Vulvovaginal pediatric hemangiomas treatment should be personalized based on the patient’s needs, according to a recent review published in Diseases.
Takeaways
- Hemangiomas, although rare in the genital area, pose significant challenges because of a lack of widely accepted treatment options.
- Treatment options for vulvovaginal pediatric hemangiomas include topical corticosteroids, propranolol, surgical excisions, embolization, laser therapy, radiotherapy, and compression techniques.
- A recent review assessed clinical characteristics and management strategies for vulvovaginal pediatric hemangiomas, drawing insights from a range of studies published between August 2009 and May 2023.
- The review included 10 studies, predominantly case reports, highlighting varying symptom presentations and treatment outcomes, including surgical excision and medical therapy.
- The findings underscore the importance of personalized management tailored to individual patient needs and clinician expertise, with a call for further research into hemangiomas of the female lower genital tract.
Hemangiomas are tumors caused by stem cells that differentiate into cell lines in response to certain stimuli. Of pediatric patients, 12% are impacted by hemangiomas, making them the most common benign pediatric soft tissue tumors.
Hemangiomas rarely affect the genital area, leading to a lack of widely accepted treatment options. The primary options available include topic corticosteroids, propranolol, and surgical excisions. Additional options include embolization, laser therapy, radiotherapy, intermittent pneumatic compression, and continuous compression.
To support the diagnosis, management, and treatment of vulvovaginal pediatric hemangiomas, investigators conducted a review assessing clinical characteristics of these lesions. The PubMed, EMBASE, Web of Science, and Cochrane Database of Narrative Reviews databases were evaluated for literature about this topic.
Case series, literature reviews, and prospective and retrospective trials published between August 2009 and May 2023 were included in the analysis. Eligibility criteria included histological features of vulvar hemangiomas, characteristics of pediatric hemangiomas, and pediatric lower genital tract hemangiomas management.
Study selection was performed by 2 independent reviewers. Case reports deemed less noteworthy on the topic, medical abstract and publications published in a non-English language, and multimedia resources pertaining to the study’s goal were excluded from the analysis.
Risk of bias was assessed by 2 independent reviewers. These reviewers also conducted data extraction. Ten studies were included in the final analysis.
Of the 10 studies, 7 were case reports with study populations aged between 5 months and 13 years. Of cases, 1 was asymptomatic, 2 reported genital area swelling, and 4 had vaginal bleeding. Associations were identified between moderate to severe symptoms and 1 case of vaginal hemangioma, 1 case of uterine hemangioma, and 2 cases of cervical hemangiomas.
The second case of cervical hemangiomas also developed an intrauterine localization. The patient presented with irregular bleeding at an early age and was diagnosed with infantile hemangiomas of the cervix, which was managed surgically. At menarche, the patient reported continued heavy menstrual bleeding and sought definitive therapy when aged 28 years.
Overall, surgical and medical therapy were both utilized during treatment. However, no case of laser therapy was reported. Surgical excision led to complete and immediate recovery in 3 patients, 1 with a highly vascularized focal intrauterine intracavitary lesion and 2 with superficial vulvar hemangiomas.
These results indicated a need to personalize management of vulvovaginal pediatric hemangiomas based on each patient’s needs and the clinician’s experience. Investigators recommended further research about hemangiomas of the female lower genital tract.
Reference
Merlino L, Volpicelli AI, Anglana F, et al. Pediatric hemangiomas in the female genital tract: A literature review. Diseases. 2024;12(3):48. doi:10.3390/diseases12030048
