The Vascular Anomalies Clinic at American Family Children's Hospital in Madison, Wisconsin, treats patients with congenital hemangiomas.
About Congenital Hemangiomas
A hemangioma is a benign (not cancerous) tumor formed by an abnormally-dense group of endothelial cells (cells that normally line the blood vessels). The exact cause of these lesions remains unknown. These lesions can be fully developed at birth and do not grow after birth.
Hemangiomas can be shallow (on the surface of the skin) or deeper in the tissue.
- Shallow lesions appear red or reddish/blue, can be flat or raised, and can be compressed when touched. Usually they have a “halo” or lighter area around them.
- Deeper lesions below the skin surface may not have much color variation and are sometimes not obvious without other imaging studies.
Hemangioma sizes vary and, while they are most common on the head or neck area, can involve any part of the body, including the liver.
Types of Congenital Hemangiomas
- Rapidly Involuting Congenital Hemangioma (RICH): These hemangiomas spontaneously start to resolve months to 1-1/2 years after birth. Most children have changes to the skin where the lesion was located.
- Non-Involuting Congenital Hemangioma (NICH): These lesions that do not spontaneously resolve and grow proportionally with the child.
Diagnosing Congenital Hemangiomas
Physicians diagnose based on the patient history, physical examination and imaging studies, including ultrasonography, magnetic resonance imaging (MRI) or computed tomography (CT). A biopsy is done if there are questions about the diagnosis or there is a chance it is a more dangerous lesion.
Certain special stains and tests with the small tissue sample help confirm the diagnosis of congenital hemangioma from other types of tumors. Time distinguishes the lesions as RICH or NICH.
Complications with congenital hemangiomas are uncommon but mostly occur with RICH, especially if the lesion is large or involves an internal organ such as the liver. These lesions have a rich blood supply with lots of blood flow, and may result in congestive heart failure, bleeding problems and skin breakdown. Your doctors can help predict if your child’s lesion is likely to cause these complications.
Management and Treatment
The RICH form of congenital hemangiomas usually do not require treatment since they shrink quickly on their own. Decisions to treat these or NICH must be made on an individual basis. To help decide if treatment is needed the team considers:
- How well the child can function physically
- Preventing permanent disfigurement
- Presence of other complication such as heart failure, ulceration and bleeding
In most cases, observation is the best course to follow, especially if the tumor is not hurting a child’s ability to function.
- Drug Therapy: The medications typically used to treat infantile hemangiomas may not work for congenital hemangiomas, but this area is under current study and may change in future.
- Surgery: Surgery may be needed for complicated congenital hemangiomas, including those in the liver and those that are causing problems with bleeding or heart failure. Additionally, depending on lesion location, an neurointerventionalist or an interventional radiologist can block the blood supply to the lesion to improve heart failure.