Not every hemangioma is a hemangioma...

Czech version

Authors: T. Kráľová ¹; M. Murgašová ^1,2; M. Pršo ¹; M. Igaz ¹; F. Olekšák ¹; P. Bánovčin ¹
Authors‘ workplace: Klinika detí a dorastu, Jesseniova lekárska fakulta v Martine, Univerzita Komenského v Bratislave, Univerzitná nemocnica Martin, Slovensko ¹; Ambulancia pediatrickej hematológie a onkológie, Univerzitná nemocnica Martin, Slovensko ²
Published in: Čes-slov Pediat 2021; 76 (6): 320-329.
Category: Case Report

Overview

Hemangiomas are benign vascular tumors belonging to the most common tumors of childhood. In clinical practice hemangiomas are quite often mistaken for other similar skin lesions (e.g. Mongolian spot) or vascular malformations (e.g. nevus flammeus, telangiectatic nevus). In some cases a serious disease may be hidden under a tiny skin lesion resembling hemangioma, which may require a completely different treatment. Therefore, it is important to identify basic morphological features and specific biological behavior of hemangiomas. Based on this knowledge we can distinguish hemangiomas from other skin lesions and subsequently select the appropriate treatment for the patient. We present case reports of three patients who were referred to our workplace with suspected hemangiomas, but after a thorough examination and multidisciplinary collaboration we diagnosed three different serious diseases (Multisystem Langerhans Cell Histiocytosis, extranodal B-cell non-Hodgkin's lymphoma and extensive arteriovenous malformation).

Keywords:

hemangioma – childhood – treatment – differential diagnosis – vascular malformations

Sources

1. Faberová R, Arenberger P, Čapková Š, et al. Infantilní hemangiomy z pohledu dermatologa. Čes-slov Derm 2017; 92 (5): 206–218.

2. Murgašová M. Novorodenecké znamienka. In: Zibolen M, et al. Zdravo rásť. Banská Bystrica: Klub priateľov Detskej nemocnice v Banskej Bystrici, 2019: 188–194.

3. Prusíková D. Zajímavé kazuistiky léčby hemangiomů z klinické praxe. Dermatol praxi 2020; 14 (4): 202–206.

4. Piccolo V, Russo T, Moscarella E, et al. Dermatoscopy of vascular lesions. Dermatol Clin 2018; 36 (4): 389–395.

5. Mulliken JB, Glowacki J. Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg 1982; 69 (3): 412–422.

6. ISSVA Classification of Vascular Anomalies 2018. International Society for the Study of Vascular Anomalies. Available at: „issva.org/classification“ (Accessed 23th January 2021).

7. Mališ J, Mišove A. Mýty a úskalí v přístupu k pacientovi s infantilním hemangiomem. Pediatr praxi 2020; 21 (4): 232–235.

8. Mališ J, Stará V, Bláhová K, et al. Infantilní hemangiomy. Současné léčebné postupy. Čes-slov Pediat 2017; 72 (4): 245–254.

9. Grešíková M, Sejnová D, Babala J. Aktuálny manažment infantilných hemangiómov. Pediatria 2020; 15 (1): 25–29.

10. Lee J, Sinno H, Tahiri Y, et al. Treatment options for cutaneous pyogenic granulomas: A review. J Plast Reconstr Aesthet Surg 2011; 64 (9): 1216–1220.

11. Carqueja IM, Sousa J, Mansilha A. Vascular malformations: classification, diagnosis and treatment. Int Angiol 2018; 37 (2): 127–142.

12. Mulligan PR, Prajapati HJ, Martin LG, et al. Vascular anomalies: classification, imaging characteristics and implications for interventional radiology treatment approaches. Br J Radiol 2014; 87 (1035): 20130392.

13. Kolenová A, Bubanská E, Špotová A, et al. Cielená liečba závažnej multisystémovej histiocytózy z Langerhansových buniek. Pediatr prax 2018; 19 (1): 27–23.

14. Fernández-Alvarez V, Suárez C, de Bree R, et al. Management of extracranial arteriovenous malformations of the head and neck. Auris Nasus Larynx 2020; 47 (2): 181–190.

15. Guo MM, Chen CC, Chen FS, et al. A case of congenital Langerhans cell histiocytosis with disseminated skin and pulmonary involvement masquerading as multiple infantile hemangiomas. Pediatr Neonatol 2017; 58 (6): 552–554.

16. Jezierska M, Stefanowicz J, Romanowicz G, et al. Langerhans cell histiocytosis in children - a disease with many faces. Recent advances in pathogenesis, diagnostic examinations and treatment. Postepy Dermatol Alergol 2018; 35 (1): 6–17.

17. Vannata B, Zucca E. Primary extranodal B-cell lymphoma: current concepts and treatment strategies. Chin Clin Oncol 2015; 4 (1): 10.

18. Weber AL, Rahemtullah A, Ferry JA. Hodgkin and non-Hodgkin lymphoma of the head and neck: clinical, pathologic, and imaging evaluation. Neuroimaging Clin N Am 2003 Aug; 13 (3): 371–392.

19. Deka JB, Deka NK, Shah MV, et al. Intraneural hemangioma in Klippel–Trenaunay syndrome: role of musculo-skeletal ultrasound in diagnosis – case report and review of the literature. J Ultrasound 2020; 23, 435–442.

20. Sudarsanam A, Ardern-Holmes SL. Sturge-Weber syndrome: from the past to the present. Eur J Paediatr Neurol 2014; 18 (3): 257–266.

21. Tomblinson CM, Fletcher GP, Lidner TK, et al. Parapharyngeal space venous malformation: An imaging mimic of pleomorphic adenoma. AJNR Am J Neuroradiol 2019; 40 (1): 150–153.

22. Wiegand S, Dietz A. Vaskuläre malformationen im Hals-Nasen-Ohren-Bereich [Vascular malformations of the head and neck]. Laryngorhinootologie 2021; 100 (1): 65–76.

23. Zaltsberg GS, Spring S, Malic C, et al. Soft tissue lesions with highvascular density on sonography in pediatric patients: Beyond hemangiomas. Can Assoc Radiol J 2020; 71 (4): 505–513.

24. Evans MS, Burkhart CN, Bowers EV, et al. Solitary plaque on the leg of a child: A report of two cases and a brief review of acral pseudolymphomatous angiokeratoma of children and unilesional mycosis fungoides. Pediatr Dermatol 2019; 36 (1): e1–e5.

25. Hassanein AH, Alomari AI, Schmidt BA, et al. Pilomatrixoma imitating infantile hemangioma. J Craniofac Surg 2011; 22 (2): 734–736.

26. Karkoska K, Ricci K, Vanden Heuvel K, et al. Metastatic neuroblastoma masquerading as infantile hemangioma in a 4-month-old child. Pediatr Blood Cancer 2021; 68 (5): e28920.

27. Makino T, Ishida W, Hamashima T, et al. An intermediate vascular tumour between kaposiform hemangio endothelioma and tufted angioma with regression of the skin lesion. Eur J Dermatol 2017 Apr 1; 27 (2):175–176.

28. Craig SK. Purpura and other hematovascular disorders. In: Consultative Hemostasis and Thrombosis. 4th ed. Elsevier, 2019: 167–189.