Management of congenital hemangioma: clinicopathological analysis of 32 cases

Abstract

Objective To explore the clinicopathological features, diagnosis, differential diagnosis and treatment of congenital hemangioma (CH). Methods The clinical data, pathological characteristics and treatment of 32 CH cases were analyzed retrospectively. Results There were 20 boys and 12 girls with a boy-to-girl ratio of 1.6∶1 and a median age of 43 months. All were unifocal lesions at head & neck region (n=8), trunk (n=12), upper extremities (n=5) and lower extremities (n=7). One lesion was detected by prenatal ultrasonography and the remainder was present at birth. Twenty-five lesions gradually expanded in size, 3 lesions had slight regression and 4 cases showed no obvious changes. One lesion felt warm on palpation, one with sinus at the center of mass while the remainder had no local pain, swelling or ulceration. All lesions had normal preoperative results of blood routine and blood coagulation function. One child received a preoperative injection of sclerosant. However, mass had no regression. All cases underwent complete resection. One child of excessive intraoperative hemorrhage received blood transfusion postoperatively. The clinical types were rapidly involuting congenital hemangioma (RICH, n=3) and noninvoluting congenital hemangioma (NICH, n=29). NICH: Tumor was dominated by lobules of capillaries, separated by dense fibrous tissues containing lymphatic vessels and small arteriovenous structures. Small intralobular vessels were lined by endothelial cells with hobnailed nuclei. The center of lobule was occupied by stelliform vessels. RICH: Tumor was dominated by lobules of capillaries, similar to those seen in NICH, most intralobular vessels were atretic and the remainder diminished. Endothelial cells became flattened. Focal hemorrhagic necrosis, hemosiderosis and calcification were observed. Immunohistochemistry showed that all cases were negative for Glut1, positive for CD34(32/32), CD31(32/32) and WT1(32/32) and D2-40 was partially positive. Twenty-five cases were followed up for 3-25 months. Slight linear scar was present. Recurrence was not found. Conclusions CH is a benign vascular tumor whose diagnosis (RICH or NICH) depends upon clinical manifestations and pathological morphology. Clinically and pathologically, it needs to be differentiated from vascular malformation, infantile hemangiomas, kaposiform hemangioendothelioma and pyogenic granuloma. Key words: Hemangioma, congenital; Diagnosis, differential; Pathology, clinical