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Tumor conference No. 9. Massive hemangioma with pharyngeal involvement
Insights
Systemic corticosteroids effectively reduced infantile hemangioma growth and stridor, with temporary recurrence upon discontinuation. Further spontaneous resolution is anticipated, possibly requiring plastic surgery.
Area of Science:
- Pediatric Oncology
- Dermatology
- Vascular Anomalies
Background:
- Infantile hemangiomas are common benign vascular tumors in children.
- Rapidly enlarging hemangiomas can cause significant functional impairment and cosmetic concerns.
Observation:
- A 7-week-old infant presented with a rapidly enlarging facial and pharyngeal hemangioma causing stridor and eyelid closure.
- Systemic corticosteroid therapy led to tumor shrinkage and symptom resolution.
Findings:
- Discontinuation of corticosteroids resulted in hemangioma regrowth and stridor recurrence.
- A subsequent course of corticosteroids again resolved symptoms, indicating a responsive but not curative treatment.
Implications:
- Corticosteroids are a viable treatment for symptomatic infantile hemangiomas.
- Long-term management may involve observation for spontaneous involution and surgical correction of residual deformities.
Abstract:
When first seen in May, 1974, this 7-week-old child presented a rapidly enlarging hemangioma involving her face, scalp, oral mucous membranes and pharynx. Because of the development of stridor and complete closure of the eyelids of one eye by the hemangioma, the child was placed on systemic corticosteroid therapy. This was continued for a three-month period at which point it was discontinued. There was unquestionalbe shrinkage of the tumor during therapy. The stridor disappeared and the eyelids opened within a few days. Within six days of discontinuation of the corticosteroids, there was sudden enlargement of the lesion and reappearance of stridor which again subsided after a six-week course of systemic corticosteroids. Currently, the child is still under observation. It is anticipated that further spontaneous resolution will take place but that she will require plastic surgery for some of the residual deformities. The questions of ocular involvement, cardiac enlargement, occlusion of the pharyngeal airway, and arteriovenous anastamoses were raised in this child. Newer treatments including embolization treatments and cryotherapy were considered for this child but were not pursued since the growth of the hemangioma came to a virtual standstill and the child is otherwise thriving.
