HEMANGIOMS: They are benign vascular tumors. It occurs in approximately 10% of children in infancy. It is three times more common in girls than boys. Hemangiomas can be present at birth or appear shortly after birth. They usually grow rapidly in the first year of life, then slow down in the next five years and return to normal at 10-15 years of age. Its incidence is doubled in premature babies.
More than half of these vascular abnormalities are in the head and neck region. Most consist of solitary lesions. It increases the risk of finding organ hemangiomas in children with more than one lesion. The majority of organ involvements are in the liver. Brain, intestinal and lung involvement can also be seen. Most hemangiomas do not require treatment. However, 10% cause problems, while 1% threaten life due to their settlements. Those close to the airway may impair breathing, those around the eyes may cause vision loss. Ulcerations and secondary infections on hemangiomas may cause regression of hemangiomas. Large hemangiomas or hemangioendotheliomas involving the liver can lead to liver enlargement, anemia, thrombocytopenia (platelet reduction), and heart failure. Diffuse hemangiomas in the liver can lead to Kasbach-Merritt syndrome. In this syndrome, thrombocytopenia (platelet reduction), hemolytic anemia, involvement of red blood cells in the hemangioma, activation of the blood clotting mechanism in the hemangioma results in disruption of the clotting mechanism (coagulopathy). In cases where there is more than one lesion on the skin, liver scan with MRI and eye examination should be done.
Treatment : Most of them do not need any specific treatment. However, treatment is essential for hemangiomas that threaten life and vision. Initial treatment is prednisone. It is administered orally (1-3 mg/kg / 24 hours). Rarely, higher doses are required. 30% of hemangiomas respond well to this treatment and regression is seen within a week. In 40%, the growth of the hemangioma stops and responds minimally, while 30% does not respond to this treatment. Interferon –x (1-3 MU/m2 / 24 hours) can be used in those who do not respond to cortisone. This treatment can respond up to 70%. However, in 10 – 20% cases, precautions may be required for the risk of neurological side effects of interferon-x. In some cases, laser therapy can be applied.
Treatment of patients with Kasabach-Merritt syndrome can be supplemented with interferon-x in addition to cortisone. Heparin therapy is contraindicated in these patients because it accelerates bleeding. Platelet transfusion should also be avoided. The use of aminocaproic acid or tranexamic acid may be beneficial. Radiation, embolization (with sclerosing agents) or surgical resection may be needed in cases that do not respond to treatment.
LYMPHANGIOM AND CYSTIC HYGROMA: These are lymphatic vessel-derived structures seen in children
and most common after hemangiomas. They originate from the embryonic lymph sac. Almost half of it is found in the head and neck region. About 50% is present at birth. The other half occurs around 2 years of age.
Lymphatic malformations are benign, but when they are between vital vessels in the neck region, they cannot be completely removed, so the term malignant is used, this expression is due to their localization. They are painless, soft masses that manifest themselves with translumination in cases close to the skin. Those in the posterior chest wall (mediasta) may have respiratory distress. Rapid enlargement of the lesion may occur with infection or internal bleeding.
They are surgically removed in localized lesions. However, this is not always possible in infiltrative lesions. Recurrence is inevitable in cases that cannot be completely resected. More than one surgical intervention may be required. When they have respiratory distress, the aspiration of the cyst can provide temporary relief. Infection of sclerosing agents and laser therapy can be used in the treatment. Systemic treatment with inder feron has also been reported.
