Morphological, genetic and clinical correlations in infantile hemangiomas and their mimics

Abstract

Infantile hemangiomas (IHs) are the most frequent pediatric benign vascular tumors, with a reported incidence of 5% to 10%. They have self-limiting evolution pattern divided into a growth phase in the first 12 months and a regression one, that may take up to 10 years. Occasionally, hemangiomas might lead to local or systemic complications, depending on their morphological characteristics. The first line of treatment is β-blockers, such as Propranolol, Timolol, Nadolol, administered either locally or systemically. Newer therapeutic strategies involving laser therapy and angiotensin-converting enzyme inhibitors are being studied, while older treatment modalities like corticosteroids, Imiquimod, Vincristine, Bleomycin and Interferon-α have become second line therapy options. Before establishing the appropriate treatment, clinical, histological, and imaging investigations are required.

Early Presentation of an Ulcerated Infantile Haemangioma in a Newborn

“…However, after the involution phase occurs, residual scarring, telangiectasia or local skin atrophy can occur in some cases and complete resolution appears to be dependent on the early onset of their involution phase [3]. Even though most IHs evolve in a benign manner, a small subgroup of patients can be at risk for complications and poor clinical outcomes if early identification and intervention do not occur [5,6].…”

“…IHs classification is therefore essential for risk stratification and assisting clinical decisions for conservative or interventional management [5,6]. IHs were classically classified based on the extent of soft tissue involvement as superficial, deep or mixed haemangiomas.…”

“…These are the least common subtype but the most prone to complications. Those who have mixed features and cannot be clearly defined as focal or segmental are classified as indeterminate [5,6].…”

“…The diagnosis of IHs is clinical and is based on the history of the lesion's evolution and clinical examination. However, imaging may be needed to reach a diagnosis in certain cases [1][2][3][4][5][6]. As previously mentioned, most uncomplicated IHs evolve in a benign way with no need for direct intervention; therefore, conservative management with ambulatory follow-up of the lesion is the most common strategy employed.…”

“…Nevertheless, intrinsic patient factors (such as gender, ethnicity, low birth weight), the evolutionary phase of the IH, lesion's size and anatomical location as well as the morphologic subtype of the IH, can determine the need for a stricter vigilance, requiring direct pharmacological or local intervention. This might especially occur in the 10% of cases when there is a direct life threat, involvement of vital organs, functional compromise, recurrent ulceration of the lesion and unacceptable aesthetic compromise [4][5][6].…”