Childhood vascular tumor

General information

A childhood vascular tumor (hemangioma, angioma, angiodysplasia) is a benign neoplasm formed from blood vessels. It belongs to the group of angiomas and has a tendency to grow. Under certain circumstances, it can transform into a malignant pathology. Surgeons, dermatologists, and oncologists diagnose and treat pediatric hemangiomas with other specialists’ participation, if necessary.

Tumors that are located in the skin or form on internal organs are dangerous. Hemangiomas that have formed on the face, especially near the eyes, lips, and mucous membranes of the mouth or nose, must be monitored.

In the vast majority of cases, such neoplasms are congenital pathologies and are formed during the intrauterine development of the child. Usually, there is endothelium or internal lining inside the vessels. Under the influence of unfavorable factors (infectious diseases, medications, Rh conflict, arterial hypertension in the mother), endothelial cells fall out of place during the laying of organs. Endothelial cells later serve as a source of vascular tumor formation.

Classification

The classification of hemangiomas in children and adults allocates several types of tumors. For practical purposes, the division considering morphological features is more often used.

• Capillary or superficial hemangioma is located over the child’s skin, clearly delineated from the surrounding tissues. Its color ranges from pink to bluish. The surface is lumpy and, when pressed, pale.
• Cavernous – located under the skin, looks like a lumpy nodule, soft to the touch, and consists of small cavities that fill with blood when physically strained. The skin covering the tumor is livid, if you press hard, it shrinks and turns pale, but then quickly recovers.
• Combined – consists of elements of capillary and cavernous tumor types, has subcutaneous and external parts;
• Mixed—contains other tissues besides blood vessels. These include angioneuromas (with nerve tissue), angiofibromas(with connective tissue), and others.

The number of hemangiomas varies, ranging from one to several. Their size also varies, ranging from a dot to occupying the entire anatomical area.

The growth rate is also essential for prognosis: a distinction is made between rapidly growing tumors, slowly growing tumors, and non-changing neoplasms.

Simple capillary hemangiomas are found in the vast majority of cases (up to 95%), with girls being three times more likely to develop the disease than boys. Blood tumors themselves do not pose a risk to life, but they can grow into adjacent organs: eyes, nose, ears, and trachea, which can cause the development of serious secondary diseases. In addition, their surface is easily damaged even by clothing, from which there are suppuration and ulcers, varying in intensity of bleeding. In adolescents, hemangiomas on the skin are an extremely unpleasant cosmetic defect, because of which the child may experience psychological discomfort.

Symptoms of childhood hemangioma

The tumor is visible immediately in the newborn; sometimes, it is visible during the first three months of life. The hemangioma grows rapidly up to 6 months of age, later its growth slows down. Most often affected are the scalp, face, especially eyelids, nose and cheeks, back, genitals, and, less often, limbs. Significantly rarely are internal organs and bones involved.

The tumor looks like a nodular bump on the skin, lilac or purple, much warmer to the touch than the surrounding tissues. Its size varies from 1 to 15 mm, sometimes up to several centimeters. While superficial hemangioma spreads wide, other forms can grow deep, squeezing the tissues and disrupting organ function. The slightest traumatization causes bleeding, which can be challenging to cope with. An ulcer may form at the injury site, with a high risk of infection and inflammation.

Superficial hemangiomas can stop growing spontaneously and regress. Reversal of the tumor begins with a pale area in the center, which gradually increases in size until the hemangioma disappears altogether. Some neoplasms go away by the end of the first year of life, others by the end of adolescence.

Causes of childhood vascular tumor

Reliable causes of hemangiomas in children have not yet been identified. It is assumed that ontogenesis is disturbed due to the impact of various unfavorable factors, including:

• poor environmental conditions;
• smoking, alcohol, or drug dependence of the pregnant woman;
• chronic and acute infectious diseases in the pregnant mother;
• irrational use of medications while carrying a fetus;
• chemical poisoning in a woman.

Researchers also link the development of blood tumors with hormonal status, as girls suffer from pathology much more often.

Some experts among the possible causes of hemangiomas in the child also include hypoxia, prematurity, and congenital anomalies of blood vessels.

Diagnosis

Several specialists are involved in examining a young patient: a pediatrician, pediatric surgeon, oncologist, and dermatologist. If the tumor affects any organ, a specialized specialist is involved: pediatric ENT, ophthalmologist, urologist, gynecologist, and others. 

To clarify the nature and localization, additional laboratory and instrumental methods of examination are used:

• coagulogram; 
• platelet count; 
• ultrasound, which measures the rate of blood flow in the hemangioma and surrounding vessels; 
• angiography; 
• radiographs of the bones of the area involved.

If the child has chronic or concomitant pathologies, consultation with a specialized specialist may be required.

Hemangioma treatment

In the vast majority of hemangioma cases, surgical treatment is prescribed. It is mandatory to work with child surgeons if the neoplasm is located on the head and neck, genitals, anorectal area, and mucous membranes. Quickly need to remove those rapidly growing hemangiomas, increasing the area of the lesion two times within a week. Immediately remove tumors in case of suppuration, bleeding, ulceration, infection, or necrosis.

The traditional scalpel is used, but increasingly less frequently. In modern medicine in children, the following methods of surgical treatment of hemangiomas are used:

• electrocoagulation – cauterization of the feeding vessel with an electric current;
• cryodestruction – destruction by liquid nitrogen and other types of targeted cold exposure;
• laser removal – vaporization of excess tissue with a directed beam of light energy;
• sclerotherapy – injection of drugs that glue the vascular wall together;
• embolization – artificial occlusion of the vessel feeding the tumor;

The surgeon chooses a particular treatment method or a combination of them to destroy the tumor and obtain a minimal cosmetic defect completely.

Post-surgical scars and scars may completely resolve as your baby grows older.

Sometimes, instead of treatment, the surgeon chooses a wait-and-see approach if there is a clear age-related regression of the hemangioma or prescribes treatment with topical hormones.

All these treatment options are available in 180 hospitals worldwide (https://doctor.global/results/diseases/childhood-vascular-tumor). For example, Childhood vascular tumor treatment can be done in 13 clinics across Germany for an approximate price of $3,2 K (https://doctor.global/results/europe/germany/all-cities/all-specializations/procedures/childhood-vascular-tumor-treatment). 

Childhood vascular tumor prevention

There is no specific prevention. The future mother is recommended to lead a healthy lifestyle, stop smoking, not use alcohol or energy, and fight drug addiction, if any.

In addition, it is necessary to control chronic inflammatory diseases, properly and timely treat acute infectious conditions, and avoid self-medication.

Rehabilitation

After surgical treatment of hemangiomas, the recovery period takes 2 to 4 weeks, depending on the form of neoplasm detected in the child and the therapy tactics. At the site of the hemangioma, a dense crust first forms, which gradually shrinks and then falls off. Under the crust is the skin: immediately after the crust is removed, it is lighter in color than healthy areas, but as recovery proceeds, the tone evens out.

During the rehabilitation period, it is essential to:

• comply with the doctor’s prescriptions, without making personal adjustments to the drug regimen or dosage, without adding other remedies, etc.;
• Protect the operated area from sunlight, hot water, chemicals, and mechanical damage;
• do not apply creams, ointments, or other compositions to the site of hemangioma without a doctor’s order.

If a suspicious mass is detected in a baby, it is advisable to consult a doctor as soon as possible. Most tumors of this nature can be treated quickly if treatment is started in time.