AtlasBenignHaemangioma

Benign Tumors

Haemangioma

aka Infantile Haemangioma

Benign vascular tumour of endothelial proliferation; presents in infancy with proliferation then involution — distinct from vascular malformations which never regress.

Marker
GLUT-1+
Rx
Propranolol 2–3 mg/kg/d
Course
Involutes 5–10 y

§ overviewOverview

Benign neoplasm of vascular endothelium characterised by GLUT-1 positivity (infantile type), rapid proliferation then spontaneous involution.

§ epidemiologyEpidemiology

Most common tumour of infancy; 4–10% of infants; F:M 3:1; more common in Caucasians, preterm infants.

§ pathogenesisPathogenesis

Proliferation phase 0–12 mo → plateau → involution over 5–10 y; leaves residual telangiectasia or fibrofatty tissue.

§ clinicalClinical Features

  • 01Bright red 'strawberry' cutaneous lesion or bluish deep swelling
  • 02Blanches on pressure
  • 03Head & neck in 60%
  • 04Beard distribution → airway involvement
  • 05PHACES syndrome (Posterior fossa, Haemangioma, Arterial, Cardiac, Eye, Sternal)

§ differentialDifferential Diagnosis

  • 01Vascular malformation (present at birth, no involution)
  • 02Pyogenic granuloma
  • 03Kaposi sarcoma
  • 04Rhabdomyosarcoma

§ investigationsInvestigations

  • 01Clinical diagnosis usually sufficient
  • 02USG with Doppler: high-flow lesion
  • 03MRI for deep/segmental lesions
  • 04Biopsy rarely required; GLUT-1 IHC differentiates from malformation

§ ihcIHC / Special Stains

  • 01GLUT-1 positive (infantile haemangioma)

§ classificationClassification

  • 01Infantile haemangioma (GLUT-1+)
  • 02Congenital haemangioma (RICH/NICH — GLUT-1−)
  • 03ISSVA 2018 classification separates tumours from vascular malformations

§ treatmentTreatment

  • 01Observation for uncomplicated lesions (spontaneous involution)
  • 02First-line pharmacotherapy: oral propranolol 2–3 mg/kg/day
  • 03Topical timolol for superficial
  • 04Systemic steroids (historical, second-line)
  • 05Pulsed-dye laser for residual telangiectasia
  • 06Surgical excision for functional/aesthetic residuum after involution

§ complicationsComplications

  • 01Ulceration, bleeding
  • 02Airway or visual obstruction
  • 03High-output cardiac failure (large hepatic)
  • 04Kasabach–Merritt phenomenon (with kaposiform haemangioendothelioma)

§ prognosisPrognosis

Excellent; 50% resolve by age 5, 90% by 9 years.

§ examKey Examination Points

  • 01Differentiate from vascular malformation (history since birth, no involution)
  • 02Assess airway and vision in periorbital/segmental lesions

§ revisionQuick Revision Summary

  • 01GLUT-1+ · propranolol first line · 90% involute by age 9

§ vivaBDS Viva Questions

  • 01Haemangioma vs vascular malformation?
  • 02Mechanism of propranolol?
  • 03What is Kasabach–Merritt syndrome?

§ mcqsMCQs — Assessment (3)

Question 1

First-line medical treatment:

Question 2

IHC marker of infantile haemangioma:

Question 3

Involution completes in most children by age:

References

  1. Léauté-Labrèze C. N Engl J Med 2015

Draft — pending faculty review. Educational use only; verify against current guidelines and primary sources before clinical application.