Juvenile capillary hemangioma.

Sir,

Hemangiomas are benign proliferative lesions of vascular origin, which are commonly present at birth and may become more apparent at any age of life. Juvenile hemangioma may be located on any part of the body surface but is most common in the head and neck region in young children, with a girl to boy ratio of 1:3.[12] It may present in skin, subcutaneous tissue, mucous membranes of lips, mouth, or internal viscera. Intramuscular hemangiomas are rare, accounting for 0.8% of all benign vascular tumors. They occur most often in young children and usually involve the lower extremities, especially the thigh. Some grow rapidly to involve the whole limb.[13] Herein we describe a 2-month-old female child presenting with right limb swelling since birth. She presented with sudden increase in leg swelling with erythema [Figure 1] and fever since two weeks. The baby was of full-term gestation and delivery was normal. On examination, the swelling was warm and indurated with mild tenderness. Hematological parameters were within normal limits. A radiograph revealed a diffuse soft tissue shadow without any bony involvement or periosteal reaction. The differential diagnoses considered were subacute osteomyelitis, eosinophilic granuloma, fibrosarcoma, Ewing's sarcoma, and other rare tumors. The child underwent a diagnostic tru-cut biopsy. Histopathology revealed intramuscular lobulated cellular growth with intervening fibrillar connective tissue. These lobules contained plump proliferating endothelial cells, a combination of numerous well and poorly canalized blood vessels, which are lined by endothelial cells [Figure 2]. A final diagnosis of benign juvenile intramuscular capillary hemangioma was made. The child returned after six months with partial regression of the swelling. A complete regression was observed at one year.

Figure 1

Right whole leg swelling with erythema

Figure 2

Histopathology showing proliferating of endothelial cells in lobules with intervening stroma (a, Hematoxylin and Eosin, 20×), (b, Reticulin stain, 20×)

Juvenile hemangiomas are benign vascular tumors, characterized by a rapid proliferative phase (0-1 years) followed by spontaneous involution (1-5 years) with continued improvement for up to 12 years (involuted phase).[4] It may present with a sudden enormous increase in the swelling posing suspicion of a rapidly progressing malignant tumor. Surgical treatment is required in approximately 60% of all hemangiomas. Superficial lesions are usually amenable to surgical excision. A wide excision during proliferative phase does not always lead to complete cure, and should be avoided due to risk of major blood loss and nerve injury. Recurrence rates following surgery can be as high as 18%.[5] In our case, the hemangioma underwent a rapid involution phase. Hence, careful observation could be recommended for spontaneous regression in juvenile capillary hemangioma, wherein the lesion does not pose any life-threatening complications or impair function.

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