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Hemangioma of Infancy

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					Hemangioma of Infancy

        Albert K. Oh, M.D.
       Assistant Professor
    Division of Plastic Surgery
    Vascular Anomalies Center
Children’s National Medical Center
                             General
                             Surgery
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                                          Gynecology
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                          Capi                          a
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       Vascular                                    Hematology
       Surgery t
                              llary          cystic hygroma
                             an                        Neurosurgery
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                                        s           giom
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    Surgery a                port-wine      hema          Ophthalmology
                ngiokera
                          toma                pyogenic g
                                                           ranuloma
Radiology                        rnou ssalmon             Orthopaedic
                 Capillary-cave                  patch      Surgery
            naev
                  us fl                                         nay
                        amm          Klippel-  Weber-Trenau
              r bleb         eus                     Otorhinolaryngology
 bl ue rubbe
                            ry                      a Juve
                                                 omPathologynile
          Plastic         er                   i
     Cirso
          Surgery St
           id        rawb          spid er ang
                              Pediatric
                              Surgery
                                      General
                                      Surgery
                        Dermatology               Gynecology

             Vascular                                          Hematology
             Surgery
                                                                    Neurosurgery
     Thoracic
     Surgery         Vascular
                     Vascular
                        Vascular Anomalies:
                               Vascular                                Ophthalmology

                         Anomalies                                    Orthopaedic
Pediatrics
                    Anomalies
                    Anomalies
                  Tumors & Malformations                               Surgery

                                                                    Otolaryngology
Radiology

                                                                    Oral Surgery
                 Plastic              Pediatric
                 Surgery              Surgery           Pathology
         Vascular Anomalies
Tumors                  Malformations

Hemangioma              Slow-flow
  Infantile                   Capillary
  NICH                        Lymphatic
  RICH                        Venous
                        Fast-flow
                              Arterial
Hemangioendotheliomas
                        Combined
Angiosarcoma
What is hemangioma of infancy?

• Clues…
  –   Female
  –   Prematurity
  –   Caucasian
  –   Intrauterine trauma
  –   Associated anomalies


• WE DON’T KNOW!!!
           Placental Role
• Association with CVS

• Monoclonal endothelial cells

• Cell markers
  – GLUT-1
  – Merosin
  – Lewis-Y antigen
                                 North et al., 2000
                                 Barnes et al., 2005
  Hemangioma and Placental Transcriptomes
       have similar molecular profiles




Mus   Scl Skin   Squ SmC Lung   Plac Hem Car Brain




                                        Barnes et al., 2005
        Presentation of HOI
• Clinically heterogeneous

• 4-8 weeks of age

• Proliferation (3-18 months)

• Involution
       Who needs imaging?
• Unclear diagnosis

• “Beard” distribution

• Lumbosacral

• Multiple cutaneous lesions

• Special/associations
           PHACES Association

• Posterior fossa malformations

• Hemangioma: large, plaque-like, regional

• Arterial: intra/extra-cranial

• Cardiac: coarctation, other arch anomalies

• Eye: microphthalmos, cataract, glaucoma

• Sternum: cleft, supraumbilical raphe
Treatment Options for HOI?
  First Line - Corticosteroids

• Response: within 2 weeks

• Rule of thirds?

• Adverse effects
  – Local
  – Systemic
       First Line – Surgical?
• Periorbital

• Nasal tip

• Auricular

• Other anatomically sensitive locations
        Second Line Options
• Pulsed dye laser

• Interferon alpha

• Vincristine

• Cyclophosphamide

• Beta-blockade
       Propranolol and HOI

• May cause regression of HOI

• Mechanism unknown

• Less adverse effects than steroids
  – Bradycardia (rarely symptomatic)
  – Hypoglycemia


                                  Léauté-Labrèze et al., 2008
    CNMC Randomized Trial

• Propranolol vs. Prednisolone

• NIH funded / Multi-center

• Infants age 2 weeks to 5 months

• Currently enrolling patients
          Conclusions:
      Hemangioma of Infancy
• Very common

• History/physical exam usually adequate

• Further workup in select patients
  – Location
  – Multiple lesions
  – Associations/syndromes
          Conclusions:
      Hemangioma of Infancy
• First line treatment
  – Medical: steroid
  – Surgical: select cases


• Second line treatments

• Shift from steroids        beta blocker
Thank you!
Questions?

				
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