Klippel-Trenaunay syndrome

An unusual and extreme case of Klippel-Trenaunay syndrome is presented. The patient has an extensive capillary hemangioma involving the right side of the body, increases in the length and girth of the right lower limb, gross varicosities of the superficial venous system, and complete absence of the deep venous system of the right lower extremity, with suprapubic shunt of the venous blood to the contralateral external iliac vein. Secondary manifestations are increased sweating and compensatory scoliosis.

Magnetic resonance imaging of meningio-angiomatosis

We report the case of a patient with meningio-angiomatosis, a rare disorder of the cerebral cortex often associated with Von Recklinghausen's neurofibromatosis. Previous reports have described a variety of radiological findings but in general they have been of little value in the diagnosis of this disorder. We describe the magnetic resonance image, which identified a well-defined lesion. The imaging techniques are reviewed.

Hippel-Lindau disease: MR imaging

Hippel-Lindau disease is an auto-somal-dominant disorder characterized by tumors arising from the central nervous system and abdominal viscera. Because of its progressive nature, frequent multisystem radiologic evaluation of affected persons and family members at risk is desirable for early detection and treatment. During a 2-year study, magnetic resonance (MR) imaging of the head, spine, and abdomen was used for screening and follow-up in 26 members of nine families with the disease. In addition to 13 previously diagnosed cases, five cases were newly diagnosed during the study. Lesions causing significant morbidity and mortality--such as cerebellar and spinal cord hemangioblastoma, renal cell carcinoma, and pheochromocytoma--were correctly depicted with MR imaging, sometimes before symptoms had developed and before the lesions could be seen with other imaging modalities. Central nervous system abnormalities were most clearly shown, but MR imaging also adequately demonstrated abdominal visceral abnormalities. It is therefore highly useful in the diagnosis and follow-up of Hippel-Lindau disease.

The Sturge-Weber syndrome

The Sturge-Weber syndrome is characterized by angiomas of the leptomeninges overlying the cerebral cortex in association with a facial nevus flammeus. Although frequently included with other neurocutaneous genodermatoses, the syndrome is almost always sporadic in occurrence. The most common associated neurologic abnormality is seizures, which are controlled in more than 50% of patients by the administration of anticonvulsants. Laser therapy is the most promising therapeutic option for cosmetic management of the facial nevus flammeus.

[A case of von Hippel-Lindau disease with multiple abdominal disorders and renal cell carcinoma]

A 52-year-old male underwent right nephrectomy after a clinical diagnosis of renal cell carcinoma. He suddenly lost consciousness 3 days after the nephrectomy and expired 3 weeks later. An autopsy revealed a hemangio-blastoma in the forehead skin. Multiple cysts, cyst-adenomas and an islet cell tumor were also identified in the pancreas. Considering the presence of blindness and the familiar, prevalence of this disease, his case was diagnosed as a rare manifestation of von Hippel Lindau disease associated with renal cell carcinoma, complicated with abdominal disorders.

The syndrome of Klippel-Trenaunay, a polyvalent angiodysplasia

The syndrome of Klippel and Trenaunay remains basically a venous angiodysplasia. Newer investigative methods have however allowed us to distinguish a polyvalence of the vascular morphology. The basic clinical triad: vascular nevus, varicosities and limb hypertrophy remains the main clinical diagnostic characteristic.

Systemic cystic angiomatosis in a woman with hematuria and splenomegaly

Cutaneous hemangiomas are frequently found on routine clinical examination and generally are not important. But when internal organs are involved, these vascular tumours assume greater importance because of associated morbidity. A case is presented of multiple organ involvement by angiomas in a woman with a history of flank hemangioma who was investigated for hematuria and splenomegaly. She subsequently underwent splenectomy. The uncommon systemic syndromes characterized by vascular tumours are discussed, and the case reported is appropriately classified. The clinical picture, pathologic features and investigations appropriate for systemic cystic angiomatosis are briefly reviewed. The authors recommend conservative management when there is splenic involvement unless the size of the spleen makes its rupture likely or when there are hematologic complications.

Diagnosis and therapeutic surgery of the uvea--Part II: Results

Fifty-five patients underwent eye wall biopsy (11) or eye wall resection (44). Eye wall resection was performed for suspected melanoma in 42 cases and large von Hippel angiomas in an additional two patients. Two of the 35 individuals with choroidal melanoma died, representing a 5.7% mortality rate over a mean follow-up period of more than five years. Visual acuity, ocular morbidity, and tumor-associated deaths in this series are compared with results using other treatment modalities for choroidal melanoma.

Von Hippel-Lindau disease in an adolescent

Von Hippel-Lindau disease is a hereditary neoplastic syndrome that generally manifests in early adulthood but does present occasionally in adolescence. In the past, diagnosis and management of this disorder fell within the domain of internists and surgeons. Because pediatricians are now seeing older patients, they must learn to recognize the various components of this disorder. Additionally, they must be able to assure appropriate medical evaluation and follow-up and also arrange for genetic counseling. Pediatricians already attuned to the benefits of preventive medicine should find themselves uniquely qualified to provide the level of care that this disease requires.

[A case of von Hippel-Lindau disease showing only spinal cord symptoms]

A rare case of von Hippel-Lindau disease showing only spinal cord symptoms is reported. This 18-year-old boy was admitted to our clinic because of urinary disturbance, slowly progressive muscle weakness and sensory disturbance of his body and four extremities. Myelography demonstrated an expanding spinal cord and a figure of complete block of contrast medium at the lower cervical level. Dilated syrinx below the level of Th-3 was shown by delayed scan (19 hr.) of metrizamide CT myelography. These findings suggest that metrizamide could pass through the cord substance from the subarachnoid space into a syrinx cavity. Contrast enhancement CT scan revealed a slightly high density mass lesion at the level of Th-1 and a more marked tumor stain at the level of C-5 and 6. Syringo-subarachnoid shunt was done but the spinal intramedullary tumors were so deeply situated in the spinal cord that total removal of them was abandoned. The pathological diagnosis was hemangioblastoma. There were also a hemangioma at the right retina and multiple small tumor stains in the cerebellum, but they presented no clinical symptoms.

[Prenatal diagnosis and obstetric management of a case of Klippel-Trenaunay-Weber syndrome]

A description is given of a case of Klippel-Trenaunay-Weber syndrome diagnosed by sonography in the 28th week of pregnancy. The ultrasound findings established in the course of pregnancy are presented. Whereas minor variants of this syndrome normally do not represent a birth hindrance, a cesarean section was indicated in the present case on the basis of the size of the deformation--especially at the hip--an in order to save the child.

Cerebellar haemangioblastoma and von Hippel-Lindau disease

Von Hippel-Lindau disease is an autosomal dominant multisystem disorder, the commonest presenting manifestations of which are haemangioblastomas of the cerebellum and retina. Affected individuals are at risk of developing a number of other lesions, the most serious of which are renal carcinoma, haemangioblastomas elsewhere in the central nervous system and phaeochromocytoma. Patients with this disease can therefore present to a number of disciplines during their lifetime and unless the possibility of von Hippel-Lindau disease is considered, the patient may wrongly be assumed to have an isolated lesion. Twenty patients with cerebellar haemangioblastomas were seen between 1972 and 1985; the diagnosis of von Hippel-Lindau disease was subsequently established in 8. Although the diagnosis had not previously been considered, in retrospect 7/8 cases were known to be at risk of this syndrome. These cases came from 7 families and an additional 4 relatives are also known to have been affected. Mean age of presentation for the various manifestations of von Hippel-Lindau disease, each of which occurred in one or other of our cases, has been calculated from 9 of our patients and 107 others reported in the literature. Clinically significant manifestations almost invariably developed before the age of 50 years. Limited screening of our index cases and their at-risk relatives demonstrated one asymptomatic renal carcinoma. We propose a protocol for screening all individuals at risk of von Hippel-Lindau disease, which involves annual retinal examination from five years, and biennial computerized tomography of the head and abdomen from fifteen and twenty years, respectively.

Atypical angiomatosis in polyarteritis nodosa

Biopsies from an area of livedo reticularis and adjacent to a leg ulcer in a woman with polyarteritis nodosa showed florid angioendothelial proliferation simulating angiosarcoma. This angioproliferative reaction has not been described previously in polyarteritis nodosa. Its microscopic differentiation from angiosarcoma is important.