Benign neonatal hemangiomatosis

Consumptive hypothyroidism in an Egyptian baby with benign neonatal hemangiomatosis: a case report

Introduction

Benign neonatal hemangiomatosis is a condition in which multiple cutaneous hemangiomas appear at birth or shortly thereafter; visceral complications are absent. Here, we report a case of a consumption hypothyroidism in an Egyptian baby with benign neonatal hemangiomatosis.

Case presentation

An 8-month-old Egyptian boy with benign neonatal hemangiomatosis was referred to our institution for evaluation of developmental delay. Initial examination revealed a quiet baby who was able to sit only with support. He had hypotonia, a large anterior fontanelle, puffy eyes, cold extremities, hypothermia, bradycardia, and abdominal distension. An examination of his skin revealed more than 100 dome-shaped red-purple cutaneous hemangiomas that varied in size from 5 to 10mm on the back, the abdomen and the extremities without mucus membrane involvement. He had low serum free thyroxine concentration and triiodothyronine levels and high thyroid-stimulating hormone and reverse-triiodothyronine levels. A work-up that involved appropriate imaging ruled out visceral involvement. Based on the above mentioned data, a diagnosis of consumptive hypothyroidism due to benign neonatal hemangiomatosis was made. He was started on oral thyroid medication which was gradually increased to 90μg L-thyroxine daily (15μg/kg/day). After three months of treatment, he was able to sit alone without support and he had normal levels of thyroid-stimulating hormone and serum free thyroxine.

Conclusion

Thyroid function should be assessed periodically in babies with benign neonatal hemangiomatosis, especially if symptoms of hypothyroidism appear or the size and number of hemangiomatosis increase rapidly. Moreover, high doses of L-thyroxine may be needed to achieve euthyroidism during the infancy.

Hemangiomas of infancy: clinical and biological characteristics

Hemangiomas of infancy are common in the general pediatric population, are usually easily diagnosed, and generally do not require treatment. However, a small but significant percentage of hemangiomas of infancy may develop complications, including infection or ulceration. In addition, hemangiomas located in some anatomic regions may be associated with other anomalies and therefore require more careful monitoring and earlier intervention to prevent permanent sequelae. This review focuses on distinguishing hemangiomas from vascular malformations and delineates the natural history of hemangiomas of infancy, with an emphasis on identifying those hemangiomas that require additional evaluation and closer follow-up. Current treatment modalities, including the use of systemic steroids and the pulsed-dye laser, are discussed. In addition, several conditions that often present with cutaneous hemangiomas are described, including PHACES syndrome and neonatal hemangiomatosis. Finally, an assessment is made of the current understanding of the biology of hemangioma proliferation and involution, including the role of endothelial growth factors and GLUT1, a new marker for hemangiomas of infancy.

Multi-organ cavernous hemangiomas: case report

Hemangiomas are rare benign tumors of vascular origin and multiple location of these tumors in different organs is extremely unusual. We report a case with multiple hemangiomas, characterized by calvarial, hepatic and suspicious costal involvement. Organ involvement and multiplicity of the neoplasm made our case very interesting and distinct. Our search of the English literature has revealed that no similar case has ever been published.

Hemangiomas: Evaluation and Treatment

BACKGROUND

Hemangiomas are common skin tumors of infancy that have undergone recent changes in nomenclature, methods of evaluation, and treatment.

OBJECTIVE

To review the nomenclature, epidemiology, evaluation, and treatment of common hemangiomas.

METHODS

A literature search was conducted utilizing MEDLINE and the Cochrane library databases. Text search words used were "hemangioma" and "infancy." The clinical experience of the authors was also used to formulate the review.

RESULTS

There have been many advances in nomenclature and therapeutic options for children with hemangiomas. Hemangiomas are proliferative tumors of infancy that should be distinguished from structural malformations, such as port-wine stains and lymphangiomas.

CONCLUSION

Natural involution remains a viable treatment option for the majority of patients with uncomplicated hemangiomas. Excisional surgery, laser, and pharmacologic remedies are indicated for a subset of complicated hemangioma patients.

Skeletal-extraskeletal angiomatosis. A clinicopathological study of fourteen patients and nosologic considerations

We reviewed the consultation files of the ARmed Forces Institute of Pathology for 1951 through 1989 and identified fourteen patients who had had skeletal-extraskeletal angiomatosis. Skeletal-extraskeletal angiomatosis was defined as a benign vascular proliferation involving the medullary cavity of bone and at least one other type of tissue. The age of the patients at the time of initial biopsy ranged from nine months to sixty-nine years (average, twenty-two years; median, ten years). Ten of the patients were male and four were female. The presenting signs and symptoms were highly variable; they included pain (four patients), a mass noted at birth (three patients), a painless mass that developed after birth (two patients), both pain and a mass (one patient), a localized deformity of the thoracic spine (one patient), and anemia associated with chronic bleeding of the gastrointestinal tract (one patient); in this last patient, skeletal lesions subsequently were found and biopsied. Skeletal-extraskeletal angiomatosis was an incidental finding in the remaining two patients. Multiple bones were involved in thirteen of the fourteen patients. Histologically, three patterns of lesion could be identified: cavernous lymphangioma (six patients), cavernous hemangioma (six patients), and arteriovenous hemangioma (two patients). Five of the patients died (three of sepsis associated with persistent lesions of angiomatosis and two of unrelated causes); eight of the patients survived but had residual disease, and one survived and had no evidence of residual disease.