253 Management of Hemangiomas: A Single Center Experience

Abstract

Background. Hemangiomas are benign neoplasms of the vasculature characterized by abnormal growth of endothelial cells.Aims. To share our experience of 185 (F/M: 2.4) patients with hemangiomas followed between 2003-2011 at Cerrahpasa Medical Faculty, Pediatric Hematology Unit in Istanbul Turkey.Results. Of the 185 patients, 40% presented at birth. Onehundredtwenty eight (69%) had a single lesion whereas 31% had multiple lesions. In patients with a single lesion; 87 (68%) had a cutaneous hemangioma in the head and neck region (44 at eyelid and/or around eye). In 57 patients with multiple hemangiomas; 46 had a lesion in the head and neck region, 21 had a visceral lesion (4 liver, 1 spleen, 3 larnyx, 2 oropharynx, 4 parotid gland, 3 vertebrae, 2 internal jugular vein, 2 common carotid artery). Most of the patients (n:94) were followed by a "watch and wait"policy and 40 of them did not require any medical or surgical intervention as the lesion convoluted on follow-up. Only 6 (3%) patients required surgery to prevent the life-threatening complications and complications interfering normal physiology. Nine patients with lesion around eye required intralesional steroids to prevent visual disturbance. In 7 patients with an open, bleeding lesion local imiquimod was used with a successful result in 7-10 days. Bleomycin was used as a sclerosing treatment in 2 patients with a giant hemangioma in the tongue. In 21 patients with multiple diffuse lesions causing cosmetic problems, interferon was given. Medical treatment was given in other patients on follow-up due to growth, ulceration, bleeding or persistance of the lesions at older ages; 14 were treated by systemic steroids, 73 by propranolol and 39 by combination therapy due to insuffient response. Propranolol was the first choice of treatment in patients diagnosed after 2008 regarding the new literature. All patients treated by propranolol were evaluated by echocardiography and electrocardiograpy before and during therapy, no cardiac side effects were noted. One patient under treatment presented with increased sweating and was found to have hypoglycemic attacks associated with propranolol during periods of restricted oral intake. The drug was restarted increasing the frequency of breastfeeding with no further hypoglycemia attacks.Conclusion: The excellent clinical outcome and apparent lack of side effects of propranolol makes it a good choice as a first-line treatment for hemangiomas especially in young patients who may have interferance in vaccination with steroid treatment. We would like to call the attention that hypoglycemia may be noted in infants under propranolol in restricted periods of feeding.