Fine clinical differences between patients with multifocal and diffuse hepatic hemangiomas.
BACKGROUND
It has been reported that multifocal and diffuse hepatic hemangiomas are true infantile hemangiomas for which a continuum probably exists. We determined the similarities and fine differences between the two types of hemangioma and identified the multifocal subgroup of type, which needs timely treatment.


METHODS
Twenty-four patients (4 males and 20 females; age 114±142days) with multifocal or diffuse hepatic hemangiomas who were treated between January 2000 and June 2015 were studied. For the multifocal type, patients were divided into countable (MC) and uncountable (MU) subgroups. The medical data were analyzed retrospectively.


RESULTS
The clinical presentations included hepatomegaly (n=11), dyspnea (n=7), heart failure (n=9), hypothyroidism (n=6), and anemia (n=1). There were 19 and 5 patients with multifocal and diffuse types, and 6 and 13 patients in the MC and MU groups, respectively. There were significant differences between the multifocal and diffuse types with respect to hepatomegaly, heart failure, dyspnea, and hypothyroidism. However, there was no difference between the MU group and the diffuse type except for hypothyroidism. Observation was commonly recommended for patients with the multifocal type, and their survival rate was clearly higher than for patients with the diffuse type. Both the MU and diffuse-type groups needed treatment, unlike MC patients. The complete remission rate was higher in the MC group than in the MU and diffuse-type groups. Patients with the diffuse type were more likely to die.


CONCLUSIONS
Patients with diffuse-type hepatic hemangioma are at high risk and need active treatment. The MU group for the multifocal type is unique and has high similarities to the diffuse type with respect to clinical presentation and treatment, which suggests that a continuum of the disease phenotypes exists.


METHODS
Case-control study, level III.
Department of Pediatric Surgery, Children's Hospital of Fudan University, 201102, Shanghai, China. Electronic address: likai2727@163.com.
Kai
K
Li
Department of Pediatric Surgery, Children's Hospital of Fudan University, 201102, Shanghai, China.
Zuopeng
Z
Wang
Department of Pediatric Surgery, Children's Hospital of Fudan University, 201102, Shanghai, China.
Yinhua
Y
Liu
Department of Pediatric Surgery, Children's Hospital of Fudan University, 201102, Shanghai, China.
Wei
W
Yao
Department of Radiology, Children's Hospital of Fudan University, 201102, Shanghai, China.
Yin
Y
Gong
Department of Pediatric Surgery, Children's Hospital of Fudan University, 201102, Shanghai, China.
Xianmin
X
Xiao
D016022:Case-Control Studies; D002681:China / Q000453:epidemiology; D005260:Female; D006391:Hemangioma / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000401:mortality; D008297:Male; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
Comparison; Diffuse-type; Hepatic hemangioma; Multifocal-type