Grading & Level of Importance: B
Infantile haemangioma, strawberry nevus, hemangioma of infancy (HI).
Relatively frequent (4-5% of infants).
Benign vascular tumours that appear in the first weeks after birth.
Aetiology & Pathogenesis
Unknown but has been discussed.
Signs & Symptoms
Dome-shaped circumscribed bright red nodules (cutaneous haemangioma), or pink to blue soft swelling (subcutaneous haemangioma), or both (mixed type) or superficial.
They can be located in any area of the body.
Superficial (cutaneous), deep (subcutaneous) or mixed (superficial and deep).
Laboratory & other workups
Laboratory tests are not needed.
Histology is not needed for the diagnosis. A proliferation of dermal mature vessels without inflammatory infiltrate is observed if a biopsy is performed. However, growing HI express more GLU-1 receptor by immunohistochemistry. This should prompt the clinician to consider intervention.
Childhood haemangiomas are not present at birth, appear in the first weeks of life, grow during a few months and then spontaneously regress in the first or first years of life. Those which are rapidly and continuously growing need intervention.
Ulceration (infection, pain), scar with esthetic consequences, bleeding (uncommon). Depending on hemangioma location:
Nose: cartilage deformation
Lips: feeding difficulties
Lower jaw: associated subglottic hemangioma with possible stridor and respiratory obstruction
Segmentary facial hemangiomas and perineal/lombo-sacral hemangiomas may be associated with underlying malformations (rare); miliary hemangiomatosis may be associated with visceral hemangiomas and high output cardiac insufficiency (rare).
Most cases: clinical. Diagnostic uncertainty: ultrasonography. Suspicious subglottic hemangioma: referral to ENT (ear-nose-throat) specialist. Suspicious PHACES or PELVIS syndrome: brain or medullary MRI, respectively. Glut-1 staining.
Differential diagnoses include vascular malformations (such as: nevus flammeus), granuloma pyogenicum, angiosarcoma, other malignant tumors (rhabdomyosarcoma, infantile fibrosarcoma). Kasabach-Merritt syndrome is characterized by profound thrombocytopenia, consumptive coagulopathy with a hemorrhagic risk, in association with vascular tumors (rare).
Prevention & Therapy
In most cases: no treatment. In case of complications related to localization or rapid growth: beta-blockers (propranolol).
Aggressive early treatment (laser) may be needed in fast growing lesions in anatomical risky localisations (i.e. eyes), however, in this situation, systemic ß-blocker administration as an inpatient may be required.
- Statement 1: A hemangioma on the upper eyelid is best removed with a dye laser
- Statement 1: Dye laser can only be used for treatment of superficial haemangioma
- Laser therapy is the treatment of choice for deep hemangiomas
- Statement 1: A hemangioma blanches when pressed with a glass slide (diascopy)
- Statement 1 A hemangioma on the upper eyelid is best removed with a dye laser
- Statement 1 Hemangiomas in anatomically difficult sites are best treated with dye lasers
- Statement 1 Dye lasers are best suited for treating superficial hemangiomas
- Statement 1 Laser therapy is the treatment of choice for deep hemangiomas
- Statement 1 Infantile hemangiomas are generally harmless
- Statement 1 A hemangioma blanches when pressed with a glass slide (diascopy)
- Statement 1 Purpura is a lesion that can be blanched with a glass slide (diascopy)
Further Images / DOIA
- E.F. Johnson, D.M. Davis, M.M. Tollefson, et al.: Vascular Tumors in Infants: Case Report and Review of Clinical, Histopathologic, and Immunohistochemical Characteristics of Infantile Hemangioma, Pyogenic Granuloma, Noninvoluting Congenital Hemangioma, Tufted Angioma, and Kaposiform Hemangioendothelioma (2018)
- C. Léauté-Labrèze, J.I. Harper, P.H. Hoege: Infantile haemangioma (2017)
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