmacological agents, such as corticosteroids and interferon alfa-2a, which accelerate regression of hemangiomas. By contrast, vascular malformations do not express proliferating cell nuclear antigen, vascular endothelial growth factor, bFGF, type IV collagenase, and urokinase. These data demonstrate immunohistochemical differences between proliferating hemangiomas and vascular malformations which reflect the biological distinctions between these vascular lesions.
authors.affiliation: Division of Hematology/Oncology, Children's Hospital, Boston, Massachusetts 02115.
authors.forename: K
authors.initials: K
authors.lastname: Takahashi
authors.forename: J B
authors.initials: JB
authors.lastname: Mulliken
authors.forename: H P
authors.initials: HP
authors.lastname: Kozakewich
authors.forename: R A
authors.initials: RA
authors.lastname: Rogers
authors.forename: J
authors.initials: J
authors.lastname: Folkman
authors.forename: R A
authors.initials: RA
authors.lastname: Ezekowitz
mesh_terms: D000293:Adolescent; D014408:Biomarkers, Tumor / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D017364:Collagenases / Q000032:analysis; D016228:Endothelial Growth Factors / Q000032:analysis; D016222:Fibroblast Growth Factor 2 / Q000032:analysis; D006023:Glycoproteins / Q000032:analysis; D006391:Hemangioma / Q000737:chemistry* / Q000473:pathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008222:Lymphokines / Q000032:analysis; D008407:Mast Cells; D020780:Matrix Metalloproteinase 9; D009367:Neoplasm Staging; D009687:Nuclear Proteins / Q000032:analysis; D018809:Proliferating Cell Nuclear Antigen; D019714:Tissue Inhibitor of Metalloproteinases; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors
chemical_list: D014408:Biomarkers, Tumor; D016228:Endothelial Growth Factors; D006023:Glycoproteins; D008222:Lymphokines; D009687:Nuclear Proteins; D018809:Proliferating Cell Nuclear Antigen; D019714:Tissue Inhibitor of Metalloproteinases; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors; D016222:Fibroblast Growth Factor 2; D017364:Collagenases; D020780:Matrix Metalloproteinase 9