Kaposiform hemangioendothelioma with fatal income: Kasabach-Merritt phenomenon and hypercalcemia

Diagnosis and differentiation of Kaposiform hemangioendothelioma based on ultrasound radiomics

Kaposiform hemangioendothelioma (KHE) is a rare neoplasm of the newborn, but has a very high mortality rate. In this study, we explore the application value of ultrasound radiomics in the differential diagnosis of KHE so as to provide reference for early diagnosis of KHE. We selected 194 cases of children with suspected KHE admitted to Henan Provincial People's Hospital from March 2016 to April 2024 for this retrospective analysis. All children completed ultrasound examinations in our hospital. After pathological biopsy, 132 cases were diagnosed with KHE. Taking pathological biopsy as the gold standard, the diagnostic rate of ultrasound examination was determined. Our results showed that ultrasound examination diagnosed 124 cases with KHE. Compared with pathological biopsy, the diagnostic sensitivity, specificity, and accuracy of ultrasound were 81.82, 77.42, and 80.41%, respectively (Kappa = 0.725). Most of the children had a single lesion, often involving the skin. The tumor was hard in texture and red or purple in color and did not fade when pressed. The two-dimensional sonogram showed a solid heterogeneous echo mass in the soft tissue. The lesion was generally large, irregular in shape, and unclear in boundaries, extending to the adipose layer and forming a "tree root-like" change. Microscopically, crossed spindle-shaped cell bundles could be seen, showing diffuse multinodular infiltrative growth. Children with the Kasabach-Merritt phenomenon (KMP) generally had larger lesions. Subsequently, the children with KHE were assigned to a training set and a validation set in a ratio of 7:3. High-throughput data acquisition of the regions of interest (ROIs) on the ultrasound images was carried out to construct a KEH prediction model based on ultrasound radiomics, and validation analysis was conducted. We found the diagnostic accuracy rate of ultrasound radiomics was 91.41%, the sensitivity was 77.44%, and the specificity was 97.21%, which were better than those of the conventional ultrasound. In conclusion, ultrasound radiomics analysis is highly effective in the diagnosis of KHE, which can contribute to the early diagnosis rate of KHE.

A case report of primary Kaposiform hemangioendothelioma of the humerus

To examine the clinicopathological and immunohistochemical features of Kaposiform hemangioendothelioma (KHE) and discuss its differential diagnosis and prognosis. A patient with KHE was examined; the patient's clinical and histopathological features were observed, and the expression levels of CD31, CD34, ERG, D2-40, SMA, GLUT-1, and LANA-1 were assessed. The patient was a four-year-old child with primary KHE of the humerus. She was admitted to the hospital because of pain in the right elbow joint and limited movement for more than 2 years. Imaging revealed Langerhans cell histiocytosis. The child was not diagnosed with Kasabach-Merritt phenomenon (KMP). The tumor consists of multiple hemangiomatous nodules with infiltrative growth separated by fibrous connective tissue. The proliferating hemangiomatoid nodules consisted of crisscrossing short spindle-shaped cell bundles and erythrocyte-containing lacunar or crescentic vessels. Immunohistochemical staining showed that the tumor cells diffusely expressed CD31, CD34, ERG, and other vascular endothelium-derived markers; further, the tumor cells expressed neither GLUT-1 nor LANA-1. The patient's general condition improved after surgical resection. There was no tumor recurrence after more than 8 months of follow-up. Primary KHE of the humerus is a rare vasculogenic tumor. It presents with morphological features that require an accurate differential diagnosis.

Spontaneous haemothorax as a complication of Kassabach-Merritt phenomenon (KMP) in a-2-years old female child: A case report

Kasabach-Merritt phenomenon (KMP) is a rare condition that is associated with two rare vascular tumours: Kapossiform haemangioendothelioma (KHE) and tufted angioma (TA). A 2-year-old girl presented to our emergency room with a haemangioma and respiratory distress. The patient had a violaceous, palpable mass in the right upper chest since she was 5 months old. Severe anaemia, thrombocytopenia, coagulopathy, and hypofibrinogenemia were found. Chest x-ray revealed massive pleural effusion in the right hemithorax. Chest computed tomography (CT) scanning revealed right pleural effusion, multiple destructions of bilateral ribs and multiple osteopenia of thoracic vertebrae. Chest CT angiography revealed a vascular mass in the sternum region. Based on clinical, laboratory and imaging findings, the diagnosis of KMP was established. Clinical, consumptive coagulopathy and thrombocytopenia were resolved by prednisone (3 mg/kg/day) and vincristine (1 mg/body surface area in m2/week) as an adjunct. Unfortunately, she had spontaneous rebleeding and died before the biopsy was done.