Learn about hemangiomas in children

This article was written by Dr. Phung Tuyet Lan - Head of Pediatric Inpatient Unit 3, Children's Center - Vinmec Times City International General Hospital.

Vascular diseases in children are divided into 2 main groups: hemangiomas and vascular malformations. Hemangiomas in children typically progress in 2 stages: the proliferative phase and the regressive phase. Unlike hemangiomas, vascular malformations (abnormalities in the structure of capillaries, arteries, veins, lymphatic systems, or a combination of them) often develop in proportion to the child's body, but do not regress on their own.

The nature of hemangiomas are benign and can regress on their own, but in some cases there may be complications such as ulcers, deformities.
Moreover, some tumors may affect vital functions or may be accompanied by malformations of the spine, nervous system, circulatory system, eyes. Blood tumors located in the liver, brain, or gastrointestinal tract can sometimes cause life-threatening complications.
Epidemiology: hemangiomas are the most common neoplasms in young children, with an estimated incidence of 4-10%, usually spontaneous in nature, but also reported to have a familial dominant inheritance pattern. Normal NST. Hemangiomas are seen more than 2-3 times in girls, the incidence is increased in preterm infants/children with low birth weight, pre-natal risk factors such as maternal age, low placenta, pre-pregnancy seizures, placental abnormalities, multiple births. Pathology: hemangioma is characterized by a proliferative phase (rapid angiogenesis in the first year) and followed by a regressive phase (the atrophic vascular component is replaced by fibrous and fatty tissue). The mechanisms of this process are not fully understood and are being elucidated, with more evidence suggesting a role for local hypoxia in the pathogenesis of hemangiomas.

Clinical manifestations: most hemangiomas have clinical manifestations in the first days or months after birth. Some children present with capillary-like patches on the skin, surrounded by pale green color. Lesions can initially be mistaken for scratches or bruises. Less commonly, red patches resembling wine port stains. In the majority of cases, lesions appear solitary, in 20% of cases there may be multiple lesions. The most common sites for hemangiomas are the head and neck, although they can occur anywhere on the skin, mucous membranes, or other organs. The size of hemangiomas can range from a few millimeters to several centimeters. Lesions may be superficial or deep, or mixed.
Progression: hemangioma is characterized by 2 stages of growth, in the first few months is a period of rapid proliferation and then slow growth. Rarely, hemangiomas develop after 1 year. The proliferative phase is followed by an autoregressive phase, usually after 1 year of age and may last several years. Superficial tumors often regress earlier than deep tumors. The first manifestation of regression is the color change starting from the central area, from bright red to dark red or purple to gray, the tumor becomes softer and more flattened. The complete regression rate of the tumor is estimated at 10%/year, so about 50% of the tumor will have completely regressed at 5 years old, 90% at 9 years old. It should be emphasized that in many cases, although the tumor regresses completely, the skin lesions do not return to normal. About 50% of hemangiomas, after regressing, become scar-like remnants, atrophy, excess skin, discolouration, vasodilation, etc. and can cause deformation in some locations (lips, eyes, etc.) , head...).

In some cases, hemangiomas can be associated with birth defects in the brain, spinal cord, spine, urinary kidneys, and genitals. Some cases of hemangiomas can be found in organs such as liver, digestive system, nervous system... Multifocal hemangiomas in the liver are common in children with many hemangiomas on the skin (> 5 tumors), progress most develop no symptoms.
Complications: Most skin hemangiomas progress smoothly without complications and do not require intervention. However, some tumors can ulcerate leading to bleeding, pain, infection, scarring, or affect organ function or deformity during or after the proliferative phase. Complications depend on the location and size of the tumor in the organs. Respiratory hemangiomas can cause respiratory failure, and periorbital tumors can affect vision. In rare cases, multifocal hemangiomas in the liver may have large shunts leading to heart failure, or diffuse tumors in the liver presenting with hepatomegaly and respiratory failure, compression of the venous system in the abdomen. Gastrointestinal tumors can affect the swallowing reflex, gastrointestinal bleeding, and jaundice due to biliary compression. Central nervous system tumors can cause neurological sequelae such as paralysis and movement disorders. Treatment: Approach and manage hemangiomas on a case-by-case basis, based on size, morphology, location of lesions, risk of complications, patient age, tumor growth rate, consideration of variables treatment-related symptoms and benefits. The goal of treatment is to prevent and treat complications that are life-threatening or threaten organ function, minimize skin damage, and minimize the patient's psychological worries and concerns. family.

Uncomplicated and localized hemangiomas, especially in locations that do not affect aesthetics, will most likely not require intervention, progress can be monitored by taking pictures regularly. Indications for the use of topical or systemic drugs will be decided by a specialist.
Hemangiomas have a high risk of complications (large hemangiomas that leave scars, cause disfiguration, ulcerative tumors, life-threatening tumors such as respiratory hemangiomas or affect function such as neoplasms). Orbital blood) should be started at specialized centers early (1 month of age). The methods used can be alone or in combination between systemic treatment (Propranolol, Corticosteroids, Vincristine, Interferon alpha) and local treatment (surgery, laser, embolism) depending on the nature of the lesion and response. treatment response.
Hemangioma is the most common type of angioma in children, usually appearing in the first month of life, the most common location is the head and neck and can affect organs such as the liver, gastrointestinal tract, and brain. Hemangiomas develop in two stages: proliferative in the first few months and followed by regression, usually after 1 year of age and may persist for several years.
Most hemangiomas are uncomplicated and do not require treatment. Children with detected hemangiomas need to be examined and monitored at medical facilities for timely advice and intervention.
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