Hemangioma Location Research Articles

Benign Neonatal Hemangiomatosis.

Benign neonatal hemangiomatosis (BNH) is a rare, self-limiting subtype of infantile hemangiomas (IHs), in which infants with multiple cutaneous hemangiomas lack visceral involvement. Other subtypes of IHs exist that may mimic BNH and can be life-threatening depending on hemangioma location and size. At birth, a 29 5 / 7 -week preterm female presented with several pinhead-sized pink papules distributed throughout her body. At 10 days of age, the patient had 12 enlarged domed-shaped red papules in a generalized distribution throughout her body. Over several weeks, the number and size of the domed-shaped red papules continued to increase to a total of 26 located on the head, chest, abdomen, back, legs and arms. They were of firm consistency with both smooth and lobulated surfaces. A diagnosis of BNH was made after extensive workup did not reveal any extracutaneous hemangiomas. Due to the lack of extracutaneous involvement and low-risk location/size of hemangiomas in our patient, no interventions were pursued and an observation-only approach was implemented. The patient remained stable while followed up over 8 months, with the size of the hemangiomas only increasing slightly in proportion to the patient's natural body growth. Given the life-threatening nature of certain hemangioma subtypes, it is important to implement a proper workup and subtype diagnosis as early as possible in any infant with multiple hemangiomas.

Propranolol Tedavisi Başarısında Hemanjiyomun Yeri ve Hasta Yaşı ile İlişkisi: Retrospektif Çalışma

Objectiveː Propranolol causes shrinkage of hemangiomas through capillary vasoconstriction, increased endothelial cell apoptosis, and decreased vascular endothelial growth factors. This study aimed to evaluate the relationship between propranolol treatment success, the location of hemangioma and patient age. Material and Methodsː Children with hemangiomas treated with propranolol between October 2016 and April 2019 were evaluated retrospectively. Propranolol was administered as 0.5 mg/kg/day. Vital signs, blood pressure and blood glucose were monitored while the dose was gradually increased to 2 mg/kg/day. Paling and shrinking of the lesions in monthly follow-ups were considered as success of the treatment. Resultsː The median treatment age in 31-children (61.3% females, 38.9% males) with hemangiomas was 6-month (1 months-16 years), the mean treatment duration was 7.74±3.66months (3 months-18 months). Hemangiomas located in head/neck-17 cases(54.8%), in trunk- 4 cases (12.9%), in genital/gluteal -4 cases(12.9%), in abdomen-4 cases (12.9%) and on extremities-3 cases (7%). Four (12.9%) patients had multiple hemangiomas. Three (9.7%) had hepatic hemangioma diagnosed prenatally. 51.6% of were between 1-3 cm2 . Blood glucose levels were stable in all. Propranolol therapy was ineffective in 4-patient aged 7, 8, 29, and 90-month, 3 with head and neck hemangiomas and 1 with trunk hemangioma. In 27-patient who had treatment success, propranolol was discontinued when the reduction in lesion size stabilized. Conclusionː Propranolol is preferred because of its ease of use, low side effects, cost-effectiveness, and rapid response. It can be successfully used even in liver hemangiomas by close monitoring of vital signs, blood sugar, and blood pressure. Treatment success of propranolol is independent of age and hemangioma location.

Quality of life in children with infantile hemangioma: a case control study

BackgroundInfantile hemangioma (IH) is the most common vascular tumor in children. It is controversial whether IHs has effects on the quality of life (QOL) in patients of whom IH poses no threat or potential for complication. Thus, we conducted this study to evaluate the q QOL in patients with IH and find the predictors of poor QOL.MethodsThe PedsQL 4.0 Genetic Core Scales and the PedsQL family information form were administered to parents of children with IH and healthy children both younger than 2-year-old. The quality-of-life instrument for IH (IH-QOL) and the PedsQL 4.0 family impact module were administered to parents of children with IH. We compared the PedsQL 4.0 Genetic Core Scales (GCIS) scores of the two groups. Multiple step-wise regression analysis was used to determine factors that influenced QOL in children with IH and their parents.ResultsExcept for physical symptom, we found no significant difference in GCIS between patient group and healthy group (P = 0.409). The internal reliability of IH-QOL was excellent with the Cronbach’s alpha coefficient for summary scores being 0.76. Multiple step-wise regression analysis showed that the predictors of poor IH-QOL total scores were hemangioma size, location, and mother’s education level. The predictors of poor FIM total scores were hemangioma location and father’s education level. The predictors of poor GCIS total scores were children’s age, hemangioma location and father’s education level.ConclusionThe findings support the feasibility and reliability of the Chinese version of IH-QOL to evaluate the QOL in children with IH and their parents. Hemangioma size, location and education level of mother are important impact factors for QOL in children with IH and their parents.

The “biker-glove” pattern of segmental infantile hemangiomas on the hands and feet

Infantile hemangiomas (IH) on the extremities have not been systematically studied. We sought to describe the clinical characteristics and distribution patterns of IH affecting acral surfaces and to explore the relationship among these patterns, limb development, and IH pathogenesis. This was a retrospective multicenter cohort study. Photographic archives from 4 tertiary pediatric dermatology referral centers were searched for patients with IH larger than 1 cm and involving 1 or more digit. Hemangioma location, distribution, and morphologic subtype were recorded. Medical records were reviewed for demographic and clinical data. In all, 73 patients were identified. The most common IH pattern resembled that of a "biker glove" (73%), followed by localized IH on the distal digits (14%), segmental IH extending over the distal digits (8%), and intermediate patterns (5%). Overall, 63% of acral IH were segmental, 26% indeterminate, and 11% localized. Five patients had associated structural anomalies. Complications were noted in 33% of cases. Limitations were retrospective study design; selection bias based on recall and photography; documentation and follow-up were not standardized across institutions; and treatment information may not reflect current approaches. Acral IH display specific patterns and are associated with a relatively high risk of ulceration.

The associations of infantile hemangiomas

Recently there has been a flurry of articles about large cutaneous hemangiomas in infancy, much of it prompted by the apparent efficacy of propranolol therapy. There also has been interest in cutaneous infantile hemangiomas and their associated congenital anomalies. In this issue of The Journal, Iacobas et al examined the association of cutaneous infantile hemangiomas of the lower body and regional congenital anomalies in 24 new patients and 29 published cases. They report on the associated urogenital, ulceration, spinal cord, and anorectal, arterial, and renal anomalies and have proposed the acronym LUMBAR to describe this association. The PHACE syndrome has many similarities, although it applies to the associations with segmental infantile hemangioma to the face. Time will show whether the LUMBAR acronym is a useful term. Article page 795 ▸ LUMBAR: Association between Cutaneous Infantile Hemangiomas of the Lower Body and Regional Congenital AnomaliesThe Journal of PediatricsVol. 157Issue 5PreviewTo define the clinical spectrum of regional congenital anomalies associated with large cutaneous hemangiomas of the lower half of the body, clarify risk for underlying anomalies on the basis of hemangioma location, and provide imaging guidelines for evaluation. Full-Text PDF

Management of complicated hemangiomas with vincristine/vinblastine: Quantitative response to therapy using MRI

Purpose To quantify the efficacy of vincristine and vinblastine in the treatment of complicated hemangiomas. Design Retrospective review. Methods Charts were reviewed to identify patients treated with vincristine or vinblastine for complicated hemangiomas from August 2002 to October 2007. Only patients who received both a pre and post-treatment magnetic resonance imaging (MRI) were considered. A database was created which includes patient gender, age at treatment initiation, rationale for treatment, hemangioma location, number of cycles of chemotherapy received, and complications of treatment. A single pediatric radiologist calculated lesion volumes from both pre and post-treatment MRI which were compared to quantify treatment response. Results Seven patients (2 male, 5 female) met criteria. Mean age at treatment initiation was 20 weeks (median 14, range 5–60). Rationale for treatment included four patients (57%) with proptosis/orbital compromise and one patient each (14%) with heart failure, airway compression, and hemangiomatosis with rapid growth of multiple lesions. Patients received a mean of 2.86 cycles of chemotherapy (median 3, range 1–5). Twelve lesions were identified and analyzed for pre and post-treatment volume on MRI in the seven patients. Eleven of twelve (92%) lesions decreased in size after treatment. The mean volume ratio of hemangiomas at the conclusion of chemotherapy was 0.45 compared to pre-treatment size (median 0.18, range 0–2.19) Orbital compromise, airway compression, and cardiac failure either improved or resolved in all patients. Three complications of treatment were seen in seven patients (42%) including bacteremia with anemia, peripheral neuropathy and motor delay. All complications resolved after cessation of chemotherapy. Conclusions Treatment of complicated hemangiomas with vincristine or vinblastine can control growth and improve symptoms in the majority of patients. Treatment often requires multiple cycles of chemotherapy. Complications of treatment are common, but reversible.

LUMBAR: Association between Cutaneous Infantile Hemangiomas of the Lower Body and Regional Congenital Anomalies

To define the clinical spectrum of regional congenital anomalies associated with large cutaneous hemangiomas of the lower half of the body, clarify risk for underlying anomalies on the basis of hemangioma location, and provide imaging guidelines for evaluation. We conducted a multi-institutional, retrospective case analysis of 24 new patients and review of 29 published cases. Hemangiomas in our series tended to be "segmental" and often "minimal growth" in morphology. Such lesions were often extensive, covering the entire leg. Extensive limb hemangiomas also showed potential for extracutaneous anomalies, including underlying arterial anomalies, limb underdevelopment, and ulceration. The cutaneous hemangioma and underlying anomalies demonstrated regional correlation. Myelopathies were the most common category of associated anomalies. We propose the acronym "LUMBAR" to describe the association of Lower body hemangioma and other cutaneous defects, Urogenital anomalies, Ulceration, Myelopathy, Bony deformities, Anorectal malformations, Arterial anomalies, and Renal anomalies. There are many similarities between LUMBAR and PHACE syndrome, which might be considered regional variations of the same. Although guidelines for imaging are suggested, prospective studies will lead to precise imaging recommendations and help determine true incidence, risk and long-term outcomes.

Proposal for staging airway hemangiomas

Objective To describe a method of airway infantile hemangioma staging using standardized assessment of airway narrowing, and hemangioma location and volume, as determined with endoscopy and CT angiography. Study design Case series with chart review. Setting Tertiary pediatric hospital, 2003-2008. Subjects and methods Subjects included airway hemangioma patients evaluated at a tertiary pediatric hospital. Data collected were age at first symptoms, diagnostic evaluation, percent airway compromise, and estimated hemangioma volume. Data were analyzed with descriptive and Fisher exact statistics. Results Twelve patients were identified and seven had complete data sets. Mean age at first symptoms was 1.9 months (SD 1.09 months, range 0.5-4 months). Evaluation consisted of nasopharyngoscopy, microlaryngoscopy, CT angiography, and/or MRI. Mean laryngeal airway narrowing was estimated at 63.75 percent (SD 19.0%, range 40%-90%). Total hemangioma volume was less in patients with isolated (focal) endolaryngeal hemangiomas compared with airway hemangiomas associated with extralaryngeal (segmental) hemangiomas. Airway hemangioma stages were stage one (5 of 12; 41.6%), stage two (6 of 12; 50.0%), and stage three (1 of 12; 8.3%). Conclusion This method of airway hemangioma staging may be applicable to treatment planning and used to measure treatment outcomes.

The Cerebral Vasculopathy of PHACES Syndrome

PHACES syndrome is a neurocutaneous disorder of unknown etiology. We studied the spectrum of associated congenital and progressive cerebral vascular anomalies. The medical records of 7 patients with PHACES syndrome were reviewed and combined with an additional 108 PHACES cases identified from the literature. We reviewed the clinical characteristics, calculated the relative frequencies of each type of vascular anomaly, and assessed site of vessel involvement relative to hemangioma location. Among a total of 115 PHACES cases, 89 (77.4%) had congenital and/or progressive cerebral vascular anomalies. The most commonly detected congenital arterial anomalies included dysplasia, aberrant origin or course, hypoplasia, and absence or agenesis. Arterial occlusions and stenoses were detected in 24 (20.9%) and 21 (18.3%) cases, respectively. Twenty (17.4%) had persistent embryonic arteries; 15 (13%) had saccular aneurysms. There appears to be a close relation between the regional distributions of cervicofacial hemangiomas and the locations of intracranial and extracranial vascular (and cardiac) anomalies. The vasculopathy of PHACES chiefly comprises a spectrum of congenital and progressive large artery lesions. Based on known embryology and the relative frequencies of specific congenital vascular anomalies, we can predict that the initial cerebral vascular changes occur early in embryogenesis, by the fifth gestational week or earlier. There appears to be both a temporal and a regional link between the arterial anomalies of PHACES and the cutaneous infantile hemangioma.

Surgery: The Treatment of Choice for Hemangiomas

The management of hemangiomas has always been a matter of controversy. Traditionally, observation has been the mainstay of therapy, with the expectation that most of the lesions will disappear spontaneously. This treatment plan was based on the premise that surgical excision or other treatments might produce a worse result than simply waiting for the lesion to resolve with an acceptable cosmetic result. This plan has been challenged because of a growing number of specialty teams that address these lesions. This article examines various cases of pediatric hemangioma and evaluates the possibility of surgical excision as a first-choice treatment in these cases. One hundred fifteen cases of surgical excision of pediatric hemangiomas performed by a single surgeon over a period of 7 years were examined. Pre- and postoperative photographs were examined. Hemangioma location, size, and type; patient's age; and surgical technique are described. Acceptable cosmetic and functional results were achieved in all surgical cases. Early excision of hemangioma should be the procedure of choice in selected cases of hemangioma. Hemangiomas in areas where a significant cosmetic defect or functional defect might ensue should have surgical excision considered as first-line treatment.