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Wang Y, He Z, Hao H. A case report of primary Kaposiform hemangioendothelioma of the humerus. Int J Immunopathol Pharmacol 2024:3946320241266914. [PMID: 39031761 DOI: 10.1177/03946320241266914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2024] Open
Abstract
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.
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Affiliation(s)
- Ye Wang
- Department of Pathology, Beihai People's Hospital, Beihai, China
| | - Zhenqi He
- Department of Pathology, Beihai People's Hospital, Beihai, China
| | - Hua Hao
- Department of Pathology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
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2
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Bello A, Alikhan MB, Subramaniam A, Yusuf ZI, Brockstein B, Ravi V. Adult-onset multifocal kaposiform hemangioendothelioma in the bone marrow, lung, liver, and brain: a case report. Front Oncol 2024; 14:1322684. [PMID: 38454925 PMCID: PMC10917883 DOI: 10.3389/fonc.2024.1322684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/01/2024] [Indexed: 03/09/2024] Open
Abstract
Kaposiform hemangioendothelioma (KHE), a rare form of vascular neoplasm, is typically seen in children. In this paper, we report a unique case of KHE replacing bone marrow tissue mimicking myeloproliferative neoplasm with additional involvement in the lung, liver, and brain in a 60-year-old Caucasian woman. The patient was initially seen in the hematology department for the chief complaint of epigastric pain and anemia. Abdominal magnetic resonance imaging (MRI) revealed mild splenomegaly with iron deposition secondary to extramedullary hematopoiesis. Additional workup was inconclusive. Subsequent bone marrow and lung biopsies eventually revealed bone marrow with extensive grade 3 fibrosis and multiple foci of low-grade vasoformative neoplasm in the lung suggestive of KHE. Although rare, KHE can present as an aggressive disease with indolent behavior in adults and can be distinguished from other vascular malignancies based on histopathology and imaging findings.
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Affiliation(s)
- Alexa Bello
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Mir B. Alikhan
- Department of Pathology, Northshore University Health System, Evanston, IL, United States
| | - Aparna Subramaniam
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Zenab I. Yusuf
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Bruce Brockstein
- Division of Hematology / Oncology, Northshore University Health System, Evanston, IL, United States
| | - Vinod Ravi
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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3
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Liu W, Zhao D, Zhou S, Chen H. Case Report: Recurrent blepharal kaposiform hemangioendothelioma in an adult patient. Front Surg 2024; 10:1306566. [PMID: 38249308 PMCID: PMC10797699 DOI: 10.3389/fsurg.2023.1306566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/20/2023] [Indexed: 01/23/2024] Open
Abstract
Background Kaposiform hemangioendothelioma (KHE) is a rare and invasive vascular tumor that mainly occurs in children and is rarely seen in adults. We report a case of KHE found on the eyelid of an adult patient. Case report We present an adult patient in whom KHE recurred 6 months after tumor resection. He underwent second surgical resection and intraoperative chemotherapy. There was no evidence of recurrence at the 3-year follow-up. Conclusion KHE in adults is easy to be misdiagnosed. KHE can be treated by surgical resection. Complete resection of the tumor and intraoperative chemotherapy may help prevent a recurrence.
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Affiliation(s)
| | | | - Shirui Zhou
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong Chen
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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4
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Fan D, Cui Y, Chen J, He X. Kaposiform hemangioendothelioma of the heart: a case report and literature review. Cardiol Young 2023; 33:2411-2414. [PMID: 37332166 DOI: 10.1017/s1047951123001269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Kaposiform hemangioendothelioma is a rare tumour of vascular origin that rarely occurs in the heart. We provided a rare case of a 26-day-old infant with tachypnoea. Echocardiography showed a solid tumour in the pericardial cavity and a large amount of pericardial effusion. The solid tumour was confirmed by surgery, and the pathology was kaposiform hemangioendothelioma. We analysed this case and reviewed the related literature to explore the clinical features and echocardiographic manifestations to improve the understanding, diagnosis, and treatment of this disease for clinicians and sonographers.
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Affiliation(s)
- Di Fan
- Department of Ultrasound Diagnosis, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Yun Cui
- Department of Ultrasound Diagnosis, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Jing Chen
- Department of Ultrasound Diagnosis, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Xinjian He
- Department of Ultrasound Diagnosis, Children's Hospital of Hebei Province, Shijiazhuang, China
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5
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Hu Y, Song D, Wu C, Wang L, Li J, Guo L. Clinical and imaging features of Kaposiform hemangioendothelioma in infants. Heliyon 2023; 9:e15425. [PMID: 37159688 PMCID: PMC10163614 DOI: 10.1016/j.heliyon.2023.e15425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 05/11/2023] Open
Abstract
Objective Kaposiform hemangioendothelioma (KHE) is a locally aggressive tumor of vascular origin. This study investigated the clinical and imaging features of KHE to provide a reference for its early diagnosis. Methods The clinical and imaging findings of 27 clinically confirmed KHE cases (including 21 with focal lesions and 6 with diffuse lesions) between January 2016 and December 2021 were retrospectively analyzed. Results The mean age of the 27 patients was 105 ± 80.27 days. Twenty-two (81.5%) of these patients had Kasabach-Merritt phenomenon. Most KHEs were located in the trunk and/or extremities (22/27). Ultrasonography showed heterogeneous echogenicity and/or striated hypoechoic bands with abundant or patchy blood flow within the tumor. On plain computed tomography (CT), they appeared as heterogeneous lesions isodense with the muscles, with a CT value of 29.58 ± 11.53 HU. In the arterial phase, the KHEs showed striated or lamellar heterogeneous enhancement, with a CT value of 153.91 ± 52.11 HU after enhancement. All KHEs showed uneven and high signal intensity on T2-weighted imaging, mixed high and low signal intensity on fat-saturated images, and no significant diffusion restriction on diffusion-weighted imaging. Conclusion KHEs can occur in various locations and present as highly infiltrative and heterogeneous masses that can invade the skin, adjacent muscles, and bones. A vascularized mass with purpuric skin changes, with uneven and high T2WI signal is highly suggestive of the diagnosis of KHE.
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Affiliation(s)
- Yuanjun Hu
- Department of Pediatric Surgery, Children's Hospital Affiliated to Shandong, University, Jinan, 250022, Shandong, China
- Department of Pediatric Surgery, Jinan Children's Hospital, Jinan, 250022, Shandong, China
| | - Dan Song
- Department of Vascular Anomalies and Interventional Radiology, Children's, Hospital Affiliated to Shandong University, Jinan, 250022, Shandong, China
- Department of Vascular Anomalies and Interventional Radiology, Jinan Children's, Hospital, Jinan, 250022, Shandong, China
- Department of Shandong Provincial Clinical Research Center for Children's Health and Disease, Jinan, 250022, Shandong, China
| | - Changhua Wu
- Department of Vascular Anomalies and Interventional Radiology, Children's, Hospital Affiliated to Shandong University, Jinan, 250022, Shandong, China
- Department of Vascular Anomalies and Interventional Radiology, Jinan Children's, Hospital, Jinan, 250022, Shandong, China
- Department of Shandong Provincial Clinical Research Center for Children's Health and Disease, Jinan, 250022, Shandong, China
| | - Liang Wang
- Department of Vascular Anomalies and Interventional Radiology, Children's, Hospital Affiliated to Shandong University, Jinan, 250022, Shandong, China
- Department of Vascular Anomalies and Interventional Radiology, Jinan Children's, Hospital, Jinan, 250022, Shandong, China
- Department of Shandong Provincial Clinical Research Center for Children's Health and Disease, Jinan, 250022, Shandong, China
| | - Jing Li
- Department of Vascular Anomalies and Interventional Radiology, Children's, Hospital Affiliated to Shandong University, Jinan, 250022, Shandong, China
- Department of Vascular Anomalies and Interventional Radiology, Jinan Children's, Hospital, Jinan, 250022, Shandong, China
- Department of Shandong Provincial Clinical Research Center for Children's Health and Disease, Jinan, 250022, Shandong, China
| | - Lei Guo
- Department of Vascular Anomalies and Interventional Radiology, Children's, Hospital Affiliated to Shandong University, Jinan, 250022, Shandong, China
- Department of Vascular Anomalies and Interventional Radiology, Jinan Children's, Hospital, Jinan, 250022, Shandong, China
- Department of Shandong Provincial Clinical Research Center for Children's Health and Disease, Jinan, 250022, Shandong, China
- Corresponding author. Department of Vascular Anomalies and Interventional Radiology, Children's, Hospital Affiliated to Shandong University, Jinan, 250022, Shandong, China.
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6
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Watanabe E, Hashizume N, Yoneda A, Kasahara M, Ozeki G, Saito T, Fujiogi M, Kano M, Yamamoto Y, Miyazaki O, Maekawa T, Nakano N, Yoshioka T, Fujino A, Kanamori Y. Infantile Kaposiform hemangioendothelioma in a female patient complicated with severe obstructed jaundice: a case report. Surg Case Rep 2022; 8:225. [PMID: 36580178 PMCID: PMC9800675 DOI: 10.1186/s40792-022-01581-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/20/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Kaposiform hemangioendothelioma (KHE) is a rare locally aggressive vascular neoplasm that occurs mainly in the pediatric population. KHE usually originates just underneath the skin and affects deeper tissues through infiltrative growth; however, visceral tissue involvement is quite rare. CASE PRESENTATION An 8-month-old girl with jaundice and acholic stool was referred to our hospital for further evaluation of a hepatoduodenal ligament tumor. A blood examination revealed high bilirubin and liver enzyme levels, but no signs of coagulopathy. The first attempt at a diagnostic surgical procedure did not provide sufficient diagnostic information. However, the histopathological diagnosis of the cystic duct excised in the second surgery indicated KHE. Therefore, in our case, KHE was considered a cause of obstructive jaundice. Sirolimus (rapamycin) was initiated, and the patient was discharged 7 months after admission. CONCLUSIONS In cases of atypical hypervascular lesions in the abdominal cavity, especially in the pediatric population, it is important to consider the possibility of KHE, and surgical intervention with proper strategies is required for diagnosis, followed sequentially by promising treatments.
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Affiliation(s)
- Eiichiro Watanabe
- grid.63906.3a0000 0004 0377 2305Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan
| | - Naoki Hashizume
- grid.63906.3a0000 0004 0377 2305Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan
| | - Akihiro Yoneda
- grid.63906.3a0000 0004 0377 2305Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan ,grid.63906.3a0000 0004 0377 2305Division of Pediatric Surgical Oncology, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan
| | - Mureo Kasahara
- grid.63906.3a0000 0004 0377 2305Organ Transplantation Center, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan
| | - Genta Ozeki
- grid.63906.3a0000 0004 0377 2305Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan
| | - Takeshi Saito
- grid.63906.3a0000 0004 0377 2305Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan
| | - Michimasa Fujiogi
- grid.63906.3a0000 0004 0377 2305Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan
| | - Motohiro Kano
- grid.63906.3a0000 0004 0377 2305Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan
| | - Yuki Yamamoto
- grid.63906.3a0000 0004 0377 2305Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan
| | - Osamu Miyazaki
- grid.63906.3a0000 0004 0377 2305Department of Radiology, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan
| | - Takanobu Maekawa
- grid.63906.3a0000 0004 0377 2305Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan
| | - Noriyuki Nakano
- grid.63906.3a0000 0004 0377 2305Department of Pathology, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan
| | - Takako Yoshioka
- grid.63906.3a0000 0004 0377 2305Department of Pathology, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan
| | - Akihiro Fujino
- grid.63906.3a0000 0004 0377 2305Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan
| | - Yutaka Kanamori
- grid.63906.3a0000 0004 0377 2305Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan
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7
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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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8
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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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9
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Kaposiform hemangioendothelioma of the temporal bone in a child. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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10
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Neonatal Intestinal Obstruction Due to Kaposiform Hemangioendothelioma of the Jejunum. ACG Case Rep J 2022; 9:e00749. [PMID: 35187187 PMCID: PMC8849271 DOI: 10.14309/crj.0000000000000749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022] Open
Abstract
Kaposiform hemangioendothelioma is a borderline vascular tumor usually seen in infants and children as cutaneous lesions classically associated with the Kasabach-Merritt phenomenon. Intestinal involvement is uncommon and can cause acute presentations, such as obstruction or gastrointestinal bleeding. A 5-day-old neonate presented with bilious vomiting for 2 days. The tumor was in the jejunum. Histopathological examination with immunohistochemistry of the resected jejunum showed CD34 positive endothelial lined vascular spaces infiltrating from submucosa to serosa, which is classical of kaposiform hemangioendothelioma. There was no deranged coagulation profile. This case forms an interesting cause for neonatal intestinal obstruction.
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11
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Salavastru CM, Butacu AI, Fritz K, Eren S, Tiplica GS. [Benign skin neoplasms in children]. Hautarzt 2022; 73:127-137. [PMID: 35029698 DOI: 10.1007/s00105-021-04935-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
Abstract
There are many different types of skin neoplasms in children and most are benign. Dermatologists should be able to differentiate between the various types of benign skin neoplasms and be able to recommend optimal treatment to concerned patients. Surgical removal of benign skin neoplasms is often the only treatment option. The aim of this paper is to provide a general overview of epidermal lesions (e.g., inflammatory linear verrucous epidermal nevus [ILVEN], nevus sebaceous), tumors of the epidermal appendages (e.g. pilomatrixoma), cutaneous neoplasms (e.g. angiofibroma), fibromatoses (e.g., knuckle pads), tumors comprised of fat, muscle, or bone tissue (e.g., osteoma cutis, subungual exostosis), epidermal cysts and pseudocysts, and pathologic fibrosis reactions after dermal injury (keloid). Scientific data are scarce and only in the last decade has it been possible to perform histopathological examinations and genetic studies together with detailed phenotyping to gain new understanding of the pathogenetic mechanisms.
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Affiliation(s)
- Carmen Maria Salavastru
- Pädiatrische Dermatologie, Dermatoonkologisches Forschungungslabor, Colentina Klinik, Carol-Davila-Universität für Medizin und Pharmazie, Bukarest, Rumänien
| | - Alexandra-Irina Butacu
- Dermatologie II, Colentina Klinik, Carol-Davila-Universität für Medizin und Pharmazie, Stefan cel Mare Street 19-21, 020125, Bukarest, Rumänien.
| | - Klaus Fritz
- Dermatologie II, Colentina Klinik, Carol-Davila-Universität für Medizin und Pharmazie, Stefan cel Mare Street 19-21, 020125, Bukarest, Rumänien.,Hautärzte und Laserzentrum Landau, Landau, Deutschland
| | - Seher Eren
- Hautärzte und Laserzentrum Landau, Landau, Deutschland
| | - George-Sorin Tiplica
- Dermatologie II, Colentina Klinik, Carol-Davila-Universität für Medizin und Pharmazie, Stefan cel Mare Street 19-21, 020125, Bukarest, Rumänien
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12
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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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13
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ElMrini S, Elhamid S, Razem B, Khoaja A, Regragui M, Slimani F. Kaposiform hemangioendothelioma: A facial exophytic presentation. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.102021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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14
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Rikhotso RE, Alharbi AA. Management of Refractory Mandibular Kaposiform Hemangioendothelioma with Sirolimus: A Case Report and Review of the Literature. J Oral Maxillofac Surg 2021; 79:2086.e1-2086.e8. [PMID: 34153244 DOI: 10.1016/j.joms.2021.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
Kaposiform hemangioendothelioma (KHE) is a rare vascular neoplasm of intermediate malignancy that generally occurs in infancy and early childhood. Typically, the lesion arises from superficial or deep soft tissues of the extremities, trunk and retroperitoneum. The paucity of reported cases of head and neck KHEs is evidence of the rarity of the disease in this region. We report on the presentation and treatment of KHE in an 11-month-old boy who presented with a mandibular lesion. We include a brief discussion about the differential diagnosis of KHE. Management involved preoperative interventional radiology, surgical excision and chemotherapeutic treatment with Sirolimus. The lesion resolved without evidence of relapse 12 months later.
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Affiliation(s)
- Risimati Ephraim Rikhotso
- Department Head, Department of Maxillofacial and Oral Surgery, Wits School of Oral Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Abdulaziz Abdullah Alharbi
- Consultant, Department of Maxillofacial and Oral Surgery, Faculty of Dentistry, Taif University, Alhawiah, Saudi Arabia
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15
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Chundriger Q, Tariq MU, Abdul-Ghafar J, Ahmed A, Din NU. Kaposiform Hemangioendothelioma: clinicopathological characteristics of 8 cases of a rare vascular tumor and review of literature. Diagn Pathol 2021; 16:23. [PMID: 33722245 PMCID: PMC7962213 DOI: 10.1186/s13000-021-01080-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Kaposiform Hemangioendothelioma (KHE) is a rare vascular tumor of intermediate malignant potential which shows locally aggressive growth but only rarely metastasizes. It is mostly considered to be a tumor of pediatric population but its occurrence in the adults is not uncommon as once considered. Histologically, KHE can mimic other soft tissue neoplasms of different behaviors (e.g. Kaposi Sarcoma, hemangioma) and establishing the correct diagnosis is important for appropriate treatment. Herein, we describe the clinicopathological features of 8 cases of KHE which will be helpful in making their diagnosis. METHODS We reviewed pathology reports, microscopy glass slides and obtained follow up information about 8 cases of KHE which were diagnosed at our institution from January 2008 till June 2020. Immunohistochemical stain for HHV8 was also performed. RESULTS Age ranged from 7 months to 25 years. Seven patients were less than 20 years of age and one patient was 25 years old. Equal gender distribution was observed. Extremities were the most common sites of involvement, followed by head and neck, pancreas and ischiorectal region. 2 cases were resection specimen and all others were incisional biopsies. The largest tumor size was 5.5 cm in one of the resections. The incisional/fragmented tissues were all less than 5 cm in aggregate. Most cases showed predominance of nodular growth and a minor component of spindle cell population along with lymphangiomatosis like vascular channels, with evidence of microthrombi in 2 cases. Few multinucleated giant cells were observed in 2 cases. None of the cases exhibited significant nuclear atypia or mitotic activity. One of the cases arising in dermis showed underlying bone involvement. HHV8 was negative in 7/7 cases. CONCLUSIONS KHE can also involve adult population and it should always be considered in the differential diagnoses of a vascular lesion. Presence of multinucleated giant cells is a rare finding. Knowledge about histological features and potential mimics is helpful in avoiding misdiagnosis.
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Affiliation(s)
- Qurratulain Chundriger
- Section of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Usman Tariq
- Section of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Jamshid Abdul-Ghafar
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan.
| | - Arsalan Ahmed
- Section of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Nasir Ud Din
- Section of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Verma S, Dhamija E, Barwad A, Kumar VS, Rastogi S. A case report of Kaposiform haemangioendothelioma; response with propranolol and steroids. Clin Sarcoma Res 2020; 10:12. [PMID: 32765826 PMCID: PMC7394668 DOI: 10.1186/s13569-020-00134-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 07/20/2020] [Indexed: 11/24/2022] Open
Abstract
Background Kaposiform haemangioendothelioma is a rare vascular tumor and may involve skin, deep soft tissue or bone. It is a locally aggressive tumor usually seen in infants. Here we report a case of kaposiform hemagioendothelioma in a child who responded to propranolol and steroids. Case presentation A 3-year-old male child presented with a swelling below his right knee with characteristic violet skin lesion. There was no evidence of Kasabach–Merritt phenomenon. After no improvement with several attempts at debridement and anti-tubercular treatment; a diagnosis of Kaposiform Haemangioendothelioma was reached on the basis of overall clinical picture and histology. The child was treated with propranolol and steroids and had an excellent clinical response and a near complete resolution on imaging at 5 months. Conclusions These cases are often misdiagnosed and despite a delay in diagnosis have good outcomes with appropriate multimodality management. This case highlights the unique and typical characteristics of kaposiform haemangioendothelioma.
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Affiliation(s)
- Saurav Verma
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Ekta Dhamija
- Department of Radiodiagnosis, Dr. B.R.A Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Adarsh Barwad
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Venkatesan S Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Rastogi
- Sarcoma Medical Oncology Clinic, Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
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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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18
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Gang MH, Lim YJ, Chang MY. Successful Management of Visceral Kaposiform Hemangioendothelioma with Kasabach‐Merritt Phenomenon Using Corticosteroids and Vincristine. NEONATAL MEDICINE 2020. [DOI: 10.5385/nm.2020.27.1.37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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19
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Bsisu IK, Alkharabsheh MM, Al-Zu'bi BB, Almuhaisen G, Awidi AS, Samarah OQ. Bifocal Tibial Kaposiform Hemangioendothelioma Responsive to Vincristine Therapy: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1923-1929. [PMID: 31866667 PMCID: PMC6944038 DOI: 10.12659/ajcr.917696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Kaposiform hemangioendothelioma is a rare locally aggressive vascular endothelial-derived spindle cells neoplasm. Herein, we report a rare case of bifocal tibial kaposiform hemangioendothelioma. CASE REPORT A 9-year-old female presented with a 2-year history of pain and swelling in the left leg. The patient had a high plasma level of the D-dimer and fibrinogen. Radiography revealed a centric lytic lesion on the left proximal tibial metaphysis and an eccentric lateral distal tibial metaphyseal. Histopathologic examination of the sample taken from the distal tibia revealed a dense spindle cell tumor with lobular architecture composed of compact spindle cells compressing small slit-like vascular spaces, forming glomeruloid nests. No necrosis was identified. Based on these findings and the positive immunohistochemical staining for CD31, CD34, and D2-40, the patient was diagnosed with kaposiform hemangioendothelioma. Treatment was started by using vincristine chemotherapy, after which the patient developed temporary peroneal neuropathy, which improved over the next 3 months. CONCLUSIONS Bifocal tibial kaposiform hemangioendothelioma lesions are unique in pediatric patients and can be successfully treated with vincristine chemotherapy. In these cases, the treating physician should be aware of peroneal neuropathy as a potential complication of vincristine administration.
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Affiliation(s)
- Isam K Bsisu
- Department of Anesthesia, School of Medicine, University of Jordan, Amman, Jordan
| | | | - Belal B Al-Zu'bi
- Department of Special Surgery, School of Higher Studies, University of Jordan, Amman, Jordan
| | - Ghadeer Almuhaisen
- Department of Pathology, School of Medicine, University of Jordan, Amman, Jordan
| | - Abdullah S Awidi
- Department of Internal Medicine, University of Jordan, Amman, Jordan
| | - Omar Q Samarah
- Department of Special Surgery, School of Medicine, University of Jordan, Amman, Jordan
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20
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Classification and ultrasound findings of vascular anomalies in pediatric age: the essential. J Ultrasound 2018; 22:13-25. [PMID: 30488172 DOI: 10.1007/s40477-018-0342-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/24/2018] [Indexed: 01/31/2023] Open
Abstract
Proper nomenclature is a major obstacle in understanding and managing vascular anomalies. Often the same term is used for totally different types of lesions or, conversely, the same lesion may be labeled with different terms. Although in recent times there has been a greater understanding of the problems concerning vascular anomalies, episodes of improper use of terminology still remain. The aim of this article, starting from the most recent classification of vascular anomalies, is to provide a clinical and instrumental approach to identifying these lesions and to converge towards a clear and unambiguous terminology that must become univocal among the various operators to avoid diagnostic misunderstandings and therapeutic errors.
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21
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Adult-onset kaposiform hemangioendothelioma with neurofibromatosis type 1: A case report and literature review. Arch Plast Surg 2018; 45:583-587. [PMID: 30466240 PMCID: PMC6258975 DOI: 10.5999/aps.2017.01032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 12/01/2017] [Indexed: 01/04/2023] Open
Abstract
Kaposiform hemangioendothelioma (KHE) is a very rare, locally aggressive vascular neoplasm. It occurs mostly in children and is rarely observed in adults. It typically originates on the skin, later affecting the deep soft tissue of the extremities, head or neck, and retroperitoneum by infiltrative growth. It is locally aggressive, does not regress spontaneously, and tends to metastasize locally as well as to the regional lymph nodes. In this article, we report a case of adult-onset KHE with neurofibromatosis type 1. The patient presented to our department with a 2-month history of a painful ulceration in her left popliteal area. Since KHE had not previously been reported in patients with neurofibromatosis, the diagnosis was difficult due to the similarity of the skin manifestation to neurofibromatosis-associated lesions. We share our experience of diagnosing and treating this rare case of adult-onset KHE.
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22
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Ji Y, Yang K, Peng S, Chen S, Xiang B, Xu Z, Li Y, Wang Q, Wang C, Xia C, Li L, Liu X, Lu G, Yang G, Wu H. Kaposiform haemangioendothelioma: clinical features, complications and risk factors for Kasabach-Merritt phenomenon. Br J Dermatol 2018; 179:457-463. [PMID: 29603128 PMCID: PMC11032113 DOI: 10.1111/bjd.16601] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Few studies have reported the clinical features, complications and predictors of Kasabach-Merritt phenomenon (KMP) associated with Kaposiform haemangioendothelioma (KHE). OBJECTIVES To determine the clinical characteristics present at diagnosis and to identify features that may aid clinicians in managing KHE. METHODS We conducted a cohort study of 146 patients diagnosed with KHE. RESULTS KHE precursors or lesions were present at birth in 52·1% of patients. In 91·8% of patients, lesions developed within the first year of life. The median age at diagnosis of KHE was 2·3 months (interquartile range 1·0-6·0). The extremities were the dominant location, representing 50·7% of all KHEs. Among KHEs in the cohort, 63·0% were mixed lesions (cutaneous lesions with deep infiltration). Approximately 70% of patients showed KMP. A KHE diagnosis was delayed by ≥ 1 month in 65·7% of patients with KMP. Patients with KMP were more likely to have major complications than patients without KMP (P = 0·023). Young age (< 6 months), trunk location, large lesion size (> 5·0 cm) and mixed lesion type were associated with KMP in a univariate analysis. In the multivariate analysis, only age [odds ratio (OR) 11·9, 95% confidence interval (CI) 4·07-34·8; P < 0·001], large lesion size (OR 5·08, 95% CI 2·24-11·5; P < 0·001) and mixed lesion type (OR 2·96, 95% CI 1·23-7·13; P = 0·016) were associated with KMP. CONCLUSIONS Most KHEs appeared before 12 months of age. KHEs are associated with various major complications, which can occur in combination and develop early in the disease process. Young age, large lesion size and mixed lesion type are important predictors of KMP.
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Affiliation(s)
- Y Ji
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - K Yang
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - S Peng
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - S Chen
- Pediatric Intensive Care Unit, Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - B Xiang
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Z Xu
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Y Li
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Q Wang
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - C Wang
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - C Xia
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - L Li
- Laboratory of Pathology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - X Liu
- Department of Vascular and Interventional Radiology, Chengdu Women and Children's Central Hospital, Chengdu, 610031, China
| | - G Lu
- Pediatric Intensive Care Unit, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - G Yang
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
- Department of Pediatric Surgery, Chengdu Shangjin Nanhu Hospital, Chengdu, 611730, China
| | - H Wu
- Vascular Biology Program and Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, U.S.A
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Regional Differences in Clinical Features of Kaposiform Hemangioendothelioma of the Intestinal Tract. J Pediatr Hematol Oncol 2018; 40:491-493. [PMID: 29554025 DOI: 10.1097/mph.0000000000001123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Abstract
This overview of mesenchymal tumors presenting in the skin and/or subcutis in children brings together the range of neoplasms and hamartomas which are seen in this age-group. It is not surprising from the perspective of the pediatric or general surgical pathologist that vascular anomalies, including true neoplasms and vascular malformations, are the common phenotypic category. Since there is considerable morphologic overlap among these lesions, clinicopathologic correlation may be more important than for many of the other mesenchymal tumors. The skin and subcutis are the most common sites of clinical presentation for the infantile myofibroma which is the most common of fibrous mesenchymal tumors in children. Several of the other mesenchymal tumors are more common adults-like dermatofibrosarcoma protuberans, but nonetheless have an important presence in children, even as a congenital neoplasm. A lipomatous tumor in a young child should be considered as a possible manifestation of an overgrowth syndrome.
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Affiliation(s)
- Louis P Dehner
- 1 Lauren V. Ackerman Laboratory of Surgical Pathology, St. Louis Children's Hospital, Washington University Medical Center, St. Louis, Missouri.,2 Dermatopathology Center and Division of Dermatology, Washington University Medical Center, St. Louis, Missouri
| | - Alejandro A Gru
- 3 Department of Pathology, University of Virginia, Charlottesville, Virginia.,4 Department of Dermatology, University of Virginia, Charlottesville, Virginia
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26
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Salman B, Sharma J, Knapp A, Akay B, Gibson D. Kaposiform hemangioendothelioma causing intestinal obstruction. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2017.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Youn JK, Park SH, Han JW, Oh C, Kim HY, Jung SE. Intestinal obstruction due to kaposiform hemangioendothelioma in a 1-month-old infant: A case report. Medicine (Baltimore) 2017; 96:e6974. [PMID: 28906349 PMCID: PMC5604618 DOI: 10.1097/md.0000000000006974] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
RATIONALE Kaposiform hemangioendothelioma (KHE) is an aggressive vascular tumor, mainly occurring in infants and young children and previously reported cases were mainly cutaneous or visceral form. Intestinal kaposiform hemangioma was first reported in 2012. Intestinal type KHE showed better prognosis if the lesion was limited in the gastrointestinal tract and coagulopathy was not accompanied. Since the number of reported cases is small, further study for treatment options and prognosis need to be done. PATIENT CONCERNS We described the case of a 1-month-old female who had abdominal distention and bilious vomiting. DIAGNOSES She was suspected as intestinal obstruction after diagnostic work up. INTERVENTIONS Surgical exploration was performed and jejunal obstruction with a mass was identified. Small bowel segmental resection and anastomosis was performed. OUTCOMES The patient discharged with symptom free. Through the pathological examination, the mass was identified as intestinal type KHE. LESSONS Intestinal KHE can cause bowel obstruction and be managed successfully with complete surgical resection. More cases should be reported and further evaluation for treatment options and prognosis evaluation is necessary.
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28
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Wlodek C, Burt H, Shaw L. A case of kaposiform haemangioendothelioma successfully and safely treated with sirolimus. Clin Exp Dermatol 2017; 42:825-827. [PMID: 28703334 DOI: 10.1111/ced.13168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2016] [Indexed: 12/01/2022]
Affiliation(s)
- C Wlodek
- Department of Paediatric Dermatology, Bristol Royal Hospital for Children, Bristol, UK
| | - H Burt
- Department of Paediatric Radiology, Bristol Royal Hospital for Children, Bristol, UK
| | - L Shaw
- Department of Paediatric Dermatology, Bristol Royal Hospital for Children, Bristol, UK
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Ji Y, Chen S, Xiang B, Li K, Xu Z, Yao W, Lu G, Liu X, Xia C, Wang Q, Li Y, Wang C, Yang K, Yang G, Tang X, Xu T, Wu H. Sirolimus for the treatment of progressive kaposiform hemangioendothelioma: A multicenter retrospective study. Int J Cancer 2017; 141:848-855. [PMID: 28486787 DOI: 10.1002/ijc.30775] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/02/2017] [Accepted: 04/26/2017] [Indexed: 02/05/2023]
Abstract
Kaposiform hemangioendothelioma (KHE) is an aggressive disease with high morbidity and mortality. The aim of this study was to retrospectively evaluate the efficacy and safety of sirolimus for the treatment of progressive KHE. A multicenter, retrospective cohort study was conducted in patients with progressive KHE treated with sirolimus. A total of 52 patients were analyzed. Thirty-seven (71%) patients exhibited Kasabach-Merritt phenomenon (KMP) and were significantly younger than the patients without KMP [95% confidence interval (CI), 14.39-41.61; p < 0.001]. Patients without KMP were all treated with sirolimus alone, whereas 21 KMP patients with severe symptoms received short-term combination therapy with prednisolone. Overall, 96% and 98% of patients showed improved relief of notable symptoms and/or improved complications at 6 and 12 months after treatment, respectively. After sirolimus treatment, significant decreases in mean severity scores occurred at 6 months (95% CI, 2.23-2.54, p < 0.001) and 12 months (95% CI, 1.53-1.90, p < 0.001). Compared to KMP patients, patients without KMP showed a response that was similar to but less pronounced during the 12 months of treatment (95% CI, 40.87-53.80; p < 0.001). For subgroup analysis of KMP patients, there were no significant differences in tumor shrinkage between those treated with combination therapy and those receiving sirolimus alone (95% CI, 18.11-25.02; p > 0.05). No patients permanently discontinued treatment due to toxicity-related events, and no drug-related deaths occurred. Sirolimus was effective and safe for the treatment of progressive KHE. Sirolimus may be considered as a first-line therapy or as part of a multidisciplinary approach for the treatment of KHE.
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Affiliation(s)
- Yi Ji
- 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
| | - Bo Xiang
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Kai Li
- Division of Oncology, Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Zhicheng Xu
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Wei Yao
- Division of Oncology, Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Guoyan Lu
- Pediatric Intensive Care Unit, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xingtao Liu
- Department of Vascular & Interventional Radiology, Chengdu Women and Children's Central Hospital, Chengdu, China
| | - Chuncao Xia
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Qi Wang
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Yanan Li
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Chuan Wang
- 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
| | - Gang Yang
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China.,Department of Pediatric Surgery, Chengdu Shangjin Nanhu Hospital, Chengdu, China
| | - Xueyang Tang
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Ting Xu
- Department of Pediatric Surgery, Shanghai Children's Hospital, Shanghai, China
| | - Hao Wu
- Vascular Biology Program and Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
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Alaqeel AM, Alfurayh NA, Alhedyani AA, Alajlan SM. Sirolimus for treatment of kaposiform hemangioendothelioma associated with Kasabach-Merritt phenomenon. JAAD Case Rep 2016; 2:457-461. [PMID: 27981218 PMCID: PMC5148769 DOI: 10.1016/j.jdcr.2016.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Alaa M Alaqeel
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Nuha A Alfurayh
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Saad M Alajlan
- Department of Dermatology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Castillo SD, Vanhaesebroeck B, Sebire NJ. Phosphoinositide 3-kinase: a new kid on the block in vascular anomalies. J Pathol 2016; 240:387-396. [PMID: 27577520 DOI: 10.1002/path.4802] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/17/2016] [Accepted: 08/26/2016] [Indexed: 12/13/2022]
Abstract
Vascular anomalies are broadly divided into vascular tumours and malformations. These lesions are composed of abnormal vascular elements of various types, and mainly affect infants, children, and young adults. Vascular anomalies may be painful, may be complicated by bleeding, infection, or organ dysfunction, and can have secondary effects on other tissues. Current treatment strategies include surgical excision, pulsed laser, and sclerotherapy, which are invasive, with risks of recurrence. There are growing pharmacological options for these vascular anomalies, but, to date, no specific targeted therapies have been developed. Phosphoinositide 3-kinases (PI3Ks) constitute a family of lipid kinases that are involved in signal transduction and vesicular traffic, and that modulate important cellular processes such as proliferation, growth, and migration. Recent findings have indicated that the PI3K signalling pathway is important in the pathogenesis of vascular anomalies. This provides an opportunity to use PI3K inhibitors, which are in clinical trials for cancer treatment, for such lesions. Here, we provide an update on the classification of vascular anomalies, with their major features, and discuss the role of the PI3K signalling pathway in the pathogenesis of vascular anomalies, and their clinical implications and therapeutic opportunities. Copyright © 2016 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | - Neil J Sebire
- UCL Institute of Child Health & Great Ormond Street Hospital for Children, London, UK
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32
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Vashi P, Abboud E, Bier-Laning C, Gupta D. Adult-onset Kaposiform hemangioendothelioma of the tongue: case report and review of the literature. ACTA ACUST UNITED AC 2016; 23:e517-e520. [PMID: 27803613 DOI: 10.3747/co.23.3239] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We present here a very rare clinical case of a 38-year-old man with Kaposiform hemangioendothelioma (khe) of the tongue who presented to our institution with a growth under the left side of the tongue with no pain or discomfort. There were no enlarged lymph nodes and no significant neurologic findings. Diagnostic histopathology confirmed the lesion to be khe. The tumour was removed surgically, and the surgical specimen confirmed the diagnosis. Follow-up at 3 months shows no clinical evidence of recurrence.
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Affiliation(s)
- P Vashi
- Department of Gastroenterology/Nutrition and Metabolic Support, Zion, IL, U.S.A
| | - E Abboud
- Department of Pathology and Laboratory Medicine, Zion, IL, U.S.A
| | - C Bier-Laning
- Department of Otolaryngology, Cancer Treatment Centers of America at Midwestern Regional Medical Center, Zion, IL, U.S.A
| | - D Gupta
- Department of Gastroenterology/Nutrition and Metabolic Support, Zion, IL, U.S.A
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Filippi L, Tamburini A, Berti E, Perrone A, Defilippi C, Favre C, Calvani M, Della Bona ML, la Marca G, Donzelli G. Successful Propranolol Treatment of a Kaposiform Hemangioendothelioma Apparently Resistant to Propranolol. Pediatr Blood Cancer 2016; 63:1290-2. [PMID: 27100060 DOI: 10.1002/pbc.25979] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 02/28/2016] [Indexed: 12/15/2022]
Abstract
A newborn with unresectable kaposiform hemangioendothelioma associated with Kasabach Merritt phenomenon, unresponsive to vincristine and prednisone, received second-line treatment with propranolol at a dose of 2 mg/kg/day, starting at 2 months of life and continued for 13 months. There was only slight reduction in tumor mass, but measurement of propranolol levels showed extremely low plasma concentrations. The propranolol dose was progressively increased to 3.5 mg/kg/day, leading to a substantial increase in plasma levels associated with clinically relevant tumor reduction. This case highlights the importance of relating propranolol dose to its plasma concentration before considering the treatment ineffective for this vascular tumor.
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Affiliation(s)
- Luca Filippi
- Neonatal Intensive Care Unit, Medical Surgical Fetal-Neonatal Department, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Angela Tamburini
- Department of Pediatric Hematology-Oncology, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Elettra Berti
- Neonatal Intensive Care Unit, Medical Surgical Fetal-Neonatal Department, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Anna Perrone
- Radiology Department, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Claudio Defilippi
- Radiology Department, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Claudio Favre
- Department of Pediatric Hematology-Oncology, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Maura Calvani
- Department of Pediatric Hematology-Oncology, "A. Meyer" University Children's Hospital, Florence, Italy
| | | | - Giancarlo la Marca
- Department of Neurosciences, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Gianpaolo Donzelli
- Neonatal Intensive Care Unit, Medical Surgical Fetal-Neonatal Department, "A. Meyer" University Children's Hospital, Florence, Italy
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Dong A, Zhang L, Wang Y, He T, Zuo C. Abdominal Kaposiform Hemangioendothelioma Associated With Lymphangiomatosis Involving Mesentery and Ileum: A Case Report of MRI, CT, and 18F-FDG PET/CT Findings. Medicine (Baltimore) 2016; 95:e2806. [PMID: 26871848 PMCID: PMC4753944 DOI: 10.1097/md.0000000000002806] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Kaposiform hemangioendothelioma (KH) is a rare vascular tumor of intermediate malignancy that occurs mainly in the childhood. Adult patients with KH are rare. Imaging findings of KH have rarely been reported before. We present magnetic resonance imaging (MRI), computed tomography (CT), and fluorine-18-fluorodeoxyglucose (F-FDG) positron emission tomography (PET)/CT findings in an adult patient with KH associated with lymphangiomatosis involving mesentery and ileum.A 22-year-old female complained of a 9-month history of intermittent melena, weakness, and palpitation. Laboratory tests revealed anemia and hypoproteinemia. Fecal occult blood test was positive. Abdominal enhanced MRI and CT showed a large abdominal mass involving mesentery and ileum. On enhanced MRI, there were many hypervascular nodules in the mass. On FDG PET/CT, the mass and the nodules showed slight FDG uptake. Small bowel capsule endoscopy showed numerous grape-shaped red nodules in the luminal wall of the involved ileum. The patient underwent resection of the abdominal mass and a segment of the ileum invaded by the abdominal mass. KH arising within lymphangiomatosis involving mesentery and ileum was confirmed by pathology. After surgery, the patient's symptoms improved.This is the first case of KH associated with lymphangiomatosis involving mesentery and ileum. In this case, the lymphangiomatosis overshadowed the small tumor nodules resulting in unusual imaging findings. Familiarity with these imaging findings is helpful for diagnosis and differential diagnosis of KH.
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Affiliation(s)
- Aisheng Dong
- From the Department of Nuclear Medicine (AD, CZ); Department of Gastroenterology (LZ); Department of Pathology (YW); and Department of Hepatopanreatobiliary Surgery (TH), Changhai Hospital, Second Military Medical University, Shanghai, China
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Kim HW, Choi YJ, Hong KT, Kang HJ, Park KD, Kim S, Choi YH, Kim WS, Suh DI. Intrathoracic hemangioendothelioma presenting as refractory unilateral pleural effusion and thrombocytopenia. ALLERGY ASTHMA & RESPIRATORY DISEASE 2016. [DOI: 10.4168/aard.2016.4.6.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Hyo Won Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Yun Jung Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Taek Hong
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hyoung Jin Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Duk Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Sehui Kim
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Young Hoon Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Woo-Sun Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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Treatment of retroperitoneal kaposiform hemangioendothelioma: 2 case reports. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Iacobas I, Simon ML, Amir T, Gribbin CE, McPartland TG, Kaufman MR, Calderwood S, Nosher JL. Decreased vascularization of retroperitoneal kaposiform hemangioendothelioma induced by treatment with sirolimus explains relief of symptoms. Clin Imaging 2015; 39:529-32. [DOI: 10.1016/j.clinimag.2015.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 12/04/2014] [Accepted: 01/05/2015] [Indexed: 11/30/2022]
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Ciliberti MP, Caponio R, Pascali A, Matichecchia G, Lioce M. A rare case of intravascular epithelioid hemangioendothelioma of the cephalic vein treated with surgery and postoperative radiation therapy: a case report and review of the literature. J Med Case Rep 2015; 9:91. [PMID: 25924932 PMCID: PMC4437253 DOI: 10.1186/s13256-015-0565-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 03/04/2015] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Epithelioid hemangioendothelioma (EHE) is a rare endothelial tumor with an intermediate grade of malignancy. Few cases of primary vascular hemangioendothelioma have been described in the literature. Surgery is the treatment of choice, but radiation therapy and chemotherapy should also be considered in particular cases. CASE PRESENTATION We present the case of a 44-year-old Caucasian woman affected by EHE of the cephalic vein, treated by complete surgical removal of the mass and postoperative local radiation therapy. At 5-year follow-up, our patient is alive, with no signs of local or distant relapse and with no late radiation-related effects. CONCLUSIONS Postoperative radiotherapy may play a role in cases in which tumor margins are close or cannot be assessed or when high-risk features are present.
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Affiliation(s)
- Maria Paola Ciliberti
- U.O. Radioterapia - National Cancer Research Centre - Istituto Tumori "Giovanni Paolo II", viale Orazio Flacco, 65-70124, Bari, Italy.
| | - Raffaella Caponio
- U.O. Radioterapia - National Cancer Research Centre - Istituto Tumori "Giovanni Paolo II", viale Orazio Flacco, 65-70124, Bari, Italy.
| | - Antonio Pascali
- U.O. Radioterapia - National Cancer Research Centre - Istituto Tumori "Giovanni Paolo II", viale Orazio Flacco, 65-70124, Bari, Italy.
| | - Gabriele Matichecchia
- U.O. Radioterapia - National Cancer Research Centre - Istituto Tumori "Giovanni Paolo II", viale Orazio Flacco, 65-70124, Bari, Italy.
| | - Marco Lioce
- U.O. Radioterapia - National Cancer Research Centre - Istituto Tumori "Giovanni Paolo II", viale Orazio Flacco, 65-70124, Bari, Italy.
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Wang Z, Li K, Yao W, Dong K, Xiao X, Zheng S. Steroid-resistant kaposiform hemangioendothelioma: a retrospective study of 37 patients treated with vincristine and long-term follow-up. Pediatr Blood Cancer 2015; 62:577-80. [PMID: 25346262 DOI: 10.1002/pbc.25296] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 08/26/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND Kaposiform hemangioendothelioma (KHE) with Kasabach-Merritt phenomenon (KMP) still remains a particular and life-threatening disease. The purpose of this study was to evaluate the efficacy of vincristine (VCR) and the possibility of replacement with steroids in the treatment of steroid-resistant KHE with KMP. PROCEDURE We retrospectively reviewed the medical records of 37 patients with steroid-resistant KHE who were treated at the Children's Hospital of Fudan University between March 2003 and March 2013. RESULTS The age of initial diagnosis with KHE was between 1 day and 10 months. Eight and 29 cases were located in the superficial and deep soft tissues, respectively. Thirty-seven KHE lesions did not respond well to steroids before starting VCR treatment. Twenty-six KHE lesions achieved complete remission, with platelet counts reaching normal levels within7.6 ± 5.2 weeks after VCR treatment. The vascular tumor began to decrease in size or soften at an average of 4.9 ± 2.7 weeks. Two KHE lesions had partial responses and one remains in treatment. Eight KHE lesions had no apparent response to VCR and thus received other therapies. Twenty-eight patients have ended treatment with VCR; the average length of treatment was 31.2 ± 5.9 weeks. Side effects occurred in 48.6% of patients who received steroids, and in 11.4% of patients who received VCR treatment. The mean follow-up time was 3.5 years. No recurrences have been reported. CONCLUSIONS VCR appears to be a safe and effective treatment option in the management of steroid-resistant KHE with KMP, and recommended as first-choice treatment.
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Affiliation(s)
- Zuopeng Wang
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, People's Republic of China
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40
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Wang Z, Li K, Dong K, Xiao X, Zheng S. Refractory Kasabach-Merritt phenomenon successfully treated with sirolimus, and a mini-review of the published work. J Dermatol 2015; 42:401-4. [PMID: 25728547 DOI: 10.1111/1346-8138.12797] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 01/03/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Zuopeng Wang
- Department of Pediatric Surgery; Children's Hospital of Fudan University; Shanghai China
| | - Kai Li
- Department of Pediatric Surgery; Children's Hospital of Fudan University; Shanghai China
| | - Kuiran Dong
- Department of Pediatric Surgery; Children's Hospital of Fudan University; Shanghai China
| | - Xianmin Xiao
- Department of Pediatric Surgery; Children's Hospital of Fudan University; Shanghai China
| | - Shan Zheng
- Department of Pediatric Surgery; Children's Hospital of Fudan University; Shanghai China
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Shivaram GM. Diagnostic Imaging and Image-Guided Therapy for Hemangiomas and Vascular Malformations: What the Dermatologist Needs to Know. CURRENT DERMATOLOGY REPORTS 2014. [DOI: 10.1007/s13671-014-0089-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Azma R, Alavi S, Khoddami M, Arzanian MT, Nourmohammad A, Esteghamati S. Multifocal kaposiform hemangioendothelioma of soft tissue with bilateral pulmonary involvement in an adolescent. KOREAN JOURNAL OF PEDIATRICS 2014; 57:500-4. [PMID: 25550706 PMCID: PMC4279012 DOI: 10.3345/kjp.2014.57.11.500] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 06/03/2013] [Accepted: 07/18/2013] [Indexed: 12/20/2022]
Abstract
Kaposiform hemangioendothelioma (KHE) is a rare, locally aggressive vascular tumor of intermediate malignancy with resemblance to Kaposi sarcoma. It occurs predominantly in pediatric age groups as a cutaneous lesion with focal infiltration into the adjacent soft tissue and bone. Although visceral involvement is very uncommon, several cases with bone, retroperitoneal, or mediastinal involvement have been described. KHE has been reported to occasionally occur in unusual sites such as the thymus, tonsils, larynx, paranasal sinuses, deltoid muscle, spleen, uterine cervix, thoracic spine, and even the breast. Multifocal KHE is an extremely rare entity with few reports available in the literature, none of which describes pulmonary involvement. Herein, we report a unique case of multifocal KHE in a 13-year-old boy presenting with a huge soft tissue mass in the upper extremity complicated by bilateral pulmonary nodules that developed into large, necrotic tumor masses.
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Affiliation(s)
- Roxana Azma
- Department of Pediatric Radiology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samin Alavi
- Pediatric Congenital Hematologic Disorders Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maliheh Khoddami
- Pediatric Pathology Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Taghi Arzanian
- Pediatric Congenital Hematologic Disorders Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Armin Nourmohammad
- Medical Imaging Center, Shafa Yahyaian Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Sadaf Esteghamati
- Department of Pediatric Radiology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Nosher JL, Murillo PG, Liszewski M, Gendel V, Gribbin CE. Vascular anomalies: A pictorial review of nomenclature, diagnosis and treatment. World J Radiol 2014; 6:677-692. [PMID: 25276311 PMCID: PMC4176785 DOI: 10.4329/wjr.v6.i9.677] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 07/29/2014] [Indexed: 02/06/2023] Open
Abstract
Vascular anomalies, including vascular malformations and tumors, are frequently straightforward to detect; however, accurate diagnosis and appropriate treatment are often challenging. Misdiagnosis of these lesions can lead clinicians in the wrong direction when treating these patients, which can have unfavorable results. This review presents an overview of the classification systems that have been developed for the diagnosis of vascular lesions with a focus on the imaging characteristics. Pictorial examples of each lesion on physical examination, as well as non-invasive and minimally invasive imaging are presented. An overview of the endovascular treatment of these lesions is also given. In some cases, vascular anomalies may be associated with an underlying syndrome and several of the most commonly encountered syndromes are discussed. Understanding of the classification systems, familiarity with the treatment options and knowledge of the associated syndromes are essential for all physicians working with this patient population. The approach to the described entities necessitates an organized multi-disciplinary team effort, with diagnostic imaging playing an increasingly important role in the proper diagnosis and a combined interventional radiologic and surgical treatment method showing promising results.
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Malhotra Y, Yang CS, McNamara J, Antaya RJ. Congenital kaposiform hemangioendothelioma with Kasabach-Merritt phenomenon successfully treated with low-dose radiation therapy. Pediatr Dermatol 2014; 31:595-8. [PMID: 23458157 DOI: 10.1111/pde.12090] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Kaposiform hemangioendothelioma (KHE) associated with Kasabach-Merritt phenomenon is a life-threatening vasculopathy. The current mainstay treatment for KHEs is corticosteroids and chemotherapy, but these medications do not work for all patients and carry significant side effects. We report a neonate with a large congenital KHE who responded extremely well to low-dose radiation therapy.
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Affiliation(s)
- Yogangi Malhotra
- Division of Neonatology, Yale University, New Haven, Connecticut; Division of Neonatology, Maria Fareri Children's Hospital, New York Medical College, Westchester, New York
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Abstract
Vascular anomalies (VAs) comprise a large variety of individual diagnoses that in different phases of treatment require a diverse number of medical specialists to provide optimal care. Medical therapies include agents usually associated with cancer chemotherapy, such as vincristine, as well more immunomodulatory types of drugs, such as glucocorticoids and sirolimus. These immunomodulating drugs are being successfully applied in cases that are typically categorized as vascular tumors, including kaposiform hemangioendothelioma (KHE) and tufted angioma (TA), as well as some of the more invasive types of vascular malformations (i.e., microcystic lymphatic malformations and blue rubber bleb nevus syndrome (BRBNS). These therapies need to be combined with good supportive care, which often involves anticoagulation, antimicrobial prophylaxis, and comprehensive pain and symptom-relief strategies, as well as appropriate drug monitoring and management of side effects of medical treatment. The optimal care of these patients frequently involves close collaboration between surgeons, interventional and conventional radiologists, medical subspecialists, and nurses.
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Affiliation(s)
- Judith F Margolin
- Baylor College of Medicine, Texas Children's Cancer and Hematology Service, Houston, Texas
| | - Heather Mills Soni
- Baylor College of Medicine, Texas Children's Cancer and Hematology Service, Houston, Texas
| | - Sheena Pimpalwar
- Division of Interventional Radiology, Department of Radiology, TCH, Baylor College of Medicine, Houston, Texas
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A severe bleeding diathesis in a 6-year-old girl secondary to a composite diagnosis of splenic hemangiomatosis and small bowel lymphangiomatosis. J Pediatr Hematol Oncol 2014; 36:404-6. [PMID: 24136025 DOI: 10.1097/mph.0000000000000012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 6-year-old girl presented with presumed relapse of childhood immune thrombocytopenia. Investigations revealed deranged coagulation parameters, abnormal small bowel thickening, and splenomegaly. A clinically significant bleeding diathesis emerged which was refractory to most hemostatic interventions. Laparatomy revealed a composite diagnosis of splenic hemangiomatosis and small bowel lymphangiomatosis. Splenectomy resulted in complete resolution of the coagulopathy. The diagnosis and management of these conditions is inherently complex and without clear guidance. We discuss our perioperative management of the bleeding diathesis. There is a need for long-term follow-up of the underlying pathologies particularly as potentially useful therapeutic agents have emerged.
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Leung M, Chao NSY, Tang PMY, Liu K, Chung KLY. Pancreatic kaposiform hemangioendothelioma presenting with duodenal obstruction and kasabach-merritt phenomenon: a neonate cured by whipple operation. European J Pediatr Surg Rep 2014; 2:7-9. [PMID: 25755958 PMCID: PMC4336109 DOI: 10.1055/s-0033-1361835] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 09/27/2013] [Indexed: 02/07/2023] Open
Abstract
Aim Kaposiform hemangiondothelioma (KHE) is a rare vascular tumor, commonly associated with Kasaback–Merritt phenomenon characterized by thrombocytopenia and consumptive coagulopathy. We report a case of pancreatic KHE presenting with neonatal duodenal obstruction and Kasaback–Merritt phenomenon. Case Report A full term male baby presented with bile stained vomiting on Day 3 of life. Contrast study and computed tomography scan showed duodenal obstruction by a 5 cm extrinsic hypervascular mass. Platelet count was 23 x 109/L. Laparotomy confirmed a vascular tumor arising from the pancreatic head compressing on the duodenum. Whipple operation was performed. Results Intestinal obstruction and thrombocytopenia resolved after surgery. There was no post-operative complications. Histology confirmed KHE. The boy was tolerating hydrolyzed milk formula and was thriving at 5 months follow up. Conclusion We reported a case of pancreatic KHE presented with neonatal intestinal obstruction and Kasaback–Merritt phenomenon. High index of suspicion is necessary for diagnosis. To our knowledge, this is the youngest patient who underwent Whipple operation.
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Affiliation(s)
- Michael Leung
- Division of Pediatric Surgery, Department of Surgery, Queen Elizabeth Hospital, Kowloon, Hong Kong, Hong Kong
| | - Nicholas Sih Yin Chao
- Division of Pediatric Surgery, Department of Surgery, Queen Elizabeth Hospital, Kowloon, Hong Kong, Hong Kong
| | - Paula Man Yee Tang
- Division of Pediatric Surgery, Department of Surgery, Queen Elizabeth Hospital, Kowloon, Hong Kong, Hong Kong
| | - Kelvin Liu
- Division of Pediatric Surgery, Department of Surgery, Queen Elizabeth Hospital, Kowloon, Hong Kong, Hong Kong
| | - Kenneth Lap Yan Chung
- Division of Pediatric Surgery, Department of Surgery, Queen Elizabeth Hospital, Kowloon, Hong Kong, Hong Kong
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Nakib G, Calcaterra V, Quaretti P, Moramarco LP, Bonalumi G, Brunero M, Pelizzo G. Chemotherapy and surgical approach with repeated endovascular embolizations: safe interdisciplinary treatment for kasabach-merritt syndrome in a small baby. Case Rep Oncol 2014; 7:23-8. [PMID: 24575011 PMCID: PMC3934804 DOI: 10.1159/000357300] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction Kasabach-Merritt syndrome (KMS) is a life-threatening disease. We describe a combined medical and multistep, endovascular embolization that was successfully performed with surgery. Case Report A 40-day-old female baby was referred because of an infiltrating pelvic mass. Blood tests showed severe anemia and thrombocytopenia with consumptive coagulopathy. The clinical aspect was pathognomonic for KMS. Administration of steroids and chemotherapy were started and coagulation parameters were normalized with tumor volume regression. Three months later, elective surgical treatment became possible, and dissection and ligature of the left internal iliac artery and sacral artery were performed. The main arterial supply of the mass was embolized with Spongostan®. Two months later, a second hybrid approach was adopted for embolization of the main vascular supply of the tumor occupying the left thigh. Via a third contralateral hybrid femoral approach and under fluoroscopy, selective catheterization of the left profunda femoris artery was performed. The arterial feeder of the tumor, localized at the left gluteus, was seen on a CT scan 2 months later and was embolized with Onyx-18. Conclusion Chemotherapy and a tailored hybrid approach comprising repeated endovascular embolizations seem to be a safe treatment in cases of unresectable and life-threatening tumors in small babies.
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Affiliation(s)
- Ghassan Nakib
- Unit of Pediatric Surgery, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Valeria Calcaterra
- Department of Internal Medicine, University of Pavia, Pavia, Italy ; Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Pietro Quaretti
- Unit of Interventional Radiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | | | - Giovanni Bonalumi
- Division of Vascular Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Marco Brunero
- Unit of Pediatric Surgery, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Gloria Pelizzo
- Unit of Pediatric Surgery, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
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Expansile kaposiform hemangioendothelioma deformed thoracic cage in an adult. Ann Thorac Surg 2013; 96:1854-7. [PMID: 24182473 DOI: 10.1016/j.athoracsur.2013.02.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 02/17/2013] [Accepted: 02/25/2013] [Indexed: 11/24/2022]
Abstract
Kaposiform hemangioendothelioma is a vascular tumor that commonly presents as a cutaneous mass, is observed in children, and is associated with Kasabach-Merritt phenomenon. Herein we report a case of kaposiform hemangioendothelioma with chest wall deformity in an adult who did not show the Kasabach-Merritt phenomenon or cutaneous lesions. To our knowledge, this is the first case of asymptomatic kaposiform hemangioendothelioma arising from the pleura and deforming the chest wall. The patient was treated with tumor excision and chest wall reconstruction.
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