Hemangiomas are common during childhood. They may be part of a systemic condition or an isolated lesion.
The clinical features depend on the location and size of the lesions. Subcutaneous lesions are locally tender. Intramus-cular lesions cause pain and fullness, and very large or multiple lesions may cause overgrowth or bony deformity.
Imaging Punctate calcification in the lesion is diagnostic. CT and MRI are most useful for diagnosis and preoperative planning.
Management Many patients are diagnosed clinically and treated symptomatically. Large and very painful lesions may require resection. Resection is often difficult, as the lesions are poorly defined and may be extensive. Recurrence is common.
Pigmented Villonodular Synovitis
These lesions are rare in children. They should be considered in the difdiagnosis of a hemarthrosis of joints. They occur in varied sites, may involve joints and tendon sheaths, can be multifocal, and may present as popliteal cysts. Manage by total synovectomy. Recurrence is common.
Fibromas may occur in infants with a lump on the anteromedial portion of the heel pad. Most remain small and asymptomatic, some disappear, but most persist, and if painful require excision.
In the child, plantar fibroma usually occurs as nodular thickening of the plantar fascia. Observe to determine the potential for enlargement. Resect enlarging lesions. Be aware that mitotic figures are common in the specimen. Recurrence is frequent, and overtreatment is common. Differentiating fibrosarcoma from desmoid tumors is difficult.
A variety of other tumors occur in childhood, including lipomas, lymphangiomas, and benign fibrous tumors.