Hemangioma da infância

Abstract

As novas classificações disponíveis e os modernos recursos diagnósticos por imagem não só permitiram a diferenciação entre os tumores e as malformações vasculares, mas também modificaram de forma substancial a abordagem e o tratamento dessas anomalias. O hemangioma da infância, o mais comum dos tumores vasculares dessa faixa etária e objeto deste trabalho, é revisto do ponto de vista de suas características clínicas e laboratoriais, diagnóstico diferencial e opções terapêuticas. Embora a conduta expectante permaneça como o tratamento de escolha para a maioria dos casos, o julgamento crítico é crucial para o emprego de outras modalidades terapêuticas.

Abordagem terapêutica dos hemangiomas cutâneos na infância

“…It is estimated that 90% of hemangiomas involute for up to 9 years. 13 The patients in whom cure was complete had small, mostly superficial lesions that involuted completely.…”

“…12 Intralesional corticosteroid therapy is used principally in cases of periocular hemangiomas or in smaller lesions; however, its use is controversial because of possibly severe side effects. 3,13 Interferon is indicated for the treatment of alarming hemangiomas when there is a risk of death and the tumor fails to respond to treatment with oral corticoids. Response may be slower compared to corticosteroid therapy, its angiogenic effect having been shown to be effective and to result in a response of 50% over a mean treatment period of 7.8 months.…”

“…15,21 Radiotherapy has been practically abandoned because of long term sequelae. 13 Vascular ligation may be considered with caution in cases of arteriovenous fistulae and when there is intense bleeding. 6 Compression therapy is another therapeutic option; however, disadvantages include possible ulceration and the discomfort provoked by pressure on the site.…”

Apresentação, evolução e tratamento dos hemangiomas cutâneos: experiência do ambulatório de Dermatologia Infantil do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

“…A better standardization started to be developed in 1982, when Mulliken and Glowacki proposed a classification in which the vascular anomalies were divided into hemangiomas and vascular malformations, based on their histopathological features, clinical and biological behavior. [1][2][3] The International Society for the Study of Vascular Anomalies (ISSVA) modified this classification in 1996 and opted to divide the vascular lesions into vascular malformations (capillary, venous, lymphatic, arterial and combined) and vascular tumors. The latter have the marked characteristic of proliferation of endothelial cells and are divided into hemangioma, rapidly involuting congenital hemangioma, non-involuting congenital hemangioma, pyogenic granuloma, Kaposilike hemangioendothelioma and tufted angioma.…”

“…The latter have the marked characteristic of proliferation of endothelial cells and are divided into hemangioma, rapidly involuting congenital hemangioma, non-involuting congenital hemangioma, pyogenic granuloma, Kaposilike hemangioendothelioma and tufted angioma. 1,4,5 Hemangioma is the most common benign tumor in childhood and it is estimated to affect 10-12% of children in their first year of life. It occurs more often in females and premature children, and it is observed in 23-30% of children who weigh less than 1,000 grams at birth.…”