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Abstract
Vascular skin lesions in children are common, but their management is complicated by the ongoing use of inappropriate and often misleading terms. Inaccurate explanations of the diagnosis and progression of these lesions may cause unnecessary distress. This study describes an audit of vascular lesions in children from one center in which the classification system described by Mulliken and Glowacki was used to establish diagnosis. Seventy patients with vascular lesions attending vascular lesion clinics, miscellaneous plastic surgery clinics and laser lists in the Royal Victoria Infirmary, Newcastle-upon-Tyne, were studied. A proforma was completed using information from the patients and their medical records. The initial diagnosis given to parents was inaccurate in 69% of patients. Furthermore, 53% of parents were given an incorrect account of what to expect with regard to progression of the lesion and the prospect of future treatment. Altogether, in 71% of instances some inappropriate terminology was applied during the course of the child's management. Plastic surgeons were the most accurate diagnosticians. This study highlights the fact that a selection of misleading and erroneous terms is still regularly used in medical practice. The recommended classifications are rarely adhered to and in consequence efficient communications between professionals and families is often lacking.
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Affiliation(s)
- Caroline C MacFie
- Plastic Surgery Department, The Royal Victoria Infirmary, Newcastle-upon-Tyne, United Kingdom.
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52
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Papp DF, Khanna AJ, McCarthy EF, Carrino JA, Farber AJ, Frassica FJ. Magnetic resonance imaging of soft-tissue tumors: determinate and indeterminate lesions. J Bone Joint Surg Am 2007; 89 Suppl 3:103-15. [PMID: 17908876 DOI: 10.2106/jbjs.g.00711] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Derek F Papp
- Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224-2780, USA
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53
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Vlahovic A, Simic R, Kravljanac D. Circular excision and purse-string suture technique in the management of facial hemangiomas. Int J Pediatr Otorhinolaryngol 2007; 71:1311-5. [PMID: 17548115 DOI: 10.1016/j.ijporl.2007.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2006] [Revised: 04/01/2007] [Accepted: 04/02/2007] [Indexed: 10/23/2022]
Abstract
Hemangiomas are the most common soft tissue tumors in infancy. Treatment options for hemangiomas are numerous. The scar after lenticular excision and linear closure is often unacceptable. Localized cutaneous infantile hemangioma acts like a tissue expander. Therefore, circular excision and purse-string suture technique are applicable for hemangioma at any stage. For 2-year period we have operated 14 patients with hemangioma using circular excision and purse-string suture technique. In eight patients hemangioma was localized in the head and neck region. Two infants with large hemangioma of the face are presented in this article. One patient had hemangioma with ulceration resistant to conservative treatment. Second patient had giant hemangioma, which caused partial disturbation of visual axis. We applied circular excision and purse-string suture technique in both patients. The results were good, without any postoperative complications.
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Affiliation(s)
- Aleksandar Vlahovic
- Division of Pediatric Surgery, Institute for Mother and Child Health Care of Serbia, Radoja Dakica 6-8, 11070 New Belgrade, Serbia.
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54
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Hemangiomas of the head and neck with phleboliths: Clinical features, diagnostic imaging, and treatment of 3 cases. ACTA ACUST UNITED AC 2007; 103:e60-4. [DOI: 10.1016/j.tripleo.2006.09.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2006] [Revised: 09/05/2006] [Accepted: 09/11/2006] [Indexed: 11/18/2022]
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55
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Corrêa PH, Nunes LCC, Johann ACBR, Aguiar MCFD, Gomez RS, Mesquita RA. Prevalence of oral hemangioma, vascular malformation and varix in a Brazilian population. Braz Oral Res 2007; 21:40-5. [PMID: 17384854 DOI: 10.1590/s1806-83242007000100007] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2005] [Accepted: 07/03/2006] [Indexed: 01/01/2023] Open
Abstract
Hemangioma, vascular malformation and varix are benign vascular lesions, common in the head and neck regions. Studies about the prevalence of these lesions in the oral cavity are scarce. The aim of this study was to estimate the prevalence of and to obtain clinical data on oral hemangioma, vascular malformation and varix in a Brazilian population. Clinical data on those lesions were retrieved from the clinical forms from the files of the Oral Diagnosis Service, School of Dentistry, Federal University of Minas Gerais, Brazil, from 1992 to 2002. Descriptive analysis was performed. A total of 2,419 clinical forms in the 10-year period were evaluated, of which 154 (6.4%) cases were categorized as oral hemangioma, oral vascular malformation or oral varix. Oral varix was the most frequent lesion (65.6%). Females had more oral hemangioma and oral varix than males. Oral vascular malformation and oral varix were more prevalent in the 7th and 6th decades, respectively. Oral hemangioma and oral varix were more prevalent in the ventral surface of the tongue and oral vascular malformation, in the lips. Oral hemangioma was treated with sclerotherapy (54.5%), and vascular malformation was managed with sclerotherapy and surgery (19.4% each). The data of this study suggests that benign vascular lesions are unusual alterations on the oral mucosa and jaws.
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Affiliation(s)
- Priscila Henriques Corrêa
- Department of Oral Surgery, Oral Medicine and Oral Pathology, School of Dentistry, Federal University of Minas Gerais, Av. Antônio Carlos 6627, Pampulha Belo Horizonte, MG, Brazil, CEP 31270-901
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56
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Abstract
Hemangiomas are the most common benign tumor of childhood. Clinical management is limited primarily to observation. Non-surgical treatment modalities have had mixed results and with morbid side effects. Improved understanding of angiogenesis over the last two decades is helping to delineate differences between various vascular tumors. This molecular understanding will be central in helping to properly diagnose and potentially treat these childhood tumors. While a number of downstream effector cytokines have been shown to have altered expression in hemangiomas, a cause for the primary dysregulation within hemangiomas has not yet been clarified. Upstream modulators of angiogenesis are now being defined. Homeobox (Hox) genes are master transcription factors, which have a centrol role during organogenesis, and more recently have been documented to be involved in postnatal tissue remodeling and tumor angiogenesis. We document increased expression of Hox D3 in proliferating hemangiomas and propose a potential role for Hox A3, B3, A5 and D10.
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Affiliation(s)
- Scott L Hansen
- Division of Plastic and Reconstructive Surgery, University of California, San Francisco, CA 94131-1302, USA.
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57
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Abramowicz S, Marshall CJ, Dolwick MF, Cohen D. Vascular malformation of the temporomandibular joint: report of a case and review of the literature. ACTA ACUST UNITED AC 2006; 103:203-6. [PMID: 17234536 DOI: 10.1016/j.tripleo.2006.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Revised: 04/02/2006] [Accepted: 05/03/2006] [Indexed: 10/24/2022]
Abstract
The diagnosis and treatment of vascular anomalies is extremely challenging because of inconsistent terminology and classification systems, as well as nonspecific clinical and radiological findings. We report a vascular malformation that was treated successfully via resection, and reconstructed using a custom-made temporomandibular joint fossa and condylar prosthesis by TMJ Concepts. The available pertinent literature is also reviewed.
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Affiliation(s)
- Shelly Abramowicz
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL 32610, USA.
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58
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Bénateau H, Labbé D, Dompmartin A, Boon L. Place de la chirurgie dans les hémangiomes au stade des séquelles. ANN CHIR PLAST ESTH 2006; 51:330-8. [PMID: 17011107 DOI: 10.1016/j.anplas.2006.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The cure without after-effect of an hemangioma is classic but sometimes the spontaneous involution, a premature surgical treatment or an evolutionary complication can be at the origin of a definitive after-effect. In these cases, the treatment of the hemangioma, often multidisciplinary, will be begun in a late way during the late childhood or the adolescence. Surgical excision of an excess tissue or of a wide scar, lipoaspiration of a fat remainder, lasertherapy and fat tissue reinjection are simple and mostly sufficient procedures. In the most complex cases, notably at the facial site, a surgery heavier as a rhinoplasty, a resection of lip, a local flap or orthognatic surgery can be necessary.
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Affiliation(s)
- H Bénateau
- Service de chirurgie maxillofaciale et plastique, CHU de Caen, 14000 Caen, France.
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59
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Pienaar C, Graham R, Geldenhuys S, Hudson DA. Intralesional bleomycin for the treatment of hemangiomas. Plast Reconstr Surg 2006; 117:221-6. [PMID: 16404271 DOI: 10.1097/01.prs.0000194906.61805.b0] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hemangiomas, although often small at birth, enter a proliferative phase in which growth may be rapid and unpredictable. Furthermore, involution often takes many years, with attendant psychological sequelae to the child. This is aggravated by the fact that most hemangiomas affect the head and neck and are visible and difficult to conceal. METHODS Thirty children (five boys and 25 girls) were treated at a pediatric teaching hospital during an 18-month period with a protocol of intralesional bleomycin, 0.3 to 0.6 mg/kg (per dose), administered under general anesthesia. The lesions were measured and photographed serially. Complications were also recorded. RESULTS The mean age of the children was 20 months (range, 3 months to 8 years) and the mean number of injections given was five (range, three to eight). The mean total dose administered was 13.6 mg (range, 1.4 to 25 mg). Outcome was assessed by a panel of five plastic surgeons. Twenty-two children were assessed as achieving a response of greater than 75 percent reduction in the size of the hemangioma (of which 10 children were assessed as having total involution >90 percent response). In seven children, there was a 50 to 75 percent reduction in size of the hemangiomas, and one child was judged to have a 25 to 50 percent reduction in size of the hemangioma. Hyperpigmentation was the most common complication, and occurred in 13 children. The mean follow-up period was 14 months (range, 3 to 35 months). CONCLUSIONS Intralesional bleomycin is another method with which to treat hemangiomas in children and may be particularly helpful for large hemangiomas of the head and neck. Repeated general anesthetics are required, and scarring with hyperpigmentation may occur.
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Affiliation(s)
- Conrad Pienaar
- Department of Plastic Surgery, Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa
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60
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Adegboyega PA, Qiu S. Hemangioma versus vascular malformation: presence of nerve bundle is a diagnostic clue for vascular malformation. Arch Pathol Lab Med 2005; 129:772-5. [PMID: 15913426 DOI: 10.5858/2005-129-772-hvvmpo] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Arteriovenous vascular malformations and hemangiomas are benign vascular lesions that are difficult to distinguish from one another clinically. Also, they may be confused with each other at histopathology. Therefore, histochemical stains for the presence of an artery are frequently used to distinguish between the two. OBJECTIVE Because it is clinically relevant to differentiate between arteriovenous vascular malformations and hemangiomas, this study was carried out to explore additional diagnostic clues that may help in the diagnosis and differentiation of these lesions. DESIGN A total of 167 cases of benign extracranial vascular lesions were retrieved from the anatomic pathology file of our institution. These comprised 66 cases diagnosed as arteriovenous vascular malformations and 101 cases previously diagnosed as hemangiomas. The hematoxylin-eosin-stained glass slides were reviewed, Movat pentichrome histochemical stain was used to identify elastic vessels (arteries/arterioles), and S100 immunostain was used to identify nerves within these vascular lesions. For immunohistochemistry, the avidin-biotin detection method was used. RESULTS With Movat stain, the presence of thick-walled elastic arteries was detected in 12 of the 101 cases previously diagnosed as hemangiomas, and these cases were therefore reclassified as vascular malformations. Using the same criterion, 2 of the 66 cases originally diagnosed as arteriovenous vascular malformations were reclassified as hemangiomas because they lacked arterial structures. Thus, with this strict criterion, we ended up with 91 cases of hemangiomas and 76 cases of arteriovenous vascular malformations. Intralesional nerves were identified in 91% (69/76) of cases of arteriovenous vascular malformations, including all the 12 arteriovenous vascular malformations previously diagnosed as hemangiomas. In contrast, no intralesional nerve was detected in any of the 91 hemangiomas. CONCLUSIONS These results show that nerve bundles are consistently present in vascular malformations and absent in hemangiomas and so can be used as a diagnostic clue to differentiate between these lesions. Also, in addition to describing a previously unreported component of vascular malformations, these data further confirm the hamartomatous nature of these lesions.
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Affiliation(s)
- Patrick A Adegboyega
- Department of Pathology, University of Texas Medical Branch, Galveston 77555-0588, USA.
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61
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Turkoz R, Gulcan O, Oguzkurt L, Atalay H, Bolat B, Sezgin A. Surgical Treatment of a Huge Cavernous Hemangioma Surrounding the Right Coronary Artery. Ann Thorac Surg 2005; 79:1765-7. [PMID: 15854977 DOI: 10.1016/j.athoracsur.2003.10.100] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2003] [Indexed: 10/25/2022]
Abstract
Hemangioma of the heart is an extremely rare benign cardiac tumor. A 61-year-old woman presented with a huge hemangioma on the right ventricle. The tumor was completely surrounding the right coronary artery. Under cardiopulmonary bypass, the right coronary artery was transected from the aortic sinus and the supplying arteries of the tumor were divided. The tumor was successfully resected, and the right coronary artery was reanastomosed to the aortic sinus.
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Affiliation(s)
- Riza Turkoz
- Department of Cardiovascular Surgery, Baskent University, Adana, Turkey.
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62
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Leon-Villapalos J, Wolfe K, Kangesu L. GLUT-1: an extra diagnostic tool to differentiate between haemangiomas and vascular malformations. ACTA ACUST UNITED AC 2005; 58:348-52. [PMID: 15780229 DOI: 10.1016/j.bjps.2004.05.029] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2003] [Accepted: 05/27/2004] [Indexed: 10/26/2022]
Abstract
The differential diagnosis between juvenile haemangiomas, vascular malformations, pyogenic granulomas and normally proliferative endothelium (granulation tissue) on the basis of histology alone is sometimes difficult. This is important because haemangiomas, are self-limiting and vascular malformations are not. We report our experience of using the immunohistochemical marker GLUT-1 to distinguish haemangiomas from vascular malformations following the initial report by North and Colleagues (1998). We studied a total of 50 specimens from patients with vascular anomalies, and found that GLUT-1 reactivity was positive in 18 out of 19 juvenile haemangiomas, negative in two out of two noninvoluting congenital haemangiomas (NICH) and negative in 29 out of 29 vascular malformations, that included capillary malformations, lymphatic malformations, venous malformations and arteriovenous malformations (95% sensitivity, 100% specificity). Pyogenic granulomas (n = 4) and granulation tissue samples (n = 4) were used as negative controls. Placenta tissue was used as positive control. GLUT-1 accurately distinguishes haemangiomas from vascular malformations, and as a result from this work, we use this technique in routine histopathological differentiation of vascular anomalies.
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Affiliation(s)
- J Leon-Villapalos
- Department of Plastic and Reconstructive Surgery, St Andrews Centre for Plastic Surgery and Burns, Court Road, Broomfield, Chelmsford CM1 7ET, UK
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63
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Essary LR, Hoang MP, Carder KR. Practical Review and Recent Developments in Pediatric Dermatopathology. ACTA ACUST UNITED AC 2005; 21:193-215. [PMID: 16350443 DOI: 10.1016/j.yadr.2005.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Lydia R Essary
- Clinical Assistant Professor of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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64
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Abstract
Hemangiomas represent one of the most common childhood neoplasms. They are often managed conservatively, requiring numerous years for spontaneous involution. No effective medical treatment has been reported for children with large, deforming hemangiomas of the parotid gland and overlying cheek. The authors retrospectively studied 17 children who underwent surgical resection of parotid hemangiomas at Childrens Hospital Los Angeles from 1997 to 2003. All 17 patients had improvements in facial asymmetry and deformity. There were no major complications. Minor complications included hematoma (11.8 percent), transient facial nerve palsy (11.8 percent), and blood transfusion (5.9 percent). All operations were performed on an outpatient basis. Surgical resection of parotid hemangiomas provides an aesthetic benefit to young children with low associated morbidity. Early resection by an experienced surgeon should be considered as a treatment option for these disfiguring lesions.
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Affiliation(s)
- John F Reinisch
- Division of Plastic Surgery, Childrens Hospital Los Angeles, California 90027, USA.
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65
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Abstract
A case of congenital absence of the nasal columella accompanying a facial hemangioma is presented. The nose is an important aesthetic unit of the face, and its projection is mainly supported by the columella. The etiology of the absent columella is unclear, and the clinical feature is rare. Reconstruction of the columella remains a challenging problem in plastic surgery, and numerous techniques have been described. The authors discuss several techniques aimed at the correction of the problem and describe a method of reconstruction of the absent nasal columella that was used in the case reported.
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Affiliation(s)
- Ufuk Bilkay
- Department of Plastic and Reconstructive Surgery, Ege University, Bornova-Izmir, Turkey.
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66
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Laor T. MR imaging of soft tissue tumors and tumor-like lesions. Pediatr Radiol 2004; 34:24-37. [PMID: 14673551 DOI: 10.1007/s00247-003-1086-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2003] [Revised: 07/17/2003] [Accepted: 09/16/2003] [Indexed: 10/26/2022]
Abstract
The evaluation of a soft tissue mass in a child should proceed with a differential diagnosis in mind, based on the clinical history, age of the child, and location of the abnormality. Small, superficial masses can be initially evaluated with sonography. More extensive or deep lesions usually require cross-sectional imaging. With the exception of myositis ossificans, magnetic resonance (MR) imaging has largely replaced the use of computed tomography. MR imaging is used to delineate the extent of a lesion, to evaluate response to therapy, and to monitor postoperative complications. There is great overlap in the MR imaging characteristics of benign and malignant lesions, making tissue sampling imperative for diagnosis.
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Affiliation(s)
- Tal Laor
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
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67
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Abstract
As novas classificações disponíveis e os modernos recursos diagnósticos por imagem não só permitiram a diferenciação entre os tumores e as malformações vasculares, mas também modificaram de forma substancial a abordagem e o tratamento dessas anomalias. O hemangioma da infância, o mais comum dos tumores vasculares dessa faixa etária e objeto deste trabalho, é revisto do ponto de vista de suas características clínicas e laboratoriais, diagnóstico diferencial e opções terapêuticas. Embora a conduta expectante permaneça como o tratamento de escolha para a maioria dos casos, o julgamento crítico é crucial para o emprego de outras modalidades terapêuticas.
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68
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Kleinman ME, Tepper OM, Capla JM, Bhatt KA, Ceradini DJ, Galiano RD, Blei F, Levine JP, Gurtner GC. Increased Circulating AC133+CD34+Endothelial Progenitor Cells in Children with Hemangioma. Lymphat Res Biol 2003; 1:301-7. [PMID: 15624558 DOI: 10.1089/153968503322758102] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
UNLABELLED Hemangioma is the most common soft-tissue tumor of infancy. Despite the frequency of these vascular tumors, the origin of hemangioma-endothelial cells is unknown. Circulating endothelial progenitor cells (EPCs) have recently been identified as vascular stem cells with the capacity to contribute to postnatal vascular development. We have attempted to determine whether circulating EPCs are increased in hemangioma patients and thereby provide insight into the role of EPCs in hemangioma growth. METHODS AND RESULTS Peripheral blood mononuclear cells (PBMCs) were isolated from hemangioma patients undergoing surgical resection (N = 5) and from age-matched controls (N = 5) undergoing strabismus correction surgery. PBMCs were stained with fluorescent-labeled antibodies for AC133, CD34, and VEGFR2/KDR. Fluorescent-labeled isotype antibodies served as negative controls. Histologic sections of surgical specimens were stained with the specific hemangioma markers Glut1, CD32, and merosin, to confirm the diagnosis of common hemangioma of infancy. EPCs harvested from healthy adult volunteers were stained with Glut1, CD32, and merosin, to assess whether cultured EPCs express known hemangioma markers. Hemangioma patients had a 15-fold increase in the number of circulating CD34 AC133 dual-staining cells relative to controls (0.78+/-0.14% vs.0.052+/-0.017%, respectively). Similarly, the number of PBMCs that stained positively for both CD34 and KDR was also increased in hemangioma patients (0.49+/-0.074% vs. 0.19+/-0.041% in controls). Cultured EPCs stained positively for the known hemangioma markers Glut1, CD32, merosin. CONCLUSIONS This is the first study to suggest a role for EPCs in the pathogenesis of hemangioma. Our results imply that increased levels of circulating EPCs may contribute to the formation of this vascular tumor.
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Affiliation(s)
- Mark E Kleinman
- Laboratory of Microvascular Research and Vascular Tissue Engineering, Institute of Reconstructive Plastic Surgery, New York University, New York, New York, USA
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