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This review provides an updated analysis of select vascular anomalies, focusing on Kaposiform hemangioendothelioma (KHE), Kaposiform lymphangiomatosis (KLA), and intramuscular fast\u2010flow vascular anomalies. It highlights the similarities and differences between these lesions, their histopathological features, and molecular underpinnings, including key genetic mutations in the RAS\/PI3K\/mTOR signalling pathways. Moreover, the role of <jats:italic>PIK3CA<\/jats:italic> mutations in vascular overgrowth syndromes is explored, alongside emerging targeted therapies, such as PI3K and MEK inhibitors, that promise improved outcomes for patients with these challenging conditions. The integration of histology, molecular diagnostics, and multidisciplinary care remains critical for the accurate diagnosis and optimal treatment of vascular anomalies in the era of precision medicine.<\/jats:p>","DOI":"10.1111\/his.15374","type":"journal-article","created":{"date-parts":[[2024,12,4]],"date-time":"2024-12-04T08:47:31Z","timestamp":1733302051000},"page":"1032-1043","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Advances in vascular anomalies: refining classification in the molecular era"],"prefix":"10.1111","volume":"86","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3487-4641","authenticated-orcid":false,"given":"Juan","family":"Putra","sequence":"first","affiliation":[{"name":"Department of Pathology Boston Children's Hospital, and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1769-7839","authenticated-orcid":false,"given":"Alyaa","family":"Al\u2010Ibraheemi","sequence":"additional","affiliation":[{"name":"Department of Pathology Boston Children's Hospital, and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,12,4]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-198203000-00002"},{"key":"e_1_2_7_3_1","unstructured":"Classification and International Society for the Study of Vascular Anomalies.https:\/\/www.issva.org\/classification. 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