Surgical excision of familial cavernous angioma in the pontomedullary region--case report

The authors report on a surgical case of cavernous angioma in the pontomedullary region. A 60-year-old male exhibited a progressive neurological deficit consisting mainly of bulbar paresis and cerebellar signs, without ictal episodes, and computed tomographic scans showed growth of the lesion over 3 years. On preoperative assessment, a glial tumor was suspected to coexist with a cavernous angioma. The vascular malformation was totally excised successfully. This case also revealed an unusual familial occurrence.

Twin vessels in familial retinal cavernous hemangioma

We investigated the presence of twin vessels in two patients and in four of their relatives at risk from one family with autosomal-dominant hereditary cavernous hemangioma of the retina associated with central nervous system involvement. Twin vessels were detected in four of the six patients examined. The proband had bilateral retinal vascular hamartomas with central nervous system involvement but no twin vessels. The proband's mother had vascular hamartomas of the retina and brain with twin vessels. In the other three family members, twin vessels were associated either with retinal cavernous hemangiomas (one patient) or with normal fundi (two patients). Because twin vessels may be an ocular manifestation of von Hippel-Lindau disease, their presence in one of our two patients and in the otherwise healthy three family members suggests that twin vessels may be associated with different retinal vascular hamartomas, including capillary and cavernous hemangiomas.

Trisomy 5 and loss of the Y chromosome as the sole cytogenetic anomalies in a cavernous hemangioma/angiosarcoma

Cytogenetic analysis of a cavernous hemangioma with transition to angiosarcoma revealed the mosaic karyotype 47,XY,+5/46,X,-Y,+5/45,X,-Y/46,XY. No cytogenetically analyzed hemangiomas or angiosarcomas have been reported before.

Familial cavernous angiomas manifesting with an acute chiasmal syndrome

We studied a family in which the proband had an acute chiasmal syndrome secondary to a cavernous angioma of the optic nerve and chiasm. A brain magnetic resonance imaging scan indicated additional asymptomatic intracerebral cavernous angioma, and several of the patient's relatives were found to have various central nervous system vascular malformations. Magnetic resonance imaging may distinguish, noninvasively, symptomatic and asymptomatic carriers of cavernous angiomas and further delineate their inheritance patterns. Asymptomatic cavernous angiomas of the central nervous system are best followed without intervention, whereas symptomatic patients should be treated on an individual basis, depending on the location of lesion and the risk of surgical removal.

Giant cavernous hemangioma of the liver and multiple primary malignant tumors in a patient with suspected familial inhibition of natural killer cell activity--a case report

A woman was operated on for a nonepithelial malignant tumor of the left leg and subsequently, for an epithelial carcinoma of the right breast and a borderline malignant tumor of the right ovary. She also developed a giant cavernous hemangioma that caused disseminated intravascular coagulation syndrome, which necessitated a left trisegmentectomy of the liver. Her family history suggested a hereditary predisposition to diverse malignant neoplasms, and also to giant cavernous hemangioma of the liver. Immunological evaluation disclosed selective inhibition of natural killer cell activity. Hormonal and hereditary factors are discussed in relation to the development of multiple primary tumors and giant cavernous hemangioma of the liver.

[Familial occurrence of intracerebral cavernous angioma]

This article reported a familial occurrence of intracerebral cavernous angioma in four members of one generation diagnosed by X-ray CT, MRI or operative specimen. Case 1, a 34-year-old female, was examined just after an episode of sudden convulsive seizure. On examination, she had a cutaneous angioma without any neurological deficit. X-ray CT revealed a high density mass lesion in the left frontal lobe, and MRI demonstrated a mass lesion in the chronic stage with an old hematoma circumscribed by hypointensity ring indicating peripheral hemosiderosis. Complete excision was carried out and a diagnosis of cavernous angioma was made after histological examination. Case 2, the 37-year-old brother of Case 1, suddenly developed left hemiparesis and hypesthesia with severe headache. X-ray CT revealed a high density mass in the right parietal lobe and two other calcifications. The right parietal lesion was excised and a histopathological diagnosis of cavernous angioma with intracerebral hematoma was made. Case 3, the 49-year-old sister of Case 1, suddenly fell into a coma and was admitted immediately. X-ray CT revealed a large pontine hemorrhage. She died on the 4th day of hospitalization without operative treatment. Necropsy was not carried out. Case 4, the 39-year-old sister of Case 1, was asymptomatic, however, she was examined on the supposition of a familial occurrence of intracerebral cavernous angioma. On examination, it was found she had multiple cavernous angioma without any neurological deficit. X-ray CT revealed parietal intracerebral calcification. MRI demonstrated a mass lesion with peripheral hypointensity ring in the right parietal lobe, and another small lesion in the pons.(ABSTRACT TRUNCATED AT 250 WORDS)

Familial cavernous angiomas of the brain in an Hispanic family

We found cavernous angiomas (CA) in 10 of 22 members of a large Hispanic family. The proband had seizures, and a CA was found at surgery. He and two sisters with seizures had normal angiograms, but CT or MRI showed lesions compatible with CA. Similar abnormalities were found in two cousins with seizures and 5 of 17 asymptomatic relatives studied. MRI proved to be more sensitive than CT for identifying CA. Hispanic families appear to have a predisposition for dominantly inherited CA of the brain.

Familial cavernous malformations of the central nervous system and retina

We studied a family in which 4 persons from three generations had multiple cavernous malformations ("angiomas") of the central nervous system (CNS) and/or retina and found accounts in the literature of sixteen other families with this condition. In these families with familial cavernous malformation of the CNS and retina, 92% of pathologically documented vascular malformations were cavernous; 50% of those subjects affected had multiple CNS and/or retinal vascular malformations and 68% (excluding probands) were symptomatic. Cutaneous vascular lesions were an inconsistant manifestation. Autosomal dominant inheritance with high penetrance was confirmed.

Proteus syndrome: an expanded phenotype

We report on 11 new cases of Proteus syndrome to illustrate the broad range of the phenotype in this hamartomatous dysplasia. The cardinal manifestations of this sporadic disorder are hemihypertrophy, macrodactyly, exostoses, scoliosis, cavernous hemangiomas, lipomas, linear sebaceous nevi, and deeply rugated soles of the feet. Intelligence is usually normal. The differential diagnosis includes Klippel-Trenaunay-Weber and partial lipodystrophy syndromes.

[Familial occurrence of intracerebral cavernous angioma]

A case of familial occurrence of intracerebral cavernous angioma is reported. The patients were a mother and her eldest son, a 48-year-old woman and a 28-year-old man, respectively. The mother, a hypovascular mass in the right frontal lobe was excised surgically, and in the son a well demarcated mass in the left temporal lobe was extirpated. Pathological examination in each case revealed cavernous angioma. Familial occurrence of intracerebral cavernous angioma is extremely rare. In the literature, 8 cases of familial occurrence have been reported, including our case, and in three out of the 8 cases the lesions were histologically confirmed. To our knowledge, this is the first case in Japan in which the diagnosis was established by surgical specimen. Of 17 cases in 8 family lines, multiple occurrence was observed in 7 cases. The clinical manifestations of the disease appear mostly in a form of adult epilepsy or intracerebral hematoma, and rarely sudden death associated with intracerebral hematoma. At present, CT scanning is widely used for diagnosis of the disease, and the lesions are surgically curable if they are located at the accessible sites. Although there has been no evidence of genetic basis, it is interesting that there is familial occurrence. From this point of view, we should carefully check the family tree of such patients.

[Multiple and familial cavernous angiomas in the brain and extremities--case report]

This is a case report of intracranial multiple cavernous angioma occurred in a member of a lineage of familial cavernous angioma. This lineage had manifested multiple small angiomata in the extremities on seven members in her family. The patient, somewhat retarded 19-year-old woman, was admitted to Fukuoka University Hospital because of convulsive seizure and headache occurred several months before admission. She had a large head and her IQ was 71. Bilateral mild hearing disturbance and a vascular anomaly in the left eyeground were noted. There were multiple hypodermic nodules on four extremities. EEG showed spike and wave focus in the right parietal region with irregular background. Plain skull X-ray disclosed scattered small calcifications. CT scan revealed multiple high density areas in the bilateral cerebral hemispheres and splenium and cerebral angiograms presented avascular mass in the right parietal region. The tumor in the right parietal lobe which seemed to be epileptogenic focus and the hypodermic nodules of the upper extremities were removed. Pathological findings of intracranial mass and hypodermic nodule were similar, these were cavernous angioma. The mother and a younger brother of the patient had similar hypodermic nodules on the extremities, and brother's nodule was removed and confirmed cavernous angioma. Eight families of familial cavernous angioma were described in the literature. This presented case is a peculiar one on the view-point of occurrence in the central nervous system among the familial hypodermic manifestation on the extremities and coexistence of retinal vascular anomaly.

Supraumbilical midabdominal raphe and facial cavernous hemangiomas

A 7-week-old Japanese female infant with supraumbilical midabdominal raphe and cavernous hemangiomas of the face is described. The combination of malformations in the infant, together with that in two infants previously reported from Germany, constitutes a clinical entity.

Familial vascular malformations. Report of 25 members of one family

Vascular malformations are described in 25 members of one affected family. Most of these lesions were cavernous hemangiomas, but arteriovenous malformations and capillary hemangiomas were also microscopically observed in some specimens. The five generation pedigree suggests the vascular malformations are genetically determined on the basis of a dominant inherited trait.

Trisomy 18/trisomy 13 mosaicism in an adult with profound mental retardation and multiple malformations

We report on an adult woman with profound mental retardation and multiple anomalies who consists of 3 cell lines: one with trisomy 18, one with trisomy 13, and a normal cell line. Her phenotype includes manifestations of both trisomy syndromes. The origin of these cell lines could have been a doubly aneuploid (48,XX + 13, + 18) or singly aneuploid (47,XX + 18 or 47,XX + 13) zygote with subsequent mitotic nondisjunctions, or a normal zygote with multiple mitotic nondisjunctions. There have been four previous reports of mosaicism involving both trisomy D and trisomy E; all died in the first six months of life. Two of these cases had a doubly aneuploid (48,XX, + D + E) cell line. Our patient illustrates the need for study of several tissues in patients with complex aneuploidy syndromes or atypical manifestations of a given syndrome (such as prolonged survival), as well as the need for caution in counseling families about prognosis for survival in autosomal trisomies which usually are lethal.

Blue rubber bleb nevus syndrome

A case and the family pedigree with the dominant genodermatosis blue rubber bleb nevus syndrome (BRBNS) are described. It is shown that the mode of inheritance is autosomal dominant with good penetrance and that the affected individuals examined all are healthy apart from the skin disease.

[Genetic aspects of blue rubber-bleb nevus syndrome and multiple generalized glomangiomatosis]

Morphology, clinical findings and histological examination allow to recognize the solitary glomus tumor from the multiple glomus tumors and the blue rubber-bleb nevus-syndrome; however, the latter are more difficult to identify separately. They are transmitted as autosomal dominant conditions with good penetrance. With the hypothesis of a dual mutation system and that of the putative induction of paramutations the authors try to account for the variable expression of these conditions. It may be suggested that the existence of a common histological pattern, the multiple systematic, the multiple generalized tumors and the blue rubber-bleb nevus syndrome being perhaps the different expression of the same basic pathologic process.

Familial cavernous angiomas: natural history and genetic study over a 5-year period

In a kindred of 122 individuals we found 5 individuals with cerebral vascular malformation, 3 representing typical cavernous angiomas. The condition was inherited as an autosomal dominant trait with variable expressivity. Forty-three relatives were examined prospectively by cranial computed tomography (CCT) and lesions were found in 15; 7 were followed prospectively with CCT scans for 5 years. Angiography in 5 of these cases failed to demonstrate the lesion. In 3 patients with previously normal CCT scans a change in blood volume or membrane permeability allowed visualization of the lesion on contrast scans. In 2 individuals, both parents of affected children, a normal CCT scan was found. This emphasizes the limitations of CCT in detecting this disorder. Biochemical and red blood cell immunological genetic linkage studies were done in 36 persons. No linkage was found with any of the markers. The natural history of this disorder, characterized by marked clinical and radiographic variation in site of lesion, and the timing and severity of intracranial hemorrhage, make it a useful model for investigating contributing factors and consequences of intracranial hemorrhage in general. For at-risk and affected patients early and sequential CCTs are necessary. Familial cavernous angioma should be included in the differential diagnosis of all young persons presenting with cerebrovascular impairment, seizures, intracranial calcifications or hemorrhage.

Cavernous hemangioma of the optic disc

Cavernous hemangioma of the optic disc and retina is a vascular hamartoma composed of clusters of thin-walled saccular aneurysms partially filled with dark venous blood. It is now considered a neuro-oculo-cutaneous syndrome whose mode of inheritance is probably autosomal dominant. This report describes a cavernous hemangioma of the optic disc in a patient without skin or neurological findings. Its clinical appearance, generally benign ocular nature, and occasional association with central nervous system or cutaneous lesions is emphasized.

[Sarcomatous degeneration of a familial cavernous angiomatosis (Bean's syndrome) (author's transl)]

Although the classification of "Ullman's universal angiomatosis" has not yet been completely defined, the authors estimed it interesting to report an observation which may fall into this denomination. This observation concerns a generalized cavernous angiomatosis differing from hereditary hemorrhagic telangiectasia (Rendu-Osler type) with its conventional skin and mucous membrane manifestations and its visceral forms. The patient presented cutaneous and probably digestive generalized cavernomatosis related to blue rubber bleb naevus. In connection with this observation, the authors attempt to offer reasons in support of the distinctions which appear to exist between glomangiomatosis and glomangioma. This observation is also interesting from two other standpoints: 1. the striking lineal descent: in five generations, seven subjects presented identical angiomatoses; 2. the malignant transformation (angiosarcoma) of one of the cavernous elements.

Cavernous hemangioma of the retina. A four-generation pedigree with neurocutaneous manifestations and an example of bilateral retinal involvement

Cavernous hemangioma of the retina is an unusual vascular hamartoma whose coexistence with vascular anomalies of the skin and central nervous system has been recognized recently. A 39-year-old woman, who had an acute palsy of the right third cranial nerve, had a history of seizures, cutaneous vascular anomalies, and a cavernous hemangioma of the retina of the right eye. One of her daughters demonstrated bilateral retinal cavernous hemangiomas, and another daughter, who developed seizures when febrile, displayed cutaneous vascular anomalies. A four-generation pedigree showed a number of cutaneous vascular anomalies, seizures, and stroke-related deaths. The pedigree suggests further support for considering this disorder an authentic oculoneurocutaneous triad.

Cavernous haemangioma of the retina

Seven cases of retinal cavernous haemangioma are presented. Three cases have been followed for more than 6 years, and three cases between 1 and 2 years. Six cases had no eye symptoms related to the vascular tumour, while in one case vitreous haemorrhage occurred on two occasions. On both these occasions full vision was regained. None of the vascular tumours were treated. Two patients had grand mal seizures. They also had convulsive disease in the family history. In three cases family members of two generations were found to have normal eyes on examination.

Familial cavernous angiomas

Cavernous angiomas are rare, surgically remediable vascular malformations of the CNS that may be characterized by hemorrhage, seizures, or focal neurologic deficits. Three families with cavernous angiomas have been described, and we report two more. In the first, the mother died suddenly with headache. A pontine cavernous angioma was found at autopsy in one son. His brother has similar pontine signs and a radiographically proved pontine mass. The brother's son has seizures and a calcified cerebral lesion. In the second family, the father had a cavernous angioma excised from the caudale. One of the daughters had a hemorrhagic mass removed from the spinal cord. Another daughter has seizures and a temporal lobe vascular lesion proved angiographically. Awareness of the possibility of familial involvement may aid in diagnosis of cavernous angioma.