How we approach hemangiomas in infants

Abstract

Pediatric oncologists are increasingly involved in the management of benign vascular tumors and their associated life-threatening complications. Hemangiomas are the most common referring diagnosis to multidisciplinary vascular anomalies clinics. However, as contemporary research has revealed, hemangiomas are not a single, easily defined entity but rather a diverse set of related vascular tumors, each having a unique natural history, growth pattern, and response to therapy. This manuscript seeks to illustrate how we evaluate and manage these complex tumors, their complications, and associated syndromes, while remaining ever vigilant for malignant hemangioma mimickers such as soft tissue sarcomas and congenital leukemia.

Introduction: The changing role of the pediatric hematologist/oncologist in the care of people with vascular anomalies

“…The articles use cases to illustrate approaches and summarize overviews. This supplement provides several articles that discuss general approaches to suspected vascular lesions, vascular tumors (including hemangiomas), and management strategies for localized lesions 1‐5 …”

“…This supplement provides several articles that discuss general approaches to suspected vascular lesions, vascular tumors (including hemangiomas), and management strategies for localized lesions. [1][2][3][4][5] There are some challenging conditions associated with vascular anomalies that require integration with other disciplines. Complex chylous effusions require multimodal approach and coagulopathies can be presenting symptoms.…”

Infantile Hemangioma: A Current Review

“…IH can sometimes ulcerate and/or bleed. The presence of a scab signifies ulceration 120. Ulceration and large size of an IH are associated with prolonged healing and worse cosmetic outcomes 26,37.…”

Mediastinal infantile hemangioma with spinal canal extension and extensive gastrointestinal involvement complicated by respiratory failure

“…Given the natural history of IH, treatment is frequently expectant, but when indicated, propranolol is considered frontline medical therapy 5,6 . Other therapeutic modalities have included vincristine, steroids, interferon, surgery, sirolimus, and topical agents, 7–9 but propranolol has been established as effective and well tolerated 10,11 …”

“…(B) Gross appearance of 4 × 4 cm mass on upper back that developed after 14-week course of vincristine and corticosteroids, near to but distinct from CH on direct examination. (C) Lesion on side profile agents, [7][8][9] but propranolol has been established as effective and well tolerated. 10,11 In this report, we describe an infant with a rare manifestation of IH who presented with a cutaneous hemangioma at birth of stable size and later development of multiorgan visceral and spinal canal IH, the associated comorbidities, and the challenging and successful management.…”