Benign perivascular tumor is a noncancerous growth that forms around small blood vessels. People with a benign perivascular tumor may notice a painless lump, swelling, or a slow-growing mass under the skin or within soft tissue. It usually grows slowly over months to years and can appear at any age, though patterns vary by subtype. The outlook is generally very good, and mortality is extremely rare. Treatment often involves monitoring or surgical removal if the benign perivascular tumor causes pain, grows, or affects nearby structures.
Overview
Benign perivascular tumorSymptoms
Benign perivascular tumor symptoms depend on location: often a slow-growing, painless lump. If near nerves or organs, may cause aching, swelling, or tingling; occasionally limited movement or pressure effects. Skin lesions may look reddish or bluish and feel firm.
Outlook and prognosis
Most people with a benign perivascular tumor do well. These tumors grow slowly, often stay small, and are frequently cured with complete removal, with low chances of coming back. Regular follow-up helps catch rare recurrences or changes early.
Causes and risk factors
Benign perivascular tumor usually develops sporadically and isn’t inherited. Aside from rare tumor-cell genetic changes or links with certain syndromes, no consistent environmental or lifestyle risks are known; it’s reported more often in adults.
Genetic influences
Genetics play a modest role in benign perivascular tumor. Most cases seem sporadic, with no clear inherited pattern. Rarely, specific genetic changes in tumor cells drive growth, but family risk appears low.
Diagnosis
Doctors usually diagnose benign perivascular tumor with a physical exam and imaging such as ultrasound or MRI. A biopsy confirms the diagnosis of benign perivascular tumor by checking the cells and ruling out cancer. Pathology reports guide treatment.
Treatment and drugs
Treatment for Benign perivascular tumor depends on size, location, and symptoms. Small, quiet tumors may be watched with periodic exams or imaging; bothersome or growing tumors are usually removed with surgery, sometimes using minimally invasive or image‑guided techniques. Pain or swelling can be managed with targeted medicines and local measures.
Symptoms
Many people first notice a small, well-defined lump under the skin that feels tender when bumped or pressed. Symptoms vary from person to person and can change over time. Early symptoms of Benign perivascular tumor often include soreness with pressure, brief, sharp pain, or sensitivity to cold if the lump is in a fingertip. These growths usually develop slowly, and for many, the main issue is discomfort during everyday tasks like buttoning a shirt or gripping a bag.
A firm or rubbery bump may appear under the skin and stay in one spot. With a Benign perivascular tumor, it often grows slowly over months.
Pain can be aching or sharp and tends to flare when the area is pressed or bumped. The discomfort may come and go through the day.
Even light pressure, like resting a bag strap or tapping a keyboard, can feel unusually sore. This tenderness often makes people protect or avoid using the area.
In fingers or toes, brief exposure to cold can trigger intense, pinpoint pain. Some living with a Benign perivascular tumor under a nail describe a quick, stabbing sensation in cold air or water.
How people usually first notice Benign perivascular tumor?
Many people first notice a small, painless lump under the skin that seems slow-growing and well-defined, often found by chance during a shower or routine exam. A clinician may spot it on imaging done for another reason, or recognize it during a skin or soft-tissue check because it feels rubbery and doesn’t stick to deeper tissues; occasionally there’s mild tenderness or a change in nearby skin color if the tumor presses on small blood vessels. If the lump changes size, becomes painful, or affects movement or sensation, that’s usually what prompts a visit to a healthcare professional who can evaluate it and confirm it’s a benign perivascular tumor.
Types of Benign perivascular tumor
Benign perivascular tumor is an umbrella term for several rare, non-cancerous growths that form around small blood vessels. These include well-recognized variants with different cell makeups, growth patterns, and usual body locations. Understanding the main variants of these tumors can clarify why symptoms differ—some stay small and painless, while others press on nearby structures. When people search for types of benign perivascular tumor, they’re usually asking about these clinical variants and where they tend to occur.
Hemangiopericytoma-like
Grows from cells wrapped around capillaries, often in the limbs or pelvis. Many stay slow-growing and painless, but larger ones can cause a lump or ache from pressure. Imaging helps define borders, while biopsy confirms the diagnosis.
Myopericytoma
Usually a small, firm nodule under the skin of the arms or legs. Most are painless and discovered by touch or during a routine exam. They rarely recur after complete removal.
Glomus tumor
Classically occurs under a fingernail or in fingers and is very sensitive to cold or touch. People often notice sharp, pinpoint pain and tenderness with temperature changes. Small size can hide it on exam until targeted imaging is done.
Angioleiomyoma
A smooth-muscle–based vascular nodule, commonly in the calf or forearm. It may cause aching pain with standing or exercise due to vessel constriction. Many are solitary and respond well to surgical removal.
Myofibroma / myofibromatosis
Appears as one or multiple nodules in infants, children, or adults. Single lesions often stay localized, while multiple lesions can span soft tissue and sometimes bone. Pain or swelling depends on location and depth.
Retiform hemangioendothelioma
A very rare, locally aggressive vascular tumor that tends to recur but rarely spreads. Lesions are usually plaque-like or nodular on limbs. Long-term follow-up is important due to local regrowth risk.
Papillary intralymphatic angioendothelioma
Forms within lymphatic channels, often in the skin or soft tissue of children and young adults. It grows slowly but can recur nearby after treatment. Symptoms are usually a soft mass or swelling rather than pain.
Glomangiomyoma
A variant with features of both glomus cells and smooth muscle, often in extremities. Pain and cold sensitivity may be milder than classic glomus tumor. Most are cured with excision.
Leiomyoma (vascular)
Benign smooth-muscle tumors arising from vessel walls in skin or deep soft tissue. They can be tender to touch or with cold, especially cutaneous types. Larger deep lesions may simply present as a firm, mobile mass.
Hemangioblastoma (CNS-associated)
A highly vascular benign tumor seen in the brain or spinal cord, sometimes linked with genetic conditions. Symptoms come from pressure on nearby nerves, causing headaches, balance problems, or limb weakness. Brain or spine imaging identifies the lesion and guides treatment.
What genetics can tell you about symptoms
Some benign perivascular tumors are linked to changes in TSC1 or TSC2 genes, which can drive cells to grow into perivascular epithelioid cell tumors (PEComas) that cause painless lumps, pressure discomfort, or organ-specific symptoms if they press nearby structures. Inherited TSC variants raise the chance of multiple tumors, while non-inherited (somatic) variants usually lead to a single growth.
Causes and risk factors
Benign perivascular tumor usually has no single clear cause.
Known risk factors for benign perivascular tumor include gene changes seen with tuberous sclerosis complex (TSC).
Age and sex are biological factors, and some types are more common in adults and in women.
There are no well-established links for diet, exercise, or everyday environmental exposures.
Having risk factors doesn’t mean you’ll definitely develop the condition.
Environmental and biological risk factors
Benign perivascular tumor refers to a noncancerous growth that forms around small blood vessels, often noticed as a firm, small lump that can get in the way of daily tasks like typing or fastening buttons. Doctors often group risks into internal (biological) and external (environmental). Risk factors don’t predict early symptoms of benign perivascular tumor, but they can guide when to ask about new or changing lumps. Most arise without a clear trigger, yet a few patterns are known.
These tumors are found more often in adults than in children. Middle age is a common time to notice them.
Sites with many tiny blood-vessel support cells, like fingertips or under the nail, are more likely locations. This is a biological pattern rather than something you cause.
Body hormone changes, such as during pregnancy, may make an existing lump grow or become more noticeable. This is a biological influence and not a cause on its own.
Some benign soft-tissue tumors are reported at sites of earlier bruises, cuts, or surgery. This link is observational, and a true cause-and-effect is not proven.
Genetic risk factors
For people facing a benign perivascular tumor, genes can sometimes help explain why it develops or who is more likely to have one. Different subtypes have different patterns, from changes you’re born with to one-off changes found only in the tumor. Carrying a genetic change doesn’t guarantee the condition will appear. Understanding genetic risk factors for benign perivascular tumor can guide testing and family conversations.
TSC1/TSC2 changes: Changes in these growth-control genes can lead to perivascular epithelioid cell tumors (PEComas). People with tuberous sclerosis complex have a higher chance of this type of benign perivascular tumor. These changes can overactivate a cell-growth switch called mTOR.
TFE3 fusions: Some PEComas have a swap involving the TFE3 gene that is found only in the tumor. This change is usually not inherited, but it can help explain the tumor’s behavior. Pathology testing can look for this pattern.
GLMN mutations: An inherited change in the GLMN gene can cause multiple glomus-type lesions (glomuvenous malformations). Families may notice several relatives with small, bluish, tender nodules under the skin. Finding the gene change can clarify risk for children.
PDGFRB variants: Changes in this signaling gene can underlie infantile myofibromatosis and some myopericytomas. These conditions sit on the perivascular tumor spectrum and can run in families. Genetic testing can help estimate recurrence risk.
Mosaic changes: Sometimes a gene change happens after conception and affects only a patch of tissue. This can lead to clusters of glomus-type lesions without a family history. The change may not show up on a standard blood test.
Family history: Having a parent or sibling with a known GLMN, PDGFRB, or TSC1/TSC2 change raises personal risk. The exact chance depends on the specific gene and whether the change is inherited or mosaic. A genetics visit can personalize risk for benign perivascular tumor.
Tumor-only mutations: Many benign perivascular tumors arise from DNA changes limited to the tumor itself. These are not passed down and usually do not increase risk for relatives. Testing the tumor can pinpoint the pathway involved.
Lifestyle risk factors
Benign perivascular tumors are usually sporadic, but day-to-day habits can influence symptoms such as pain, swelling, and bruising, and can affect recovery after treatment. The following lifestyle risk factors for Benign perivascular tumor center on behaviors that may aggravate vascularity, pressure, or bleeding tendency, or that support healing. Discuss any changes with your clinician, especially if you have a tumor near critical structures or are planning surgery.
Tobacco impairs small-vessel blood flow and delays wound healing after tumor removal. It may also increase infection and scar problems around the tumor site.
Aspirin, anticoagulants, and frequent NSAID use can increase bruising and bleeding from a vascular tumor. Do not stop prescribed medicines without medical guidance.
Constant friction from tight clothing, straps, or occupational tools can worsen tenderness and provoke bleeding in superficial lesions. Padding or adjusting gear can reduce irritation.
Running or contact sports can aggravate pain and microbleeding in tumors located in weight-bearing or high-motion areas. Low-impact activity often maintains fitness with fewer flare-ups.
Risk prevention
Benign perivascular tumor usually can’t be prevented from forming, but you can lower the chance of problems and catch changes early. Prevention is about lowering risk, not eliminating it completely. Regular monitoring and protecting the area can help avoid pain, bleeding, or irritation in daily life. Talk with your care team about a plan that fits where the tumor is and how it behaves.
Schedule skin or soft-tissue exams as advised by your clinician. Imaging or ultrasound may be used if the benign perivascular tumor is deep or near nerves.
Tell your doctor about new pain, rapid growth, color change, warmth, or bleeding. Knowing the early symptoms of benign perivascular tumor helps you get timely care.
Avoid repeated friction, pressure, or direct blows to the lump, especially during sports or heavy work. Soft padding or clothing adjustments can reduce irritation and bleeding risk.
If you take blood thinners or aspirin, ask whether any adjustments are needed before procedures. Keep small cuts clean and covered if the tumor is bumped and bleeds.
Transmission
Benign perivascular tumor is not contagious; it cannot be spread through casual contact, coughing, sex, or shared items.
In most people, these tumors arise sporadically and are not passed from parent to child; the genetic transmission of Benign perivascular tumor is uncommon. Rarely, a perivascular tumor occurs in someone who inherited a condition called tuberous sclerosis, which raises the chance of certain growths, but even then the tumor itself is not directly inherited or transferable. If tuberous sclerosis runs in your family, a genetics professional can explain how Benign perivascular tumor is inherited in that context and discuss your individual risks.
When to test your genes
Consider genetic testing if a benign perivascular tumor appears unusually early, grows quickly, recurs after treatment, or if multiple tumors occur in you or close relatives. Testing helps confirm the diagnosis, uncover inherited syndromes (like TSC), and guide surveillance. Discuss timing with your care team before or after biopsy.
Diagnosis
You might notice a small, painless lump or a spot that aches after activity, prompting a visit to your doctor. Doctors usually begin with a focused exam and simple imaging to understand what the mass is and how it behaves. The diagnosis of Benign perivascular tumor typically involves imaging to map the area and a biopsy to confirm the tissue type. Sometimes this takes a few steps so your team can be confident about the plan.
Your doctor asks about when the lump appeared, any pain, growth, or skin changes. They’ll examine size, firmness, tenderness, and whether it moves under the skin.
An ultrasound can show if the mass is solid or fluid-filled and how it relates to nearby blood vessels. Doppler ultrasound can check how much blood flow is inside the mass.
MRI shows the mass’s exact size and edges, and how it sits next to muscles, nerves, and vessels. CT may be used when MRI isn’t suitable or to assess deeper locations.
Routine bloodwork is usually normal with benign tumors. Tests may be ordered to rule out infection or inflammation if symptoms suggest another cause.
Stages of Benign perivascular tumor
Benign perivascular tumor does not have defined progression stages. These growths are noncancerous and typically don’t spread to distant areas; how they behave depends more on the exact tumor type, size, and location than on a stepwise stage. Early symptoms of benign perivascular tumor may simply be a small, slowly growing lump or tenderness nearby, so doctors confirm the diagnosis with an exam and imaging such as ultrasound or MRI, and sometimes a biopsy. Different tests may be suggested to help monitor for regrowth after treatment, usually with periodic check-ups and imaging rather than stage-based plans.
Outlook and prognosis
Looking ahead can feel daunting, but many people with a benign perivascular tumor do well for the long term. These growths usually stay localized, grow slowly, and don’t spread to distant organs. When completely removed with surgery, the chance of the same tumor coming back is low; if it does recur, it often grows at a measured pace and can be treated again. Mortality from a benign perivascular tumor is rare, and risk to life is typically tied to location—for example, a tumor pressing on vital structures—rather than the tumor “turning into” cancer.
Understanding the prognosis can guide planning and helps set expectations about follow‑up. Doctors may recommend periodic check‑ins and imaging for a few years after treatment, especially if the tumor was near important nerves or blood vessels or if the edges were close on pathology. Some people experience mild, nagging symptoms like pressure or discomfort if the tumor sits in a tight space, while others notice no symptoms at all after recovery. Early symptoms of benign perivascular tumor—such as a painless lump that slowly gets larger—don’t necessarily predict a worse outlook, but they are a good reason to seek evaluation.
The outlook is not the same for everyone, but most people return to regular activities once soreness fades and strength comes back. Recurrence rates depend on the exact subtype and how fully it was removed; incomplete removal raises the chance of a local return and the need for another procedure. In medical terms, the long-term outlook is often shaped by both genetics and lifestyle, though for this tumor type, surgical factors and location typically matter more than inherited risk. Talk with your doctor about what your personal outlook might look like, including how often you’ll need follow‑up and what signs should prompt a call.
Long-term effects
Most people do well long-term after treatment for a benign perivascular tumor, especially when it’s fully removed. Long-term effects vary widely and often depend on where the tumor started and how it was treated. Some changes relate to the scar or nearby nerves and blood vessels, rather than the tumor itself. People sometimes realize later that the early symptoms of benign perivascular tumor were subtle, like a small, painless lump that slowly became noticeable with activity.
The tumor can come back in the same area if it wasn’t completely removed. When this happens with a benign perivascular tumor, it is usually slow-growing and manageable.
If tissue remains after surgery, a small lump may slowly enlarge over years. This can cause new pressure or discomfort in the area.
Some people notice ongoing soreness or sensitivity at the scar line. This may flare with pressure, activity, or changes in temperature.
A tumor near a nerve can lead to numbness, tingling, or occasional shooting pain. In some cases of benign perivascular tumor, weakness or fine-motor changes can develop if a nearby nerve is compressed.
How is it to live with Benign perivascular tumor?
Living with a benign perivascular tumor is often more about monitoring than daily disruption. Many notice a painless lump or swelling that changes slowly, if at all, and day-to-day life typically continues normally unless the tumor presses on nearby structures and causes discomfort, cosmetic concern, or limited movement in that area. Follow-up visits and occasional imaging can feel tedious, and if surgery is recommended—often for symptoms, growth, or uncertainty—the short-term recovery may briefly affect work, exercise, or caregiving routines. Family and friends usually play a supportive role, helping with appointments or recovery, and most feel reassured once they understand the tumor is noncancerous and has a good outlook.
Treatment and drugs
Treatment for a benign perivascular tumor focuses on relieving symptoms and preventing local problems, since these tumors are noncancerous and usually slow growing. Many people do well with watchful waiting, with regular check-ins and imaging to track any changes, especially if the tumor is small, not painful, and not pressing on nearby structures. If it causes pain, swelling, or functional issues, surgery to remove the tumor is the most common approach and is often curative; in some cases, a partial removal can still ease symptoms when a full excision isn’t safe. When surgery isn’t an option, doctors may consider targeted procedures such as image‑guided embolization to reduce the tumor’s blood supply, or, less commonly, medicines that shrink or stabilize vascular growths, chosen case by case. Your doctor can help weigh the pros and cons of each option, including recovery time, scarring, and the small chance of recurrence, based on the tumor’s size, location, and your overall health.
Non-drug treatment
Treatment without medication focuses on watching the tumor over time, easing symptoms, and using procedures that remove or shrink it when needed. Non-drug treatments often lay the foundation for day-to-day comfort and function. Your team will tailor options based on the tumor’s size, location, growth pattern, and how it affects nearby structures. Many people with a Benign perivascular tumor do well with a stepwise plan that changes only if the tumor changes or symptoms progress.
Regular check-ins with exams and imaging track any growth or change. This avoids unnecessary procedures when the tumor is quiet. This approach can be safe when early symptoms of benign perivascular tumor are absent or mild.
Removing the tumor can relieve pain or pressure and often prevents it from coming back. This is commonly used when a Benign perivascular tumor is well-defined or causing symptoms.
Techniques like radiofrequency or cryoablation use needles and energy to destroy the tumor through a small skin puncture. Recovery is usually faster than open surgery when the tumor’s size and location are suitable.
A radiologist threads a tiny catheter into the feeding vessels and blocks blood flow to the tumor. This can shrink a Benign perivascular tumor or reduce bleeding before surgery, which may make removal safer.
Your genes may have an impact on how drugs work for you
Medicines for benign perivascular tumors can work differently from one person to another because genes affect how drugs are absorbed, broken down, and cleared. Genetic differences may guide dosing, predict side effects, and help your care team choose the safest, most effective option.
Pharmacological treatments
Medicines for a benign perivascular tumor focus on easing symptoms like soreness, pressure, or nerve-type pain, and—in select subtypes—on slowing growth. If you’re watching for early symptoms of benign perivascular tumor, drugs won’t usually shrink the mass itself, but they can make day-to-day comfort better and support recovery after procedures. In rare cases where the tumor is growing or not removable, targeted options may be considered by specialists. Not everyone responds to the same medication in the same way.
Acetaminophen can ease aching without thinning the blood. This is useful if a benign perivascular tumor is tender after activity or pressure.
Ibuprofen or naproxen can reduce pain and swelling when the area feels inflamed. Take with food and avoid if you have stomach, kidney, or bleeding risks.
Gabapentin or duloxetine may help if the tumor irritates nearby nerves causing burning, tingling, or shooting pain. These medicines are started low and adjusted slowly based on benefit and side effects.
Lidocaine 4% patches or gels can numb a small, superficial sore spot over the tumor. This can be handy for short bursts of relief during activities that press on the area.
Genetic influences
In most people, these tumors arise by chance and are not inherited. If you’re wondering whether Benign perivascular tumor is hereditary, most cases are sporadic and not passed down. That said, a minority are linked to underlying gene changes, including some subtypes tied to a genetic condition called tuberous sclerosis complex, which can raise the chance of developing perivascular tumors. Family history is one of the strongest clues to a genetic influence. Features that suggest a genetic cause include tumors that start at a young age, occur in several body areas, or appear in multiple relatives. When this pattern is present, a genetics professional can review your personal and family history and discuss whether testing might help clarify risk and guide care.
Is Benign perivascular tumor genetic?
Genetics play a modest role in benign perivascular tumor. Most cases seem sporadic, with no clear inherited pattern. Rarely, specific genetic changes in tumor cells drive growth, but family risk appears low.
Pharmacogenetics—how genetics influence drug effects
When you and your care team are weighing treatment options for benign perivascular tumor, surgery is usually the first choice, and medicine is considered only in select situations. If the tumor shows changes that switch on a growth pathway called mTOR—sometimes seen in people living with tuberous sclerosis complex—targeted drugs such as mTOR inhibitors may help when growth continues or surgery isn’t feasible. Genes can influence how quickly you clear these medicines, which can affect dose needs and the chance of side effects. Genetics can also shape how you respond to common pain medicines after a procedure; for example, some people don’t convert codeine into its active form well, so another pain reliever may work better. In practice, testing the tumor’s genes helps confirm the subtype and decide whether a targeted drug fits, while pharmacogenetic testing of your own DNA isn’t routinely required but may be considered if you’ve had unusual drug reactions or take many medicines. Because mTOR inhibitors and several other treatments interact with liver enzyme pathways, your team will watch for drug–drug interactions and adjust doses to keep levels safe and effective.
Interactions with other conditions
For most, a benign perivascular tumor is a standalone issue and doesn’t meaningfully affect other diagnoses. A small subset, especially perivascular epithelioid cell tumors, can occur with tuberous sclerosis complex, so clinicians may recommend syndromic screening and coordinated follow-up. Shared genetic variants may explain why certain conditions cluster together. If you have a bleeding disorder or take anticoagulants or antiplatelet medicines, these tumors can bruise or bleed more easily, and procedures such as biopsy or removal may carry higher bleeding risk. Diabetes, peripheral vascular disease, or smoking can slow wound healing after surgery, so teams plan treatment options for benign perivascular tumor with those factors in mind. Painful lesions (for example, in a fingertip) can add to existing chronic pain or nerve conditions, and anxiety about pain sometimes worsens sleep or migraine patterns.
How genes can cause diseases
Humans have more than 20,000 genes, each carrying out one or a few specific functions in the body. One gene instructs the body to digest lactose from milk, another tells the body how to build strong bones and another prevents the body's cells from beginning to multiply uncontrollably and developing into cancer. As all of these genes combined are the building instructions for our body, a defect in one of these genes can have severe health consequences.
Through decades of genetic research, we know the genetic code of any healthy/functional human gene. We have also identified that in certain positions on a gene, some individuals may have a different genetic letter from the one you have. We call these hotspots "Genetic Variations" or "Variants" in short. In many cases, studies have been able to show that having the genetic letter "G" in the position makes you healthy, but having the letter "A" in the same position disrupts the gene function and causes a disease. Genopedia allows you to view these variants in genes and summarizes all that we know from scientific research, which genetic letters (Genotype) have good or bad consequences on your health or on your traits.
History
Throughout history, people have described slow‑growing, painless lumps just under the skin or within soft tissues that bothered more by location than by pain—something noticed in a mirror, or felt while putting on a shoe. Community stories often described the condition as a harmless “knot” that doctors watched over time rather than rushed to remove. These day‑to‑day observations match what we now recognize as a benign perivascular tumor: a noncancerous growth arising around small blood vessels.
First described in the medical literature as a vascular‑related soft‑tissue mass, these tumors were initially grouped with a wide range of “vascular lesions.” In the mid to late 20th century, surgeons and pathologists began to separate them from other look‑alike growths by how the cells were arranged around tiny vessels and by their steady, noninvasive behavior. Early reports called them by several names, reflecting uncertainty about which features mattered most.
Over time, descriptions became more precise as microscopes improved and special tissue stains entered routine practice. This allowed pathologists to see hallmark patterns—cells circling a vessel like a sleeve, and a clean boundary from nearby tissue. As medical science evolved, case series showed that most benign perivascular tumors stayed small, grew slowly, and rarely returned after complete removal, which reassured both clinicians and patients.
In recent decades, awareness has grown that “benign perivascular tumor” is an umbrella term that includes a few related subtypes, each with its own typical location and cellular look but similar calm behavior. Imaging added another layer: ultrasound and MRI helped clinicians tell these tumors apart from more aggressive masses before surgery, reducing unnecessary extensive procedures.
Advances in genetics refined the picture further. While no single change defines every case, modern studies have identified recurring molecular patterns in some subtypes that act like dimmer switches for growth signals rather than on–off triggers. This supported what doctors had seen for years—that these tumors tend to behave gently, even when they sit close to nerves or joints.
Not every early description was complete, yet together they built the foundation of today’s knowledge. What was once a broad “vascular lump” category is now a better‑defined group with clear expectations for behavior and treatment. For many living with a benign perivascular tumor, this history explains the common care plan: confirm the diagnosis, remove it if it causes symptoms or uncertainty, and otherwise monitor with confidence that the outlook is good.