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Hepatic hemangiomas in infants and children: a review of 30 cases
C P Iyer1, P Stanley, G H Mahour
1Division of Pediatric Surgery, Childrens Hospital Los Angeles, CA 90027, USA.
Insights
This study reviews 30 pediatric hepatic hemangioma cases from 1958-1992. Steroids, radiotherapy, surgery, and embolization were used, with embolization showing promise for steroid-resistant cases.
Area of Science:
- Pediatric Hepatology
- Vascular Malformations
- Interventional Radiology
Background:
- Hepatic hemangiomas are rare vascular tumors in infants.
- Presentation varies, including coagulopathy, heart failure, and abdominal mass.
- Early diagnosis and management are crucial for patient outcomes.
Purpose of the Study:
- To review treatment modalities for pediatric hepatic hemangiomas.
- To evaluate the efficacy of different therapeutic approaches.
- To identify optimal management strategies based on patient presentation and hemangioma characteristics.
Main Methods:
- Retrospective review of 30 pediatric patients with hepatic hemangiomas treated between 1958 and 1992.
- Analysis of treatment interventions including steroid therapy, radiotherapy, surgical resection (liver lobectomy), hepatic artery embolization, and interferon alpha-2.
- Evaluation of patient outcomes and mortality.
Main Results:
- Most patients were infants under one year old.
- Steroid therapy was initiated in 14 patients, with 8 requiring subsequent radiotherapy.
- Surgical resection was performed for localized hemangiomas, and hepatic artery embolization was successful in 5 recent cases.
- Six deaths occurred, primarily due to congestive heart failure.
Conclusions:
- Hepatic artery embolization is a viable alternative for steroid-resistant hepatic hemangiomas.
- Surgical resection via liver lobectomy is effective for solitary, localized lesions.
- Interferon alpha-2 shows limited efficacy in massive hemangiomas with thrombocytopenia based on current experience.
Abstract:
From 1958 through 1992, 30 patients with hepatic hemangiomas were seen and treated at Children's Hospital Los Angeles. The majority of the patients were less 1 month of age (90 % younger than the first year of life) and there was no difference in sex distribution. Patients presented with coagulopathy, heart failure, abdominal mass, and respiratory distress. Eleven patients (33%) had hemangiomas in other sites. Fourteen patients were treated with steroid therapy. Of these, eight patients did not respond and received radiotherapy. Eleven patients who had the hemangioma confined to an anatomical lobe had resection of the hemangioma by liver lobectomy. Five of the most recent patients were successfully treated with hepatic artery embolization. Two other patients who were seen many years ago underwent diagnostic laparotomy and biopsy of the lesion before treatment with steroids. In one patient who presented with ruptured hepatic hemangioma, hepatic arterial ligation was performed. In another patient, seen recently, treatment with interferon alpha-2 was initiated, but the patient died. There were six deaths in the series. Four patients died of intractable congestive heart failure, steroids are given first. Course of steroid therapy may be repeated if necessary. Whereas formerly radiation therapy was added to the treatment of a patient resistant to steroids, therapeutic hepatic arterial embolization is a very good alternative for these patients. Surgical excision of the lesion can be performed by liver lobectomy if there is a solitary hemangioma within the boundaries of the surgical excision. Recently, in massive hemangioma with intractable thrombocytopenia, interferon alpha-2 therapy has been used, but so far our experience of this mode of therapy is limited.