Color Doppler Evaluation of Arterial Resistive Index in Infantile Hemangioma: A Useful Parameter to Monitor the Response to Oral Propranolol?

Infantile hemangioma (IH) is the most common benign vascular tumor in childhood. In more than 85% of all cases, IHs undergo spontaneous involution, but nearly 10–12% of IHs develop complications and require immediate therapy. Oral propranolol is currently the first-line treatment for IHs. Color Doppler ultrasound is the gold standard in the diagnosis of deep IH, and it is used to evaluate the morphological change and the modification of vascularization that occur during its evolution and treatment. To date, only few data in the literature described the changes of intralesional arterial resistive index (RI) during treatment with propranolol; particularly, some authors have shown an increase of intralesional arterial RI in IHs with clinical regression during treatment with propranolol. The objective of this paper is to evaluate the changes of RI of the intralesional arteries of the IHs during the treatment with oral propranolol. We retrospectively analyzed a total of 64 IHs in 60 patients treated with oral propranolol with a good clinical response. Gray-scale ultrasonography and color Doppler imaging were performed before and during the therapy. The intralesional RIs were measured before and during the treatment. For each lesion, we recorded the RI values, and then we calculated the mean RI value for any single lesion. We compared the mean RI value observed at the baseline with the mean RI value of the last detectable sampling at color Doppler. We also compared between them the mean RI values observed during intermediate ultrasound. The RI values were compared in 44 lesions, with at least two significant samplings of RI. In the 44 lesions compared, we did not find statistically significant variations in the mean RI values between the baseline control and the values recorded at the last post-treatment control. The time trend of mean RI values of the intermediate color Doppler analysis performed between the first pre-treatment control and the last measurable control did not show any statistically significant variation in the trend of mean RI values. Contrarily to what has been described by some authors, in our experience, we have not observed an increase of RI in IHs treated with oral propranolol.

Burn Hemangioma: A New Variant of Hemangioma

<b><i>Background:</i></b> Burn hemangioma, also known as scalded pyogenic granuloma, is considered a variant of pyogenic granuloma, but unlike the classic type it presents with rapid progression. Most patients are infants and young children with a history of burns caused by liquids. <b><i>Objective:</i></b> The present study aims to present all patients with burn hemangiomas treated at our institutions with a full clinical and histopathological assessment. <b><i>Patients and Methods:</i></b> This case series includes 34 cases that were treated during the period from 2016 to 2021. <b><i>Results:</i></b> A total of 34 patients (16 female/18 male, mean age of 17.6 years) were included. Two age groups presented: infants and children (<i>n</i> = 22, age range 0.5–8 years, 10 female/12 male), and adults (<i>n</i> = 11, age range 25–44 years, 6 female/6 male). Lesions appeared 1–2 weeks following predominantly second-degree burns, and multiple lesions predominated in infants and children. The lesions evolved to large lesions within weeks, and these appeared to be either static or involute. The histopathology was compatible with hemangioma, rather than pyogenic granuloma. <b><i>Conclusion:</i></b> Burn hemangioma should be considered a new variant of hemangioma rather than a type of pyogenic granuloma that follows second-degree burns. They have many similarities with infantile hemangioma, both clinically and histopathologically.

Inhibiting IL-6/STAT3/HIF-1α signaling pathway suppressed the growth of infantile hemangioma

Purpose This study aimed to evaluate the expression of Interleukin 6 (IL-6) in IH patients and investigate the role of IL-6/signal transducers and activators of transduction-3 (STAT3)/hypoxia inducible factor-1α (HIF-1α) pathway in the progression of infantile hemangioma (IH). Methods Serum samples obtained from IH patients and normal infants were measured for IL-6 expression. Hemangioma-derived stem cells (HemSCs) were transfected with siRNAs targeting IL-6, HIF-1α or STAT3. And then, cell-viability assay and wound healing assay were conducted. After that, the tumor mouse model of HemSCs was established. The in vivo anticancer effect of IL-6 inhibitor was investigated. Results IH patients had much higher IL-6 levels as comparing to the healthy controls (P=0.005). HemSCs transfected with IL-6 siRNA had significantly lower viability and migration rate than normal HemSCs. And HemSCs transfected with STAT3 siRNA or HIF-1α siRNA had the similar tendency. On tumor bearing mice, IL-6 inhibitor treatment significantly delayed the tumor growth. Compared with control group, Caspase 3 was significantly increased in IL-6 inhibitor group (P<0.05), whereas Ki67 was decreased in IL-6 inhibitor group (P<0.05). In TUNEL assay, IL-6 inhibitor group had much higher apoptosis rate than control (P<0.05). Conclusion Our findings indicated that inhibiting IL-6/STAT3/HIF-1α signaling pathway could suppress IH growth.

Results of Infantile Hemangioma Laser Therapy in Children with Persistent Residual Signs after Systemic Propranolol Therapy: Clinical Cases

Background. Infantile hemangiomas are revealed in 1-3% of newborns and 10-12% of infants. There are only anecdotal reports on the laser therapy efficacy in this pathology management. However, there is no common approach to the use of this method in the complex treatment of infantile hemangioma in infants. Clinical Cases Description. Two clinical cases of infantile hemangioma are presented. Patients underwent complex treatment: systemic propranolol and laser therapy via pulsed dye laser. Laser exposure modes ware selected individually: laser spot sizes were 10 and 12 mm, energy levels were 5-10 J/cm2, burst duration was short (0.45 ms) or long (10-20 ms), procedure duration was from 15 to 40 minutes, number of procedures varied from 1 to 8. Laser therapy has shown its efficacy in treatment of superficial infantile hemangioma. Conclusion. The indication for using laser therapy in management of infants with hemangiomas is especially persistent residual signs such as telangiectasias and erythema after spontaneous or drug involution phase. Laser therapy allows us to avoid aggressive methods and improves the quality of life of our patients according to this article.