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Kaposiform haemangioendothelioma of the spine associated with fixed hyperlordotic deformity and Kasabach-Merritt Syndrome: a case report and literature review. Skeletal Radiol 2023; 52:783-790. [PMID: 35948828 DOI: 10.1007/s00256-022-04152-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/04/2022] [Accepted: 08/04/2022] [Indexed: 02/02/2023]
Abstract
Kaposiform haemangioendothelioma (KHE) is a rare childhood disease classified by the International Society for the Study of Vascular Anomalies (ISSVA) as a locally aggressive vascular tumor. It has been reported to affect any site, with a predilection for the extremities and trunk. Although it typically manifests as an enlarging cutaneous or soft tissue lesion, less than 10% of cases have no skin involvement, with the retroperitoneum being the most frequently involved extracutaneous site. Approximately twenty cases of KHE with bony involvement have been reported in the literature to date, with only five of those cases involving the spine specifically.We present a, rare case of KHE who presented with progressive fixed hyperlordotic deformity, multiple non-specific spinal lesions, and abnormal blood tests, posing a clinical and radiological diagnostic challenge. Additionally, we conducted a thorough review of the literature to compare and contrast the various multimodality imaging manifestations of KHE involving the spine.
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2
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Shyam K, Thippeswamy PB, Kamashi J, Kanakeshwar RB, Rajasekaran S. Multivertebral Kaposiform hemangioendothelioma presenting as scoliosis - A case report and review of literature. J Clin Orthop Trauma 2023; 39:102147. [PMID: 37021123 PMCID: PMC10068252 DOI: 10.1016/j.jcot.2023.102147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/15/2023] [Indexed: 04/07/2023] Open
Abstract
Kaposiform hemangioendothelioma (KHE) is a rare, locally invasive vascular tumour of childhood that may occur in soft tissue or bones, and is associated with cutaneous plaques and Kasabach-Merritt phenomenon (KMP). We present an instance of a 9-year-old girl with primary vertebral involvement of KHE, whose clinical presentation was with painless, progressive scoliosis alone, sans cutaneous markers. We highlight the imaging features of this rare manifestation and importance of histopathological diagnosis for optimal management.
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Affiliation(s)
- Karthik Shyam
- Department of Radiology, Ganga Medical Center and Hospital, Mettupalayam Road, Coimbatore, Tamil Nadu, 641043, India
| | - Pushpa Bhari Thippeswamy
- Department of Radiology, Ganga Medical Center and Hospital, Mettupalayam Road, Coimbatore, Tamil Nadu, 641043, India
| | - Jayanthi Kamashi
- Department of Pathology, Ganga Medical Center and Hospital, Mettupalayam Road, Coimbatore, Tamil Nadu, 641043, India
| | - Raja Bhaskara Kanakeshwar
- Department of MSK Oncology, Ganga Medical Center and Hospital, Mettupalayam Road, Coimbatore, Tamil Nadu, 641043, India
| | - Shanmuganathan Rajasekaran
- Department of Orthopedics and Spine Surgery, Ganga Medical Center and Hospital, Mettupalayam Road, Coimbatore, Tamil Nadu, 641043, India
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3
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Ying H, Qiao C, Wang L, Lin X. Progressive kaposiform hemangioendothelioma and sirolimus-related severe thrombocytopenia. Indian J Dermatol Venereol Leprol 2023; 89:54-59. [PMID: 36688881 DOI: 10.25259/ijdvl_799_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 04/01/2020] [Indexed: 12/15/2022]
Abstract
Kaposiform hemangioendothelioma is a locally invasive tumor and we were unable to find any previous reports of multifocal progression. Sirolimus, a mammalian target of rapamycin inhibitor, has been widely used to treat kaposiform hemangioendothelioma. Herein, we report a case of multifocal progressive kaposiform hemangioendothelioma, wherein sirolimus treatment caused severe thrombocytopenia. A 12-year-old East Asian girl presented with indurated dark-purple masses on her back. The patient had received three surgical interventions following the first appearance of the masses in 2012 and subsequent reappearances in 2014 and 2016. Kaposiform hemangioendothelioma was diagnosed based on radiological and pathological findings. Two more masses appeared in the following year. The patient was treated with oral sirolimus (2.5 mg/ m2/day) and developed grade 3 thrombocytopenia 8 days later. The patient was uneventfully relieved 5 days later after the withdrawal of sirolimus and the administration of appropriate medications. This rare case indicated that kaposiform hemangioendothelioma could be progressive with local metastatic characteristics in children. Besides, the severe sirolimus-induced complication highlights the importance of serum drug level monitoring during treatment. Physicians should be extremely cautious while treating kaposiform hemangioendothelioma patients with sirolimus.
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Affiliation(s)
- Hanru Ying
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Congzhen Qiao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lizhen Wang
- Department of Oral Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoxi Lin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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4
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Cohen OG, Florez-Pollack S, Finn LS, Larijani M, Jen M, Treat J, Adams DM, Acord MR. Multifocal Kaposiform Hemangioendothelioma in a Newborn With Confirmatory Histopathology. Pediatrics 2022; 150:189664. [PMID: 36193691 DOI: 10.1542/peds.2022-056293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/05/2022] Open
Abstract
Kaposiform hemangioendothelioma is classified as a locally aggressive vascular tumor of childhood resulting from abnormal angiogenesis and lymphangiogenesis. Most commonly, KHE presents as a single tissue mass, ranging from an erythematous papule to a violaceous indurated tumor. Definitive diagnosis requires tissue sampling with the demonstration of ill-defined nodules and fascicles of spindle-shaped D2-40 positive endothelial cells, forming slit-like vascular channels. This newborn presented with multifocal cutaneous Kaposiform hemangioendothelioma associated with Kasabach-Merritt phenomenon confirmed on histopathology with immunostaining.
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Affiliation(s)
| | | | - Laura S Finn
- Departments of Pathology and Laboratory Medicine
| | | | | | - James Treat
- Section of Dermatology.,Comprehensive Vascular Anomaly Program
| | - Denise M Adams
- Comprehensive Vascular Anomaly Program.,Division of Oncology
| | - Michael R Acord
- University of Pennsylvania Perelman School of Medicine.,Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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5
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Boccara O, Dangien A, Fitoussi F, Ducou Le Pointe H, Coulomb L'Hermine A, Fraitag S, Lorrot M. Bone kaposiform hemangioendothelioma: A rare entity dramatically improved by sirolimus. J Paediatr Child Health 2022; 58:1676-1679. [PMID: 35138010 DOI: 10.1111/jpc.15897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/24/2021] [Accepted: 01/04/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Olivia Boccara
- Department of Dermatology and Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Université Paris, Paris-Centre, Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, APHP, Paris, France
| | - Ambre Dangien
- Department of Dermatology and Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Université Paris, Paris-Centre, Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, APHP, Paris, France
| | - Franck Fitoussi
- Department of Orthopedic Surgery, Hôpital Universitaire Trousseau, Sorbonne Université, APHP, Paris, France
| | | | | | - Sylvie Fraitag
- Department of Pathology, Hôpital Universitaire Necker-Enfants Malades, APHP, Paris, France
| | - Mathie Lorrot
- Department of Pediatrics, Hôpital Universitaire Trousseau, Sorbonne Université, APHP, Paris, France
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Cai Y, Li J, Yang W, Zhang N, Sun H, Zhang W, Ge M. Case Report: Congenital Intracranial Kaposiform Hemangioendothelioma Treated With Surgical Resection. Front Surg 2022; 9:831190. [PMID: 35433800 PMCID: PMC9012330 DOI: 10.3389/fsurg.2022.831190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/22/2022] [Indexed: 11/21/2022] Open
Abstract
Background Kaposiform hemangioendothelioma (KHE) is a locally aggressive but non-metastatic vascular neoplasm. Most studies have been restricted to small case series of limited generalizability. Intracranial KHE is extremely rare with only three cases reported in the literature. Here, we report a case of congenital intracranial KHE who underwent surgical resection, and no lesion recurrence was seen during the follow-up period of 13 months. Case Description A 2-month-old boy initially presented with a left temporal mass following birth. Antenatal ultrasound at 36 weeks of gestation demonstrated a hyperechoic signal present in the left frontal lobe, with clear borders and irregular morphology. There were neither cutaneous abnormalities nor other neurologic examination abnormalities. No laboratory abnormality was identified. Computed tomography (CT) scans suggested that a massive hematoma was noted under the left frontal skull plate, with a little subdural hemorrhage in the adjacent temporal area. The adjacent meninges enhanced and thickened on contrasted T1 magnetic resonance (MR). After the multidisciplinary diagnostic assessment, the surgery was performed by the left frontotemporal craniotomy approach. The operation was extremely difficult. We completely removed the tumor, and the involved dura and brain tissue were resected with the lesion in a piecemeal fashion. On postoperative-day (POD) 3 and POD 14, the head CT re-examination revealed that cerebral perfusion improved gradually. The MRI of 6- and 12-month after operation showed no local recurrence or metastasis. Conclusions Intracranial KHE is difficult to diagnose early and the prognosis has been uniformly poor. We supposed that meticulous intraoperative hemostasis is the key for a successful operation, and the radical resection of the tumor and involved structures are essential to reduce recurrence.
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Affiliation(s)
- Yingjie Cai
- National Center for Children's Health, Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jiayi Li
- Graduate School, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Wei Yang
- National Center for Children's Health, Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Nan Zhang
- National Center for Children's Health, Department of Pathology, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Hailang Sun
- National Center for Children's Health, Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Weiping Zhang
- Graduate School, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
- *Correspondence: Weiping Zhang
| | - Ming Ge
- National Center for Children's Health, Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, Beijing, China
- Ming Ge
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Xu H, Song L, Duan J. 18F-FDG PET/CT Findings in a Woman With Kaposiform Hemangioendothelioma in the Sacrum. Clin Nucl Med 2022; 47:e353-e354. [PMID: 35020652 DOI: 10.1097/rlu.0000000000004000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Kaposiform hemangioendothelioma is a rare vascular tumor with borderline malignancy and is typically diagnosed in infancy or early childhood. It most commonly affects cutaneous tissues, whereas the subtype with only primary bone involvement is extremely rare. Herein, we report a case of Kaposiform hemangioendothelioma involving the sacrum in a 37-year-old woman, with intense 18F-FDG accumulation in the lytic lesion on PET/CT. This case indicates that Kaposiform hemangioendothelioma with the primary bone involvement should be taken into consideration as a rare differential diagnosis for lytic lesions with increased 18F-FDG uptake on PET/CT.
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Affiliation(s)
- Haiqing Xu
- From the Department of Nuclear Medicine, Anqing Municipal Hospital of Anhui Province, Anqing, China
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8
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Kuo C, Warren M, Malvar J, Miller JM, Shah R, Navid F, Luu M, Anselmo DM, Mascarenhas L. Kaposiform hemangioendothelioma of the bone in children and adolescents. Pediatr Blood Cancer 2022; 69:e29392. [PMID: 34606171 DOI: 10.1002/pbc.29392] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/06/2021] [Accepted: 09/16/2021] [Indexed: 12/18/2022]
Abstract
Kaposiform hemangioendothelioma (KHE) is a rare, locally aggressive vascular tumor that mainly occurs during infancy or early childhood. Approximately 70% of cases are complicated by Kasabach-Merritt phenomenon. Although osseous extension of the primary lesion is relatively common, primary bone involvement by KHE is rare. Given the paucity of literature on primary KHE of the bone, we report a case series of primary KHE of the bone treated at our institution and describe the clinical presentation, radiologic and pathologic findings, management and outcomes.
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Affiliation(s)
- Christopher Kuo
- Cancer and Blood Disease Institute, Division of Hematology-Oncology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Mikako Warren
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jemily Malvar
- Cancer and Blood Disease Institute, Division of Hematology-Oncology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Joseph M Miller
- Keck School of Medicine, University of Southern California, Los Angeles, California.,Department of Radiology, Children's Hospital Los Angeles, Los Angeles, California
| | - Rachana Shah
- Cancer and Blood Disease Institute, Division of Hematology-Oncology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Fariba Navid
- Cancer and Blood Disease Institute, Division of Hematology-Oncology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Minnelly Luu
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Dean M Anselmo
- Keck School of Medicine, University of Southern California, Los Angeles, California.,Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Leo Mascarenhas
- Cancer and Blood Disease Institute, Division of Hematology-Oncology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles, California
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Qiu T, Yang K, Dai S, Chen S, Ji Y. Case Report: Kaposiform Hemangioendothelioma With Spinal Involvement. Front Pediatr 2021; 9:600115. [PMID: 33912518 PMCID: PMC8071878 DOI: 10.3389/fped.2021.600115] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 03/17/2021] [Indexed: 02/05/2023] Open
Abstract
Introduction: Kaposiform hemangioendothelioma (KHE) is a rare, locally invasive vascular tumor that mostly appears in infants and adolescents. KHE with spinal involvement is extremely rare. The aim of this study was to review the imaging features, clinical manifestations and treatment of KHE patients with spinal involvement. Materials and Methods: We reviewed patients with KHE who were admitted to Pediatric Surgery of West China Hospital of Sichuan University from April 2014 to August 2020, and the cases were evaluated. Results: Seven patients with spinal involvement were enrolled in the study, including four (57.1%) males and three (42.9%) females. The age at onset ranged from 1.0 day to 4.0 years, with an average of 1.6 years. Five (71.4%) had pain due to bone destruction, three patients (42.9%) had decreased range of motion (ROM), four (57.1%) patients had scoliosis, two (28.6%) patients developed claudication, and three patients (42.9%) presented with a soft tissue mass in the neck of the back. Five patients (71.4%) had the Kasabach-Merritt phenomenon (KMP), with a minimum platelet value of 8 × 109/L. All patients were treated with sirolimus, and showed regression of the lesion and/or normalization of the hematologic parameters. Conclusion: KHE with spinal involvement is difficult to diagnose due to its rarity and variable symptoms, which need to be recognized to start early treatment. The management of KHE with spinal involvement should be performed by a multidisciplinary team. Sirolimus can improve outcomes in patients with KHE with spinal involvement.
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Affiliation(s)
- Tong Qiu
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Kaiying Yang
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Shiyi Dai
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Siyuan Chen
- Pediatric Intensive Care Unit, Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Yi Ji
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
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Eseonu K, Anwar H. Kaposiform Hemangioendothelioma in the Thoracic Spine: A Case Report and Review of the Literature. Int J Spine Surg 2020; 14:426-432. [PMID: 32699767 DOI: 10.14444/7056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Kaposiform hemangioendothelioma (KHE) is a rare, locally aggressive vascular tumor of childhood. It has been most commonly reported in the trunk, retroperitoneum, and extremities, but cases involving the head and neck have been described. While thought to have limited metastatic potential, it is associated with Kasabach-Merritt syndrome (KMS), a consumptive coagulopathy and profound thrombocytopenia that is associated with significant mortality. Twelve cases of KHE with bony involvement have previously been reported. Of these, only 2 involved the spine, and both were managed with medical therapy alone. CASE PRESENTATION We report the first case of spinal KHE causing spinal cord compression managed with surgical excision presented in the literature to date. CONCLUSIONS There are a number of treatment modalities outlined in the literature. The lack of a consensus is due to the varying methods of presentation, difficulty in diagnosis, and disease rarity. Our case highlights the potential speed of local growth of this tumor, meaning that excision may be a technical challenge, especially when there is epidural extension. Treating clinicians should be aware of the risk of progression beyond the initial tumor boundaries to involve new vertebrae.
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Affiliation(s)
- Kelechi Eseonu
- Royal National Orthopaedic Hospital, Stanmore, London, United Kingdom
| | - Hanny Anwar
- Royal National Orthopaedic Hospital, Stanmore, London, United Kingdom
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Kaposiform Hemangioendothelioma in Adolescent-Onset Scoliosis: A Case Report and Review of Literature. Case Rep Orthop 2020; 2020:1839053. [PMID: 32089925 PMCID: PMC7029270 DOI: 10.1155/2020/1839053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/31/2020] [Indexed: 11/20/2022] Open
Abstract
Background and Objectives. Kaposiform hemangioendothelioma (KHE) is a vascular tumor of very low incidence, which occurs mostly in children and infants. The tumor is recognized for its locally aggressive, yet rarely metastatic behavior. It may cause consumptive coagulopathy known as Kasabach-Merritt phenomenon. We report a distinctive case, where an 11-year-old boy is presented with progressive thoracolumbar scoliosis without any symptom or neurological sign. Case Report. The patient underwent spinal deformity correction via posterior pedicle screw instrumentation and fusion, along with tumor biopsy. The pathology report confirmed KHE. The patient did not show a prominent progression of scoliosis after the surgery without any further treatments. Conclusions. Many of scoliotic patients do not have any apparent cause, thereby regarded as idiopathic scoliosis. The presented case is where kaposiform hemangioendothelioma is likely to be linked to the patient's scoliosis. We demonstrate the possibility of secondary scoliosis should always be kept in mind of orthopaedic doctors. We also conclude that secondary scoliosis does not show exacerbation after growth completion.
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13
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Ji Y, Chen S, Li L, Yang K, Xia C, Li L, Yang G, Kong F, Lu G, Liu X. Kaposiform hemangioendothelioma without cutaneous involvement. J Cancer Res Clin Oncol 2018; 144:2475-2484. [PMID: 30293120 DOI: 10.1007/s00432-018-2759-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 09/24/2018] [Indexed: 02/05/2023]
Abstract
PURPOSE We sought to characterize the clinical features and management of patients diagnosed as Kaposiform hemangioendothelioma (KHE) without cutaneous involvement. METHODS The electronic patient chats at six Triple A hospitals in China were searched to find all patient diagnoses with KHE without cutaneous involvement. RESULTS Of 30 patients (mean age at diagnosis, 55.6 months), 17 (56.7%) were male. Fourteen (46.7%) patients were associated with Kasabach-Merritt phenomenon (KMP). Patients with KMP were significantly more likely to have lesions involving truck compared to patients without KMP (odds ratio 10.000; 95% confidence interval 1.641-60.921; P = 0.011). Other common complication included severe anemia and decreased range of motion. In the majority of cases (93.3%), the lesions were highly infiltrative and locally invasive with ill-defined margins. Histological examination was required in all patients without KMP for precise diagnosis. In all, 16 (53.3%) patients received corticosteroid treatment, 19 (63.3%) received oral sirolimus treatment, 7 (23.3%) received intravenous vincristine, and 5 (16.7%) patients used propranolol. Patients had varied responses to conventional drugs, whereas all patients receiving sirolimus treatment had better response. In all, three patients (10%) died of disease, all presented with KMP. Feature of these recalcitrant cases (death) included young age, visceral location, extensive involvement, and lack of improvement with high-dose corticosteroids. CONCLUSIONS Our study clearly demonstrated that KHE without cutaneous involvement could be associated with important complication, which might result in death or severe morbidity. Increased awareness of KHE without cutaneous involvement is required for early diagnosis and aggressive therapy in an attempt to prevent complication.
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Affiliation(s)
- Yi Ji
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, #37# Guo-Xue-Xiang, Chengdu, 610041, China.
| | - Siyuan Chen
- Pediatric Intensive Care Unit, Department of Critical Care Medicine, West China Hospital of Sichuan University, #37# Guo-Xue-Xiang, Chengdu, 610041, China.
| | - Lizhi Li
- Department of Pediatric Surgery, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Kaiying Yang
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, #37# Guo-Xue-Xiang, Chengdu, 610041, China
| | - Chunchao Xia
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Li Li
- Laboratory of Pathology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Gang Yang
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, #37# Guo-Xue-Xiang, Chengdu, 610041, China.,Department of Pediatric Surgery, Chengdu Shangjin Nanfu Hospital, Chengdu, 611730, China
| | - Feiteng Kong
- Department of Pediatric Surgery, Sichuan Women and Children's Hospital, Chengdu, 610045, China
| | - Guoyan Lu
- Pediatric Intensive Care Unit, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Xingtao Liu
- Department of Vascular and Interventional Radiology, Chengdu Women and Children's Central Hospital, Chengdu, 610031, China
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14
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Patel S, Kamath S, Shillingford NM, Zeinati C, Tolo V, Luu M. Restricted Range of Motion and a Cold Upper Extremity in a Two-Year-Old Boy: Kaposiform Hemangioendothelioma of the Bone and the Brachial Plexus: A Case Report. JBJS Case Connect 2017; 7:e79. [PMID: 29286963 DOI: 10.2106/jbjs.cc.17.00027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE We report a case of kaposiform hemangioendothelioma (KHE) of the scapula in a 2-year-old boy with motor and sensory abnormalities of the left upper extremity, suggesting brachial plexus involvement. The locally invasive nature prevented resection; sirolimus therapy resulted in improvement of the motor and sensory impairment, as well as decreased tumor size on imaging. CONCLUSION Osseous infiltration of KHE is known to occur, but its primary presentation in bone without skin involvement is rare and diagnostically challenging. Awareness of rare presentations of KHE, along with accurate histopathologic interpretation, is important to achieve a diagnosis and to differentiate KHE from more common vascular lesions (e.g., infantile hemangioma). Sirolimus therapy is emerging as a promising treatment for unresectable KHE.
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Affiliation(s)
- Sachi Patel
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Sonia Kamath
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Nick M Shillingford
- Departments of Pathology and Laboratory Medicine (N.M.S.) and Radiology (C.Z.), Children's Orthopaedic Center (V.T.), and Division of Dermatology (M.L.), Children's Hospital Los Angeles, Los Angeles, California
| | - Chadi Zeinati
- Departments of Pathology and Laboratory Medicine (N.M.S.) and Radiology (C.Z.), Children's Orthopaedic Center (V.T.), and Division of Dermatology (M.L.), Children's Hospital Los Angeles, Los Angeles, California
| | - Vernon Tolo
- Departments of Pathology and Laboratory Medicine (N.M.S.) and Radiology (C.Z.), Children's Orthopaedic Center (V.T.), and Division of Dermatology (M.L.), Children's Hospital Los Angeles, Los Angeles, California
| | - Minnelly Luu
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
- Departments of Pathology and Laboratory Medicine (N.M.S.) and Radiology (C.Z.), Children's Orthopaedic Center (V.T.), and Division of Dermatology (M.L.), Children's Hospital Los Angeles, Los Angeles, California
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15
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Zhou S, Wang L, Panossian A, Anselmo D, Wu S, Venkatramani R. Refractory Kaposiform Hemangioendothelioma Associated with the Chromosomal Translocation t(13;16)(q14;p13.3). Pediatr Dev Pathol 2017; 19:417-420. [PMID: 26555222 DOI: 10.2350/15-09-1707-cr.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a 7-year-old male with a history of recurrent kaposiform hemangioendothelioma (KHE) in the sacral area and multiple thoracic vertebral lesions. Tumor karyotyping revealed the balanced translocation t(13;16)(q14;p13.3). He had mildly decreased platelet counts but never experienced any episodes of Kasabach-Merritt phenomenon. He was treated with vincristine for 1 year but improvement was minor. Significant clinical improvement was seen with sirolimus therapy. To the best of our knowledge, this is the first report to demonstrate that KHE is associated with a clonal karyotypic abnormality.
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Affiliation(s)
- Shengmei Zhou
- 1 Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA.,2 Keck School of Medicine, University of Southern California Los Angeles, Los Angeles, CA, USA
| | - Larry Wang
- 1 Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA.,2 Keck School of Medicine, University of Southern California Los Angeles, Los Angeles, CA, USA
| | - Andre Panossian
- 2 Keck School of Medicine, University of Southern California Los Angeles, Los Angeles, CA, USA.,3 Division of Plastic and Maxillofacial Surgery, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Dean Anselmo
- 2 Keck School of Medicine, University of Southern California Los Angeles, Los Angeles, CA, USA.,3 Division of Plastic and Maxillofacial Surgery, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Samuel Wu
- 1 Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA.,2 Keck School of Medicine, University of Southern California Los Angeles, Los Angeles, CA, USA
| | - Rajkumar Venkatramani
- 4 Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX, USA
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Alonso Arroyo V, Lopez-Gutierrez JC, Martinez R, Fernandez-Pineda I. Identical Presentation of Scapular Osteolysis in Two Patients with Thoracic Kaposiform Hemangioendothelioma. Pediatr Dermatol 2017; 34:e146-e149. [PMID: 28382716 DOI: 10.1111/pde.13114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Kaposiform hemangioendothelioma (KHE) is a rare, locally aggressive vascular tumor that does not metastasize. We report two unique cases of KHE involving the right hemithorax and the upper ipsilateral extremity. Kasabach-Merrit phenomenon and osteolytic lesions in the scapula were observed in both cases.
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Affiliation(s)
| | | | - Rox Martinez
- Department of Pediatric Hematology and Oncology, Hospital Escuela, Tegucigalpa, Honduras
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17
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Mota JM, Scaranti M, Fonseca LG, Tolói DA, de Camargo VP, Munhoz RR, Feher O, Hoff PM. Response to Paclitaxel in an Adult Patient with Advanced Kaposiform Hemangioendothelioma. Case Rep Oncol 2016; 9:481-487. [PMID: 27721772 PMCID: PMC5043218 DOI: 10.1159/000448111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/01/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Kaposiform hemangioendothelioma (KHE) is a rare neoplasm of vascular origin that typically arises from the skin or soft tissues as a solitary tumor. The optimal therapy for this disease is still unknown. We report the case of an adult patient presenting with metastatic KHE of the spleen, who had a partial response after treatment with paclitaxel. CASE PRESENTATION A 36-year-old man presented in November 2012 with a nontraumatic rupture of the spleen. A splenectomy was performed, and the pathology was consistent with a nonspecific vascular proliferation. Follow-up scans revealed lytic bone lesions and liver metastasis. A biopsy of the liver was performed and confirmed KHE. The decision was made to proceed with treatment with gemcitabine and docetaxel, which was discontinued due to myelotoxicity. The patient was then transferred to our institution, and a pathology review supported the diagnosis of metastatic KHE. His disease remained stable until February 2014, when he developed progression in the liver. Chemotherapy was restarted with paclitaxel, and a partial response was documented after 3 cycles. Unfortunately, disease progression occurred after 24 weeks, and subsequent treatments included prednisone, doxorubicin, interferon-α, gemcitabine, and ifosfamide, without any response. The patient developed Kasabach-Merritt phenomenon and passed away 1 week later due to a major gastrointestinal bleeding. CONCLUSIONS This case report suggests that paclitaxel could be considered as a treatment option for advanced KHE, a rare condition for which no standard treatment exists.
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Affiliation(s)
- José Maurício Mota
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Mariana Scaranti
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Leonardo G Fonseca
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Diego Araújo Tolói
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Veridiana Pires de Camargo
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Rodrigo Ramella Munhoz
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Olavo Feher
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Paulo M Hoff
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
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18
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O'Rafferty C, O'Regan GM, Irvine AD, Smith OP. Recent advances in the pathobiology and management of Kasabach-Merritt phenomenon. Br J Haematol 2015; 171:38-51. [PMID: 26123689 DOI: 10.1111/bjh.13557] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Kasabach-Merritt Phenomenon (KMP) refers to the clinical constellation of thrombocytopenia, consumptive coagulopathy and purpura associated with Kaposiform haemangioedothelioma or tufted angioma, but not the more common infantile haemangioma. It shows a variable and unpredictable response to traditional pharmacological agents, such as steroids, vincristine or interferon alpha 2a or 2b. More recently, the interaction between platelets and endothelial cells and the proangiogenic phenotype that results has been recognized to underly the pathogenesis of this disorder. Recent efforts have attempted to target the platelet by using antiplatelet agents and by the withholding of platelet transfusions even in those patients who have significant thrombocytopenia and laboratory evidence of coagulopathy. Excellent response rates and prompt results have been achieved by combining antiplatelet therapy with vincristine, without the need for steroid use. This synergistic approach moves away from the conventional wisdom of treating the underlying lesion to control the coagulopathy. Sirolimus, which is directed against the PI3/AKT/mTOR downstream signalling pathway involved in lymphangiogenesis, has also shown promising results, although further study is needed.
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Affiliation(s)
- Ciara O'Rafferty
- Department of Haematology, Our Lady's Children's Hospital, Dublin, Ireland
| | - Grainne M O'Regan
- Department of Dermatology, Our Lady's Children's Hospital, Dublin, Ireland
| | - Alan D Irvine
- Department of Dermatology, Our Lady's Children's Hospital, Dublin, Ireland.,Trinity College, Dublin, Dublin, Ireland
| | - Owen P Smith
- Department of Haematology, Our Lady's Children's Hospital, Dublin, Ireland.,Trinity College, Dublin, Dublin, Ireland
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Yang CS, Kim C, Antaya RJ. Review of thalidomide use in the pediatric population. J Am Acad Dermatol 2015; 72:703-11. [DOI: 10.1016/j.jaad.2015.01.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 12/22/2014] [Accepted: 01/05/2015] [Indexed: 02/08/2023]
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Wallenstein MB, Hole MK, McCarthy C, Fijalkowski N, Jeng M, Wong WB. Mediastinal kaposiform hemangioendothelioma and Kasabach-Merritt phenomenon in a patient with no skin changes and a normal chest CT. Pediatr Hematol Oncol 2014; 31:563-7. [PMID: 24047193 DOI: 10.3109/08880018.2013.825356] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A 16-month-old previously healthy boy was admitted to the hospital with respiratory distress and thrombocytopenia. Initial workup demonstrated large pleural and pericardial effusions. The patient had no cutaneous abnormality on physical examination, and his initial chest CT (computed tomography) was nondiagnostic. He required multiple platelet transfusions, chest tube placement, and pericardiocentesis. Sixteen days after admission, a chest MRI (magnetic resonance imaging) revealed a large infiltrative mass of the superior mediastinum, consistent with kaposiform hemangioendothelioma (KHE). The patient's thrombocytopenia was due to associated Kasabach-Merritt phenomenon (KMP). The patient now has complete resolution of KMP after medical treatment with prednisolone, aminocaproic acid, vincristine, and aspirin.
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Affiliation(s)
- Matthew B Wallenstein
- Department of Pediatrics, Stanford University School of Medicine , Stanford, California , USA
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21
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Winter A, Siu A, Jamshidi A, Malawer M, Sherman JH. Spindle cell hemangioendothelioma of the sacrum. J Neurosurg Spine 2014; 21:275-8. [DOI: 10.3171/2014.3.spine13651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Spindle cell hemangioendothelioma is a rare benign vascular tumor that is not known to involve the sacrum. The authors describe the case of a 31-year-old woman presenting with low-back and radicular pain without weakness or bowel or bladder dysfunction. Admission CT and MRI studies revealed a large S1–3 lytic sacral lesion. The patient initially underwent a nondiagnostic percutaneous biopsy. She subsequently underwent an open biopsy, during which the lesion was found to be highly vascular. Histological investigation revealed a vasoformative lesion consistent with spindle cell hemangioendothelioma. Preoperative embolization followed by resection via intralesional currettage resulted in resolution of symptoms up to 9 months postintervention. Despite the authors' recommendation, the patient became pregnant at that time and requested no additional follow-up imaging. The authors present the first reported case of a spindle cell hemangioendothelioma of the sacrum and review the current literature.
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Affiliation(s)
- Andrea Winter
- 1George Washington University School of Medicine and Health Sciences; and
| | - Alan Siu
- Departments of 2Neurological Surgery and
| | - Aria Jamshidi
- 1George Washington University School of Medicine and Health Sciences; and
| | - Martin Malawer
- 3Orthopedic Surgery, The George Washington University Hospital, Washington, DC
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22
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Wang Z, Kong QT, Wu XH, Li B, Shen ZT, Li J, Zhu XX. CyberKnife Treatment for Kaposiform Hemangioendothelioma of the Ilium in an Adult: Case Report and Review of the Literature. Oncol Res Treat 2014; 37:412-6. [DOI: 10.1159/000363427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 04/11/2014] [Indexed: 11/19/2022]
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23
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Ma J, Shi QL, Jiang SJ, Zhou HB, Zhou XJ. Primary kaposiform hemangioendothelioma of a long bone: Two cases in unusual locations with long-term follow up. Pathol Int 2011; 61:382-6. [DOI: 10.1111/j.1440-1827.2011.02681.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Zhu Y, Qiu G, Zhao H, Liang J, Shi X. Kaposiform hemangioendothelioma with adolescent thoracic scoliosis: a case report and review of literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 20 Suppl 2:S309-13. [PMID: 21387193 DOI: 10.1007/s00586-011-1731-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 10/22/2010] [Accepted: 02/19/2011] [Indexed: 11/25/2022]
Abstract
Kaposiform hemangioendothelioma (KHE) is a rare locally aggressive vascular tumor that usually presents as a superficial or deep soft tissue mass with associated cutaneous lesions. We report a unique spinal KHE with painless thoracic scoliosis in a 14-year-old girl. She underwent simultaneous tumor biopsy, spinal deformity correction and fusion. At 3 years follow-up, the patient's MRI showed no significant deterioration of process without any therapy. KHE presenting as scoliosis is rare and to our knowledge this is the first recognized case in the reported world literature.
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Affiliation(s)
- Yong Zhu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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