Hemangioma in the baby

Most, namely about three quarters, of all hemangiomas occur in infancy. At birth, hemangiomas are often not yet clearly visible and only the growth in size in the first year of life makes the hemangioma visible. The frequent occurrence of hemangiomas in infancy can be explained by the fact that it is an embryonic tumor.

A hemangioma, also known as haemangioma, thus consists of cells that humans only produce in their embryonic period and in infancy. About three to five percent of all babies are affected. Premature babies are affected up to twenty times more often than mature babies.

In most babies, the first step is to wait and see how the hemangioma develops, since many hemangiomas regress during the first years of life and hemangiomas do not degenerate malignantly. Treatment of the baby is sought if the hemangioma is particularly large or if the localization is unfavorable. In babies and toddlers, drug treatment with the beta-blocker propanolol is approved, which can contribute to regression.Blood sponges are normally completely painless for the baby and do not restrict him or her in everyday life.

Forms of the hemangioma

One form of hemangioma is the so-called capillary hemangioma. It is derived from the capillaries, the smallest blood vessels in the human body. Capillaries form a fine network in the organs and tissues of the body and enable the exchange of oxygen and nutrients between blood and body tissue.

Approximately 30 to 40 percent of all vascular tumors can be classified as capillary hemangiomas. A capillary hemangioma appears on the skin as a bright red and slightly raised vascular network. It occurs very frequently (one in 200 births) and usually shortly after birth.

In the first months of life the capillary hemangioma often increases in size. However, more than 70 percent of haemangiomas completely regress by the age of 7. Treatment is not necessary for uncomplicated hemangiomas.

However, if the capillary hemangioma is localized in the face or in the buttock or genital area, therapy should be initiated early. Therapy can be carried out using laser technology or cold therapy (cryogenics). For very large haemangiomas, treatment with chemotherapeutic drugs (inhibit the growth of cells), with cortisone or with beta blockers (drugs that lower blood pressure and also act on certain receptors of the haemangioma vessels) can be used.

In very rare cases, surgical intervention may also be necessary. The so-called cavernous hemangioma or cavernoma is in some cases already visible at birth, but more often it develops in the first days of life. A cavernoma is a bright red vascular malformation with large vascular cavities.

Depending on the layer of skin in which a cavernoma occurs, it is classified as a cutaneous, cutaneous-subcutaneous or subcutaneous hemangioma. About 80 percent of all cavernomas regress independently. Cavernous hemangiomas can bleed heavily, which is a dangerous complication of this form of hemangioma.

Large cavernomas can cause growth problems in children’s arms or legs. In these cases, early therapy should be initiated. The cavernous hemangioma is easily treatable and is therefore usually treated nowadays.

A cavernoma can also occur in the central nervous system, i.e. in the brain or spinal cord. This can trigger epileptic seizures or neurological deficits (e.g. paralysis, sensory disorders, etc.). The most severe complication of a cavernous hemangioma is cerebral hemorrhage.

Depending on the size of the cavernoma, the probability of bleeding is 1 to 10 percent per year. If a bleeding occurs or if epileptic seizures occur that cannot be treated otherwise, a cavernous hemangioma in the area of the brain is removed by surgery. Such an operation is not generally recommended in the case of symptom-free findings.

An important special form of hemangioma is the cavernous hemangioma. A sclerosing hemangioma can occur particularly in middle adulthood. This form of haemangioma is a relatively mobile node in the skin (dermis) or subcutis (subcutis) up to one centimeter in size.

The sclerosing hemangioma grows slowly and is considered a benign tumor of the skin. It can occur on any part of the skin of the body, but it preferentially occurs on the extremities. Treatment of sclerosing hemangioma is not absolutely necessary.

However, the haemangioma can be surgically removed very easily at the request of the affected person. In about five percent of cases, a recurrence (relapse) of the sclerosing hemangioma can occur. In principle, hemangiomas can occur anywhere where vessels also run.

It is therefore not uncommon for hemangiomas to also occur in the area of the brain. Not all of these angiomas lead to the development of symptoms. However, this is largely dependent on the size and exact localization.

Thus, slight symptoms such as headaches or dizziness can develop, but these can often not be diagnosed as such in small children. However, impaired vision, sensitivity disorders, speech disorders, memory disorders and other neurological deficits are also possible as a result of displacement by a hemangioma. Another reason is that the weaker vascular wall in the area of the hemangioma does not allow blood pressure to build up as high as would be necessary to ensure adequate supply to the surrounding areas.

Thus, these symptoms represent a clear indication for therapy. Depending on the exact location, various therapeutic options such as radiation, embolization (= closure of the hemangioma) and surgical intervention are possible.A hemangioma can also occur in the orbit of the eye. The orbit is an area surrounded by skull bones in which comparatively very few tumors occur.

For this reason, the hemangioma is the most common benign tumor of the adult orbit. The hemangioma of the orbit is often discovered as a chance finding during skull examinations. In some cases, it is noticeable by a change in the position of the eyeball, as the hemangioma can increase in size and thus displace the eyeball.

The diagnosis can be made by means of angio-magnetic resonance imaging (magnetic resonance imaging to show the vessels) or computer tomography (CT) of the paranasal sinuses. A hemangioma of the orbital cavity (also called orbital hemangioma) occurs in middle age. The slow but steady growth of the hemangioma leads to complications such as progressive exophthalmos (pathological protrusion of the eyeball from the orbit), a decrease in visual acuity (visual acuity reduction), farsightedness (hyperopia) or diplopia (seeing double images).

Treatment is used only in cases of steadily growing hemangiomas of the orbit that cause discomfort. This requires a surgical procedure in which the vascular tumor is first sclerosed and then removed. Since such an operation involves many dangers, hemangiomas that do not cause any complaints should be left untreated.

In these cases, regular check-ups should be performed. Hemangiomas in the lip area are relatively common. They are often treated at a very early stage for aesthetic reasons, but the risk of functional disorders should also be reduced.

If it is a strongly growing hemangioma, this can lead to disturbance of food intake and jaw and tooth development in the lip area. In addition, there is a risk that above a certain size a permanent deformation of the lip will remain even after the operation. All these are reasons why in the case of a diagnosed hemangioma of the lip, action is taken relatively early on and the patient does not wait for the tumor to recede, as is the case with other localizations.

Furthermore, the smaller the hemangioma, the easier it is to remove. This means that gentle techniques can be used during a guided therapy, which show aesthetic results. Hemangiomas in the skin area occur very frequently and can vary greatly in their severity.

They usually present as dark blue to black-blue areas that are either flat or spherical. The structure is soft and often expressable. Their size can vary from a few millimeters to 10 cm.

In the first months of life it shows a rapid growth, but after the first 9 months of life it slowly decreases. Fortunately, most hemangiomas of the skin show a spontaneous regression after the age of 6-9 years. In many cases no signs or only small scars remain.

Life threatening complications are not to be expected. Hemangiomas of the skin, for example, usually require therapy only if they have exceeded a certain size. However, they are often removed beforehand for aesthetic reasons.

The most frequent benign new formation (neoplasia) of the liver is the hemangioma. In most cases, hemangiomas of the liver are discovered as a random finding during an ultrasound examination (sonography) or during an MRI of the liver. These hemangiomas are not dangerous and can be left in the liver without therapy.

Only if a hemangioma is located on the surface of the liver can it tear open and bleed. In rare cases, a deeper hemangioma of the liver can lead to an obstruction in the drainage of bile. The benign cells of the hemangioma do not degenerate into malignant tumor cells.

Hemangiomas are the most common benign tumors of the spleen and are often a chance finding during an ultrasound examination. In many cases they are unproblematic and recede on their own after a few years. During this time, however, there is a risk of splenomegaly, i.e. an enlargement of the spleen, and a slightly higher risk of bleeding within the spleen.

In this case, bleeding initially occurs into the tight spleen capsule. If the bleeding is severe, the splenic capsule may rupture, resulting in a major internal bleeding. However, this still occurs very rarely.

Hemangiomas of the spleen, for example, do not require therapy in most cases and are only treated if they lead to symptoms. Hemangiomas can occur not only in the skin, but also in other parts of the body. A hemangioma vertebra is a hemangioma in the vertebral body.

Women are more frequently affected than men.Normally, a hemangioma vertebra is a random finding, since it only causes symptoms in very rare cases. The hemangioma is visible in computer tomographic images or in magnetic resonance imaging. Treatment is rarely necessary.

If symptoms occur rarely, pain therapy or surgical treatment may be sought. A hemangiomatosis is the simultaneous presence of many hemangiomas. In many cases, hemangiomatosis is a component of other diseases, such as Sturge-Weber syndrome or Mafucci-Kast syndrome.

If the internal organs, especially the liver, are involved, there is an acute danger to the life of the affected newborn, since the hemangiomas change the blood circulation. There are many different forms of hemangiomatosis. These range from a limitation to the skin to hemangiomas in all organs.

Benign neonatal hemangiomatosis is the most harmless form, as it is merely an accumulation of hemangiomas of the skin. The very rare diffuse neonatal hemangiomatosis also affects all internal organs. The cause is not yet known.

Capillary pulmonary hemangiomatosis particularly affects the lungs and can therefore lead to pulmonary hypertension and cardiac stress. In addition to these forms, there are other genetic causes for hemangiomatosis. Depending on the location of the hemangiomas, different concomitant diseases and complications occur.

In most cases, hemangiomatoses are chronic diseases in which only the symptoms can be alleviated. The so-called Kasabach-Merritt syndrome is characterized by the occurrence of a special form of giant hemangiomas. The disease is accompanied by a consumption coagulopathy (coagulation disorder), which means that the consumption of coagulation factors and blood platelets (thrombocytes) occurs.

Hemangiomas lead to the formation of blood clots (thrombi) and the consumption of platelets increases the tendency to bleed. Giant hemangiomas can, for example, extend over an entire extremity. To date, the origin of hemangiomas is unknown; in some cases, they regress on their own. Treatment of the disease may include laser surgery, interventional radiology or drug therapies (e.g. with cortisone).