A Case Series of Tardive Expansion Congenital Hemangioma: A Variation of Noninvoluting Congenital Hemangioma or a New Hemangiomatous Entity?

J Am Acad Dermatol. 2020 Feb 4;S0190-9622(20)30155-9. doi: 10.1016/j.jaad.2020.01.069. Online ahead of print.

Abstract

Background: Congenital hemangiomas present fully grown at birth and share a remarkably similar lack of disproportionate or accelerated postnatal proliferation.

Objective: We report a series of unusual congenital hemangiomas that arise prenatally and initially exhibit a proportional growth pattern similar to that of noninvoluting congenital hemangioma. However, a tardive expansion of the lesion, similar to the proliferation phase of infantile hemangioma, occurs later during childhood.

Methods: A total of 11 unusual congenital hemangiomas were reviewed in regard to clinical presentation, imaging, and pathologic characteristics.

Results: The infants included 9 boys and 2 girls. The tumors were located in the head and neck (n=10) and abdominal wall (n=1). Spontaneous expansion began at the age of 12 months to 61 months, as determined from clinic notes and paired follow-up photographs. Uniform parenchymal masses and fast-flow vessels were confirmed by imaging examination. There are both histopathological overlap and distinction between these lesions and other congenital hemangiomas.

Limitations: Only a small number of cases were identified.

Conclusion: We propose that these lesions be denominated "tardive expansion congenital hemangioma (TECH)" to indicate their specific clinical and histological distinctiveness. Recognition of these distinct lesions will contribute to a better understanding of congenital hemangiomas.

Keywords: noninvoluting congenital hemangioma; rapidly involuting congenital hemangioma; tardive expansion congenital hemangioma; vascular tumors.