title: Spectrum of hepatic hemangiomas: management and outcome.
abstract: OBJECTIVE
  Infants with multiple cutaneous hemangiomas often present with hepatic hemangiomas. They can follow a benign clinical course or require complex management. We reviewed our experience in the management of hepatic hemangiomas.
  
  
  METHODS
  We performed a retrospective review of patients (1996-2007) with hepatic hemangiomas treated in our institution.
  
  
  RESULTS
  Twenty-six patients were diagnosed with hepatic hemangiomas as follows: 8 focal, 12 multiple, and 6 diffuse lesions. Nineteen (73%) patients had associated cutaneous hemangiomas. Sixteen patients had multiple and 3 patients had single cutaneous hemangiomas. All patients with multiple or diffuse liver lesions were screened for heart failure and hypothyroidism. Congestive heart failure developed in 4 patients, 3/4 of these patients had diffuse lesions. Two patients required thyroid replacement because of elevated thyroid-stimulating hormone. Because of progression of disease, 9 patients required steroid treatment. Two patients were treated with vincristine and 3 patients received alpha-interferon because of poor response to steroid treatment. Two patients went on to surgical resection for failed response to medical management and worsening heart failure (left lobectomy, liver transplant). Both patients had uncomplicated postoperative courses. Five patients had a previously undescribed constellation of rapidly involuting cutaneous hemangiomas (gone by 3 months, glut-1-negative) with associated liver lesions also resolving at a faster pace (mean resolution of cutaneous hemangiomas, 1.9 vs 7.9 months; P = .001; liver, 5.8 vs 25.3 months; P = .004). All patients in our series survived.
  
  
  CONCLUSIONS
  Patients with multiple cutaneous hemangiomas should be screened for hepatic lesions. Patients with diffuse or multifocal liver hemangiomas should be screened for congestive heart failure and hypothyroidism. A subgroup of rapidly involuting cutaneous hemangiomas have a significantly shorter time for involution of hepatic lesions. The status of cutaneous lesions can be used as indicators for the liver hemangiomas.
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45236, USA.
authors.forename: Belinda
authors.initials: B
authors.lastname: Dickie
authors.forename: Roshni
authors.initials: R
authors.lastname: Dasgupta
authors.forename: Rajalakshmi
authors.initials: R
authors.lastname: Nair
authors.forename: Maria H
authors.initials: MH
authors.lastname: Alonso
authors.forename: Frederick C
authors.initials: FC
authors.lastname: Ryckman
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Tiao
authors.forename: Denise M
authors.initials: DM
authors.lastname: Adams
authors.forename: Richard G
authors.initials: RG
authors.lastname: Azizkhan
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006333:Heart Failure / Q000209:etiology; D006391:Hemangioma / Q000145:classification* / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007037:Hypothyroidism / Q000209:etiology; D007223:Infant; D007231:Infant, Newborn; D008113:Liver Neoplasms / Q000145:classification* / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000150:complications; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D005938:Glucocorticoids