most common tumor in infants

1. HAEMANGIOMA OF INFANCY
Habakuk larry omondi

2. DEFINITION
• It is a localized proliferative process of
angioblastic mesenchyme.

3. EPIDEMIOLOGY
• It is the most common tumour of infancy.
• Incidence:
– 1-2% in newborns.
– 10% by the age of 1 year.
• Male to female ratio is 3:1.

4. ETIOLOGY AND PATHOGENESIS
• Clonal expansions of endothelial cells that
may result from somatic mutations of genes
regulating endothelial cell proliferation.

5. CLINICAL PRESENTATION
• Proliferative phase occurs during the first year.
• Involution phase occurs during 2-6 years and is
complete by 10 years.
• Skin lesions:
– Soft, bright red to deep purple
– Compressible
– Nodule or plaque, 1-8 cm wide
– Ulceration may occur
– White to gray area appears on the surface with onset
of regression.

7. • Distribution :
– Solitary and localized or may extend over an entire
region.
– Head and neck:50%
– Trunk: 25%
– Legs
– Oral mucosa

8. SPECIAL PRESENTATIONS
1) DEEP HAEMANGIOMA
• In lower dermis and subcutaneous fat.
• Localized, firm, rubbery mass.
• Bluish or normal skin colour.
• Telangiectasia occurs in overlying skin.
• Can be combined with superficial
haemangioma.
• Does not involute as well as superficial type.

10. 2) MULTIPLE HAEMANGIOMA OF INFANCY
• Small (<2cm) and multiple.
• Cherry red
• Papular
• Involves :
– skin alone(benign cutaneous haemangiomatosis)
– or skin and internal organs (diffuse neonatal
haemangiomatosis).

11. 3) CONGENITAL HEMANGIOMA
• Develop in utero.
• 2 types:
– Rapidly involuting congenital haemangiomas
(RICH).
– Non-involuting congenital haemangiomas (NICH).

12. • Presentation:
– Violaceous tumours.
– Overlying telangiectasia.
– Large veins in periphery.
• Or as:
– Red-violaceous plaques invading deeper tissues
• NICH are fast flow haemangiomas requiring
surgery.

16. DIAGNOSIS
• Diascopy : lesion does not blanch completely.
• Arteriography to demonstrate fast flow
• Doppler ultrasound
• MRI
• Clinical findings
• Lab: dermopathology
– Proliferation of endothelial cells in dermis and/or
subcutaneous tissue.
– GLUT-1 immunoreactivity is present

17. TREATMENT
• Observe and wait for spontaneous involution.
• Medical care
– Intralesional and systemic high dose
glucocorticoids
– Interferon alfa
– Beta blocker (propranolol)
• Surgical care
– Continuous phase or pulsed dye laser
– cryosurgery

18. COMPLICATIONS
• Ulceration
• Airway obstruction
• Visual obstruction
• Psychological problems

19. PROGNOSIS
• In 80%, there is no skin changes after
involution.
• Atrophy, depigmentation, telangiectasia and
scarring occurs in 20%.