APSA PaperHepatic hemangiomas: subtype classification and development of a clinical practice algorithm and registry
Section snippets
Purpose
Infantile hemangioma (IH) is the most common pediatric tumor, affecting 4% to 5% of white infants. It is a benign endothelial cell neoplasm that exhibits rapid postnatal growth followed by slow involution during childhood. Nevertheless, approximately 10% to 20% of IHs cause vision-threatening, life-threatening, or disfiguring complications [1]. The life cycle evolves in 3 stages: (1) a proliferating phase of rapid growth, beginning shortly after birth and lasting approximately 9 to 12 months;
Methods
We performed a Pubmed search with keywords hepatic hemangioma, liver hemangioma, visceral hemangioma, and hemangioma screening, limiting the inquiry to publications over the past decade (1995-2005) that correctly identified hepatic hemangiomas. These publications, chiefly composed of retrospective radiographic, dematologic, and histopathologic analyses as well as case reports, were critically reviewed to elucidate patterns of physiologic and radiographic presentation that might allow more
Focal lesions
This type can be identified on magnetic resonance imaging (MRI) as a well-defined, solitary, spherical tumor that is hypointense relative to liver on T1-weighted sequences and hyperintense on T2-weighted sequences (Fig. 1). The typical tumor demonstrates centripetal enhancement on gadolinium sequences. Areas of central necrosis, thrombosis, or intralesional hemorrhage are heterogeneously enhanced. The solid nonthrombosed (noninvoluted) areas of the lesion exhibit intense homogeneous
Conclusion
Infantile hepatic hemangiomas represent a clinically diverse spectrum of benign hepatic tumors. A novel systematic classification scheme encompassing clinical presentation, radiographic appearance, pathologic features, physiologic behavior, and natural (untreated) and treated history is presented along with a proposed therapeutic algorithm. A registry for prospective data collection has been established with the goal of validating and refining current understanding and management of hepatic
References (30)
- et al.
Growth of giant hepatic hemangioma after triplet pregnancy
J Hepatol
(2005) - et al.
Monosegmental living-donor liver transplantation for infantile hepatic hemangioendothelioma
J Pediatr Surg
(2003) - et al.
Antenatal diagnosis of fetal hepatic hemangioma treated with maternal corticosteroids
Obstet Gynecol
(1999) - et al.
Interventional treatment of infantile hepatic hemangioendothelioma
J Pediatr Surg
(2003) - et al.
GLUT1 endothelial reactivity distinguishes hepatic infantile hemangioma from congenital hepatic vascular malformation with associated capillary proliferation
Hum Pathol
(2004) - et al.
The role of GLUT1 immunostaining in the diagnosis and classification of liver vascular tumors in children
J Pediatr Surg
(2005) - et al.
Cutaneous haemangioma: prevalence and sonographic characteristics of associated hepatic haemangioma
Clin Radiol
(2004) - et al.
Congenital hemangiomas and infantile hemangioma: missing links
J Am Acad Dermatol
(2004) - et al.
Prenatal diagnosis and therapy for a fetal hepatic vascular malformation
Obstet Gynecol
(1995) - et al.
Vascular anomalies
Curr Probl Surg
(2000)
Infantile hepatic hemangioendothelioma presenting as early heart failure: report of two cases
Chang Gung Med J
Severe hypothyroidism caused by hepatic hemangioendothelioma in an infant of a diabetic mother
Horm Res
Spontaneous regression of severe acquired infantile hypothyroidism associated with multiple liver hemangiomas
Pediatrics
Congenital hepatic shunts
Radiographics
New insight into the pathophysiology of severe hypothyroidism in an infant with multiple hepatic hemangiomas
J Pediatr Endocrinol Metab
Cited by (0)
Presented at the 37th Annual Meeting of the American Pediatric Surgical Association, May 20–24, 2006, Hilton Head, SC.