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Reticular infantile hemangioma of the limb can be associated with ventral-caudal anomalies, refractory ulceration, and cardiac overload.
Pediatr Dermatol. 2007 Jul-Aug; 24(4):356-62.PD

Abstract

We describe six patients with an uncommon variant of infantile hemangioma that we have termed reticular, occurring in the extremity, which were associated with intractable ulceration, anogenito-urinary-sacral anomalies, and sometimes cardiac overload. The extreme end of the spectrum is exemplified by a male neonate who presented with a stained, enlarged, pulsatile lower extremity, and cardiac failure. He also had hepatic hemangiomas and ambiguous genitalia. Progressive soft tissue necrosis and bony destruction necessitated amputation. The histopathologic features differed from those of typical infantile hemangioma: infiltrative (not lobular) and involving fascia, muscle, and bone. The mid-spectrum is illustrated by five females with reticular infantile hemangioma of the lower limb, buttock, and perineum. Four of these infants had a ventral-caudal anomaly, including omphalocele, recto-vaginal fistula, solitary/duplex kidney, imperforate anus, and tethered cord; one infant also had hepatic hemangiomas. Deep ulcerations healed following corticosteroid therapy; one patient required skin graft for closure of a thigh wound. The minor end of the spectrum is exemplified a patchy lesion in the distal limb. The reticular variant of infantile hemangioma can be confused with other vascular anomalies in the limb, such as capillary malformation, cutis marmorata telangiectasia congenita, diffuse arteriovenous malformation (Parkes Weber syndrome) and capillary-lymphatico-venous malformation (Klippel-Trenaunay syndrome). The macular network-like appearance of the tumor and coexisting ventral-caudal structural anomalies is analogous to the association of posterior fossa brain malformations, hemangiomas, arterial anomalies, coarctation of the aorta and cardiac defects, and eye abnormalities association in the craniofacial region.

Authors+Show Affiliations

Department of Plastic Surgery, Children's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA. john.mulliken@childrens.harvard.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

17845155

Citation

Mulliken, John B., et al. "Reticular Infantile Hemangioma of the Limb Can Be Associated With Ventral-caudal Anomalies, Refractory Ulceration, and Cardiac Overload." Pediatric Dermatology, vol. 24, no. 4, 2007, pp. 356-62.
Mulliken JB, Marler JJ, Burrows PE, et al. Reticular infantile hemangioma of the limb can be associated with ventral-caudal anomalies, refractory ulceration, and cardiac overload. Pediatr Dermatol. 2007;24(4):356-62.
Mulliken, J. B., Marler, J. J., Burrows, P. E., & Kozakewich, H. P. (2007). Reticular infantile hemangioma of the limb can be associated with ventral-caudal anomalies, refractory ulceration, and cardiac overload. Pediatric Dermatology, 24(4), 356-62.
Mulliken JB, et al. Reticular Infantile Hemangioma of the Limb Can Be Associated With Ventral-caudal Anomalies, Refractory Ulceration, and Cardiac Overload. Pediatr Dermatol. 2007 Jul-Aug;24(4):356-62. PubMed PMID: 17845155.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reticular infantile hemangioma of the limb can be associated with ventral-caudal anomalies, refractory ulceration, and cardiac overload. AU - Mulliken,John B, AU - Marler,Jennifer J, AU - Burrows,Patricia E, AU - Kozakewich,Harry P W, PY - 2007/9/12/pubmed PY - 2007/11/9/medline PY - 2007/9/12/entrez SP - 356 EP - 62 JF - Pediatric dermatology JO - Pediatr Dermatol VL - 24 IS - 4 N2 - We describe six patients with an uncommon variant of infantile hemangioma that we have termed reticular, occurring in the extremity, which were associated with intractable ulceration, anogenito-urinary-sacral anomalies, and sometimes cardiac overload. The extreme end of the spectrum is exemplified by a male neonate who presented with a stained, enlarged, pulsatile lower extremity, and cardiac failure. He also had hepatic hemangiomas and ambiguous genitalia. Progressive soft tissue necrosis and bony destruction necessitated amputation. The histopathologic features differed from those of typical infantile hemangioma: infiltrative (not lobular) and involving fascia, muscle, and bone. The mid-spectrum is illustrated by five females with reticular infantile hemangioma of the lower limb, buttock, and perineum. Four of these infants had a ventral-caudal anomaly, including omphalocele, recto-vaginal fistula, solitary/duplex kidney, imperforate anus, and tethered cord; one infant also had hepatic hemangiomas. Deep ulcerations healed following corticosteroid therapy; one patient required skin graft for closure of a thigh wound. The minor end of the spectrum is exemplified a patchy lesion in the distal limb. The reticular variant of infantile hemangioma can be confused with other vascular anomalies in the limb, such as capillary malformation, cutis marmorata telangiectasia congenita, diffuse arteriovenous malformation (Parkes Weber syndrome) and capillary-lymphatico-venous malformation (Klippel-Trenaunay syndrome). The macular network-like appearance of the tumor and coexisting ventral-caudal structural anomalies is analogous to the association of posterior fossa brain malformations, hemangiomas, arterial anomalies, coarctation of the aorta and cardiac defects, and eye abnormalities association in the craniofacial region. SN - 1525-1470 UR - https://www.unboundmedicine.com/medline/citation/17845155/Reticular_infantile_hemangioma_of_the_limb_can_be_associated_with_ventral_caudal_anomalies_refractory_ulceration_and_cardiac_overload_ L2 - https://doi.org/10.1111/j.1525-1470.2007.00496.x DB - PRIME DP - Unbound Medicine ER -