Hemangioma Treatment Publications

[Karla Hall]

New Publications on Infantile Hemangioma released this month:

J Eur Acad Dermatol Venereol. 2010 Jun;24(6):631-8.
Infantile haemangiomas: a challenge in paediatric dermatology.
Schwartz RA, Sidor MI, Musumeci ML, Lin RL, Micali G.
New Jersey Medical School, Newark, NJ, USA. roschwar@cal.berkeley.edu
Abstract
Infantile haemangiomas, common benign vascular tumours of childhood, are characterized by rapid growth during the first year of life and a slow regression that is usually completed at 7-10 years of age. These tumours are composed of endothelial cells with high mitotic rates and stromal components such as fibroblasts, mast cells and pericytes. Haemangiomas become a challenge when they are part of a syndrome, are located in certain areas of the body or when complications develop. The above-mentioned factors also influence the treatment modality used. However, although there remain many uncertainties regarding management, the beta-adrenergic receptor blocker propranolol is a promising new candidate for first-line systemic therapy. It produces such a dramatic and rapid response that the appearance of an infantile haemangioma should impart expeditious consideration of the risks and benefits of its use.
PMID: 20565561 [PubMed - in process]


Int J Pediatr Otorhinolaryngol. 2010 Jun 15. [Epub ahead of print]
Management of infantile subglottic hemangioma: Acebutolol or propranolol?
Blanchet C, Nicollas R, Bigorre M, Amedro P, Mondain M.
ENT Department, CHU Montpellier, France.
Abstract
The successful management of subglottic hemangioma with propranolol has been reported. We report three cases of subglottic hemangioma treated with the cardioselective beta-blocker acebutolol, 8mg/kg/day. Treatment was efficient in two cases while an open procedure was necessary in the third child. In our experience, acebutolol could be easily administered in oral form twice-a-day only with a dose that was adaptable according to the growth of the child and showed no side effects. We also report a case of rebound growth after beta-mimetic drug use and the efficiency of propranolol treatment in such a recurrence. Considering the lack of side effects and the advantages in terms of administration, we suggest acebutolol as a first-line treatment of subglottic hemangiomas for which intervention is required. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
PMID: 20557953 [PubMed - as supplied by publisher]


J. Dermatol. 2010 Apr;37(4):283-98.

Recent progress in studies of infantile hemangioma.
Jinnin M, Ishihara T, Boye E, Olsen BR.

Department of Dermatology and Plastic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Kumamoto University, Honjo, Kumamoto, Japan. mjin@kumamoto-u.ac.jp

Abstract
A hallmark of infantile hemangioma, the most common tumor of infancy, is its dramatic growth after birth, by diffuse proliferation of immature endothelial cells, followed by spontaneous regression. The growth and involution of infantile hemangioma is quite different from other vascular anomalies, which do not regress and can occur at any time during life. Some hemangioma lesions can be extremely disfiguring and destructive to normal tissue and may even be life-threatening. Unfortunately, existing therapeutic approaches have limited success and significant adverse effects of some treatment modalities limit their use. Better understanding of the pathogenesis of hemangioma will enable the development of better therapeutic strategies. Here, we review recent studies and new hypotheses on the pathogenesis of the tumor. Detailed mechanisms of activated vascular endothelial growth factor signaling in tumor cells, identification of their origin and characterization of multipotent stem cells that can give rise to infantile hemangioma are shedding new light on this intriguing vascular tumor.

PMID: 20507397 [PubMed - in process]

[susan shannon]

Hello,

My 10 year old daughter was diagnosed with a hemangioma (It is 7 cm long and is quite deep). in her foot two years ago. My instinct at the time was to have it removed surgically, but Dr. Bruckner in Bellevue, WA suggested a 'wait and watch' approach. Since then, we have had two MRI's that show no shrinkage. The 'h' has been truly affected my daughter's ability to participate in physical activities and I believe it is actually hurting her long term health (ie, she avoids all strenuous activity and has a propensity towards weight gain). I worry about her future. Also, I worry that if we wait too long, her ability to heal will be jeapardized.

The reason given was that the scar would be more painful than the 'h'. I find it so hard to believe that a scar could be that painful. Even my C-section scar has healed (and it was cut open three times!) without pain. While I realize that the foot is a weight bearing part of the body, I feel skeptical about waiting any longer for the surgery.

We have an appointment this week to determine what we should do. Can you give me more information about your results with foot surgeries for hemangioma? Thanks, susan

[Karla Hall]

Susan: Welcome to NOVA
My first concern is that your daughter is now 10 years of age with no evidence of involution having occured. It has been reported in the literature that 50% of infantile hemangioma have involuted by the age of 5 with a continued rate of involution occuring 1 % each year. There may be some residual scarring. ( I am paraphrasing) At any rate by age 10 infantile hemangiomas mostly have regressed, some have residual fibrofatty tissue and small veins left in its wake but there should not be a full size hemangioma.

One type of vascular anomaly known as congential hemangioma has a subclassification of being a "noninvoluting congential hemangioma" NICH. These lesions are fully formed at birth and so not involute. The other from is a RICH lesion where as the lesion is a rapidly invluting congenital hemagnioma. Both of these differ from the more common infantile hemangioma. Ifantile hemangioma are fully are not fully formed at birth, develop over the first year of life. Stop growing at about a year of age and then spontaneously regress in the process called involution. Involution varies in time and degree.

Another type of vascular anomaly is a venous malformation. This is a type of vascular malformation, abnormally deeloped blood vessels that form a significant mass. They are not tumors. They can look like a infantile hemangioma. One signficant difference is that they never involute!

I am not a physician! I can not diagnose anything but I can suggest to you that you question the exact diagnosis of your daughter's vascular anomaly. I would be suspect at this point! That would be my step 1 if she were my child.

Many doctors are not fully informed of the classification of vascular anomalies. Many do not know the difference between the differnt type of anomalies and often call everything hemangioma. The problem with this is that treatment differs depending on the different type of anomalies. While it may be acceptable to leave a small hemangioma alone and allow it to involute naturally a malformation or a congenital hemangioma will not involute and in the case of a malformation it will grow with the child and only become more of a problem.

Having your daughter evaluated by a multidisciplinary team of physicians that fully understand the type of anomalies and the different treatments is important. The team should have an interventional radiologsit, surgeon, hem/oncologist, dermatologist. All should have experience with hemangioma. There is a team in Washington:

Seattle Children’s Hospital VAC
4800 Sand Point Way NE
PO Box 5371 G- 0035
Seattle, WA 98105
206-987-3878
Clinic Meets 4th Monday of each month from 8-4

Multidisciplinary Team
Jonathan Perkins,
Robin Hornung, MD Dermatolgy 206-987-2380
Thomas Pendergrass, MD Hem/Onc 206-987-2380
Manrita Sindu, MD Interventional Radiology 206-987-2380
Joseph Gruss, MD Plastic Surgery 206-987-2380
Richard Hopper, MD Plastic Surgery 206-987-2380
Robert Sawin, MD Surgery


I would try to get an appointment there for a new opinion.

I hope this helps.
Karla Hall

[Andrea7777]

Karla, thanks for all the informative information re: hemangiomas. I have an 8 month old who has one on her upper lip that is under the skin. It is still growing and is causing her nose to be misshapen. I have seen a family doctor when she was small and recently a very Old School pediatrician. I have been told to wait and see. I don't have good access to healthcare in Montreal as we just moved from BC. Do you know of anywhere in Montreal where I could try to have follow up or a third opinion?

Many Thanks

Andrea