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[Giant infantile hepatic hemangioma: which therapeutic options?]
Cristina Gonçalves1, Luisa Lobo2, Rui Anjos3
1Unidade de Gastrenterologia Pediátrica. Departamento de Pediatria. Hospital de Santa Maria. Centro Académico de Medicina de Lisboa. Lisboa. Portugal.
Insights
Infantile hepatic hemangioma (IHH) in children can cause heart failure and Kasabach-Merritt syndrome, but may spontaneously regress. This case highlights a conservative approach for a large IHH with favorable outcomes.
Area of Science:
- Pediatric Oncology
- Hepatology
- Vascular Anomalies
Background:
- Infantile hepatic hemangioma (IHH) is a common pediatric liver tumor, particularly in infants under six months.
- Treatment strategies for IHH require individualization based on clinical presentation and tumor characteristics.
Observation:
- A 4-year-old boy presented with a large, vascular liver tumor diagnosed neonatally as IHH.
- The patient experienced spontaneous regression of associated heart failure and Kasabach-Merritt syndrome (thrombocytopenia, anemia).
Findings:
- Sequential imaging (ultrasound, MRI, CT) confirmed IHH and provided vascular mapping.
- Progressive tumor regression was observed from the first year of life, supporting a conservative management approach.
Implications:
- This case underscores the potential for spontaneous regression in large infantile hepatic hemangiomas, even with severe initial complications.
- A conservative, observation-based strategy may be effective, though optimal therapeutic decisions for IHH require ongoing evaluation of individual patient factors and cost-effectiveness.
Abstract:
Infantile hepatic hemangioma is the third most frequent liver tumor in children and the most common below 6 months of age. Therapeutic options depend on clinical manifestations and should be tailored on an individual patient basis. We present the case of a 4 year old boy with neonatal diagnosis of large vascularized liver tumor with imagiological criteria of infantile hepatic hemangioma. We highlight the occurrence of heart failure and Kasabach-Merrit syndrome (thrombocytopenia, anemia) that have spontaneously regressed. During follow up, sequential imaging (ultrasound with Doppler, magnetic resonance imaging, dynamic contrast enhancement computed tomography) confirmed the hypothesis of IHH, allowing vascular mapping of the lesion. From the first year on, we observed a favorable course with progressive tumor regression. In the present case, a conservative approach has been maintained, but the best therapeutic option remains unclear. We highlight the specific features of this case, discussing the most cost-effective approach.
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