Haemangioma left pinna with extensive , multiple skin ulcerations

Hemangioma is a benign vascular tumours constitute 7% of all benign tumours arise from arterioles, venules & capillaries. It is deep red or blue-purple in colour, blench on pressure. Usually it is small & of no consequence is seen in isolation, but few may be multiple and /or part of a wider syndrome. It is prone to extenssive bleeding if wall is damaged. It is best treated with cryosungery or laser or if so large then by ligation or embolization of the feeding vessels. Here we have encountered a case of haemangioma in the left pinna with extensive and multiple ulcerations of the skin, which is not so common site for development.

different.If on skin surface it may be strawberry like, if just under skin it may be present as a bluish swelling even it may present as a flat red or pink area.According the researches of university of Arkansas maternal placenta may embolize to the fetal dermis, during gestational period and can result in formation of haemangioma 2,3 .It usually not associated with complications.It may be problematic & ulcerates if surface is lacerated or severely staveted.

Case report:
A 20-year-old young male came to our hospital on January, 2010 with the complaint of a swelling in the upper part of left pinna for 3 years which was very slowly enlarging.The swelling mainly involving in the upper part of the medial and ateral surface of pinna bluishblack in colour about 5cmx 3cm in size with multiple ulcerations in the upper part of the lesion(fig: 1).It was incised locally in village 1 month ago by surgery and bleeding became very difficult to control.After admission to our hospital we had decided to operete the case.
. At the initial stage of surgery we aspirate and blood comes out from the lesion.Then we opened the pinna and found skin was involved and most of the involved part was necrosed.We excised the involved part of skin, subcutaneous tissue and preserving cartilage as much as possible(fig: 2).The proper haemostasis was secured and wound was closed and specimen was sent for histopatholgy.Post operatively the shape of the pinna was acceptable.
Histopatholgical sections shown benign tumour composed of proliferating blood vessels heavily infiltrate with inflamatory cells containing numerous eosinophils.Surface ulecration and presence of epidermal inclusion cysts are also seen and the features consistent with haemangioma.

Discussion:
Haemangiomas are common lesions of face, nose, throat, ear, neck, liver and most often seen to involve the lips, tongue and buccal mucosa.They are classified into three basic types, capillary haemangioma, cavernous haemangioma and arterial or plexiform haemangioma.Before considering the haemangioma, it is important to understand that there have been changes in the terminology used to define, describe and categorise vascular anomalies.The term haemangioma was originally used to describe any vascular tumour like structure, where it was present at or around birth or appeared in later life.
Mulliken et at.catagorized the conditions into two families, a family of self involuting tumours growing lesions that eventually disappear and another family of malformations (enlarged or abnormal vessels present at birth and essentially permanent) The importance of this distinction is that it makes possible for early in-life differentiation between lesions that will resolve versus that are permanent 3 .
Haemangiomas are the most common childhood tumour, but in our case report the age of the patient was 20 years.Females are there to five times more likely to have haemangiomas than male but our patient is male.They are also common in twin pregnancies.Approximately 80% are located on the face and neck, with next most prevalent location being the liver 4,5 .
Hemangioma in the pinna is a rare condition.Hemangioma in the middle ear are found.They develop at a number of site, in the temporal bone with the geniculate ganglion being the most common.Usually they present with conductive deafness.Some haemangiomas may regress spontaniously while others continue to grow and are locally destructive.Hemangioma in the pinna usually are not associated with complications, until cartilage in it may break down on the surface (ulcerated).
The most frequent complaints about haemongioma, however, stem from psychosocial complications, the condition can affect a persons appearance and can provoke attention and malicious reaction from others.The potential for psychological injury develops from school age onwards.It is therefore important to consider treatment prior to school if adequate spontaneous improvement has not occurred.
Most haemoagiomas disappear without treatment, leaving minimal or no visible marks.Large haemongiomas can leave visible skin changes secondary to severe stretching of the skin or damage to surface texture.When haemangiomas interfere with hearing, vision, breathing or threaten significant cosmetic injury, they are usually treated 6,7 .
Up until recently, the mainstay of treatment was oral corticosteriod therapy.Beta blocker treatment using agents such as propanolol is revolutionising therapy, producing impressive responses.A publicaition in the international literature in June 2008 first suggested that propranolol (a Beta blocker) could be used to treat severe haemangioma 8 .This treatment is proving superior to corticosteroids, in terms of both effectiveness and safety.Surgical removal is sometimes indicated, particularly if there has been delay in commencing treatment and structural changes have become irreversible.Surgery also may be required to correct distortion of apperance, again in the case of inadequate or failed early medical intervention.Our case was excellent after surgery.