Vascular Tumour Service
A new clinical service was initiated at SickKids in January 2006 based on the need for focused, expert, inter-disciplinary care for children with vascular tumours with systemic complications. The service involves a inter-disciplinary outpatient clinic and an inpatient consultation service. The leading services are Dermatology, Paediatric Medicine, and Hematology/Oncology with ‘consultant’ input from Interventional Radiology, General Surgery, Thrombosis, Neurology, and Cardiology. The goals of this service are to provide best care for children with Vascular Tumors by:
- Developing a clinical expertise amongst a consistent group of multi-disciplinary specialists
- Developing management guidelines based on consensus and the available literature
- Conducting scholarly work in the area of VTs
Definition:
Vascular tumors (VTs) are benign endothelial cell proliferations that include infantile hemangioma (IH), congenital hemangioma, kaposiform hemangioendothelioma (KHE), tufted angioma (TA) and lymphangioendotheliomatosis.
Infantile hemangioma (IH)
Infantile hemangioma is the most common benign vascular tumour of infancy(1). Although most regress spontaneously, 10% of hemangiomas require treatment because of serious medical complications. These include life threatening mass effect (e.g. airway compromise)(2), high-flow shunts resulting in heart failure (e.g. multifocal hepatic hemangiomas)(3), abdominal compartment syndrome (diffuse hepatic hemangioma)(3) and severe hypothyroidism(4). They may also be disfiguring, and cause problems due to ulceration.
Kaposiform hemangioendothelioma (KHE) and Tufted Angioma (TA)
KHE and TA are rare and distinct clinical, morphologic and pathologic entities from IH(5;6). Unlike IH, KHE and TA are associated with Kasabach-Merritt Phenomenom (KMP)(7-9) which results in severe thrombocytopenia, hypofibrinogenemia, coagulopathy, and anemia. These tumours are not responsive to corticosteroids and require multi-modal therapy(7).
Lymphangioendotheliomatosis
Multifocal lymphangioendotheliomatosis with thrombocytopenia is a recently described entity(10). Clinically, affected patients present as numerous congenital cutaneous and gastrointestinal (GI) vascular papules and plaques leading to severe GI bleeding commencing in early infancy. Thrombocytopenia, most likely due to platelet trapping in the vascular lesions is an additional essential finding in all reported patients.
Location of Clinic:
Clinic 7, Main Floor, Elm Wing
Our Specialists:
Co-Directors:
E. Pope (Dermatology)
S. Mahant (Pediatric Medicine)
Coordinator:
Jackie Su, RN
Team:
M Weinstein (Dermatology)
M Carcao (Hematology)
S. Weitzmen (Oncology)
P.R. John (Interventional Radiologist)
D.L. MacGregor (Neurology)
A.I. Dipchand (Cardiology)
T.J Gerstle (General Surgery)
S. Baruchel (Angiogenesis Lab)
How to Contact Us:
Please follow the referral process to book an appointment for the VAST Clinic. If you are a SickKids patient please contact 416-813-7384 to book an appointment.