[Fegelers syndrome, acquired port-wine stain or acquired capillary malformation: three cases and a literature review]

Acquired port-wine stains: A report of two cases and review of the literature

BACKGROUND

Acquired port-wine stains (APWS) are rare vascular malformations that share the same clinical and histological features as their congenital counterparts. Rare cases of AWPS secondary to trauma or in association with medications have been reported in the literature.

PATIENTS AND METHODS

We report two cases of APWS. One case appeared at the age of 2 months, the earliest reported in the literature and continued to evolve till the age of 3 years presenting with multifocal distribution mainly affecting the lower face. The second case developed during oral isotretinoin intake and persisted after discontinuation of the treatment.

RESULTS AND CONCLUSIONS

The second patient declined treatment, but the first patient had a remarkable improvement following treatment with the pulsed dye laser, which remains the standard of care for capillary malformations on the face.

Acquired port-wine stains in six pediatric patients

BACKGROUND/OBJECTIVES

Port-wine stains, also known as capillary malformations, are due to dermal vascular ectasia and dilation and are most commonly congenital; however, acquired port-wine stains (APWS) developing later in life have been noted in the literature, most commonly in the context of trauma.

METHODS/RESULTS

This case series presents 6 pediatric patients with APWS who first developed lesions between ages 3 and 11 years in the absence of a traumatic or other etiologic trigger.

CONCLUSIONS

The epidemiology, clinical features, and treatment response of these patients are compared to what has been previously described in other cases in the literature.

Angioma serpiginosum: a case report and review of the literature

Background

Angioma serpiginosum is a rare vascular anomaly whose pathogenesis is still unknown. It is characterized by the onset of vascular reddish macules and papules during childhood, lesions are usually monolateral with a linear serpiginous pattern. It is rarely associated with extracutaneous findings. This entity has not yet been included in the classification of the International Society for the Study of Vascular Anomalies.

Case presentation

We describe the first Italian report of angioma serpiginosum with a congenital symmetrical presentation. The patient had a further extension of macules during puberty involving both of the soles. No extracutaneous manifestations were present. Diagnosis was confirmed with dermoscopy and light microscopy that revealed the typical clusters of dilated, thickened and PAS+ capillaries in the upper dermis. Moreover, Immunohistochemistry showed positive WT-1 staining. Genetic analysis with next generation sequencing did not detected any mutation.

Conclusions

Our patient presented a peculiar symmetrical and planar extension with a serpiginous linear pattern. The proliferative nature of this condition has been widely discussed in literature. In our case immunohistochemistry was positive for Wilms tumor-1, a new endothelial marker expressed during angiogenesis in reparative processes and endothelial tumors.

Clinical evolution, histological and immunohistochemical findings suggest that angioma serpiginosum should be considered as a vascular proliferation. For these reasons we think it should be included in the international classification as a tumor.

High-Frequency Ultrasound Investigation of Port-Wine Stains: Hemodynamic Features Revealed By 10- and 22-MHz Transducers

OBJECTIVES

The hemodynamics of the ultrasound (US) features of port-wine stains (PWSs) have not been reported. The purpose of this study was to evaluate the high-frequency US findings of PWSs.

METHODS

We retrospectively reviewed 98 PWS cases and categorized them into 4 groups based on clinical manifestations and pathologic findings (14 nodular, 28 thickened, 52 flattened, and 4 acquired). We evaluated the US findings with 10- and 22-MHz transducers.

RESULTS

For nodular PWSs, the mean thickened skin ± SD was 0.6 ± 0.5 mm, and the nodule thickness was 5.7 ± 3.3 mm; 63.6% of skin lesions showed vessel density of 2.16 ± 0.93/cm² with venous flow of 4.6 ± 1.1 cm/s, and all nodules showed vessel density of 6.14 ± 1.92/cm² with arterial and venous flow of 26.6 ± 17.9 and 9.9 ± 5.1 cm/s, respectively. The thickened skin of the thickened type was 1.4 ± 2.7 mm; 76.5% of skin lesions showed vessel density of 3.81 ± 1.98/cm² with venous flow 4.6 ± 2.1 cm/s. The thickened skin of 36 flattened lesions was 0.1 ± 0.1 mm; 91.7% of skin lesions showed vessel density of 1.08 ± 0.28/cm² . The thickened skin of 4 acquired lesions was 0.7 ± 0.4 mm; 50% showed vessel density of 1.08 ± 0.28/cm² . The thickened skin and vessel density of nodular and thickened PWSs were thicker and higher than those of the flattened ones. The 22-MHz transducer produced clearer contrast and higher vessel density than the 10-MHz transducer.

CONCLUSIONS

These results showed differences in US findings of PWSs, which may be useful for clinical diagnosis.