Congenital hemangioma: evidence of accelerated involution.
OBJECTIVE
To study the course of hemangiomas that proliferate in utero, are fully grown at birth, and begin to regress during early infancy.


METHODS
We analyzed retrospectively 31 infants with congenital hemangioma seen at Tarnier-Cochin Hospital (Paris) and Children's Hospital (Boston). Diagnosis was made by clinical and radiologic examination and, if necessary, by biopsy. Age, gender, location, appearance, and evolution were noted for each infant.


RESULTS
Only 3 of 23 congenital hemangiomas were diagnosed in utero by ultrasonography. The three most common morphologic forms were raised violaceous tumor with ectatic veins (n = 8), raised grayish tumor with multiple tiny telangiectasias, surrounded by a pale halo (n = 8), and flat infiltrative tumor with violaceous overlying skin (n = 5). Two congenital hemangiomas had associated thrombocytopenic coagulopathy (Kasabach-Merritt phenomenon). All the untreated congenital hemangiomas (n = 24) regressed by the time the infants were 14 months of age, leaving either atrophic skin or extra skin. Seven congenital hemangiomas required therapy for complications: three tumors responded to systemic corticosteroid administration and four were resected.


CONCLUSIONS
Hemangiomas can proliferate in utero and manifest as fully developed tumors at birth. These congenital hemangiomas can regress rapidly. This phenomenon raises new questions about the pathogenesis of this tumor.
Boon
L M
LM
Division of Plastic Surgery, Children's Hospital, Boston, Massachusetts, 02115, USA.
Enjolras
O
O
Mulliken
J B
JB
D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging; D006391:Hemangioma / Q000151:congenital* / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009365:Neoplasm Regression, Spontaneous; D011239:Prednisolone / Q000627:therapeutic use; D011247:Pregnancy; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000151:congenital* / Q000175:diagnosis / Q000628:therapy; D013997:Time Factors; D016216:Ultrasonography, Prenatal
D018931:Antineoplastic Agents, Hormonal; D011239:Prednisolone