Update on infantile hemangiomas
Introduction
Infantile hemangiomas (IH) are the most common tumor of infancy, affecting up to 4–5% of infants.1 These tumors are more common in female infants, in Caucasians, in multiple births, and in infants of low birth weight, regardless of gestational age. Although typically benign, both microscopically and in clinical behavior, these tumors can compromise breathing or feeding, obstruct vision leading to amblyopia, cause high-output cardiac failure or hypothyroidism due to visceral involvement, produce painful ulceration and bleeding, be associated with tethering of the spinal cord or severe genitourinary abnormalities, or lead to permanent and significant residual cosmetic deformity. Infantile hemangiomas are described as localized (focal), meaning that they are spatially confined, or segmental, covering a neurovascular territory (Fig. 1). Sometimes, the lesions are indeterminate. They may be superficial (in the dermis), deep (in the adipose tissue), or demonstrate mixed superficial and deep morphology. This review seeks to provide an update on the pathogenesis, clinical manifestations, and treatment options for IH.
Section snippets
Pathogenesis
The pathogenesis of IH has been recently reviewed.2 Infantile hemangiomas arise from endothelial stem cells,3, 4 and later proliferate by vasculogenesis, the recruitment of endothelial precursor cells to the sites of new vessel formation followed by maturation of the cells. Hemangiomas evolve through three phases: proliferation, involution, and involuted. The proliferative phase lasts from shortly after birth until up to one year, but is usually shorter, and occasionally longer. During this
Segmental hemangiomas with systemic involvement
Although the majority of IH affect only the territory in which they are situated, i.e., the skin and underlying structures, there are segmental hemangiomas that are associated with regional congenital anomalies or systemic complications, some of which can be quite deleterious. Segmental hemangiomas are associated with developmental neuroectodermal segments and respect embryologic anatomic boundaries, rather than being focal (i.e., limited to one area). These can be linear or geographic,
Treatment
Treatment is indicated for any infant with IH that obstruct vital structures such as the airway or visual pathway, symptomatic ulcerated hemangiomas, complex hepatic hemangiomas, asymptomatic lesions that continue to grow in size, mid-facial lesions that threaten permanent disfigurement, or large lesions that cause cardiac overload. Prompt treatment during the proliferative phase has the potential to arrest growth, leading to involution of the hemangioma. Use of propranolol for late hemangiomas
Conclusion
The serendipitous discovery of the therapeutic efficacy of propranolol in the management of infantile hemangiomas has revolutionized the care and understanding of these lesions, and greatly improved the prognosis for a good cosmetic outcome. The rapidity with which it has become first-line therapy, and its striking effectiveness in numerous published series, have made conducting randomized controlled trials problematic. Indeed, the same can also be said of other revolutionary therapies in the
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2020, Archives of Biochemistry and BiophysicsCitation Excerpt :Hemangioma (HA) is the most common benign tumor and formed by the proliferating endothelial cells of blood vessels [1].
Implantation of a cardiac pacemaker to circumvent complete heart block in a life-threatening hemangioma to allow the use of propranolol
2019, JAAD Case ReportsCitation Excerpt :Systemic steroids were the mainstream systemic treatment until the advent and US Food and Drug Administration approval of propranolol in 2014.3 Propranolol's mechanism of action on IH remains uncertain, but many hypotheses were suggested including initial vasoconstriction followed later by inhibition of angiogenesis.4,5 Well-known but rare side effects include bradycardia, hypotension, hypoglycemia, bronchial constriction, and sleep disturbances.2
Mono (2-ethylhexyl) phthalate (MEHP) triggers the proliferation of hemangioma-derived endothelial cells via YAP signals
2019, Chemico-Biological InteractionsCitation Excerpt :Hemangiomas (HAs) is a kind of neoplasm formed by the proliferating endothelial cells of blood vessels [1] with 75%–80% of HA patients are females [2].
Segmental Infantile Hemangioma With Minimal or Arrested Growth in LUMBAR Syndrome
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