An article published in the July/Aug 2004 issue of the American Academy of Dermatology outlines the similarities and differences between Congenital Hemangioma and the more common Infantile Hemangioma.  The study conducted at Boston Children's Hospital under the direction of Dr. John Mulliken details subcategories of congenital hemangioma and classifies these lesions as Rapidly Involuting Congenital Hemangioma and Non-involuting Congenital Hemangioma.  Dr. John Mulliken and Dr Odile Enjolaras of France coordinated their research for this publication.

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Known Classifications

Congenital Hemangioma:   characterized as a hemangioma that has grown to maximum sized at birth, with no post-natal growth.  This type of hemangioma can be viewed on ultrasound during gestational development.

Infantile Hemangioma:  appears post-natally, most often at 2 weeks of age.  These lesions grow rapidly and are known to regress or involute very slowly.  These lesions appear between 2 weeks and 4 months. There is a 3-5:1 female preponderance.  During involution these lesions will often regress into fibro-fatty tissue mass.  Rapid growth for first year, slow involution for 1-7 years with complete involution occurring at 8+ years of age. These hemangioma demonstrate a endothelium immunotstain for glucose transporter protein-1 (glut-1)

Sub-Categories

Rapidly Involuting Congenital Hemangioma: are present at birth, having developed pre-natally. Demonstrate similar growth pattern as infantile hemangioma.  Involution is rapid, often within the first year.  Involution leaves thin skin, small vessels and fibro-fatty tissue.  There is an equal male:female preponderance with this type of hemangioma.  RICH-has a negative endothelium immunostain for glucose transporter protein-1 (glut-1)

Non-Involuting Congenital Hemangioma:  also apparent at birth, have an initial growth to a plateau in first year.  Never enters spontaneous post-natal involution or regression.  The demonstrate equal male/female preponderance.  NICH- has a negative endothelium immunostain for glucose transporter protein-1 (glut-1).

It has been described that childhood hemangioma are characterized by a rapid postnatal growth and slow involution cycle.  Other pediatric vascular tumors are known to be present at birth but behave very differently post-natally.  These RICH and NICH tumors have very similar characteristics like appearance, location, size, sex ratio, and often have overlapping radiological and histological characteristics with infantile hemangioma.  These differences and similarities give rise to questions of whether this spectrum of congenital hemangioma are variants in hemangioma or entirely different tumors.  Dr. Mulliken and Dr. Enjolras describe two groups of patients which suggest a linkage between the groups but also establish "missing links" yet to be evaluated.

Reference:  J. Am Acad. Dermatol 2004;50:875-82

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