| Objective:Infantile hemangiomas(IH)are common vascular tumors in the skin and soft tissues.The appearance of some tumor residual skin after IH treatment has subsided,which affects the appearance of children to varying degrees,leading to parents’ anxiety and children’s psychological problems such as inferiority,cowardice and fear.In this paper,a retrospective analysis was conducted on paraffin specimens of patients with IH treated by oral propranolol treated in our hospital from January 1,2019 to December 31,2020 after surgical resection and pathological examination or retrospective examination,and clinical data of children with IH treated by oral propranolol treated in our hospital from January 1,2019 to May 31,2022.To preliminarily investigate the tumor residual manifestations and related factors after treatment with IH propranolol,so as to provide evidence for clinical measures to prevent the complications of residual manifestations after IH resolution,and provide guidance for clinical diagnosis and treatment decision.Methods:In this study,IH paraffin specimens archived in the First Affiliated Hospital of Gannan Medical University from January 1,2019 to December 31,2022 were collected.IH specimens were divided into three stages,namely,proliferation stage,regression stage and regression completion stage.HE staining was used to observe the histological characteristics of IH in the natural course of disease.Children with IH admitted to Pediatric Surgery Department of the First Affiliated Hospital of Gannan Medical University from January 1,2019 to May 31,2022 were followed up.All the children included in the study were treated with standardized oral propranolol,and the "progressive administration" method was adopted,with the initial oral dose of 0.5mg/kg /d,gradually increased to 2 mg/kg /d,and maintained at the same dose.The drugs were administered three times,and vital signs,including blood pressure,blood oxygen,pulse and peripheral blood sugar concentration,were monitored 30 minutes before and 2 hours after administration,and short-term adverse reactions were monitored to observe whether the children showed drowsiness,excitement,sleep disorders,diarrhea and other adverse reactions.Information on IH discovery time,initial treatment time,gender,lesion site,lesion size,imaging examination,duration of medication,appearance of residual skin prognosis,information at birth: whether the child was premature(gestational age between 28 weeks and 37 weeks),whether the child was a low birth weight child(birth weight less than 2500 grams),etc.The skin in the tumor area of the children was evaluated,and the follow-up photos were used to determine whether the skin in the tumor area had normal skin appearance and whether there were residual appearance changes in the tumor area(including telangiectasia,fibrous fat residue,pigmentation,skin folds and scars),and the tumor residual manifestations and related factors were statistically analyzed.Results:1.25 paraffin specimens of IH were collected,12 cases at the proliferative stage,7 cases at the regression stage,and 6 cases at the regression completion stage.Histological features of IH at different stages: Proliferative stage: a large number of cells were observed under light microscope,with dense and irregular cell clusters,little septal tissue,proliferative capillaries arranged in lobules,vascular endothelial cells were hypertrophy,vascular lumens were not obvious,and spindle-shaped perivascular cells surrounded the vascular endothelial cells.In the regression stage,the boundaries of the cell mass were blurred,the arrangement was loose,the spacing tissue was increased,the fibroadiposis in the subcutaneous tissue was hyperplasia,there were more microvessels in the protocell mass,the tube diameter was larger,the endothelial cells were flattened,and the perivascular cells were reduced.Fibrous adipose tissue is seen between microvessels.Completion stage of regression: The fibrous adipose tissue with lobular distribution can be observed under light microscope,and the cell mass is not obvious.There were still a few small arteriovenous vessels and microvessels with normal morphology scattered in IH tissue.Telangiectasia and pigmentation were observed in some IH tissues in the dermis.2.A total of 138 cases of infantile hemangiomas were enrolled in this study.After regression,39 cases(28.3%)were normal skin(NS)and 99 cases(71.7%)were lesion skin(LS).The incidence of telangiectasia was the highest(37 cases,37.4 %),followed by fibrofatty residue(26,26.3 %)and hyperpigmentation(26,26.3 %),and the incidence of skin folds(6,6 %)and scars(4,4 %)was low.3.There were 26 males(18.8%,26/138)and 73 females(52.9%,73/138).The ratio of male to female was 1:2.81.Nine cases were premature,accounting for 6.5%.There was no correlation between prematurity and propranolol treatment of infantile hemangiomas skin residual appearance changes(P > 0.05).Nine cases were low birth weight infants,and there was no correlation between low birth weight and the change of skin residual appearance after propranolol treatment of infantile hemangiomas(P >0.05).4.Among the types of infantile hemangiomas,34 cases(24.6 %)were superficial type,52 cases(37.7 %)were mixed type,and 13 cases(9.4 %)were deep type.The type of infantile hemangiomas was correlated with the residual skin appearance changes(P < 0.05).Among the sites of infantile hemangiomas,50 cases were located in the head and neck,accounting for 36.2%;Twenty-three cases(16.7 %)occurred in the trunk.Eighteen cases(13%)occurred in the extremities.Eight cases(5.8%)occurred in the perineum and vulva.The location of infantile hemangiomas was correlated with the residual skin appearance changes(P < 0.05).In the distribution of infantile hemangiomas,28 cases were segmental,accounting for 20.3 %,and 71 cases were non-segmental,accounting for 51.4 %.The distribution of infantile hemangiomas was correlated with the residual appearance of skin(P < 0.05).In the number of infantile hemangiomas,89 cases(64.5 %)were single and 10 cases(7.2 %)were multiple.There was no correlation between the number of infantile hemangiomas and the residual skin appearance changes(P > 0.05).In the blood flow velocity of infantile hemangiomas,38 cases were visible(27.5 %),61 cases were abundant(44.2 %).There was no correlation between the blood flow velocity of hemangiomas and the residual skin appearance(P > 0.05).5.There was no correlation between the time of infantile hemangiomas detection,the time of starting treatment and the efficacy(P > 0.05).The duration of treatment was correlated with the appearance changes of residual tumors(P < 0.05).The children visited the hospital from 0 to 3 months,4 to 6 months.Conclusion:1.Pathological sections at the later stage of IH regression showed fibroadipose tissue and telangiectasia,etc.,which provided certain theoretical basis for clinical observation of residual IH after regression,such as telangiectasia,fibroadipose residue and skin folds.2.The included cases in this study suggested that the residual manifestation rate of IH after oral propranolol treatment was high,which was 71.7 %.3.Telangiectasia was the most common residual manifestation after IH resolution,followed by pigmentation and fibrous fat residue,with fewer skin folds and scars.4.The skin residual manifestations are correlated with the duration of medication,the site of occurrence of hemangioma,the classification of hemangioma,the clinical classification of hemangioma,and whether there is an ulcer.Ruptured skin is a high risk factor.It was independent of the child’s gender,time of hemangioma discovery,time of treatment initiation,and blood flow velocity.5.Mixed,segmental and trunk IH are more likely to have skin residual manifestations.Superficial hemangioma is more likely to occur telangiectasia or pigmentation,mixed type and deep type more likely to occur fiber fat residue. |
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