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Volume 83 | Number 2 | September - October - November - December 2020
Four monthly publication of the Greek Paediatric Society
148
EDITORIAL
Stelios Antoniadis
150
AWARDED PAPER
CpG methylation haplotypes of the insulin gene promoter as a predictive biomarker in a cohort of children and adolescents with type 1 diabetes
Eleni P Kotanidou, Konstantina Mouzaki, Ioanna Chouvarda, Elisavet Koutsiana, Alexandra Kosvyra, Vasiliki Regina Tsinopoulou, Styliani Giza, Anastasios Serbis, Assimina Galli-Tsinopoulou
164
REVIEW ARTICLES
Thyroid cancer in children and adolescents: what’s new Eleni Tsotridou, Savvas Kolanis, Assimina Galli-Tsinopoulou
178
Evaluation of lower esophagus and its pathology with transabdominal ultrasound in pediatric patients.
Sfakiotaki Rodanthi, Pitsoulaki Despoina, Athanasiou Anastasia, Hountala Anna
190
Pleuropulmonary blastoma in childhood
Koutsaftiki Chryssie, Mammas Ioannis, Papatheodoropoulou Alexia, Priftis Konstantinos
194
CASE REPORTS
Teenage girl with obesity amenorrhea and pcos- complete remission of the syndrome with weight loss.
Elpis-Athina Vlachopapadopoulou, Anatoli Fotiadou, Eirini Dikaiakou, Fani Athanasouli, Stefanos Michalacos
President A. Constantopoulos
Editorial board
Editor- in- Chief
S. Antoniadis
Members
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A. Evangeliou
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P. Panagiotopoulou-Gartagani
A. Papadopoulou
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Manuscript submission
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204
A case report of an infantile hepatic haemangioma
D. Rallis, F. Balomenou, A. Drougia, V. Xydis, N. Giantzouli, I. Basoukas, A. Zellou, V. Giapros
210
UPDATE ARTICLE
Infantile haemangiomas
Alexis Alexopoulos
214 BETWEEN COLLEAGUES
Stelios Antoniadis
216
BOOK REVIEW
Stelios Antoniadis
220 INSTRUCTIONS TO AUTHORS
ΕΠΙΣΤΟΛΗ
(Random forest/ Support Vector Machine Radial-Linear/Generalized Linear Regression/Linear Discriminant Analysis)
F.
e-mail: agalli@auth.gr
Correspondence
Assimina Galli-Tsinopoulou
Stilponos Kyriakidi 1, 54636
Thessaloniki
T. +302310994801
F. +302310994803
e-mail: agalli@auth.gr
insulin gene promoter as a predictive biomarker in a cohort of children and
Eleni P. Kotanidou, Konstantina Mouzaki, Ioanna Chouvarda, Elisavet Koutsiana, Alexandra Kosvyra, Vasiliki Regina-Tsinopoulou, Styliani Giza, Anastasios Serbis, Assimina Galli-Tsinopoulou
Abstract
Eleni P. Kotanidou
Konstantina Mouzaki
Styliani Giza
Anastasios Serbis
Assimina Galli-Tsinopoulou 2nd Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
Ioanna Chouvarda
Elisavet Koutsiana
Alexandra Kosvyra
Vasiliki Regina-Tsinopoulou
Laboratory of Computing, Medical Informatics and Biomedical Imaging Technologies School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
Background: Cytosine-guanine (CpGs) sites in genome can be identified as methylated or unmethylated; the combination of them in the genetic sequence of an individual includes a methylation haplotype (methyl-haplotype) for a specific locus. The insulin gene promoter (IGP) expression is highly regulated by methylation mechanisms. Our aim was to identify IGP methylhaplotypes among children/adolescents with type 1 diabetes (T1D) and to deploy a predictive model for the classification of cases and controls, using methyl-haplotypes as biomarkers. Methods: DNA from peripheral whole blood of 40 participants (20 T1D) was extracted and IGP region was sequenced by Next Generation Sequencing. A python-based pipeline for targeted deep bisulfite sequenced amplicons (ampliMethProfiler) was applied to estimate methylation status. Methylation profile at 10 CpG sites proximal to transcription start site of the IGP was recorded (site 1/-357, site-2/- 345, site 3/-234, site 4/-206, site 5/-180, site 6/-135, site 7/-102, site 8/69, site 9/-19, site 10/+60). Methylation of each site was coded as 0(zero) for unmethylation or 1(one) for methylation. A single read with the 10 CpG sites could result in “1111111111” methyl- haplotype (all methylated), in “000000000” methyl-haplotype (all unmethylated) or any other combination. The generated methyl-haplotypes were tested as predictive biomarkers in five different classifiers (Random forest/Support Vector Machine Radial and Linear/Generalized Linear Regression/Linear Discriminant Analysis). Predictive models were evaluated with the Receiver Operating Characteristics.
Results: 469 different methyl-haplotypes were recorded. After normalization of the features according to the number of readings, three distinct methyl-haplotypes: “1110101110”, “1110111110” and “1111111100” were more closely related to T1D compared to the controls (p-values: 0.00018,0.00032, 0.00095 respectively). The Support Vector Machine Radial presented the best accuracy (0.82±0.09) and a balanced performance between the two categories having sensitivity 0.86±0.12 and specificity 0.77±0.15.
Conclusions: Methylation based biomarkers, such as IGP methyl-haplotypes 1110101110, 1110111110 and 1111111100 could serve as a strategy to identify individuals at high risk for T1D.
Keywords: children, type 1 diabetes, DNA methylation, insulin gene, epigenetics
(cross-sectional)
ADA: American Diabetes Association
CpGs: Cytosine-Guanine sites
GLM: Generalized Linear Regression
IGP: Insulin Gene Promoter
ISPAD: International Society for Pediatric and Adolescence Diabetes
LDA: Linear Discriminant Analysis
NGS: Next Generation Sequencing
MWW: Mann-WhitneyWilcoxon test
RF: Random forest
SVM: Support Vector Machine
TSS: Transcription Start Site
ΣΔ1:
(International Society for Pediatric and Adolescence
(American Diabetes Association, ADA) (9,10).
DNA Blood Mini Kit, QIAGEN Inc, USA)
260/280 (1OD=50μg/ml) (Bio Photometer 6131 Eppendorf AG, Germany)
EZ DNA MethylationGoldTM Kit (Zymo Research, Methylation Gold kit, USA).
CGTCAGATGTGTATAAGAGACAG-3΄, INS_R:5΄-GTCTCGTGGGCTCGGAGATGTG TATAAGAGACAG-3΄
(Adaptor: Nextera Transposase Adaptors, Illumina)
(Next Generations Sequencing, NGS),
(Transposase Adaptors)
(Read_1 Forward_5΄- TCGTCGGCAGCGTCAGATGTGTATAAGAGACAG-3΄, Read_2 Reverse_5΄GTCTCGTGGGCTCGGAGATGTGTATAAGAGACAG-3΄).
(Nextera XT, DNA Library Preparation Kit, Research Illumina).
(pair–end reads)
NGS
Illumina.
(α) Random forest (RF), (β) Support Vector Machine Linear (SVM Linear), (γ) Support Vector Machine Radial (SVM Radial), (δ) Generalized Linear Regression (GLM), (ε) Linear Discriminant Analysis (LDA),
(Receiver Operating Characterisitc-
(16).
(MIS5033021),
Βιβλιογραφία
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e-mail: agalli@auth.gr
Correspondence
Assimina Galli-Tsinopoulou
Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece. T.+302310994801
e-mail: agalli@auth.gr
Eleni Tsotridou, Savvas Kolanis, Assimina Galli-Tsinopoulou
Abstract
The incidence of thyroid cancer in the paediatric population is constantly rising during the last few decades. There are important differences in thyroid cancer between children and adults, as children present more frequently with advanced-stage disease in the time of diagnosis but have considerably lower mortality rates due to differences in molecular findings. Several risk factors, including iodine deficiency, previous radiation exposure, autoimmune thyroiditis and some genetic syndromes have been associated with the development of thyroid cancer. The greater risk of malignancy of thyroid nodules in children necessitates careful evaluation of a combination of clinical, imaging and histopathological findings aiming at early diagnosis and proper risk stratification, which will determine postoperative management and surveillance. Total thyroidectomy with or without adjuvant therapy with radioactive iodine is considered to be the gold standard in paediatric thyroid cancer and leads to high survival rates. The recent discoveries in the molecular mechanisms implicated in the various types of thyroid cancer and especially in the follicular subtype (the vast majority of cases) have provided new therapeutic opportunities through the use of targeted therapies for patients with disease not amenable to surgery and refractory to radioactive iodine. It is of the utmost importance that these patients are managed by a multidisciplinary team (paediatric endocrinologists, oncologists, radiologists, pathologists, endocrine surgeons and psychologists) in centers with experience in paediatric population.
Keywords: thyroid cancer, children, radioactive iodine, precision medicine
Eleni Tsotridou
Savvas Kolanis
Assimina Galli-Tsinopoulou
2nd Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University General Hospital
AHEPA
Skarpa, 2011 (16)
Corrias, 2008 (17)
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59. Hillier K, Hughes A, Shamberger RC, Shusterman S, Perez-Atayde AR, Wassner AJ, et al. A Novel ALK Fusion in Pediatric Medullary Thyroid Carcinoma. Thyroid. 2019;29(11):1704–7.
60. Subbiah V, Yang D, Velcheti V, Drilon A, Meric-Bernstam F. State-of-the-Art Strategies for Targeting RET-Dependent Cancers. J Clin Oncol. 2020;38(11):1209–21.
e-mail:rodosfa@hotmail.com
Correspondence
Sfakiotaki Rodanthi
Εvrota 22, N. Psychiko
ΤΚ 15451 Athens
Τ. +30 6977748270
e-mail:rodosfa@hotmail.com
Sfakiotaki Rodanthi, Pitsoulaki Despoina, Athanasiou Anastasia, Hountala Anna
Abstract
Pediatric lower esophageal disorders, apart from gastroesophageal reflux, are rare in the pediatric population. The most common ones include hiatal hernia, esophagitis, esophageal varices, duplication cyst, and achalasia. These disorders have a spectrum of clinical symptoms, including a number of asymptomatic cases. Clinical examination can provide little information in patients who are asymptomatic. However morphologic and functional information of lower esophagus can be acquired rapidly, relatively inexpensive, with no patient discomfort and no radiation exposure by transabdominal ultrasonography. The educational objective of this pictorial essay is to present the imaging findings and the contribution of transabdominal sonography in the diseases of lower esophagus. Taking into account these findings, pediatricians can adapt the treatment protocol to the different diagnostic results.
Keywords: esophagus; ultrasound; pediatric; hiatus hernia; esophageal duplication cyst; achalasia
Sfakiotaki Rodanthi
Pitsoulaki Despoina
Hountala Anna
Children's Hospital "P. & A. Kyriakou", Athens, Greece, Radiology Department
Athanasiou Anastasia
Children's Hospital "P. & A. Kyriakou", Athens, Greece, 1st Department of Pediatrics
1. Koumanidou C, Vakaki M, Pitsoulakis G, Anagnostara A, Mirilas P. Sonographic measurement of the abdominal esophagus length in infancy: a diagnostic tool for gastroesophageal reflux. AJR Am J Roentgenol. 2004 Sep;183:801-7.
2. Savino A, Cecamore C, Matronola MF, Verrotti A, Mohn A, Chiarelli F, et al. US in the diagnosis of gastroesophageal reflux in children. Pediatr Radiol.2012 May; 42:515-24.
3. Gomes H, Lallemand A, Lallemand P. Ultrasound of the gastroesophageal junction. Pediatr Radiol. 1993; 23:94-9
4. Halkiewicz F, Kasner J, Karczewska K, Rusek-Zychma M. Ultrasound picture of gastroesophageal junction in children with reflux disease. Med Sci Monit. 2000Jan-Feb;6(1):96-9.
5. Karabulut B, Bostanci I, Kacar M, Karaca G, Kosar P. Transcutaneous cervical and transabdominal ultrasonography as a diagnostic tool in gastroesophageal reflux in childhood. ORL J Otorhinolaryngol Relat Spec. 2010;72(6):300-4.
6. Rosen R, Vandenplas Y, Singendonk M, Cabana M, DiLorenzo C, Gottrand F, et al. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2018 Mar;66:516-554.
7. Chavhan GB, Babyn PS, Cohen RA, Langer JC. Multimodality imaging of the pediatric diaphragm: anatomy and pathologic conditions. Radiographics. 2010Nov;30:1797-817.
8. Hallal C, Kieling CO, Nunes DL, Ferreira CT, Peterson G, Barros SG, et al. Diagnosis, misdiagnosis, and associated diseases of achalasia in children and adolescents: a twelve-year single center experience. Pediatr Surg Int. 2012 Dec;28:1211-7.
9. Iacob D, Fufezan O, Farcau D, Hagău N, Ciuce C. Clinical and ultrasound approach to achalasia in a child. Case report. Med Ultrason. 2010 Mar;12:66-70.
10. Lee TH, Cho JY. Sonographic evaluation of esophageal achalasia. Korean JIntern Med. 2014 Mar;29:262.
11. Madhusudhan KS, Seith A, Srinivas M, Gupta AK. Esophageal duplication cyst causing unilateral hyperinflation of the lung in a neonate. Acta Radiol. 2007Jun;48:588-90.
12. Gana JC, Turner D, Mieli-Vergani G, Davenport M, Miloh T, Avitzur Y, et al. A clinical prediction rule and platelet count predict esophageal varices in children. Gastroenterology. 2011 Dec;141:2009-16.
13. De Giacomo C, Tomasi G, Gatti C, Rosa G, Maggiore G. Ultrasonographic prediction of the presence and severity of esophageal varices in children. JPediatr Gastroenterol Nutr. 1989 Nov;9:431-5.
e-mail:
Correspondence
Koutsaftiki Chryssie
Sofokli Venizelou 77, Halandri, 15232 Τ. +30 6970061238 e-mail: kochrysa@yahoo.com
Koutsaftiki Chryssie, Mammas Ioannis, Papatheodoropoulou Alexia, Priftis Konstantinos
Abstract
The term pulmonary blastoma stands for a rare but highly malignant tumor of the lungs in childhood. It involves the intrathoracic mesenchyma, both the pulmonary and the pleura. In 1988 the International Pleuropulmonary Blastoma Registry (IPPBR) was founded to organize centrally the collection and qualification of the biopsies and medical records of the patients diagnosed with Pleuropulmonary blastoma. In this short review, there is also a comment regarding the translation of the term pleuropulmonary blastoma in Greek, which is being translated as if the term pleura refers to the ribs and not to the thin fluid-filled space that covers the lungs due to the linguistic phenomenon of reborrowing. Usually it is being diagnosed before the fourth year of age and it is responsible for the 15% of all primary pediatric tumors. In 75% of the cases it is sporadic and in the rest 25% it is seen in children with congenital lung cyst or in children from families with other malignancies or serious conditions. It affects both genders equally with small predominance of males in certain types. It is categorized as Type I (I-Ir), type II and type III. The prognosis is not good in general, mostly for types II-III, since there is often metastasis, in contrast to type I, where the rates of survival can be as high as 90%.
Keywords: pulmonary blastoma, pleura, children
Koutsaftiki Chryssie
Paediatric department, Rafina’s Health Centre, Rafina
Mammas Ioannis
Department of clinical virology, School of Medicine, University of Crete, Heraklion Crete
Papatheodoropoulou Alexia
PICU, University General Hospital of Patras, PatrasRio
Priftis Konstantinos
Department of Paediatric pulmonology-allergology, University of Athens, Αthens
Paediatric pulmonologyallergology department, Paediatric Centre of Athens
PPB: Pleura-Pulmunary Blastoma
1) Khan AA, El Borai AK, Alnoaiji M. Pleuropulmonary blastoma: a case report and review of the literature. Case Rep Pathol. 2014;2014:509086
2) Μπαμπινιώτης
Ε.Π.Ε., Αθήνα, 2002. Σελ 2032
3) Manivel JC, Priest JR, Watterson J, Steiner M, Woods WG, Wick MR, et al. Pleuropulmonary blastoma. The so-called pulmonary blastoma of childhood. Cancer. 1988;62:1516–1526.
4) Messinger YH, Stewart DR, Priest JR, Williams GM, Harris AK, Schultz KA, et al. Pleuropulmonary b;astoma: a report on 350 central pathology-confirmed pleuropulmonary blastoma cases by the International Pleuropulmonary Blastoma Registry. Cancer.2015;121:276-285. doi: 10.1002/cncr.29032.
5) Priest JR, Watterson J, Strong L, Huff V, Woods WG, Byrd RL, et al. Pleurupulmonary blastoma: a marker for familial disease. J Pediatr. 1996; 128:220-224.
6) Hill DA, Ivanovich J, Priest JR, Gurnett CA, Dehner LP, Desruisseau D, et al. DICER1 mutations in familial pleuropulmonary blastoma. Science.2009;325:965
7) Stocker JT, Hussain AN, Dehner LP. “Pediatric tumors” in Dail and Hammar’s pulmonary pathology Vol.II, Tomashefski JF, Cagle PT, Farver CF, Fraire AE, Eds.,pp.542-557, Springer, New York, NY, USA, 3rd edition, 2008.
8) Hasiotou M, Polyviou P, Strantzia CM, Pourtsidis A, Stinios I. Pleuropulmonary blastoma in the area of a previously diagnosed congenital lung cyst: report of two cases. Acta Radiol 2004; 45: 289-292.
9) Federici S, Domenichelli V, Tani G, Sciutti R, Burnelli R, Zanetti G, Domini R. Pleuropulmonary blastoma in congenital cystic adenomatoid malformation: report of a case. Eur J Pediatr Surg 2001; 11:196-199.
10) Priest JR, McDermott MB, Bhatia S, Watterson J, Manivel JC, Dehner LP. Pleuropulmonary blastoma: a clinicopathologic study of 50 cases. Cancer 1997; 80: 147-61.
11) Κουτσαυτίκη
12) Naffaa LN, Donnelly LF. Imaging findings in pleuropulmonary blastoma. Pediatr Radiol. 2005; 35: 387-391.
K.
email: elpis.vl@gmail.com
Correspondence
Elpis-Athina
Vlachopapadopoulou
T. +302132009851
M. +306932247228
email: elpis.vl@gmail.com
Elpis-Athina Vlachopapadopoulou, Anatoli Fotiadou, Eirini Dikaiakou, Fani Athanasouli, Stefanos Michalacos
Abstract
Introduction: Polycystic ovary syndrome (PCOS) is a common endocrine disorder during puberty characterized by menstrual irregularities and hyperandrogenism. Insulin resistance and metabolic syndrome are linked to PCOS. Diagnostic criteria for PCOS in adolescence are controversial, because common pathological features used as criteria for adult women may be normal variants for adolescents. The management of PCOS in puberty consists of lifestyle modifications and pharmacological interventions if needed.
Case presentation: We report a case of PCOS in a fourteen years old obese adolescent girl with secondary amenorrhea whose lifestyle modification alone leading to weight loss was effective to treat PCOS, restore ovulation and regular menstrual cycles. This case is reported in order to emphasize the importance to implement a step wise approach for the management of PCOS in adolescence. Primarily a modification of dietary habits and increased physical activity is recommended and in case of no improvement, medical treatment follows.
Conclusions: The diagnosis of PCOS should be contemplated in adolescent girls with menstrual disturbances, hyperandrogenemia and obesity. Other causes should be excluded. Therapeutic approach as a first step aims to a decrease of body mass index following adherence to a healthy diet and increased physical activity.
Keywords: PCOS, Hyperandrogenism, Hirsutism, Hyperinsulinemia, Obesity, adolescence
Elpis-Athina
Vlachopapadopoulou
Eirini Dikaiakou
Fani Athanasouli
Stefanos Michalacos
Dept. of EndocrinologyGrowth and Development, Children’s Hospital “P&A Kyriakou”
Anatoli Fotiadou
2nd Department of Paediatrics, University of Athens, “P&A Kyriakou” Children's Hospital, Athens, Greece
ΕΘ), ύψος σώματος: 161,5 εκατοστά (90η ΕΘ), ΔΜΣ: 31,1kg/m² (>95η ΕΘ), περίμετρος μέσης: 102cm (>90η ΕΘ), στάδιο ενήβωσης κατά Tanner V (μασχάλη, μαστοί, εφήβαιο). Η ασθενής παρουσίαζε δασυτριχισμό σε ανδρογονοεξαρτώμενες περιοχές (πρόσωπο, μαστοί, μέση γραμμή και κοιλιακή χώρα- Ferriman Gallwey score 12), μελανίζουσα
ΔΜΣ:
ΕΘ:
υδροξυπρογεστερόνη
ΣΠΩ:
DHEAS:
FG: Ferriman Gallwey
FSH:
Hb1Ac:
HOMA IR: Homeostatic Model Assessment for Insulin Resistance
LH:
ΡCOS: Polycystic Ovary Syndrome
SHBG:
TSH:
SHBG, DHEAS,
Βιβλιογραφία
1. Witchel SF, Oberfield SE, Peña AS. Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment with Emphasis on Adolescent Girls. J Endocr Soc. 2019;3(8):1545‐1573
Published 2019 Jun 14. doi:10.1210/js.2019-00078
2. Witchel SF, Oberfield S, Rosenfield RL, et al. The Diagnosis of Polycystic Ovary Syndrome during Adolescence [published online ahead of print, 2015 Apr 1]. Horm Res Paediatr. 2015;83:376–38910.1159/000375530
3. Ibáñez L, Oberfield SE, Witchel S, Auchus RJ, Chang RJ, Codner E et al. An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence. Horm Res Paediatr. 2017;88(6):371‐395. doi:10.1159/000479371
4. Rothenberg SS, Beverley R, Barnard E, Baradaran- Shoraka M, Sanfilippo JS. Polycystic ovary syndrome in adolescents. Best Pract Res Clin Obstet Gynaecol. 2018;48:103‐114. doi:10.1016/j. bpobgyn.2017.08.008
5. Anderson AD, Burt Solorazano CM, McCartney CR Childhood Obesity and its Impact on Adolescent PCOS Semin Reprod Med 2014 May;32(3):202-13 doi: 10.1055/s-0034-1371092
6. Moran LJ, Pasquali R, Teede HJ, Hoeger KM, Norman RJ. Treatment of obesity in polycystic ovary syndrome: a position statement of the Androgen Excess and Polycystic Ovary Syndrome Society. Fertil Steril. 2009;92(6):1966–1982.
7. Diamanti-Kandarakis E, Dunaif A. Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr Rev. 2012;33(6):981–1030
8. Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev. 1997;18(6):774–800.
9. Rosenfield RL. The Diagnosis of Polycystic Ovary Syndrome in Adolescents. Pediatrics.
2015;136(6):1154‐1165. doi:10.1542/peds.2015-1430
10. Al Khalifah RA, Florez ID, Dennis B, Thabane L, Bassilious E. Metformin or Oral Contraceptives for Adolescents With Polycystic Ovarian Syndrome: A Meta-analysis. Pediatrics. 2016;137(5):e20154089. doi:10.1542/peds.2015-4089
email:
Correspondence
Vasileios Giapros
Stavrou Niarchou Avenue, Ioannina, 45110, Greece
T. +30 2651099326
M. +30 6974754893
email: vgiapros@uoi.gr
D. Rallis, F. Balomenou, A. Drougia, V. Xydis, N. Giantzouli, I. Basoukas, A. Zellou4, V. Giapros
Abstract
Introduction: Infantile hepatic haemangiomas are the most common neonatal benign vascular lesions, the prognosis of which is depended on the size and the location. We describe the case of an infant with multiple cutaneous haemangiomatosis and hepatic haemangiomas.
Case report: A male term infant was diagnosed since birth with multiple pigmented cutaneous lesions. A further evaluation detected multiple hepatic haemangiomas. The thyroid function was normal, while the a-fetoprotein values were gradually decreased. The infant received orally propranolol, without presenting any side effects.
Discussion: Infantile hepatic haemangiomas may present asymptomatic, or they may be related with significant systematic complication. The diagnosis requires further imaging in cases were a strong suspicion arises due to multiple cutaneous lesions. Currently propranolol is considered as the first line treatment, and has replaced the previous options of steroids or interferon-a. Finally, the invasive approach has been limited to only specific cases.
Keywords: neonatal haemangiomas, multiple cutaneous haemangiomatosis, propranolol
D. Rallis
F. Balomenou
A. Drougia
V. Giapros
NICU, University Hospital of Ioannina, Ioannina
V. Xydis
N. Giantzouli
Radiology Department, University Hospital of Ioannina, Ioannina
I. Basoukas
Dermatology Department, University Hospital of Ioannina, Ioannina
A. Zellou
Division of Pediatric
Gastroenterology at Children’s Hospital
“Mitera”, Athens
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email: atosmedicals@yahoo.
Βιβλιογραφία
1. Dickison P, Christou E, Wargon O A prospective study of infantile hemangiomas with a focus on incidence and risk factors. Pediatr Dermatol 2011;28:663–669
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for retinopathy of prematurity: risks, safety concerns, and perspectives. J Pediatr 2014;163:1570–1577
3. Munden A, Butschek R, Tom WL, Marshall JS, Poeltler DM, Krohne SE et al Prospective study of infantile haemangiomas: incidence, clinical characteristics and association with placental anomalies. Brit J Dermatol 2014;170:907–913
4. Darrow DH, Greene AK, Mancini AJ, Nopper AJ. Diagnosis and Management of Infantile Hemangioma. Pediatrics. 2015 Oct;136(4):e1060-104.
5. Hermans DJ, Boezeman JB, Van de Kerkhof PC, Rieu PN, Van der Vleuten CJ (2009) Differences between ulcerated and nonulcerated hemangiomas, a retrospective study of 465 cases. Eur J Dermatol 2009;19:152–156
6. Wedgeworth E, Glover M, Irvine AD, Neri I, Baselga E, Clayton TH et al Propranolol in the treatment of infantile haemangiomas: lessons from the European Propranolol In the Treatment of Complicated Haemangiomas (PITCH) Taskforce survey. Br J Dermatol. 2016 Mar;174(3):594-601
7. Vergine G, Marsciani A, Pedini A, Brocchi S, Marsciani M, Desiderio E, et al Efficacy of propranolol treatment in thyroid dysfunction associated with severe Infantile hepatichaemangioma. Horm Res Paediatr 2014;78:256–60
8. Chen TS, Eichenfield LF, Friedlander SF Infantile hemangiomas: an update on pathogenesis and therapy. Pediatrics 2013;131:99–108
9. Marqueling AL, Oza V, Frieden IJ, Puttgen KB Propranolol and infantile hemangiomas four years later: a systematic review. Pediatr Dermatol 2013;30:182–191
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