Kasabach-Merritt syndrome: dangers of interferon and successful treatment with pentoxifylline

Multimodal treatment of Kasabach-Merritt syndrome arising from tufted angioma: A case report

Kasabach-Merritt syndrome (KMS) is a rare type of vascular tumor associated with a severely decreased platelet count. No standard guidelines for the treatment of the disease have been established so far. In the present study, a 1-year-old pediatric patient with KMS arising from tufted angioma was successfully and variously treated with steroids, vincristine, surgery and propranolol for 18 months. Systemic steroids stabilized the platelet count stable, while vincristine reduced the size of the tumor. Due to unpredictable response, the patient was operated. Combination of vincristine and propranolol was introduced post-surgery to improve the severely low platelet count of the patient. Following multimodal therapy for 18 months, there has been no evidence of recurrence or metastasis during 2 years of follow-up. Currently, the patient is alive and well. The management of KMS presents a challenge, and well-designed studies are required to clearly determine the benefits and risks of multidisciplinary treatment.

Kasabach-Merritt syndrome: case reports of successful treatment with partial tumor resection and vincristine chemotherapy

Kasabach-Merritt syndrome is a life-threatening and localized consumption coagulopathy, characterized with profound thrombocytopenia and microangiopathic anemia. The huge tumor is the major cause of rapid platelet destruction, so we supposed the reduction of tumor size could reduce the platelet destruction and improve the clinical condition. In our cases, the vascular tumor occupied one of the extremities, or the head or face. However, removal of the whole tumor would have resulted in the amputation of this extremity or the destruction of the face, and partial tumor removal was suitable. The wound could be repaired with skin graft. Vincristine chemotherapy after the operation was necessary to prevent the enlargement of the remaining tumor. Two cases which were ineffectively treated by other means were treated in this way.

Kasabach-Merritt phenomenon: a single centre experience

OBJECTIVE

Kasabach-Merritt phenomenon (KMP) can lead to life-threatening bleeding, and its optimum treatment has not been established. We review the experience of managing KMP in a single institution.

METHODS

A retrospective chart review on all children with KMP treated at the Hospital for Sick Children, Toronto, over an 18 yr period was carried out.

RESULTS

All 15 patients had profound thrombocytopenia and hypofibrinogenemia at presentation, half had bleeding symptoms, and three had cardiac failure. All patients received corticosteroids. Five responded to steroids alone, given for an average of 13 wk, increasing platelets to >20 x 10(9)/L at a mean of 6.2 d and fibrinogen >1 g/dL at 25.6 d. Ten patients received at least one other therapeutic modality in addition to steroids, including vincristine, interferon, anti-platelet agents and pentoxifylline. Five patients received vincristine, for a mean of 6 wk, with two patients responding. Eight patients received interferon, for a mean of 4 months, with two patients responding. Overall, the mean time to increasing platelets >20 x 10(9)/L was 56 d, to >150 x 10(9)/L was 88 d and fibrinogen >1 g/dL 49 d. Ten patients showed a partial response to embolisation, with a mean of 2.8 procedures performed. Thrombotic complications occurred in 7%. Twelve patients remain alive, with relapse in six patients, all treated successfully. One patient died, and two patients have been lost to follow-up.

CONCLUSION

KMP is a rare condition, with significant morbidity and mortality. The therapeutic approach should include a multidisciplinary team and consensus on guidelines.

Spontaneous regression of a vascular tumor of the skull base--infantile hemangioendothelioma?

Extracerebral masses involving the skull base in children and adolescents are rare. We report on a 4-month-old infant who was diagnosed with a large extracerebral mass in the anterior fossa. Subtotal resection to prevent impending blindness was complicated by almost fatal bleeding. Histopathologically, vessel malformation, epitheloid hemangioendothelioma, and angiosarcoma were possible diagnoses. The residual tumor regressed spontaneously and completely within 6 months after surgery. Retrospectively, histologic and radiologic findings and clinical course prompted the diagnosis of an infantile hemangioendothelioma. To our knowledge, this is the first report on an infantile hemangioendothelioma of the skull base.