Infantile hemangiomas: risk factors for complications, recurrence and unaesthetic sequelae

Abstract Background: Infantile hemangiomas (IH) occur in approximately 4% to 10% of the pediatric population. The identification of clinical subtypes and conditions that indicate increased risk for complications is essential for therapeutic success. Objectives: To identify risk factors for complications, recurrence and unaesthetic sequelae. Methods: Retrospective cohort of patients with infantile hemangiomas undergoing follow-up at the Dermatology Service of Universidade Federal de Ciências da Saúde de Porto Alegre, between 2006 and 2018. Results: 190 patients were included; 24% had some type of complication, ulceration being the most frequent, and 86% required treatment. On correlation, ulceration was statistically related to mixed IH (p = 0.004), segmental IH (p < 0.01) and location in the gluteal region (p = 0.001). The mean time of treatment with propranolol was 12.7 months. Patients with PHACES syndrome and segmental infantile hemangioma required longer treatment (p < 0.001 and p = 0.0407, respectively), as well as those who started treatment after five months of life (p < 0.0001). Recurrence occurred in 16.6% of the treated patients, all-female; 94% were located on the head and neck (mainly on the upper eyelid, cyrano, S3 segment, and with parotid involvement); 61% and 38.8% were of the mixed and deep subtypes, respectively. Approximately 1/3 of the patients had some unaesthetic sequelae. Study limitations: As this is a retrospective study, data and photos of some patients were lost. Conclusions: Mixed and segmental hemangiomas are risk factors for ulceration and sequelae. Recurrence occurs more often in females and segmental hemangiomas. Segmental infantile hemangioma and PHACES syndrome require a longer time of treatment. Specific protocols are required for infantile hemangiomas with a high risk of recurrence.

Hemangioma hepático gigante / Giant Hepatic Hemangioma

Introducción: Los hemangiomas hepáticos son lesiones no epiteliales que se observan con mucha frecuencia en piezas quirúrgicas resecadas por otras razones. Los hemangiomas que miden 10 cm o más, denominados "hemangiomas gigantes", pueden producir síntomas, como dolor y manifestaciones de un síndrome de reacción inflamatoria y coagulopatía. Los hemangiomas hepáticos son los tumores hepáticos primarios más frecuentes y están presentes en un 0,4-20 por ciento de la población general y es característico que se detecten de manera accidental durante la evaluación de síntomas abdominales inespecíficos. Objetivo: Presentar a una paciente portadora de un hemangioma gigante y características anatómicas peculiares intervenida quirúrgicamente con buenos resultados y evolución excelente. Caso clínico: Paciente de sexo femenino de 24 años de edad, portadora de un Hemangioma hepático gigante en segmento lateral, con variante anatómica vascular que dificultó la embolización y facilitó la cirugía. Se realizó una lobectomía hepática izquierda con una evolución clínica satisfactoria y sin complicaciones. Conclusiones: Las resecciones quirúrgicas de hemangiomas gigantes sintomáticos son una opción terapéutica segura y muy válida ante el fracaso de la embolización(AU)

Introduction: Hepatic hemangiomas are nonepithelial lesions much frequently observed in surgical specimens resected for other reasons. Hemangiomas ten centimeters or more, called "giant hemangiomas," can cause symptoms such as pain, as well as manifestations of an inflammatory reaction syndrome and coagulopathy. Hepatic hemangiomas are the commonest primary hepatic tumors, are present in 0.4-20 percent of the general population, and are typically accidentally detected during the evaluation of nonspecific abdominal symptoms. Objective: To present the case of a patient with a giant hemangioma and unusual anatomical characteristics, who underwent surgery with good outcome and excellent evolution. Clinical case: 24-year-old female patient with a giant hepatic hemangioma in the lateral segment, with a vascular anatomical variant that made embolization difficult and facilitated surgery. A left hepatic lobectomy was performed with satisfactory and uncomplicated clinical evolution. Conclusions: Surgical resections of symptomatic giant hemangiomas are a safe and very valid therapeutic option in case of embolization failure(AU)

Canine cutaneous neoplasms in the metropolitan region of Goiânia, Goiás state, Brazil / Neoplasias cutâneas caninas na região metropolitana de Goiânia, Goiás, Brasil

ABSTRACT: The present study aimed to describe the occurrence and epidemiological features of skin neoplasms diagnosed in dogs in the metropolitan region of Goiânia, Goiás state, Brazil. Diagnoses from dog biopsies from 2011 to 2016 provided by a private veterinary pathology laboratory were analyzed. The main diagnoses were mast cell tumor, hemangiosarcoma, squamous cell carcinoma, malignant melanoma, and hemangioma. Highest frequency of neoplasms was found in female dogs, dogs aged > 8 years, and purebred dogs, particularly the American Pit Bull Terriers and the Poodles. Most common sites affected by the neoplasms were the limb and the head. Using multiple correspondence analysis, groups of neoplasms were found to be associated with different epidemiological features and the size of the neoplasms was associated with the biological behavior. The results of this study described predispositions and verified the importance of different types of skin neoplasms in dogs in the region being studied.(AU)

O objetivo deste estudo foi determinar a prevalência e as características epidemiológicas das neoplasias cutâneas em cães na região metropolitana de Goiânia, Goiás. Foram analisados os diagnósticos de um laboratório do setor privado de 2011 a 2016. Mastocitoma, hemangiossarcoma, carcinoma de células escamosas, melanoma maligno e hemangioma representaram os principais diagnósticos. A maioria dos casos ocorreram em cães de raças definidas, fêmeas e com idade >8 anos. American Pit Bull Terrier e Poodle foram as raças mais encontradas. As neoplasias acometeram principalmente regiões de membros e cabeça. Pela análise de correspondência múltipla, associou-se os grupos de neoplasias com diferentes características epidemiológicas e o tamanho da neoplasia com o comportamento biológico. A comparação dos resultados com pesquisas prévias possibilitou confirmar predisposições previamente descritas e verificar a importância dos diferentes tipos de neoplasias cutâneas em cães na região estudada.(AU)

Corioangioma gigante de la placenta con buenos resultados perinatales / Giant Placenta Chorioangioma with Good Perinatal Outcomes

El corioangioma fue descrito por primera vez en 1798 por Clarke. Este es un tumor no trofoblástico de la placenta, constituye una entidad poco usual y se reporta en 1 por ciento de las placentas examinadas microscópicamente, con evidencia clínica en aproximadamente 1:3 500 a 1:9 000 nacimientos. Presentamos el caso de una paciente de 21 años, con una historia obstétrica de embarazos 2, abortos 1, que es valorada en servicio de emergencias con embarazo a término con corioangioma gigante de la placenta. El ultrasonido muestra una imagen redondeada hipoecogénica que se interpreta como: cotiledón placentario aberrante. Se le realizó cesárea y se observa una tumoración redondeada en borde placentario con presencia de una red vascular evidente en su superficie. El ultrasonido es el medio que más favorece el diagnóstico, sobre todo el Doppler. La detección precoz y oportuna de esta afección permite la vigilancia fetal y la prevención de las complicaciones(AU)

Clarke first described Chorioangioma in 1798. This is a placenta non-trophoblastic tumor; it is an unusual entity and is reported in 1 percent of the placentas examined microscopically, with clinical evidence in approximately 1: 3 500 to 1: 9 000 births. We present the case of a 21-year-old patient, with an obstetric history of two pregnancies and one abortions, who is evaluated in emergency services with full-term pregnancy with giant placenta chorioangioma. Ultrasound shows a rounded hypoechoic image that is interpreted as aberrant placental cotyledon. A caesarean section was performed and a rounded tumor was observed on the placental border with the presence of an evident vascular network on the surface. Ultrasound is the way that most favors diagnosis, especially Doppler. Early and timely detection of this condition allows fetal monitoring and prevention of complications(AU)

Afecciones de hemangiomas cutáneos en la infancia registrados en Villa Clara desde 2012 hasta 2015 / Cutaneous hemangiomas in children, registered in Villa Clara from 2012 to 2015

Introducción: los hemangiomas son el tumor cutáneo más común en la infancia. Se clasifican dentro de las anomalías vasculares congénitas. Objetivo: identificar el comportamiento clínico-epidemiológico y resultados terapéuticos de los hemangiomas en pacientes atendidos en el Hospital Infantil "José Luis Miranda" de Santa Clara, Villa Clara en el período 2012-2015. Materiales y Métodos: se empleó el método bibliométrico y técnicas de visualización y representación de información. El estudio clasifica como descriptivo de tipo longitudinal retrospectivo. El universo lo constituyó todos los niños con hemangiomas cutáneos atendidos en el Hospital Infantil "José Luis Miranda", de Villa Clara. Las variables que se analizaron fueron: edad, tipo de lesión, localización, complicaciones, afecciones por sexo, raza, antecedentes familiares del padecimiento, así como el tratamiento prescripto y su evaluación. Resultados: se determinaron las afecciones por raza, edad, sexo y antecedentes familiares de los infantes. Se estudiaron las lesiones por tipos y complicaciones. El comportamiento de las afecciones de hemangiomas cutáneos en la infancia registrada en Villa Clara, entre los años 2012 y 2015, coincide con criterios descritos por varios especialistas e investigadores de esta afección. Conclusiones: se corroboró que el sexo femenino, niños menores de 1 año y de piel blanca, fueron los pacientes afectados con mayor regularidad. Se identificó que las lesiones se localizaron con mayor frecuencia en cara, cuero cabelludo y tronco. Los tratamientos más efectivos fueron la cirugía, electrodesecación y los esteroides locales y sistémicos (AU).

Introduction: hemangiomas are the most common cutaneous tumor in the childhood. They are classified among the congenital vascular anomalies. Objective: to identify the clinic-epidemiological behavior and therapeutic outcomes of the hemangiomas attended in the Infantile Hospital "Jose Luis Miranda", of Santa Clara, Villa Clara, in the period 2012-2015. Materials and Methods: the bibliographic method and techniques of information visualization and representation were used. The study classifies as retrospective, descriptive of longitudinal type. The universe was composed by all the children with cutaneous hemangiomas attended at the Infantile Hospital "José Luis Miranda", of Villa Clara. The analyzed variables were: age, kind of lesion, location, complications, conditions by sex, race, and family antecedents and also the prescribed treatment and evolution. Results: the conditions were determined by the children´s race, age, sex and family antecedents. Lesions were studied according to their kind and complications. The behavior of the cutaneous hemangiomas in childhood registered in Villa Clara between 2012 and 2015 agree with the criteria described by several specialists and researchers of this condition. Conclusions: it was corroborated that the patients more regularly affected were the female, white ones, aged less than a year. Lesions were located more frequently on the face, the scalp and the trunk. The most effective treatments were surgery, electro-desiccation and local and systemic steroids (AU).

Angiomatosis encefalotrigeminal o síndrome de Sturge-Weber. A propósito de un caso / Encephalotrigeminal angiomatosis or Sturge-Weber syndrome. A propos of a case

El síndrome de Sturge-Weber consiste, en su forma completa, en la asociación de anomalías cerebrales, cutáneas y oculares. Desde el punto de vista clínico, se caracteriza por una mancha color vino en la cara, epilepsia, retraso mental, otras manifestaciones neurológicas deficitarias y glaucoma. Se presentó el caso de un paciente de 9 años de edad, masculino, piel negra, producto de parto eutócico, con peso de 4 200 g y antecedentes patológicos perinatales de cianosis, constatándose desde el nacimiento varios hemangiomas faciales. Al examen físico se confirma en cara y cráneo, una frente huidiza con presencia del hemangioma facial o hemangioma coroideo, glaucoma unilateral izquierdo, micrognatia. Se precisó mala oclusión dentaria, y en las extremidades superiores una clinodactilia del quinto dedo. Además, tiene el tronco asimétrico, retraso mental severo y aparecen cuadros convulsivos tónico-clónicos que repiten frecuentemente. Teniendo en cuenta todos estos elementos se comienza a sospechar el posible diagnóstico de un síndrome de Sturge-Weber (AU).

The Sturge-Weber syndrome is, in its complete form, the association of ocular, cutaneous and cerebral anomalies. From the clinical point of view, it is characterized by a wine-color spot on the face, epilepsy, mental retardation, other neurological deficit manifestations and glaucoma. We presented the case of a male, black patient, aged 9 years, who was born by eutocic delivery, with 4 200 g weight, and perinatal symptoms of cyanosis, finding several facial hemangioma from the moment of birth. At the physical examination, it was confirmed on the face and crania, evasive forehead with facial hemangioma or choroidal hemangioma, left unilateral glaucoma, micrognathia. Dental malocclusion was stated and clinodactyly of the fifth finger. Besides that, he has an asymmetric trunk, severe mental retardation and tonic-clonic convulsive episodes frequently repeated. Taking into account all these elements we began to suspect the possible diagnosis of a Sturge-Weber syndrome (AU).

An Adult Male Presenting with a Left Gluteal Region Hemangioma – An Unusual Site.

The word “hemangioma” comes from the Greek haema- (αιμα), “blood”; angeio (αγγειο), “vessel”; -oma (-ωμα), “tumor”. A Hemangioma is a benign and usually selfinvoluting tumor of the endothelial cells that lines blood vessels, and is characterized by increased number of normal or abnormal vessels filled with blood. It usually appears in the initial weeks of life and grows most rapidly over the first six months. Usually, growth is complete and involution has commenced by twelve months. Half of all infantile hemangiomas have completed involution by age five, 70% by age seven, and most of the remainder by age twelve years1. In more severe cases hemangiomas may leave residual tissue damage. In infancy, it is the most common tumor 2.

Características clínicas y epidemiológicas del hemangioma en población pediátrica ≤ 3 meses en el Servicio de Dermatología del Instituto Nacional de Salud del Niño(INSN)durante el periodo Enero-Diciembre 2008 / Clinical and epidemiological characteristics of pediatric hemangioma ≤ 3 months in the Dermatology Department of the National Institute of Child Health (INSN) during the period January to December 2008

La investigación realizada fue descriptiva de tipo retrospectiva cuyo objetivo principal fue determinar las características clínicas y epidemiológicas en la población pediátrica S 3 meses en el Servicio de Dermatología del INSN durante el periodo Enero- Diciembre 2008. Se obtuvo una población de 800 historias clínicas con diagnóstico de hemangioma en el Servicio de Dermatología del INSN durante el periodo del año 2008 proporcionada por la Unidad de Estadística del INSN. De éstas; se tomó una muestra de 163 historias clínicas con el diagnóstico dé Hemangioma en niños s 3 meses de edad en el año 2008, de las cuales se analizaron los datos de 127 historias clínicas. Entre los resultaron obtuvimos que la incidencia fue de 15.87 por ciento, 67 por ciento de los casos fueron de sexo femenino, 54 lesiones fueron localizadas en cara y cuello, 97.6 por ciento de los casos fue de tipo localizado, el 80 por ciento de los casos tuvieron hemangiomas superficiales, la aparición de la lesión en un 77 por ciento de los casos fue al nacimiento y 3.2 por ciento en la primera semana de vida, 13 de una total de 14 complicaciones reportadas fueron ulceraciones y 90 por ciento de los casos no contaban con el dato de peso al nacer en la historia clínica. Concluimos que la incidencia encontrada en nuestro estudio fue alta, El sexo predominante encontrado fue el femenino y la localización más frecuente fue cara y cuello, el tipo de hemangioma más común según su distribución fue el localizado, la ulceración fue la complicación más frecuente encontrada y el peso al nacer reportado en nuestro estudio fue normal

The research was descriptive and retrospective whose main objective was to determine the clinical and epidemiological features in children s 3 months in the Dermatology Department of the INSN during the period of January to December 2008. We obtained a population of 800 medical records with a diagnosis of hemangioma in the Dermatology Department of the INSN during the period of 2008 provided by the Statistics Unit of the INSN. Of these, we took a sample of 163 medical records with the diagnosis of hemangioma in children s 3 months in the year 2008 and analyzed data from 127 medical records. Among the results, we obtained that the rate was 15.87 per cent, 67 per cent of cases were female, 54 lesions were located in the face and neck, 97.6 per cent of the cases was localized type, 80 per cent of the cases had superficial hemangiomas the appearance of the lesion in 77 per cent of the cases was at birth and 3.2 per cent in the first week of life, 13 of a total of 14 complications were reported ulcers and 90 per cent of cases did not have the data of birth weight in the history. We conclude that the incidence found in our study was high, the predominant sex was female, and the most common location was the face and neck, the most common type of hemangioma according to their distribution was the located one, ulceration was the most common complication found and reported birth weight was normal in our study

Prevalence of oral hemangioma, vascular malformation and varix in a Brazilian population

Hemangioma, vascular malformation and varix are benign vascular lesions, common in the head and neck regions. Studies about the prevalence of these lesions in the oral cavity are scarce. The aim of this study was to estimate the prevalence of and to obtain clinical data on oral hemangioma, vascular malformation and varix in a Brazilian population. Clinical data on those lesions were retrieved from the clinical forms from the files of the Oral Diagnosis Service, School of Dentistry, Federal University of Minas Gerais, Brazil, from 1992 to 2002. Descriptive analysis was performed. A total of 2,419 clinical forms in the 10-year period were evaluated, of which 154 (6.4 percent) cases were categorized as oral hemangioma, oral vascular malformation or oral varix. Oral varix was the most frequent lesion (65.6 percent). Females had more oral hemangioma and oral varix than males. Oral vascular malformation and oral varix were more prevalent in the 7th and 6th decades, respectively. Oral hemangioma and oral varix were more prevalent in the ventral surface of the tongue and oral vascular malformation, in the lips. Oral hemangioma was treated with sclerotherapy (54.5 percent), and vascular malformation was managed with sclerotherapy and surgery (19.4 percent each). The data of this study suggests that benign vascular lesions are unusual alterations on the oral mucosa and jaws.

Hemangioma, malformação vascular e variz são lesões vasculares benignas comuns na região de cabeça e pescoço. Estudos sobre a prevalência dessas lesões em boca são escassos. O objetivo deste estudo foi estimar a prevalência e realizar um levantamento de dados clínicos de hemangioma, malformação vascular e variz de boca. Dados clínicos dessas lesões foram consultados em fichas clínicas do arquivo do Serviço de Diagnóstico Oral da Universidade Federal de Minas Gerais, Brasil, no período de 1992 a 2002. Uma análise descritiva foi realizada. Foram obtidas neste período de 10 anos 2.419 fichas clínicas. Cento e cinqüenta e quatro (6,4 por cento) casos foram categorizados como hemangioma, malformação vascular e variz de boca. Variz de boca foi a lesão mais freqüente (65,6 por cento). Mulheres foram mais acometidas pelos hemangiomas e varizes de boca. Malformação vascular e variz de boca foram mais prevalentes na 7ª e 6ª décadas de vida, respectivamente. A localização prevalente do hemangioma e da variz de boca foi a superfície ventral da língua, e da malformação vascular, os lábios. Hemangioma de boca foi tratado com escleroterapia em 54,5 por cento dos casos e a malformação vascular com escleroterapia e cirurgia em 19,4 por cento cada. Este estudo sugere que lesões vasculares benignas são alterações incomuns na mucosa bucal e nos maxilares.

Endoscopic diagnosis and treatment of severe lower gastrointestinal bleeding.

Severe hematochezia is a common reason for hospitalization but the causes have changed in the last decade. Changes are in part related to the aging population, the evaluation and treatment by colonoscopists rather than surgeons or non-endoscopists, and the changes in colonoscopic practices such as piecemeal polypectomy. A careful history, physical examination, rectal examination, and nasogastric lavage may help localize the bleeding site and focus the differential diagnosis. This should be routine while resuscitating the patient. However, purging the colon for urgent colonoscopy may be the most definitive way to combine diagnosis and treatment of bleeding colonic lesions. Complete colonoscopy with intubation of the terminal ileum is recommended, and also examination of the rectum with a slotted anoscope. If those examinations are negative, a push enteroscopy is recommended for combined diagnosis and treatment. With recent advances in colonoscopic hemostasis, patients will benefit from diagnosis and treatment by experienced colonoscopists. Also, urgent colonoscopy after purge has been reported to be more cost-effective than elective colonoscopy or other strategies for diagnosis of severe hematochezia.

Actualización en el diagnóstico y tratamiento de los hemangiomas / Update on diagnosis and treatment of hemangiomas

Enfatizar en la correcta clasificación es aún una alta prioridad en la literatura ya persiste una gran desinformación al respecto. Nuevos progresos en la ciencia han permitido una mejor comprensión de estas lesiones. El avance en el diagnóstico precoz y la experiencia terapéutica han mejorado nuestra habilidad para tratar lesiones extensas y mejorar la calidad de vida de los pacientes.

Emphasis on correct classification is still a high priority in the literature and yet there remains a great deal of misinformation. Many new developments in the basic science of these lesions are allowing better understanding of why these lesions occur while improving our management in these patients. Advances in early diagnosis and therapeutic experience have improved our ability to treat extensive lesions and also improve patients' quality of life.

Ulcerated hemangiomas: clinical features and management.

Hemangioma is the most common tumor of infancy and ulceration is the most frequent complication of hemangioma. The purpose of this report was to review the clinical features and management of ulcerated hemangioma. A retrospective study of ulcerated hemangioma at the outpatient pediatric dermatology clinic, King Chulalongkorn Memorial Hospital from 1992 to 2001 was performed. The medical records of 41 patients were reviewed. Twenty-eight females and 13 males were seen with a female/male ratio of 2.2: 1. Superficial hemangioma was the most common type (51%). Head and neck were the most frequently involved sites, affecting 21 cases (51%). Ulcerated hemangiomas were found on extremities, torso, and perineum of 9 patients (22%), 6 patients (15%) and 5 patients (12%), respectively. Ulceration was developed at a mean age of 3.9 months (range, 1-7 months). Conventional treatment with topical and/or systemic antibiotic was successfully used in 19 patients (46%). Oral prednisolone was used in 4 patients with large hemangiomas. The mean duration of treatment with oral prednisolone was 12 months. Flashlamp-pumped pulsed-dye laser (FPDL) was used in 16 patients who failed topical and/or systemic antibiotic. Fifteen patients (94%) healed within 1 to 3 treatments. Excision was done on a small superficial hemangioma on the cheek. In conclusion, head and neck were the most common sites of ulcerated hemangioma. Topical antibiotics and/or systemic antibiotics could be used as the first-line management of ulcerated hemangioma. FPDL was very effective in the treatment of ulcerated hemangioma.

Spider angiomas are not found in the retina of patients with cirrhosis.

To determine the prevalence of spider angiomata in patients with cirrhosis, the factors influencing them and whether or not they are present in the retina of patients with cirrhosis, 93 cirrhotics were studied. Cutaneous spider angioma were seen in 19 (20%) patients. All patients with spiders had at least one episode of variceal bleeding and had grade III or IV oesophageal varices. Spiders were seen more commonly in patients with alcoholic cirrhosis than in those with non-alcoholic cirrhosis (53.5% vs 6%, p < 0.001), in patients with Child's C cirrhosis than those with Child's A and B cirrhosis (67% vs 4%, p < 0.001). However, although spiders were seen more often in patients undergoing sclerotherapy than those not, the difference was statistically not significant (23% vs 19%, p = NS). Spiders had no association with presence or absence of portal hypertensive gastropathy or gastric varices. None of the patients showed any abnormality or presence of spiders in the retina. It is concluded that spider angiomas are seen more commonly in patients with alcoholic cirrhosis, those with more severe liver disease and patients having large oesophageal varices and they are not seen in the retina of patients with cirrhosis.

Hemangioma: aspectos clínicos, diagnóstico e terapêutica de 235 casos / Hemangioma: clinical features, diagnosis and therapeutics of 235 cases

Realizou-se levantamento de 8505 fichas de pacientes atendidos no período de janeiro/72 a dezembro/90 no Serviço de Estomatologia do Hospital Heliópolis - SUS, no qual foram registrados 235 casos de hemangiomas (2,76 por cento). Houve predominância do sexo feminino. O local de maior incidência de lesöes foi o labío e o tempo de duraçäo foi de um ano. O método de diagnóstico mais efetivo foi o exame clínico e o tratamento mais empregado foi a esclerose

Incidencia de lesiones cutáneas en el recién nacido / Incidence of cutaneous injuries in the newborn

En el recipen nacido se puede apreciar una gran variedad de lesiones cutáneas, que generalmente corresponden a cambios fisiológicos de la piel, transitorios y benignos. Sin embargo, se pueden presentar lesiones cutáneas marcadoras de enfermedades sistémicas, tumorales u otras enfermedades dermatológicas que tanto pediatras como dermatológos deben saber diferenciar. El objetivo de nuestro trabajo fue conocer la incidencia y frecuencia relativa de estos cambios cutáneos

Tumores en recién nacidos / Tumors in newborn infants

Se presenta una serie de 51 casos de tumores registrados en el período neonatal, entre 1.180 pacientes pediátricos con tumores, atendidos entre los años 1969 y 1989 en un hospital pediátrico del área metropolitana de Santiago. Los tumores neonatales más frecuentes fueron los teratomas (n:30), seguidos de los tumores de origen vascular (n:6), neuroblastomas IV-S (n:5), hamartomas hepáticos (n:4), los tumores renales (n:3), sarcoma de partes blandas (n:2) y melanoma melanocítico (n:1). Se destaca el comportamiento diferente de los procesos neoplásticos durante esta etapa de la vida y la importancia que tiene el tratamiento quirúrgico

Corioangioma: diagnóstico e Implicaciones Fisiopatológicas: presentación de un caso

Se presenta un caso en el cual en la semana 25 de gestación se diagnosticó ecográficamente un corioangioma placentario asociado a polidramnios. El polidramnios fue tan severo que obligó a la interrupción del ebarazo. La incidencia de este tumor es mayor que la habitualmente descrita. Se plantean los diagnósticos diferenciales de la imagen ecográfica. El corioangioma se asocia con muerte fetal, polidramnios u oligoamnios, insuficiencia placentaria, preeclampsia, abruptio placentae, alteraciones de los niveles de alfa feto proteína y malformaciones fetales. Se discuten la fisiopatología de estas alteraciones y el manejo perinatal. El corioangioma debe destacarse sistemáticamente en todos los casos de polidramnios inexplicado y los embarazos en que se encuentre, deben ser seguidos cuidadosamente y considerados como embarazos de alto riesgo

Formas de presentación y procedimientos diagnósticos de Trece Hemangiomas Hepáticos

Presentamos una serie de trece pacientes diagnosticados de Hemangioma Hepático Gigante, en los últimos veinte años. La edad media de los pacientes era 48 años y nueve de ellos eran mujeres. Sólo cinco referían sintomatología de dolor abdominal. Se encontraron alteraciones de la bioquímica hepática en 8 pacientes, pero dos de ellos tenían otra hepatopatía de base sinendo el hallazgo más constante, la elevación de la fosfatasa alcalina. Hemos revisado los diferentes medios diagnósticos utilizados: Gammagrafía hepática etiquetada con sulfuro coloide de Tc99, gammgrafía hepática con hematíes marcados, ecografía abdominal, tomografía computarizada, arteriografía hepática, laparoscopia, laparotomía y biopsia hepática. Generalmente se utilizó más de uno de los mencionados medios para llegar al diagnóstico. Habiéndose observado una evolución hacia métodos menos invasivos. El diagnóstico se confirmó en todos los pacientes de la presente revisión, a excepción de uno, mediante laparotomía o laparoscopia