Zaldívar-Reyna O, Parra-Soto I, Guerrero-Ruiz LI, Gil-Hernández G, Orozco-Cervantes CA, Díaz-Aguilar CY, Estrada-Chávez CM

Language: Spanish
References: 15
Page: 118-122
PDF size: 246.64 Kb.

ABSTRACT

Introduction. Hemangiomas are vascular bening tumors that occur most frequently in childhood; being the most of the benign tumors, with more predominance in females. They characterized by rapid growth during the first year of life and a slow regression. They comprise of endothelial clonal cells associated with dendritic and mast cells. Most are found in head and neck and usually do not cause problems, indications for treatment are ocular involvement, airway comprise, presence of ulceration, functional impairment or a combination of the above. Treatment options include: steroids, chemotherapeutic agents, sclerotherapy, embolization, cryosurgery, laser surgery, debulking and surgical excision. Literature reports regression based in therapy with propranolol. The mechanism of action of propranolol is not clearly understood, it has been proposed that induce vasoconstriction and capillary endothelial cell apoptosis. Interferes with pro-angiogenic mechanisms involved in the proliferative phase, leading to down regulation of factors such as VEGF and bFGF. There are also published data that indicated a selective role of propranolol in the inhibition of expression of MMP-9 and HBMEC these play a structural and functional role in tumor angiogenesis by increasing the anti-angiogenic effect of propranolol. Case report. Male of 58 years old, with the presence of tumor at the beginning of 3 x 3 cm on the left hemiface with hematic secretion that required stitching, antibiotic and analgesic management, with 8 years of evolution and progressive growth of lesion that involved all left hemiface, presenting three events of spontaneous bleeding that required hospitalization because of the anemia, TAC reports a high flow vascular malformation on the left face connected to the right side vasculature, depending to the external carotid. Biopsy of the lesion was negative for malignancy, we decided to treat with propanolol (1 mg/kg/day) showing significant improvement in the first month, less inflammation, increasing the hemoglobin, with no evidence of infection, and with improved of eye opening. Conclusions. Treatment with propranolol is a relatively new. In most of the reports it has been used in children, with similar dosage used in this case. The use can avoid the common side effects of steroids in high doses, also can always resort to it as a rescue measure in complex cases like the one presented in this article. Treatment with propranolol causes a rapid arrest of proliferation and promotes regression of problematic hemangioma with a good safety profile.

REFERENCES

1. Zimmermann AP, Wiegand S, Werner JA, Eivazi B. Propranolol therapy for infantile haemangiomas: Review of the literature. Int J Ped Otorhinolaryngol 2010; 74(4): 338-42.

2. McGee P, Miller S, Black C, Hoey S. Propranolol for infantile haemangioma: A Review of Current Dosing Regime in a Regional Paediatric Hospital. Ulster Med J 2013; 82(1): 16-20.

3. Drolet BA, Esterly NB, Frieden IJ. Hemangiomas in children. N Engl J Med 1999; 341(3): 173-81.

4. Kramer D, et al. Propranolol en el tratamiento de los hemangiomas de la infancia. Rev Chil Pediatr 2010; 81(6): 523-30.

5. Xiao Q, Li Q, Zhang B, Yu W. Propranolol therapy of infantile hemangiomas: efficacy, adverse effects, and recurrence. Pediatr Surg Int 2013; 29(6): 575-81.

6. Werner JA, Dünne AA, Lippert BM, Folz BJ. Optimal treatment of vascular birthmarks. Am J Clin Dermatol 2003; 4: 745-56.

7. Nguyen J, Fay A. Pharmacological therapy for periocular infantile haemangiomas: a review of the literature. Semin Othalmol 2009; 24: 178-84.

8. Starkey E, Shahidullah H. Propranolol for infantile haemangiomas: a review. Arch Dis Child 2011; 96(9): 890.

9. Chung SH, et al. Successful and safe treatment of hemangioma with oral propranolol in a single institution. Korean J Pediatr 2012; 55(5): 164-70.

10. Pandey A, Gangopadhyay AN, Upadhyay VD. Evaluation and management of infantile hemangioma: an overview. Ostomy Wound Manage 2008; 54: 16-8, 20, 22-6, 28-9.

11. Leaute-Labreze C, de la Roque ED, Hubiche T, et al. Propranolol for severe hemangiomas of infancy. N Engl J Med 2008; 358: 2649-51.

12. Holmes WJ, Mishra A, Gorst C, Liew SH. Propranolol as firstline treatment for rapidly proliferating infantile haemangiomas. J Plast Reconstr Aesthet Surg 2011; 64: 445-51.

13. Rosbe KW, Suh KY, Meyer AK, Maguiness SM, Frieden IJ. Propranolol in the management of airway infantile hemangiomas. Arch OtolaryngolHead Neck Surg 2010; 136: 658-65.

14. Frieden IJ, Drolet BA. Propranolol for infantile hemangiomas: promise, peril, pathogenesis. Pediatr Dermatol 2009; 26: 642-4.

15. Lawley LP, Siegfried E, Todd JL. Propranolol treatment for hemangioma of infancy: risks and recommendations. Pediatr Dermatol 2009; 26: 610-4.