Circulating Level of Vascular Endothelial Growth Factor in Differentiating Hemangioma from Vascular Malformation Patients

Background: The majority of vascular anomalies can be diagnosed accurately based on natural history and physical examination; however, there is no convenient, noninvasive, and objective method to (1) differentiate hemangioma from vascular malformation; (2) determine whether a hemangioma is in the proliferating or involuting phase; (3) tell whether or not corticosteroids or interferon alfa-2a is effective for hemangioma; or (4) follow up hemangioma. Although the differences in endothelial cell, protein, and mRNA expression levels of some positive and negative angiogenic factors in the lesions can help to solve these problems, these methods (pathological section, immunohistochemical analysis, and in situ hybridization techniques) necessitate that a biopsy be performed, and the procedures are complicated. A nonsurgical and convenient method would have significant clinical applications. Methods: Fifty-nine patients with proliferating hemangiomas, 38 with involuting hemangiomas, 18 with vascular malformations, and 12 negative control subjects were examined for serum levels of vascular endothelial growth factor using enzyme-linked immunosorbent assays. Results: The serum level of vascular endothelial growth factor in proliferating hemangiomas was significantly higher than that in involuting hemangiomas, vascular malformations, and negative controls, while differences among involuting hemangiomas, vascular malformations, and negative controls were not statistically significant. In addition, after systemic steroid therapy, the serum level of vascular endothelial growth factor was significantly reduced compared with pretreatment levels in six patients with proliferating hemangiomas. Conclusions: The serum level of vascular endothelial growth factor may be useful in differentiating hemangioma from vascular malformations, staging hemangiomas, judging the efficacy of steroid therapy, and evaluating follow-up criteria for hemangiomas. The results probably shed new light on the pathogenesis of hemangiomas.