Pediatric Vascular Anomalies and Embryonal Tumors

Hemangiomas: Congenital Vascular Anomalies

Epidemiology and Onset

• Newborns: 1.1% - 2.6%
• Infants: 10.1%
• Gender Ratio: Girls to Boys (3:1)

Onset occurs in the first year of life. Slow reduction until complete disappearance is possible from Year 2.

Complications

• Ulceration
• Infection
• Bleeding

Treatment Options

1. Spontaneous reduction: Possible without cosmetic or functional consequences.
2. Conservative treatment:
   • Compression Therapy: Used for the trunk, extremities, or abdomen (Note: can cause thrombosis).
   • Laser Therapy: Treatment of surface port-wine stains.
   • Sclerotherapy: Liquid nitrogen.
3. Surgery: Surgical intervention when necessary.

Angiomatosis

General Characteristics

• Wide damage zone.
• Internal visceral organs are affected.

Common Locations

• Extremities
• Abdominal wall
• Perineum
• Buttocks

Clinical Features

1. Rapid growth.
2. Color change (blue or pink spots).
3. Size of extremities changes when lifting.

Differential Diagnosis

• Lymphedema
• Varicose veins

Lymphangioma

Cause: Tumors of the lymph vessels or congenital anomalies.

Locations and Prevalence

• Neck, armpit, cheek, tongue, and mediastinum.
• 50% of cases are seen at birth.

Classification

• Simple capillary (surface)
• Cavernous
• Cystic (Hygromas)

Treatment

• Extirpation.
• Emergency puncture.
• Cystic Hygroma: Can be treated with OK-432 (Picibanil), a low-virulent strain of Streptococcus liquid affected by penicillin.
• Sclerotherapy, cryotherapy, and laser are not as effective.

Teratoma

General Characteristics: Congenital embryonic encapsulated tumor containing tissue and organ components. The tumor is polymorphic.

Diagnosis

1. Localization and typical clinical view.
2. Internal teratomas via Digital Rectal Examination (DRE), though usually diagnosed too late.
3. X-ray.
4. CT: Used to determine the size of the teratoma and its relations with the sacrum and abdominal organs.

Malignancy: Malignization typically begins in the second year of life.

Treatment

Extirpation: Urgent operation is required if there is rapid growth, rupture risk, bleeding, ulceration, or malignization.

Nephroblastoma: Wilms Tumors

General Characteristics

• Equal incidence in girls and boys.
• Most patients are under 3 years old; rare in adults.
• Both kidneys are affected in 5% of cases.

Clinical Features

The course is often asymptomatic. Symptoms may include anorexia, pallor, nausea, and subfebrile fever.

• Palpation is painless.
• The disease can easily be felt by the mother or a doctor during a prophylactic review.
• With tumor growth: Pain and hematuria.

Diagnosis

• US and CT: Determines whether the mass is cystic or solid and whether the renal vein or vena cava is involved.
• Biopsy: For definitive diagnosis.
• Chest CT: To check for metastases.

Treatment

• Surgery and chemotherapy.
• Sometimes radiation therapy.

Specifics of Childhood Tumors

Symptoms and Syndromes

• Intoxication syndrome.
• Bone pain.
• Frequent infections.
• Headaches with nausea in the morning.
• Hemorrhagic syndrome.
• Seizures and disorders of balance.
• Disorders of vision and endocrine disorders.
• Systemic disease and rapid growth.
• Higher frequency of malignant tumors (sarcomas) compared to adults.

Complex Treatment

• Surgery and biopsy.
• Chemotherapy.
• Radiotherapy.
• Autologous stem cell transplantation.