Clinical characteristics and treatment modalities of childhood hemangiomas

Öz

Hemangiomas are the most common type of congenital anomaly in childhood. Fortunately, most hemangiomas only grow to small size and do not cause problems. However, there is a small subset of hemangiomas that destroy tissue or endanger the infant's life, either because of tumor's size, location or agressive growth. The pathogenesis of hemangiomas 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.

Anahtar Kelimeler

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Çocukluk çağı hemanjiomlarının klinik özellikleri ve tedavi yöntemleri

Öz

Hemanjiomlar çocukluk çağında en sık görülen konjenital anomalidir. Hemanjiomlar genellikle sorun yaratmaz. Küçük bir bölüm hemanjiom ise doku harabiyetine yol açması, boyutu, yeri ya da agresif büyümesi nedeniyle süt çocuğunda sorun yaratabilir. Hemanjiomların patogenezi çok iyi anlaşılamamıştır, fakat son bulgular vasküler homeostazisteki regülasyon bozukluğu ile vasküler fenotipin ortaya çıktığını desteklemektedir. Bu derlemede bu tümörlerin patogenezi ile ilgili yeni bilgiler, probleme neden olan sendromik hemanjiomları da içeren kaygı verici prezantasyonları sunulmuştur. Ayrıca tedavi stratejileri ve tedavi seçenekleri tartışılmıştır.

Anahtar Kelimeler

• Hemanjiom, Klinik bulgular, Tedavi, Çocuklukçaðý

Kaynakça

1. l.Mulliken JB, Glowacki J. Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg, 1982;69:412-420
2. 2.Enjolras O, Mulliken JB. Vascular tumors and vascular malformations (new issues), Adv Dermatol, 1997; 13: 375-423
3. 3.Jacobs AH, Walton RG. The incidence of birthmarks in the neonate. Pediatrics, 1976;58:218-222
4. 4.Bruckner AL, Frieden II Hemangiomas of infancy. J Am Acad Dermatol, 2003;48:477-493
5. 5.Mulliken JB, Fishman SJ, Burrows PE. Vascular anomalies. Curr Probl Surg, 2000;37:519-584
6. 6.Gonzales-Crussi F, Reyes-Mugica M. Cellular hemangiomas ("hemangioendotheliomas") in infants: light microscopic, immunohistochemical, and ultrastructural observations. Am J Surg Pathol, 1991; 15:769-778
7. 7.Takahashi K, Mulliken JB, Kozakewich HPW, Rogers RA, Folkman J, Ezekowitz RAB. Cellular markers that distinguish the phases of hemangioma during infancy and childhood. J Clin Invest, 1994;93:2357-2364
8. 8.Tan ST, Velickovic M, Ruger BM, Davis PF. Cellular and extracellular markers of hemangioma. Plast Reconstr Surg, 2000; 106:529-538

9. 9.Kraling BM, Razon MJ, Boon LM, Zurakowski D, Seachord C, Darveau RP, et al. E-selectin is present in proliferating endothelial cells in humans hemangiomas. Am J Pathol 1996;148:1181-1191
10. lO.Isik FF, Rand RP, Gruss JS, Benjamin D, Alpers CE. Monocyte chemoattractant protein-1 mRNA expression in hemangiomas and vascular malformations. J Surg Res, 1996;61:71-76
11. 11.North PE, Waner M, Mlzeracki A, Mihm MC. GLUT1: a newly discovered immunohistochemical marker for juvenile hemangiomas. Hum Pathol. 2000;31:ll-22
12. 12.North PE, Waner M, Mizeracki A, Mrak RE, Nicholas R, Kincannon J, et al. A unique microvascular phenotype shared by juvenile hemangiomas and human placenta. Arch Dermatol, 2001;137:559-570
13. 13.Arbiser JL. Angiogenesis and the skin: a primer. J Am Acad Dermatol, 1996;34:486-497
14. 14.Folkman J. Clinical applications of research on angiogenesis. N Engl J Med, 1995;333:1757-1763
15. 15.Cohen MM. Vasculogenesis, angiogenesis, hemangiomas, and vascular malformations. Am J Med Genet, 2002;108:265-274
16. 16.Walter JW, Blei F, Anderson JL, Orlow SJ, Speer MC, Marchuk DA. Genetic mapping of a novel familial form of infantile hemangioma. Am J Med Genet, 1999;82:77-83
17. 17.Finn MC, Glowacki J, Mulliken JB. Congenital vascular lesionsxlinical application of a new classification. J Pediatr Surg, 1983; 18:894-899
18. 18.Drolet BA, Esterly NB, Frieden IX Hemangiomas in children. N Engl J Med, 1999;341:173-181
19. 19.Higuera S, Gordley K, Metry DW, Stal S. Management of hemangiomas and pediatric vascular malformations. J Craniofac Surg 2006; 17:783-789
20. 2O.Gampper TJ, Morgan RF. Vascular anomalies: Hemangiomas Plast Reconstr Surg, 2002;110:572-585
21. 21.Mulliken JB, Enjolras 0. Congenital hemangiomas and infantile hemangioma: missing links. J Am Acad Dermatol, 2004;50:875-882
22. 22.Haik BG, Karcioglu ZA, Gordon RA, Pechous BP. Capillary hemangioma (infantile periocular hemangioma). Surv Ophthalmol, 1994;38:399-426
23. 23.Goldberg NS, Rosanova MA. Periorbital hemangiomas. Dermatol Clin, 1992;10:653-661
24. 24.Goldberg NS, Hebert AA, Esterly NB. Sacral hemangiomas and multiple congenital abnormalities. Arch Dermatol, 1986; 122:684-687
25. 25.Bouchard S, Yazbeck S, Lallier M. Perineal hemangioma, anorectal malformation, and genital anomaly: a new association? J Pediatr Surg, 1999;34:1133-1135
26. 26.Frieden IJ, Reese V, Cohen D. PHACE syndrome: the association of posterior fossa brain malformations, hemangiomas, arterial anomalies, coarctation of the aorta and cardiac defects, an deye abnormalities. Arch Dermatol, 1996;132:307-311
27. 27.Metry DW, Dowd CF, Barkovich AJ, Frieden IJ. The many faces of PHACE syndrome. J Pediatr, 2001;139:117-123
28. 28.Hall GW. Kasabach-Merritt Syndrome: pathogenesis and management. Br J Haematol, 2001;112:851-862
29. 29.Kasabach HHM, Merritt KK. Capillary hemangioma with extensive purpura. Report of a case. Am J Dis Child, 1940;59:1063-1070
30. 3O.Ezekpwitz RAB, Mulliken JB, Folkman J. Interferon alfa-2a therapy for life-threatening hemangioma of infancy. N Engl J Med, 1992;326:1456-1463
31. 31.Worle H, Maass E, Kohler B, Treuner J. Interferon-2a therapy in hemangioma of infancy:Spastic diplegia as a severe complaint. Eur J Pediatr, 1999;158:344
32. 32.Burrows PE, Laor T, Paltiel h, Robertson RL. Diagnostic imaging in the evaluation of vascular birthmarks. Dermatol Clin, 1998;16:455-488
33. 33.Dubois J, Garel L. Imaging and therapeutic approach of hemangiomas and vascular malformations in the pediatric age group. Pediatr Radiol, 1999;29:879-893
34. 34.Donnelly LF, Adams DM, Bisset GS. Vascular malformations and hemangiomas: a practical approach in multidisciplinary clinic. AJR Am J Roentgenol, 2000; 174:597-608
35. 35.Frieden IJ. Which hemangiomas to treat-and how? Arch Dermatol, 1997; 133:1593-1595
36. 36.Kushner BJ. The treatment of periorbital infantile hemangioma with intralesional corticosteroid. Plast Reconstr Surg, 1985;76:517-526
37. 37.Reyes BA, Vazquez-Botet M, Capo H. Intralesional steroids in cutaneous hemangioma. J Dermatol Surg, Oncol 1989;15:828-832
38. 38.White CW, Sondheimer HM, Crouch EC, Wilson H, Fan LL. Treatment of pulmonary hemangiomatosis with recombinant interferon alfa-2a. N Engl J Med, 1989;320:1197-1200
39. 39.0rchard PJ, Smith CM, Woods WG, day DL, Dehner LP, Shapiro R. Treatment of haemangioendotheliomas with alpfa interferon. Lancet, 1989;2:565-567
40. 40.Ezekowitz RAB, Mulliken JB, Folkman J. Interferon alfa-2a therapy for life-threatening hemangiomas of infancy. N Engl J Med, 1992;326:1456-1463
41. 41.Ricketss RR, Hatley RM, Corden BJ, Sabio H, Howell CG. Interferon-alpha-2a for the treatment of complex hemangiomas of infancy and childhood. Ann Surg, 1994;219:605-614
42. 42.Chang E, Boyd A, Nelson CC, Crowley D, Law T, Keough KM, et al. Successful treatment of infantile hemangiomas with interferon-alpha-2b. J Pediatr Hematol Oncol, 1997; 19:237-244
43. 43.Boehm DK, Kobrinsky NL. Treatment of cavernous hemangioma with vincristine. Ann Pharmacother, 1993;27:981
44. 44.Moore J, Lee M, Garzon M, Soffer S, Kim E, Saouaf R, et al. Effective therapy of a vascular tumor of infancy with vincristine. J Pediatr Surg, 2001;36:1273-1276
45. 45.Payarols JP, Masferrer JP, Bellvert CG. Treatment of life-threatening infantile hemangiomas with vincristine. N Engl J Med, 1995;333:69
46. 46.Hurvitz SA, Hurvitz CH, Sloninsky L, Sanford MC. Successful treatment with cyclophosphamide of life-threatening diffuse hemangiomatosis involving the liver. J Pediatr Hematol Oncol 2000;22:527-532