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Lumbar tumor in a newborn - what to think?
Dora Isabel Fonseca de Sousa1, Mário Rui Pacheco Correia2, Sandra Pereira3, Sara Isabel da Silva Leite3.
1Department of Pediatrics, Centro Materno Infantil do Norte (CMIN) - Centro Hospitalar Universitário de Santo António (CHUdSA), Porto, Portugal,
2Department of Pediatric Surgery, CMIN - CHUdSA, Porto, Portugal,
3Neonatology Intensive Care Unit, Department of Neonatology and Pediatric Intensive Care, CMIN - CHUdSA, Porto, Portugal.
ADDRESS FOR CORRESPONDENCE
Dora Fonseca Sousa, Largo da Maternidade de Júlio Dinis 45, 4050-651 Porto, Portugal.
Email: dorafonsecasousa@hotmail.com
Rapid involuting congenital hemangioma, RICH, newborn, tumor.
Male newborn, born to a 27-year-old healthy gravida two, para one, caucasian woman. Supervised pregnancy, with negative results on prenatal screening including fetal ultrasounds. Family history was unremarkable and the parents were non-consanguineous.
Vaginal delivery at 37 weeks. Apgar scores of nine and ten, at first and fifth minute, respectively. At birth, he had a weight of 3160 g (68th percentile), length of 49 cm (62nd percentile), and head circumference of 33 cm (41st percentile). Physical examination after birth showed a right lumbar subcutaneous mass, purpuric in the center with pale halo (Figure 1). It was mobile, with elastic consistency, measuring approximately 20x30 mm. The exam was otherwise described as normal. Pediatric Surgery collaboration was requested and congenital hemangioma was the most likely diagnosis. At six months of age the lesion was getting smaller, measuring approximately 15x25 mm, compatible with a rapidly involuting congenital hemangioma (RICH).
Figure 1. Image of a congenital hemangioma (white arrow), presenting at birth examination as mobile and elastic lumbar mass (violaceous center with pale halo), measuring approximately 20x30 mm.
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Figure 1. Image of a congenital hemangioma (white arrow), presenting at birth examination as mobile and elastic lumbar mass (violaceous center with pale halo), measuring approximately 20x30 mm.
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What is the diagnosis?
Unlike infantile hemangiomas, congenital hemangioma is a benign vascular tumor fully grown with its maximum size at birth, not exhibiting postnatal growth.1,3 They are typically fully developed solitary raised tumors, pink to violaceous in color, firm to hard on palpation.3 Based on involution they can be classified as noninvoluting or partial involuting congenital hemangiomas or RICH.2 Head, neck and limbs are the most common locations.4 Involution can start within the first week of life usually ending by six to fourteen months of age.4 If complete, it may leave a residual patch of skin with prominent veins with little or none subcutaneous fat.1,4 It can leave a vascular plaque with coarse telangiectasia if incomplete.2 The diagnosis is clinical, without the need for unnecessary exams that will raise parental concerns. Doppler ultrasound may show high blood flow followed by low flow during involution.2 The prognosis is good with conservative treatment consisting of close follow-up.2,4 |
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Funding: None
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Conflict of Interest: None
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- Mulliken, J.B. and Enjolras, O. (2004) "Congenital hemangiomas and infantile hemangioma: Missing links," Journal of the American Academy of Dermatology, 50(6), pp. 875-882. Available at: https://doi.org/10.1016/j.jaad.2003.10.670. [CrossRef] [PubMed]
- Brás, S., Mendes-Bastos, P. and Amaro, C. (2017) "Rapidly involuting congenital hemangioma," Anais Brasileiros de Dermatologia, 92(6), pp. 861-863. Available at: https://doi.org/10.1590/abd1806-4841.20175608. [CrossRef] [PubMed] [PMC free article]
- Boon, L.M., Enjolras, O. and Mulliken, J.B. (1996) "Congenital hemangioma: Evidence of accelerated involution," The Journal of Pediatrics, 128(3), pp. 329-335. Available at: https://doi.org/10.1016/s0022-3476(96)70276-7. [CrossRef] [PubMed]
- Krol, A. and MacArthur, C.J. (2005) "Congenital hemangiomas," Archives of Facial Plastic Surgery, 7(5), pp. 307-311. Available at: ttps://doi.org/10.1001/archfaci.7.5.307. [CrossRef] [PubMed]
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DOI: https://doi.org/10.7199/ped.oncall.2027.1 |
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Cite this article as:
Sousa D I F d, Correia M R P, Pereira S, Leite S I d S. Lumbar tumor in a newborn - what to think?. Pediatr Oncall J. 2023 Nov 24. doi: 10.7199/ped.oncall.2027.1
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