Reviewers: Li Liu, MD
Source: New England Journal of Medicine, 341:173-181, July 1999
This is a comprehensive review of hemangiomas in children. It provides useful information regarding the pathogenesis, clinical manifestations, complications, and management of these lesions.
Hemangiomas occur in approximately 5 to 10% of one-year-old children. Pathogenesis of hemangiomas remains unclear at this point. However, recent advances in our knowledge of normal vascular development and angiogenesis may lead us to discover the precise mechanisms controlling the growth and involution of hemangiomas.
The appearance of hemangiomas may vary in depth, location, and stage of evolution. Most of these tumors are present at birth and will resolve completely without intervention. Ultrasound with Doppler, CT scan, and MRI sometimes are performed to make definitive diagnoses and distinguish vascular malformations from more aggressive neoplastic processes.
The majority of hemangiomas are benign. Location probably has the most crucial role in determining the seriousness of hemangiomas. Hemangiomas may occur in any organ system, and life-threatening complications may occur if they are not managed properly.
Irradiation was one of the treatments of choice in the 1940s and 1950s, but has subsequently fallen out of favor due to the development of newer therapeutic options and potential complications associated with irradiation. Systemic corticosteroids, recombinant interferon, angiogenesis inhibitors, laser therapy, cryotherapy, and surgery have all been proven effective in selected patients. It is worthwhile to mention that in selected children who failed the aggressive treatments mentioned above treatment with low dose radiation can reverse life threatening thrombocytopenia and bleeding.