Sakai Yuki, Tsuge Itaru, Kataoka Masako, Takeuchi Yasuhide, Katayama Yasuhiro, Yamanaka Hiroki, Katsube Motoki, Sowa Yoshihiro, Sakamoto Michiharu, Morimoto Naoki
From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Plast Reconstr Surg Glob Open. 2023 May 10;11(5):e4975. doi: 10.1097/GOX.0000000000004975. eCollection 2023 May.
Infantile hemangioma (IH) is a common pediatric vascular tumor and is easily diagnosed in most cases based on the clinical course and appearance, but deep IHs are difficult to diagnose based on external appearance alone. Clinical and imaging findings are therefore important clues to the diagnosis of soft tissue tumors; however, a definitive diagnosis is decided based on the pathological examination of biopsy or resection specimens. A 1-year-old girl with a subcutaneous mass on her glabella was referred to our hospital. At 3 months of age, her mother noticed a tumor that swelled when she cried. It gradually enlarged, and ultrasonography and magnetic resonance imaging were performed at 12 months of age. Doppler ultrasonography showed a hypo-vascular mass. Magnetic resonance imaging revealed a subcutaneous mass with low-intensity on T1-weighted image and slightly high-intensity on T2-weighted image, with tiny flow voids. Computed tomography showed no frontal bone defect. The soft tissue tumor could not be diagnosed based on these imaging findings; thus, we decided to perform total resection under general anesthesia. A histopathological examination showed a highly cellular tumor with capillaries with opened small vascular channels and glucose transporter 1 positivity. Thus, it was diagnosed as deep IH transitioning from the proliferative phase to the involuting phase. Deep IHs are difficult to diagnose because characteristic imaging findings disappear during the involuting phase. We emphasize the importance of performing Doppler ultrasonography in the early phase (eg, at 6 months of age) for soft tissue tumors of infancy.
婴儿血管瘤（IH）是一种常见的儿科血管肿瘤，大多数情况下根据临床病程和外观很容易诊断，但深部IH仅根据外观很难诊断。因此，临床和影像学表现是软组织肿瘤诊断的重要线索；然而，最终诊断是基于活检或切除标本的病理检查来确定的。一名1岁女童因眉间皮下肿块被转诊至我院。3个月大时，她的母亲注意到一个肿块，孩子哭闹时会肿胀。肿块逐渐增大，12个月大时进行了超声检查和磁共振成像。多普勒超声显示为低血流肿块。磁共振成像显示皮下肿块在T1加权像上呈低信号，在T2加权像上呈稍高信号，有微小的流空信号。计算机断层扫描显示额骨无缺损。根据这些影像学表现无法诊断该软组织肿瘤；因此，我们决定在全身麻醉下进行完整切除。组织病理学检查显示为高细胞性肿瘤，有开放的小血管通道的毛细血管，葡萄糖转运蛋白1呈阳性。因此，诊断为深部IH，正从增殖期过渡到消退期。深部IH难以诊断，因为在消退期特征性的影像学表现会消失。我们强调在婴儿期软组织肿瘤的早期阶段（如6个月大时）进行多普勒超声检查的重要性。
