Diffuse and benign Hemangiomatosis

Finding out that your child has a hemangioma can be upsetting. If your child’s hemangioma does need treatment, you’re in the right place. Here at Sakra, we have expert teams of surgical specialties who are specialists in the field of vascular anomalies. The team’s approach ensures that your child’s treatment plan is carefully developed and coordinated with the expertise of our specialists in vascular anomalies.

As with other conditions, bleeding and ulceration are the complications of hemangioma. The doctors at Sakra, help you to determine if your child’s hemangioma may be likely to have a complication based on the location, size and speed of the growth. Our surgeons emphasize that treatment for hemangioma also requires good post op care. Generally shrinking of hemangioma takes 1 to 5 years of life.

What are hemangiomas?         

The most common benign tumors or vascular neoplasms that occur during infancy are called as hemangiomas. Hemangiomas are formed due to the abnormal collection of blood vessels. Infantile hemangiomas are generally characterized by early proliferation and involution of blood vessels.  Hemangiomas appear in varying size - small to large. Larger sized hemangiomas grow gradually into lesions which may require surgical removal. Hemangioma cells multiply to grow and thicken though they are considered as noncancerous lesions. They are different from cancerous lesions as they stop growing with time.

What causes hemangiomas in infants?
The reason for the occurrence of hemangiomas in infants is unknown. However certain known facts about hemangiomas are as follows;

  • More common in girls
  • Mostly seen in Caucasian children
  • Observed in babies born before their due date

What are the types of hemangiomas in infants?              
There are three types which include -   

  • Hemangiomas which occur on the outer layers of the skin are called superficial hemangiomas. They appear purple to bright red in color
  • Hemangiomas which grow under the skin of the fat is called as deep hemangiomas which are characterized by blue or purple in color.
  • The components of both deep and superficial hemangiomas are called mixed hemangiomas.

What are the sites at which hemangiomas develop?

  • Cutaneous hemangiomas- 60% of cutaneous hemangiomas occurs in the head and neck region. About 25% on the trunk and 15% on the extremities (legs and hands).
  • Extracutaneous hemangiomas- The sites at which extracutaneous hemangiomas occurs are; Liver, Pancreas, Gallbladder, Lymph nodes, Spleen, Urinary bladder, Lung, Thymus, Central nervous system, Larynx, Adrenal glands, Gastrointestinal tract

What are diffuse hemangiomas?

If more than 10 cutaneous hemangiomas are present they will be classified as diffuse hemangiomas.  Diffuse neonatal hemangiomas are characterized by raise in visceral lesions. Diffuse hemangiomas are life threatening conditions which can cause congestive heart failure due to raised vascular volume. Diffuse hemangioma mostly affects liver and gastrointestinal tract. Diffuse hemangioma can be treated with corticosteroids, interferon –α and conventional surgery.

What are the characteristic features of infantile hemangiomas?

Slow involution and rapid growth are important characteristics of infantile hemangiomas.

  • The most characteristic hallmark of infantile hemangiomas are rapid growth during birth to 4 weeks. This is called the proliferation stage of hemangioma
  • A very little change in the morphological characteristic of hemangioma which lasts until in 1-2 years old infants is the resting stage of hemangioma
  • Infantile hemangioma is tumoral, plaque-like and dome shaped. Sometimes there are combinations of these morphologies.
  • The growth of infantile hemangiomas occurs during first 4-6 months after birth.
  • After 6-12 months of birth, proliferation of hemangiomas slows considerably.
  • Diminish in the size of hemangioma occurs at the involution phase of hemangiomatosis.
  • About 50% of complete involution occurs at 5 years of age and 70% of complete involution occurs at 7 years of age.
  • Additional 3-5 years of time is required for complete involution to take place.
  • Girls are most commonly affected by hemangiomas when compared to boys
  • Seen mostly in caucasian children
  • Hemangiomas occur for infants who are born before their due date.

What are the symptoms of hemangiomas?

Hemangiomas are generally unnoticed, however when they develop into lager lesions or when multiple hemangiomas occur, they start exhibiting following symptoms which includes;

  • Nausea
  • Loss of appetite
  • Vomiting
  • Weight loss
  • Abdominal distress
  • Feeling oh abdominal fullness

What are the complications of hemangioma?

  • Bleeding
  • Ulceration
  • Interference in function of the organ

What are the treatment options for hemangiomas?

Most of the hemangiomas go away without any treatment, however treatment is required in some cases.

Treatment of hemangiomas depends on the following factors;

  • Age
  • Size of hemangioma
  • The growth of hemangioma
  • Location of hemangioma

Treatment also depends based on location of hemangiomas. Appearance of hemangiomas on the following locations requires quick treatment

  • Hemangiomas located on the airway or liver
  • Disfiguring hemangioma on skin
  • Hemangiomas appearing on ear canal and eye.

Based on the factors and locations of hemangiomas, following treatment options are opted;

  • Surgical removal- In rare cases, surgery is used to remove hemangioma
  • Cortisone can be injected directly into hemangioma or can be taken by mouth.
  • Laser therapy- laser therapy is suggested in the early flat stage of hemangioma. Laser therapy is to target blood vessels directly. Laser therapy is also used to remove scarring, loose skin and to remove fatty lumps which remains after the partial disappearance of hemangioma.

Other treatment options include;

  • Propranolol administration
  • Oral systemic corticosteroids
  • Treatment with gel containing Becaplermin
  • Vincristine treatment
  • Interferon α treatment

Quick Enquiry

Doctors

Dr. C. Ramachandra.

Senior Consultant & HOD - Pediatric Surgery

Dr. Anil Kumar P.L..

Consultant - Pediatric Surgery

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