Get access

Infantile haemangiomas that failed treatment with propranolol: Clinical and histopathological features

Authors

  • Roderic J Phillips,

    Corresponding author
    1. Vascular Biology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
    2. Paediatrics, Monash University, Melbourne, Victoria, Australia
    • Correspondence: Associate Professor Roderic J Phillips, Royal Children's Hospital, Flemington Road, Melbourne, Vic. 3052, Australia. Fax: +61-3-93455522; email: rod.phillips@rch.org.au

    Search for more papers by this author
  • Zerina Lokmic,

    1. Vascular Biology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
    Search for more papers by this author
  • Catherine M Crock,

    1. Haematology, Royal Children's Hospital, Melbourne, Victoria, Australia
    Search for more papers by this author
  • Anthony Penington

    1. Vascular Biology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
    2. Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
    Search for more papers by this author

  • Licence for publication: The corresponding author has the right to grant on behalf of all authors, and does grant on behalf of all authors, an exclusive licence on a world-wide basis to the Journal of Paediatrics and Child Health and Blackwell Publishing Asia Pty Ltd ACN 004 901 562 (Blackwell Publishing) to publish the this article including the abstract in printed and electronic form, in all languages, and to administer subsidiary rights agreements with third parties for the full period of copyright and all renewals, extensions, revisions and revivals. The article is deemed to include all material submitted for publication and includes the text, figures, tables, author contact details and all supplementary material accompanying the article.
  • Conflict of interest: None declared.

Abstract

Aim

To describe the clinical and histopathological characteristics of infantile haemangiomas that failed treatment with oral propranolol .

Design

This study is a case series from the vascular birthmarks clinic at Royal Children's Hospital, Melbourne.

Patients

The patients for this study were infants who commenced treatment with oral propranolol before 6 months of age and who were treated for at least 4 months without a satisfactory result. For histology and immunohistochemistry, tissue from the four non-responding patients who subsequently underwent surgical excision was matched with four historical controls.

Outcome measures

Based on medical record review and photographic assessments, infants were defined as having failed treatment with oral propranolol if the infantile haemangioma either continued to grow or showed 20% improvement or less. Tissue sections were examined for tissue structure, mast cells, sympathetic innervations and beta-2 adrenergic receptor expression, and the number of mast cells and beta-2 adrenergic positive cells.

Results

From a group of 135 infants who met the inclusion criteria, 14 infants failed propranolol treatment. Eleven of these infants had focal facial haemangiomas. No difference was seen in tissue morphology, tissue innervations, beta-2 adrenergic receptor expression, cell number or mast cell distribution, and number between non-responding and control haemangiomas.

Conclusion

We report a treatment failure rate of 10%, which is higher than previously reported. Focal facial lesions failed to respond twice as frequently as other types of haemangioma. No histopathological reason was identified to indicate why some haemangiomas failed to respond.

Get access to the full text of this article

Ancillary