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Infantile Hemangioma
Bernadette L. Koch, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Infantile hemangioma (IH)
            • Synonyms

              • Older, inappropriate terms: Hemangioma of infancy, capillary hemangioma
                • Widespread misuse of term hemangioma in literature
                  • Cavernous hemangioma, vertebral body hemangioma, & synovial hemangioma = venous malformations
                  • Hemangioendothelioma = higher grade vascular tumor
            • Definitions

              • Benign vascular neoplasm of proliferating endothelial cells; most common soft tissue tumor of infancy
              • Not vascular malformation
              • 2018 revised classification by International Society for Study of Vascular Anomalies (ISSVA) retains 2 main categories
                • Vascular tumors: True neoplasms with cellular proliferation; generally grow out of proportion to patient
                • Vascular malformation: Congenital errors of vessel development; generally grow commensurate with patient

            IMAGING

            • General Features

              • Imaging Recommendations

                DIFFERENTIAL DIAGNOSIS

                  PATHOLOGY

                  • General Features

                    • Microscopic Features

                      • Immunohistochemical Features

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  Selected References

                                  1. ISSVA 2018 Classification
                                  2. Laken PA: Infantile hemangiomas: pathogenesis and review of propranolol use. Adv Neonatal Care. 16(2):135-42, 2016
                                  3. Merrow AC et al: 2014 Revised classification of vascular lesions from the International Society for the Study of Vascular Anomalies: radiologic-pathologic update. Radiographics. 36(5):1494-516, 2016
                                  4. Wassef M et al: Vascular anomalies classification: recommendations from the International Society for the Study of Vascular Anomalies. Pediatrics. 136(1):e203-14, 2015
                                  5. Blei F et al: Current workup and therapy of infantile hemangiomas. Clin Dermatol. 32(4):459-70, 2014
                                  6. Nasseri E et al: Partially involuting congenital hemangiomas: a report of 8 cases and review of the literature. J Am Acad Dermatol. 70(1):75-9, 2014
                                  7. Bingham MM et al: Propranolol reduces infantile hemangioma volume and vessel density. Otolaryngol Head Neck Surg. 147(2):338-44, 2012
                                  8. Restrepo R et al: Hemangiomas revisited: the useful, the unusual and the new. Part 1: overview and clinical and imaging characteristics. Pediatr Radiol. 41(7):895-904, 2011
                                  9. Restrepo R et al: Hemangiomas revisited: the useful, the unusual and the new. Part 2: endangering hemangiomas and treatment. Pediatr Radiol. 41(7):905-15, 2011
                                  10. Holmes WJ et al: Propranolol as first-line treatment for infantile hemangiomas. Plast Reconstr Surg. 125(1):420-1, 2010
                                  11. Maturo S et al: Initial experience using propranolol as the sole treatment for infantile airway hemangiomas. Int J Pediatr Otorhinolaryngol. 74(3):323-5, 2010
                                  12. Sinno H et al: Management of infantile parotid gland hemangiomas: a 40-year experience. Plast Reconstr Surg. 125(1):265-73, 2010
                                  13. Storch CH et al: Propranolol for infantile haemangiomas - insights into the molecular mechanisms of action. Br J Dermatol. 163(2):269-74, 2010
                                  14. Metry D et al: Consensus statement on diagnostic criteria for PHACE syndrome. Pediatrics. 124(5):1447-56, 2009
                                  15. Judd CD et al: Intracranial infantile hemangiomas associated with PHACE syndrome. AJNR Am J Neuroradiol. 28(1):25-9, 2007
                                  16. Drolet BA et al: Early stroke and cerebral vasculopathy in children with facial hemangiomas and PHACE association. Pediatrics. 117(3):959-64, 2006
                                  17. Rossi A et al: Agenesis of bilateral internal carotid arteries in the PHACE syndrome. AJNR Am J Neuroradiol. 27(8):1602, 2006
                                  18. Kronenberg A et al: Ocular and systemic manifestations of PHACES (posterior fossa malformations, hemangiomas, arterial anomalies, cardiac defects and coarctation of the aorta, eye abnormalities, and Sternal abnormalities or ventral developmental defects) syndrome. J AAPOS. 9(2):169-73, 2005
                                  19. Robertson RL et al: Head and neck vascular anomalies of childhood. Neuroimaging Clin N Am. 9(1):115-32, 1999
                                  20. Mulliken JB et al: Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg. 69(3):412-22, 1982
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Top Differential Diagnoses

                                        • Pathology

                                          • Clinical Issues

                                            TERMINOLOGY

                                            • Abbreviations

                                              • Infantile hemangioma (IH)
                                            • Synonyms

                                              • Older, inappropriate terms: Hemangioma of infancy, capillary hemangioma
                                                • Widespread misuse of term hemangioma in literature
                                                  • Cavernous hemangioma, vertebral body hemangioma, & synovial hemangioma = venous malformations
                                                  • Hemangioendothelioma = higher grade vascular tumor
                                            • Definitions

                                              • Benign vascular neoplasm of proliferating endothelial cells; most common soft tissue tumor of infancy
                                              • Not vascular malformation
                                              • 2018 revised classification by International Society for Study of Vascular Anomalies (ISSVA) retains 2 main categories
                                                • Vascular tumors: True neoplasms with cellular proliferation; generally grow out of proportion to patient
                                                • Vascular malformation: Congenital errors of vessel development; generally grow commensurate with patient

                                            IMAGING

                                            • General Features

                                              • Imaging Recommendations

                                                DIFFERENTIAL DIAGNOSIS

                                                  PATHOLOGY

                                                  • General Features

                                                    • Microscopic Features

                                                      • Immunohistochemical Features

                                                        CLINICAL ISSUES

                                                        • Presentation

                                                          • Demographics

                                                            • Natural History & Prognosis

                                                              • Treatment

                                                                DIAGNOSTIC CHECKLIST

                                                                • Consider

                                                                  Selected References

                                                                  1. ISSVA 2018 Classification
                                                                  2. Laken PA: Infantile hemangiomas: pathogenesis and review of propranolol use. Adv Neonatal Care. 16(2):135-42, 2016
                                                                  3. Merrow AC et al: 2014 Revised classification of vascular lesions from the International Society for the Study of Vascular Anomalies: radiologic-pathologic update. Radiographics. 36(5):1494-516, 2016
                                                                  4. Wassef M et al: Vascular anomalies classification: recommendations from the International Society for the Study of Vascular Anomalies. Pediatrics. 136(1):e203-14, 2015
                                                                  5. Blei F et al: Current workup and therapy of infantile hemangiomas. Clin Dermatol. 32(4):459-70, 2014
                                                                  6. Nasseri E et al: Partially involuting congenital hemangiomas: a report of 8 cases and review of the literature. J Am Acad Dermatol. 70(1):75-9, 2014
                                                                  7. Bingham MM et al: Propranolol reduces infantile hemangioma volume and vessel density. Otolaryngol Head Neck Surg. 147(2):338-44, 2012
                                                                  8. Restrepo R et al: Hemangiomas revisited: the useful, the unusual and the new. Part 1: overview and clinical and imaging characteristics. Pediatr Radiol. 41(7):895-904, 2011
                                                                  9. Restrepo R et al: Hemangiomas revisited: the useful, the unusual and the new. Part 2: endangering hemangiomas and treatment. Pediatr Radiol. 41(7):905-15, 2011
                                                                  10. Holmes WJ et al: Propranolol as first-line treatment for infantile hemangiomas. Plast Reconstr Surg. 125(1):420-1, 2010
                                                                  11. Maturo S et al: Initial experience using propranolol as the sole treatment for infantile airway hemangiomas. Int J Pediatr Otorhinolaryngol. 74(3):323-5, 2010
                                                                  12. Sinno H et al: Management of infantile parotid gland hemangiomas: a 40-year experience. Plast Reconstr Surg. 125(1):265-73, 2010
                                                                  13. Storch CH et al: Propranolol for infantile haemangiomas - insights into the molecular mechanisms of action. Br J Dermatol. 163(2):269-74, 2010
                                                                  14. Metry D et al: Consensus statement on diagnostic criteria for PHACE syndrome. Pediatrics. 124(5):1447-56, 2009
                                                                  15. Judd CD et al: Intracranial infantile hemangiomas associated with PHACE syndrome. AJNR Am J Neuroradiol. 28(1):25-9, 2007
                                                                  16. Drolet BA et al: Early stroke and cerebral vasculopathy in children with facial hemangiomas and PHACE association. Pediatrics. 117(3):959-64, 2006
                                                                  17. Rossi A et al: Agenesis of bilateral internal carotid arteries in the PHACE syndrome. AJNR Am J Neuroradiol. 27(8):1602, 2006
                                                                  18. Kronenberg A et al: Ocular and systemic manifestations of PHACES (posterior fossa malformations, hemangiomas, arterial anomalies, cardiac defects and coarctation of the aorta, eye abnormalities, and Sternal abnormalities or ventral developmental defects) syndrome. J AAPOS. 9(2):169-73, 2005
                                                                  19. Robertson RL et al: Head and neck vascular anomalies of childhood. Neuroimaging Clin N Am. 9(1):115-32, 1999
                                                                  20. Mulliken JB et al: Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg. 69(3):412-22, 1982