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Almothahbi A, Bukhari M, Almohizea M, Alsubaie N, Alharbi TF, Alhazzani HM, Zagzoog F. Recent updates in laryngeal hemangioma management: a scoping review. Eur Arch Otorhinolaryngol 2024; 281:2211-2222. [PMID: 38158419 DOI: 10.1007/s00405-023-08378-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/24/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE To provide a comprehensive review of the current strategies in the management of laryngeal hemangiomas, with an aim to introduce a management algorithm that aligns with the variable clinical presentations and anatomical complexities of these lesions. METHODS We conducted an extensive literature search across major databases using specific and general terms, combined with Boolean operators, to ensure comprehensiveness. Articles from January 2004 to August 2023 were included, with findings categorized by management approach. RESULTS Laryngeal hemangiomas exhibit a spectrum of manifestations, ranging from asymptomatic lesions to those causing severe airway obstruction. Optimal management demands an individualized approach tailored to the patient's unique presentation and anatomical considerations. Diverse treatment modalities, each with distinct indications, advantages, and limitations, are explored. Notable highlights encompass the prominent role of Beta-blockers, notably Propranolol, in addressing problematic infantile hemangiomas, the nuanced efficacy of laser therapies contingent upon hemangioma type and depth, and the critical relevance of tracheotomy in emergencies. Novel approaches like transoral robotic surgery and transoral ultrasonic surgery, demonstrate promise in specific scenarios. We propose a management algorithm based on the complexity and presentation of laryngeal hemangiomas, emphasizing individualized treatment strategies, thereby addressing the unique challenges and nuances of each case. CONCLUSION Laryngeal hemangioma management requires personalized approaches informed by diverse therapies, clinical expertise, and collaboration. The review introduces an algorithm spanning observation to advanced interventions, adapting to each case's complexity. Ongoing research promises innovative treatments.
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Affiliation(s)
- Ali Almothahbi
- King Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia.
| | - Manal Bukhari
- King Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia
| | | | - Nawaf Alsubaie
- King Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Talal F Alharbi
- King Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia
| | | | - Faisal Zagzoog
- King Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia
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Satterfield KR, Chambers CB. Current treatment and management of infantile hemangiomas. Surv Ophthalmol 2019; 64:608-618. [PMID: 30772366 DOI: 10.1016/j.survophthal.2019.02.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 01/27/2019] [Accepted: 02/04/2019] [Indexed: 12/19/2022]
Abstract
Infantile hemangiomas, otherwise known as infantile capillary hemangiomas, strawberry hemangiomas, or strawberry nevi, are nonmalignant vascular tumors that commonly affect children. The natural disease course typically involves growth for up to a year, followed by regression without treatment over a period of years with no cosmetic or functional sequelae. Less commonly, however, infantile hemangiomas can become a threat to vision or even life depending on location and size of the lesion. In addition, infantile hemangiomas, particularly those involving the face, may be disfiguring and result in lifelong sequelae. β-blockers have become a mainstay of therapy given their relatively low-risk profile and efficacy. Other treatment modalities previously described in the literature include corticosteroids (both intralesional and systemic), imiquimod, vincristine, bleomycin A5, and interferon α. More recently, angiotensin-converting enzyme inhibitors such as captopril have been used. Laser therapy and, less commonly, surgical excision are also available treatment options. We review current recommended management and treatment of capillary hemangiomas and discuss the benefits and risks of all previously reported treatment modalities.
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Affiliation(s)
- Kellie R Satterfield
- Department of Medicine, Scripps Mercy Hospital, San Diego, California, USA; Department of Ophthalmology, University of Washington, Seattle, Washington DC, USA
| | - Christopher B Chambers
- Department of Ophthalmology, University of Washington, Seattle, Washington DC, USA; Department of Oculoplastic and Reconstructive Surgery, University of Washington, Seattle, Washington DC, USA.
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Keller RG, Patel KG. Evidence-Based Medicine in the Treatment of Infantile Hemangiomas. Facial Plast Surg Clin North Am 2016. [PMID: 26208774 DOI: 10.1016/j.fsc.2015.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Over the past decade, the treatment of infantile hemangiomas has undergone dramatic breakthroughs. This review critically evaluates the latest literature that supports the myriad treatment options for infantile hemangiomas. It chronicles the fading role of steroid therapy and evolution of propranolol use as the major treatment modality. Although propranolol is helping this disease become more of a medical disease and less of a surgical dilemma, the report also reveals a continued search to find nonsystemic treatment options. In summary, this is an evidence-based medicine review for the treatment of infantile hemangiomas.
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Affiliation(s)
- Robert G Keller
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC 29425, USA
| | - Krishna G Patel
- Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC 29425, USA.
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Abstract
PURPOSE OF REVIEW Infantile hemangiomas are the most common benign, soft-tissue tumors of infancy, affecting between 5 and 10% of newborns, and up to 30% of premature infants. Morbidity may include disfigurement and scarring, difficulty in feeding, ulceration, vision loss, airway compromise, congestive heart failure, and death. Advances in understanding the pathogenesis of infantile hemangiomas have given rise to a number of promising treatments. This article reviews the current options for medical management of infantile hemangiomas. RECENT FINDINGS In the proliferative phase of infantile hemangiomas, vascular endothelial growth factor and basic fibroblast growth factor have shown increased expression, and vascular endothelial growth factor expression has been up-regulated by adrenergic stimulation. Moreover, the role of the renin-angiotensin system in the pathogenesis of infantile hemangiomas has been demonstrated. Numerous medical options have been under investigation. Since 2008, propanolol has become the first-line therapy, whereas other medical treatments are used less frequently or when propanolol is unsuccessful. SUMMARY Propranolol has been recently adopted as the first-line medical treatment for complicated infantile hemangiomas. Although emerging treatment options and modalities have shown promising results, there need to be high-quality multicenter randomized trials to support these preliminary data.
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Rumore MM. Medication Repurposing in Pediatric Patients: Teaching Old Drugs New Tricks. J Pediatr Pharmacol Ther 2016; 21:36-53. [PMID: 26997928 PMCID: PMC4778695 DOI: 10.5863/1551-6776-21.1.36] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Gaps in pediatric therapeutics often result in off-label use and specifically, novel uses for existing medications, termed "drug repurposing." Drug Information (DI) queries to a Pediatric Medication Resource Center of a large metropolitan pediatric hospital in New York and inherent difficulties in retrieving evidence-based information prompted a review of current medication repurposing for pediatric patients. The objective included characterization of innovative off-label use of medications Food and Drug Administration (FDA)-approved for 1 or more indications to treat a totally different disorder or indication in pediatric patients. METHODS A systematic literature review was conducted to retrieve publications describing repurposed medications in pediatric patients. Excluded was FDA-approved indications used off-label in pediatric patients (e.g., different dose), preclinical data, adult use only, and experimental use. Evidence quality was classified using a modified American Academy of Neurology Level of Evidence. Results were analyzed using χ(2) at p < 0.05. RESULTS Over 2000 references were retrieved and reviewed. A total of 101 medications repurposed for novel off-label uses for pediatric patients were identified: 38 for neonates, 74 for children, and 52 for adolescents. Neonates and infants were least likely to receive a medication for a repurposed use. Strong or intermediate evidence existed in 80.2% of cases. The evidence was weak in 19.8%. No significant relationship was observed between the pediatric age group and strength of the literature. Most repurposed uses pertained to generic or widely used medications. Less than 5% of medications were first marketed after 2011. CONCLUSIONS While not exhaustive, the present study represents the most comprehensive listing of novel uses exclusive to pediatric patients. Further research is needed to identify the frequency of repurposed uses. The valuable DI role of pharmacists in assessing repurposed uses is of expanding and increasing importance to ensure such uses are evidence-based.
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Affiliation(s)
- Martha M. Rumore
- Department of Social, Behavioral and Administrative Sciences, Touro College of Pharmacy, New York, New York; Of Counsel, Sorell, Lenna, & Schmidt, LLP, Hauppauge, New York
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Li P, Guo Z, Gao Y, Pan W. Propranolol represses infantile hemangioma cell growth through the β2-adrenergic receptor in a HIF-1α-dependent manner. Oncol Rep 2015; 33:3099-107. [PMID: 25872592 DOI: 10.3892/or.2015.3911] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/02/2015] [Indexed: 11/06/2022] Open
Abstract
Propranolol, as a non-selective blocker of the β-adrenergic receptor (AR), is utilised as the first-line treatment for infantile hemangiomas. However, the underlying mechanism remains poorly understood. The present study was designed to investigate the molecular basis of propranolol on the regression of infantile hemangiomas using a proliferating infantile hemangioma-derived endothelial cell line. In infantile hemangioma patients, we found that propranolol significantly decreased the expression levels of the hypoxia inducible factor (HIF)-1α in serum and urine, as well as in hemangioma tissues. In vitro analysis revealed that propranolol reduces the expression of HIF-1α in hemangioma cells in a dose- and time-dependent manner, mainly by acting on β2-AR. Interestingly, it was observed that overexpression of HIF-1α apparently abrogated the inhibitory effects of propranolol on vascular endothelial growth factor (VEGF) expression and cell growth. Our data further demonstrated that propranolol inhibited the signal transducer and activator of transcription 3 (STAT3), a critical oncogenic signaling molecule, and the anti-apoptotic protein Bcl-2. Additionally, overexpression of HIF-1α significantly reversed the inhibitory effects of propranolol on STAT3 signaling. In a mouse xenograft hemangioma model, overexpression of HIF-1α significantly attenuated the therapeutic effects of propranolol and inhibited propranolol-induced hemangioma cell apoptosis. Moreover, the protein levels of VEGF, phosphorylated STAT3, total STAT3 and Bcl-2 were significantly upregulated by HIF-1α overexpression in propranolol-treated nude mice bearing hemangiomas. Collectively, our data provide evidence that propranolol may regress infantile hemangiomas by suppressing VEGF and STAT3 signaling pathways in an HIF-1α-dependent manner.
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Affiliation(s)
- Peng Li
- Department of Pediatric Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Zhengtuan Guo
- Department of Pediatric Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Ya Gao
- Department of Pediatric Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Weikang Pan
- Department of Pediatric Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
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Wang Z, Li K, Yao W, Dong K, Xiao X, Zheng S. Steroid-resistant kaposiform hemangioendothelioma: a retrospective study of 37 patients treated with vincristine and long-term follow-up. Pediatr Blood Cancer 2015; 62:577-80. [PMID: 25346262 DOI: 10.1002/pbc.25296] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 08/26/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND Kaposiform hemangioendothelioma (KHE) with Kasabach-Merritt phenomenon (KMP) still remains a particular and life-threatening disease. The purpose of this study was to evaluate the efficacy of vincristine (VCR) and the possibility of replacement with steroids in the treatment of steroid-resistant KHE with KMP. PROCEDURE We retrospectively reviewed the medical records of 37 patients with steroid-resistant KHE who were treated at the Children's Hospital of Fudan University between March 2003 and March 2013. RESULTS The age of initial diagnosis with KHE was between 1 day and 10 months. Eight and 29 cases were located in the superficial and deep soft tissues, respectively. Thirty-seven KHE lesions did not respond well to steroids before starting VCR treatment. Twenty-six KHE lesions achieved complete remission, with platelet counts reaching normal levels within7.6 ± 5.2 weeks after VCR treatment. The vascular tumor began to decrease in size or soften at an average of 4.9 ± 2.7 weeks. Two KHE lesions had partial responses and one remains in treatment. Eight KHE lesions had no apparent response to VCR and thus received other therapies. Twenty-eight patients have ended treatment with VCR; the average length of treatment was 31.2 ± 5.9 weeks. Side effects occurred in 48.6% of patients who received steroids, and in 11.4% of patients who received VCR treatment. The mean follow-up time was 3.5 years. No recurrences have been reported. CONCLUSIONS VCR appears to be a safe and effective treatment option in the management of steroid-resistant KHE with KMP, and recommended as first-choice treatment.
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Affiliation(s)
- Zuopeng Wang
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, People's Republic of China
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Kuroda T, Hoshino K, Nosaka S, Shiota Y, Nakazawa A, Takimoto T. Critical hepatic hemangioma in infants: recent nationwide survey in Japan. Pediatr Int 2014; 56:304-8. [PMID: 24689756 DOI: 10.1111/ped.12347] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 03/04/2014] [Accepted: 03/24/2014] [Indexed: 12/16/2022]
Abstract
The International Society for the Study of Vascular Anomalies (ISSVA) classification divides vascular lesions into two major entities: neoplasms originating from the vascular endothelium and vascular malformations. Although this concept has been widely accepted, little has been established regarding vascular lesions in deep organs, such as infantile hepatic hemangioma (IHH). The current nationwide survey identified 19 critical infantile hemangiomas during the most recent 5 years. On histopathology all the lesions examined were neoplastic, but portovenos shunt was found histologically or clinically in some cases. High-output cardiac failure, consumption coagulopathy, and respiratory distress were the major symptoms, and treatment-resistant coagulopathy seemed to be the most reliable predictor of fatal outcome. Although steroid has been the gold standard treatment for these lesions, 25% of the patients were totally insensitive to steroids, whereas propranolol had a prompt effect in one case. For critical IHH with steroid-insensitive thrombocytopenia and prothrombin time prolongation, novel therapeutic options including beta-blocker therapy, surgery, and liver transplantation should be urgently considered as alterative treatment. The present review summarizes the results of the survey.
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Affiliation(s)
- Tatsuo Kuroda
- Infantile Hepatic Hemangioma Study Group, Department of Pediatric Surgery, Keio University, School of Medicine, National Center for Child Health and Development, Tokyo, Japan
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Craiglow BG, Antaya RJ. Management of infantile hemangiomas : current and potential pharmacotherapeutic approaches. Paediatr Drugs 2013; 15:133-8. [PMID: 23456550 DOI: 10.1007/s40272-013-0008-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Infantile hemangiomas (IH), benign vascular neoplasms, are the most common tumors of infancy and childhood. Most IH are medically insignificant; however, a proportion will require treatment because of interference with vital structures, threat of significant disfigurement, ulceration, or bleeding. This article reviews current and potential pharmacotherapeutic approaches to the treatment of IH. While corticosteroids have long been considered the mainstay of medical therapy for IH, several new treatments have recently emerged, the most promising of which is oral propranolol. Topical timolol and imiquimod are additional new therapies that may also prove to be effective, particularly for the treatment of superficial IH.
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Affiliation(s)
- Brittany G Craiglow
- Department of Dermatology, Yale University School of Medicine, P.O. Box 208059, New Haven, CT 06520, USA.
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11
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Chisholm KM, Chang KW, Truong MT, Kwok S, West RB, Heerema-McKenney AE. β-Adrenergic receptor expression in vascular tumors. Mod Pathol 2012; 25:1446-51. [PMID: 22743651 DOI: 10.1038/modpathol.2012.108] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Propranolol has recently emerged as an effective therapy for infantile hemangiomas causing regression. The β-adrenergic receptor (AR) antagonist is thought to cause vasoconstriction by its effect on nitric oxide, block angiogenesis by its effect on vascular endothelial growth factor (VEGF), and induce apoptosis. In a prior report, we identified expression of β2-AR (B2-AR) and its phosphorylated form (B2-ARP) in a case of infantile hemangioma that responded to propranolol treatment. We now explore the expression of βARs on a variety of vascular lesions utilizing a tissue microarray containing 141 lesions, including infantile hemangiomas, angiosarcomas, hemangiomas, hemangioendotheliomas, and various vascular malformations. The array was immunostained for B2-AR, B2-ARP, and β3-AR (B3-AR), and the results scored for the intensity of endothelial cell expression as negative, weak positive, or strong positive. All phases of infantile hemangiomas had strong expression of all three receptors, with the exception of only weak expression of B2-ARP in the proliferative phase infantile hemangioma. Strong expression of all three receptors was present in many hemangiomas, hemangioendotheliomas, and vascular malformations. Absent to weak expression of all three receptors was seen in glomus tumor, hobnail hemangioendothelioma, pyogenic granuloma, and reactive vascular proliferations. This is the first study to report β-AR expression in a variety of vascular lesions. Although immunohistochemical expression of the receptors does not necessarily indicate that similar pathways of responsiveness to β-blockade are present, it does raises the possibility that β-blockade could potentially affect apoptosis and decrease responsiveness to VEGF. Additional study is warranted, as therapeutic options are limited for some patients with these lesions.
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Affiliation(s)
- Karen M Chisholm
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305, USA
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Fuchimoto Y, Morikawa N, Kuroda T, Hirobe S, Kamagata S, Kumagai M, Matsuoka K, Morikawa Y. Vincristine, actinomycin D, cyclophosphamide chemotherapy resolves Kasabach-Merritt syndrome resistant to conventional therapies. Pediatr Int 2012; 54:285-7. [PMID: 22507155 DOI: 10.1111/j.1442-200x.2011.03414.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Yasushi Fuchimoto
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
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Critical infantile hepatic hemangioma: results of a nationwide survey by the Japanese Infantile Hepatic Hemangioma Study Group. J Pediatr Surg 2011; 46:2239-43. [PMID: 22152857 DOI: 10.1016/j.jpedsurg.2011.09.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Accepted: 09/03/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND The current survey aimed to describe the clinical features of critical infantile hepatic hemangioma (IHH) and the implications of recent treatments. MATERIALS AND METHODS A nationwide survey of critical IHH patients treated between 2005 and 2010 was performed in all 117 registered pediatric surgical hospitals in Japan. As a result, 19 patients were identified and reviewed using a statistical analysis. RESULTS Abdominal distention (47.4%), high-output cardiac failure (47.4%), coagulopathy (42.1%), and respiratory distress (31.6%) were the major symptoms. Three patients died (1 of coagulopathy, 1 of cardiac failure, and 1 of both). An accompanying portovenous shunt was also highlighted. Infantile hepatic hemangioma was totally insensitive to steroid treatment in 3 (23.1%) of the 13 patients, and 9 (47.4%) of the 19 patients required other treatments. Surgical resection and β-blocker improved the hematologic data, whereas hepatic arterial ligation and embolization seemed to produce a limited effect. Among the dead patients, several hematologic parameters were significantly worse: the thrombocyte count (pretherapeutic: 73,000 vs 300,000/mm(3), dead vs survivor, respectively [P < .03]; posttherapeutic: 66,000 vs 388,700/mm(3) [P < .003]) and the prothrombin time (posttherapeutic, 35.0 vs 12.1 seconds [P < .0001], dead vs survivor, respectively). CONCLUSION For critical IHH cases with steroid-insensitive hematologic disorders, alternative treatments including β-blocker therapy, surgery, and liver transplantation should be considered.
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Fukushima H, Kudo T, Fuskushima T, Takahashi-Igari M, Shiigai M, Mori K, Sumazaki R. An infant with life-threatening hemangioma successfully treated with low-dose cyclophosphamide. Pediatr Int 2011; 53:1073-5. [PMID: 22181565 DOI: 10.1111/j.1442-200x.2011.03452.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hiroko Fukushima
- Department of Pediatrics, Tsukuba University Hospital, Tsukuba, Japan.
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Intralesional bleomycin injection treatment for vascular birthmarks: a 5-year experience at a single United Kingdom unit. Plast Reconstr Surg 2011; 127:2031-2044. [PMID: 21532430 DOI: 10.1097/prs.0b013e31820e923c] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The authors present their experience using an established chemotherapeutic agent as a scarless treatment for vascular birthmarks. One hundred sixty-four of more than 600 patients seen in the authors' center received intralesional bleomycin injection over 5 years. METHODS Patient demographics, clinical response, treatment, and complication details were recorded prospectively. Respiratory surveillance was provided by adult and pediatric pulmonologists. Eighty-one venous malformations, 39 hemangiomas, 26 lymphatic malformations, 10 mixed malformations, two arteriovenous malformations, two cystic hygromas, two capillary malformations, and two angiokeratomas underwent intralesional bleomycin injection. RESULTS The authors observed that 45.7 percent of patients completed treatment in a mean of 3.8 sessions and mean duration of 107 days. Complete resolution occurred in 56.0 percent, with a 93.3 percent overall response rate, and 82.7 percent of lesions demonstrated complete response or significant improvement. Three patients developed transient skin hyperpigmentation. One patient each developed skin ulceration, blistering, infection, swelling, headache, bruising, and rash. One patient required intubation following treatment of a panfacial and thoracic lymphatic malformation. A full recovery ensued. No patients developed pulmonary fibrosis. One venous malformation recurred. CONCLUSIONS The authors' single-site multidisciplinary team has successfully treated complex and recurrent vascular anomalies with acceptable complication and recurrence profiles. These findings represent the authors' experience and provide a reference for the management of these challenging lesions.
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Abstract
Vascular tumors of childhood are typically benign. The 4 most common types are infantile hemangioma (IH), congenital hemangioma (CH), kaposiform hemangioendothelioma (KHE), and pyogenic granuloma (PG). Vascular tumors must be differentiated from vascular malformations. Although tumors and malformations may appear as raised, blue, red, or purple lesions, their management differs significantly.
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Affiliation(s)
- Arin K Greene
- Department of Plastic and Oral Surgery, Vascular Anomalies Center, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
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Lee SJ, Lee SB, Chung HY, Lee JM, Lee SH. Current drug therapies for infantile hemangioma: focused on beta blocker. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2011. [DOI: 10.5124/jkma.2011.54.8.876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Seok-Jong Lee
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
- Vascular Anomalies Center, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sang-Bum Lee
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea
| | - Ho Yun Chung
- Department Plastic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jong Min Lee
- Department of Radiology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seung Huh Lee
- Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea
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Fay A, Nguyen J, Waner M. Conceptual approach to the management of infantile hemangiomas. J Pediatr 2010; 157:881-8.e1-5. [PMID: 20884010 DOI: 10.1016/j.jpeds.2010.08.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 06/30/2010] [Accepted: 08/12/2010] [Indexed: 11/29/2022]
Affiliation(s)
- Aaron Fay
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
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Pérez-Valle S, Peinador M, Herraiz P, Saénz P, Montoliu G, Vento M. Vincristine, an efficacious alternative for diffuse neonatal haemangiomatosis. Acta Paediatr 2010; 99:311-5. [PMID: 20353500 DOI: 10.1111/j.1651-2227.2009.00466.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Diffuse neonatal haemangiomatosis (DNH) is an uncommon condition characterized by multiple cutaneous and visceral haemangiomas frequently causing severe complications. Corticosteroids constitute the first therapeutic line; however, when they fail, other alternatives are available, provided possible side effects are closely monitored during and after treatment. We present a case of life-threatening DNH, non-responsive to corticosteroids, successfully treated with Vincristine with minor side effects. We conclude that Vincristine is a valid alternative in corticosteroid-resistant DNH.
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Affiliation(s)
- S Pérez-Valle
- Servicio de Neonatología, Hospital Universitario Materno-Infantil La Fe, Valencia, Spain
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Tumores vasculares en la infancia. An Pediatr (Barc) 2010; 72:143.e1-143.e15. [DOI: 10.1016/j.anpedi.2009.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Revised: 10/12/2009] [Accepted: 10/13/2009] [Indexed: 12/12/2022] Open
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Nguyen J, Fay A. Pharmacologic Therapy for Periocular Infantile Hemangiomas: A Review of the Literature. Semin Ophthalmol 2009; 24:178-84. [DOI: 10.1080/08820530902805602] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Couvillion SS, Wykoff CC, Tutiven JL, Schaefer AM, Murray TG. Diffuse neonatal hemangiomatosis presenting as bilateral iris hemangiomas in an infant. Retin Cases Brief Rep 2009; 3:279-282. [PMID: 25389584 DOI: 10.1097/icb.0b013e3181737767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To describe a case of diffuse neonatal hemangiomatosis presenting as bilateral iris hemangiomas. METHOD Case report. PATIENT A 2-month-old girl presented with bilateral enlarging red masses of her irises, congestive heart failure, and abdominal distension. The iris masses were diagnosed as hemangiomas, and she was found to have diffuse neonatal hemangiomatosis also involving her skin, liver, heart, and cerebellum. RESULTS The patient's systemic hemangiomas were successfully treated with four cycles of weekly intravenous vincristine (0.05 mg/kg/dose) with concurrent resolution of her right iris hemangioma within 6 weeks. The left iris lesion then regressed within 1 month following 1 subTenon injection of 20 mg of triamcinolone acetonide with residual iridocorneal adhesions at the site. CONCLUSION Diffuse neonatal hemangiomatosis should be considered in the setting of bilateral iris hemangiomas. Also, this case demonstrates that iris hemangiomas associated with diffuse neonatal hemangiomatosis may respond to systemic vincristine, and that periocular steroids may be useful for treating iris hemangiomas that are unresponsive to systemic vincristine alone.
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Affiliation(s)
- Stephen S Couvillion
- From the *Department of Ophthalmology, Bascom Palmer Eye Institute, and †Department of Anesthesiology, University of Miami Miller School of Medicine; and ‡Department of Hematology and Oncology, Joe DiMaggio Childrens Hospital, Hollywood, Florida
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Wharton S, Soueid A, Nishikawa H, Sridhar AV. Endangering cutaneous infantile hemangioma treated with vincristine: a case report. EUROPEAN JOURNAL OF PLASTIC SURGERY 2008. [DOI: 10.1007/s00238-008-0295-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Yesudian PD, Klafkowski J, Parslew R, Gould D, Lloyd D, Pizer B. Tufted Angioma???Associated Kasabach-Merritt Syndrome Treated with Embolization and Vincristine. Plast Reconstr Surg 2007; 119:1392-1393. [PMID: 17496631 DOI: 10.1097/01.prs.0000255189.06739.07] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Paul D Yesudian
- Department of Dermatology (Yesudian, Parslew) Department of Radiology (Klafkowski, Gould) Department of Surgery (Lloyd) Department of Paediatric Oncology, Royal Liverpool Children's Hospital, Liverpool, United Kingdom (Pizer)
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Kaselas C, Tsikopoulos G, Papouis G, Kaselas V. Intralesional administration of interferon A for the management of severe haemangiomas. Pediatr Surg Int 2007; 23:215-8. [PMID: 17171547 DOI: 10.1007/s00383-006-1840-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2006] [Indexed: 11/29/2022]
Abstract
Intralesional administration of interferon alpha (INF-A) is a new approach in haemangiomas treatment that we electively apply to our patients. The aim of this study is to report the beneficial results of this new kind of therapy. Thirty-two patients with severe haemangiomas, 19 females and 13 males, were treated at our department from January 2000 to December 2004. All patients received INF-A intralesionally at a dose of 1-3 MIU/m(2) of body surface once a day for the first week, and then once a week until completion of therapy. Reduction was evaluated after clinical and radiological measurement before, during and after completion of therapy and was graded as complete (>80%), significant (50-80%), medial (20-50%) and no response (<19%). Mean duration of therapy was 8 weeks (2 months). Most patients had not received prior therapy. Complete regression was noticed in 18 patients, satisfactory in 8 patients, minimal in 4 and no response in 2 patients. Minimal complications such as flu-like malaise with fever were reported by 23 patients at the beginning of therapy, but it was resolved easily by paracetamol administration. Complications such as haemorrhage or allergic reaction during administration or neurological symptoms were not reported or noticed. Intralesional administration of interferon A can be considered as a safe option for the management of massive or life-threatening haemangiomas as it requires reduced duration of treatment; hence this option results in reduced financial cost, is well tolerated by patients and is free of major complications.
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Affiliation(s)
- C Kaselas
- Pediatric Surgery Department, "Hippokration" General Hospital, 4, I. Dragoumi str., Panorama, 55236, Thessaloniki, Greece,
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Boon LM, Bataille AC, Bernier V, Vermylen C, Verellen G. Traitement médical des hémangiomes immatures. ANN CHIR PLAST ESTH 2006; 51:310-20. [PMID: 16997446 DOI: 10.1016/j.anplas.2006.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Infantile hemangioma always involute in 5 to 7 years. However, 10% of proliferating hemangiomas will necessitate a therapeutic approach, often medical, in order to avoid life or organ threatening, fonctional or esthetic sequelae. "Which hemangioma need to be treated, when and how" are important questions for the optimal management of infantile hemangiomas. Corticotherapy is still the treatment of choice for these lesions. Other anti-angiogenic molecules have also been successfully used such as interferon alfa-2a and vincristine. This chapter tries to answer these questions and detail the different medical modalities for the treatment of infantile hemangioma.
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Affiliation(s)
- L-M Boon
- Service de chirurgie plastique, centre des anomalies vasculaires, cliniques universitaires Saint-Luc, 10, avenue Hippocrate, 1200 Bruxelles, Belgique.
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Abstract
Hemangiomas of infancy are the most common tumors of childhood. They are clinically heterogeneous and as such require individualized treatment plans. Although there are no Food and Drug Administration (FDA)-approved agents for treatment of hemangiomas of infancy, there are many widely used therapeutic options available. This review highlights the treatments currently in use and the factors that direct treatment.
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Affiliation(s)
- Victoria R Barrio
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
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Abstract
Haemangiomas are common, benign tumours of the vascular endothelium which present within the first few weeks of life. Clinically, they are very heterogeneous, with size, location and rate of proliferation having a significant effect on the risk of complications. Most haemangiomas are uncomplicated, and can be observed for spontaneous involution. However, some may be life- or function-threatening and require treatment. Corticosteroids, which may be used topically, intralesionally or systematically, are the mainstay of therapy. IFN-alpha, vincristine and cyclophosphamide are therapeutic options for complicated haemangiomas which do not respond to corticosteroids. Vascular-specific laser therapy may be considered for superficial haemangiomas, ulcerated haemangiomas or postinvolution sequelae, such as telangiectasia. A periorbital haemangioma that obstructs the visual axis or exerts pressure on the globe is an ocular emergency; systemic corticosteroids and patching of the unaffected eye should be instituted as soon as possible.
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Affiliation(s)
- Yuin-Chew Chan
- National Skin Centre, 1 Mandalay Road, Singapore 308205.
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Abstract
Vascular anomalies are lesions seen in all surgical disciplines, particularly in pediatric patients. Specialization in vascular anomalies involves a team effort, with the team consisting of plastic surgeons, general surgeons, neurosurgeons, pediatricians, interventional radiologists, dermatologists, ophthalmologists, otolaryngologists, hematologists, and pathologists. Inconsistent nomenclature in the literature has historically resulted in confusion about classification, diagnosis, and treatment. A biologic classification system has emerged, based on clinical observations, natural history, and cellular features, which separates vascular anomalies into two broad categories: vascular tumors and vascular malformations. For many vascular anomalies, photodocumentation, psychosocial support, and communication are important throughout the treatment course.
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Affiliation(s)
- Michelle A Spring
- Division of Plastic and Reconstructive Surgery, University of Wisconsin-Madison, 53792, USA
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Abstract
Infantile hemangiomas are the most common tumors of infancy, but less common vascular tumors also can affect young infants and children. In most cases, the diagnosis of IH can be made clinically, but imaging studies and even biopsy may be required in less-than-typical cases. With a careful history and physical examination focusing on the timing, location, and type of hemangioma, as well as extracutaneous signs and symptoms, the general pediatrician will know when to be concerned about a high risk vascular tumor and proceed with referral or further evaluations.
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Affiliation(s)
- Tara Miller
- University of California, San Fransisco, CA, USA
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Fawcett SL, Grant I, Hall PN, Kelsall AWR, Nicholson JC. Vincristine as a treatment for a large haemangioma threatening vital functions. ACTA ACUST UNITED AC 2004; 57:168-71. [PMID: 15037175 DOI: 10.1016/j.bjps.2003.11.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2003] [Accepted: 11/06/2003] [Indexed: 11/17/2022]
Abstract
We report the use of vincristine to treat a large steroid resistant haemangioma of the lower face and neck. At the time of treatment the lesion had shown no signs of involution. The haemangioma was not life threatening but extension within the mouth was associated with bleeding and ulceration, which was impairing feeding and speech development. A significant improvement was seen with vincristine treatment.
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Enjolras O, Brevière GM, Roger G, Tovi M, Pellegrino B, Varotti E, Soupre V, Picard A, Leverger G. Traitement par vincristine des hémangiomes graves du nourrisson. Arch Pediatr 2004; 11:99-107. [PMID: 14761730 DOI: 10.1016/j.arcped.2003.10.014] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2003] [Accepted: 10/17/2003] [Indexed: 11/18/2022]
Abstract
AIM To evaluate the efficacy of vincristine treatment for function- and life-threatening hemangiomas. PATIENTS AND METHOD Nine infants, eight girls and one boy, received vincristine treatment (VCR) for endangering hemangiomas. In six cases, the hemangiomas involved head and neck in a segmental unilateral or bilateral distribution (3/6 also had laryngeal and 2/6 tracheal location causing respiratory distress, 5/6 had eyelid and orbital involvement); one infant had disseminated neonatal hemangiomatosis (skin, liver, kidney); two infants had liver hemangiomas with cardiac failure. VCR was prescribed after failure of high-dosage corticosteroid treatment in six, and of both corticosteroids and interferon alpha 2b (5 months) in one; two infants received VCR as first line treatment. RESULTS A dosage of 1 mg/m(2) IV injection was delivered, with weekly injections first, and then tapering, increasing the interval between injections, depending on the clinical response. The nine infants received from 5 to 25 injections (average: 16), for a length of treatment of 1.5-8 months (average: 5.5 months). In seven patients a clear clinical response was observed at the end of the first month of treatment, while a slow protracted response was noted in two. Transient mild side effects were present in four patients. DISCUSSION Corticosteroid treatment, although a worldwide recognized treatment of problematic hemangiomas, cannot always control the growth of alarming hemangiomas. Interferon alpha 2a and 2b have proven a 90% effectiveness: treatment for cortico-resistant, function- and life-threatening, hemangiomas.
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Affiliation(s)
- O Enjolras
- Consultation des angiomes, hôpital Lariboisière, AP-HP, 75010 Paris, France.
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Wananukul S, Nuchprayoon I, Seksarn P. Treatment of Kasabach-Merritt syndrome: a stepwise regimen of prednisolone, dipyridamole, and interferon. Int J Dermatol 2003; 42:741-8. [PMID: 12956695 DOI: 10.1046/j.1365-4362.2003.01796.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Kasabach-Merritt syndrome (KMS) is a rare, aggressive, vascular tumor with thrombocytopenia and consumptive coagulopathy. A standard treatment regimen for KMS has not been established. We reviewed our experience of a stepwise approach for the treatment of 10 children with KMS. METHODS All patients were first treated with oral corticosteroid (initially 3 mg/kg/day then 5 mg/kg/day) and dipyridamole. Interferon-alpha-2b (IFNalpha2b) was used as second therapy for steroid-resistant cases for 12 months, then tapered to an alternate-day regimen, and then discontinued. Adjunctive therapy, including embolization of the feeding vessel or chemotherapy, was additionally used in patients who failed to respond to IFN or could not be taken off IFN. RESULTS Ten patients were treated on this protocol with a follow-up time of 1-6 years. Oral corticosteroid plus dipyridamole was successful in four patients, but was tapered off by 12 months without recurrence in only two cases. Of the eight steroid-resistant cases, IFNalpha2b successfully induced regression of the tumor and increased the platelet count in six patients; however, IFNalpha2b was successful as monotherapy in only three cases; two patients died of aspiration pneumonia whilst on therapy and one patient could not be taken off IFNalpha2b until weekly vincristine was given (eight doses). Two other patients did not respond to IFNalpha2b in 4 weeks; embolization and vinblastine was used in one patient to induce regression of the tumor and resolution of thrombocytopenia. Hypertension developed in all children on high-dose prednisolone. CONCLUSIONS KMS may be treated in a stepwise approach. High-dose steroid does not result in a high response rate and is not tolerated well. The response to IFNalpha2b is more favorable, but life-threatening adverse events may occur. Chemotherapy with vincristine or vinblastine may be useful as adjunctive therapy in KMS, but experience is still limited.
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Affiliation(s)
- Siriwan Wananukul
- Division of Pediatric Dermatology, Department of Pediatrics, Chulalongkorn University, Bangkok, Thailand.
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Abstract
UNLABELLED Hemangiomas of infancy are unique, benign, pediatric tumors of endothelial cells characterized by an initial phase of rapid proliferation, followed by slow involution, often leading to complete regression. Although most of these tumors are small and innocuous, some may be may be life- or function-threatening, or have associated structural congenital anomalies. Uncertainties regarding their diagnosis or management often prompt referral to a dermatologist. The pathogenesis of hemangiomas of infancy is not well understood, but recent findings suggest a unique vascular phenotype with dysregulated vascular homeostasis. This article reviews new information regarding the pathogenesis of these tumors and highlights the more worrisome presentations, including syndromic hemangiomas, that are likely to be problematic. In addition, management strategies and treatment options are discussed. (J Am Acad Dermatol 2003;48:477-93.) LEARNING OBJECTIVE At the completion of this learning activity, participants should be able to describe the clinical features of hemangiomas of infancy and potential complications as well as to understand the strengths and limitations of various treatment options.
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