Absent/reduced glucose transporter-1 protein expression in infantile subglottic haemangiomas

Extensive airway hemangiomas in two patients without beard hemangiomas

Airway hemangiomas are most often seen in association with cutaneous hemangiomas involving the "beard area." We report two unusual cases of extensive airway hemangiomas developing in patients with facial hemangiomas predominantly involving the upper face, emphasizing the need to consider the possibility of airway hemangiomas even in the absence of "beard area" hemangiomas.

Histopathologic and immunophenotypic profile of subglottic hemangioma: multicenter study

OBJECTIVE

Subglottic hemangioma (SGH) is a rare tumor of childhood often associated with airway compromise. Recently, the possibility that many SGH may be congenital hemangiomas rather than classical infantile hemangiomas (IH) has been raised, with important diagnostic and therapeutic implications. We present the largest, multi-institutional study, to date, with immunophenotypic characterization of SGH.

METHODS

Biopsy proven SGH samples were retrieved from the archived files of three tertiary referral children's hospitals. Relevant demographic and clinical data corresponding to each of the specimen was collected. Standard hematoxylin and eosin staining (H&E) and glucose transporter protein isoform 1 (GLUT 1) immunohistochemical staining was used to confirm the histological diagnosis and evaluate the immunophenotypic profile of the specimens.

RESULTS

19 cases of SGH were reviewed, 18 of these with tissue blocks available for histological and GLUT1 immunohistochemical staining, and the remaining case with GLUT1 immunostaining previously reported. There was a female to male ratio of 3.75:1. Stridor was the presenting feature of all the patients. Concomitant cutaneous lesions were noted in 9 of 19 patients; with three of the PHACES variety. 16/19 specimens were histologically diagnostic of classical IH by H&E staining and also demonstrated strong GLUT 1 positivity; 1/19 was too small for histological diagnosis, but contained GLUT1-positive capillaries; 1/19 was inflamed granulation tissue by histology and was GLUT1-negative; the final 1/19 was inflamed fibrous tissue, negative for GLUT1.

CONCLUSIONS

This multi-institutional pathologic assessment confirms that most subglottic hemangiomas examined were histologically and immunohistochemically confirmed to be IH and similar to IH located in other anatomic locations. GLUT-1 immunohistochemical staining is a valuable tool for confirmatory diagnosis in these patients.

Airway procedures and hemangiomas: treatment patterns and outcome in U.S. pediatric hospitals

OBJECTIVE

Characterize and compare care in children with hemangiomas, who do or do not undergo airway procedures.

METHODS

National retrospective cohort study of patients aged 0-18 with hemangiomas, from 33 freestanding United States pediatric hospital discharge records, 2001-2005. The main outcome measures were therapy, readmission and mortality.

RESULTS

Of 2890 patients diagnosed with hemangiomas, 337 (12%) underwent airway procedures. Most airway procedures were for patients between ages 1 and 11 months. Patients with hemangiomas and airway procedures had more steroid use (80%), increased readmission (30%), and increased mortality (2%) compared to hemangioma patients without airway procedures. Procedures (i.e. laser, open surgery, tracheotomy) and age over 4 months in airway procedure patients were associated with decreased readmission. Increased readmissions were associated with systemic steroid administration.

CONCLUSION

Hemangioma patients who undergo airway procedures experience increased medical and surgical therapy compared to those who do not. Readmission is increased in patients with hemangiomas and airway procedures, but surgical intervention and age greater than 4 months decreased readmission.