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Schmalz M, Iacobas I, Mahajan P. Purpuric Lesion in a Newborn. Clin Pediatr (Phila) 2024; 63:1001-1004. [PMID: 37646241 PMCID: PMC11127499 DOI: 10.1177/00099228231196744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
- Megan Schmalz
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Ionela Iacobas
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Cancer and Hematology Center, Texas Children’s Hospital, Houston, TX, USA
| | - Priya Mahajan
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Cancer and Hematology Center, Texas Children’s Hospital, Houston, TX, USA
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Yin CG, Qi WW, Wang S, Pan D, Chen XL, Li SY. Efficacy of transcatheter arterial chemoembolization combined with sirolimus for treating Kasabach-Merritt phenomenon in infants, a retrospective study. Ann Med 2023; 55:2196090. [PMID: 37038342 PMCID: PMC10101661 DOI: 10.1080/07853890.2023.2196090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
OBJECTIVE This retrospective study aimed to observe the efficacy of transcatheter arterial chemoembolization (TACE) combined with sirolimus in the treatment of haemangioma combined with the Kasabach-Merritt phenomenon (KMP). METHODS A total of 11 infants with KMP who were treated at our hospital from January 2016 to September 2021 were selected and treated with arteriosclerosis embolotherapy using a microsphere emulsion formed by bleomycin + ultra-fluid lipiodol + dexamethasone + contrast agent or bleomycin mixed microspheres as the embolising agent. The patients were administered sirolimus orally after TACE. The clinical efficacy and examination indicators before and after treatment were observed and compared. RESULTS The 11 infants underwent TACE treatment by arteriosclerosis embolotherapy a total of 21 times; of these cases, 10 were cured, and 1 showed a moderate response. There were no cases of non-response or death. The platelet count rose from 10.0 (7.0, 18.0) x 109/L before TACE to 236.0 (188.0, 275.0) x 109/L six months after the first TACE, and the tumour size decreased from 49.0 (43.0, 111.7) cm3 before TACE to 7.0 (3.5, 17.0) cm3 six months after the first TACE. The differences were statistically significant (the Z values were -2.943 and -2.934, respectively, p < 0.05). CONCLUSION The combination of TACE and sirolimus has significant efficacy on critical children with KMP.
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Affiliation(s)
- Chuan-Gao Yin
- Department of Radiology, Anhui Provincial Children's Hospital, Hefei, China
| | - Wei-Wei Qi
- Department of Radiology, Anhui Provincial Children's Hospital, Hefei, China
| | - Song Wang
- Department of Radiology, Anhui Provincial Children's Hospital, Hefei, China
| | - Deng Pan
- Department of Radiology, Anhui Provincial Children's Hospital, Hefei, China
| | - Xiao-Li Chen
- Department of Radiology, Anhui Provincial Children's Hospital, Hefei, China
| | - Shi-Yu Li
- Department of Radiology, Anhui Provincial Children's Hospital, Hefei, China
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Cai Y, Li J, Yang W, Zhang N, Sun H, Zhang W, Ge M. Case Report: Congenital Intracranial Kaposiform Hemangioendothelioma Treated With Surgical Resection. Front Surg 2022; 9:831190. [PMID: 35433800 PMCID: PMC9012330 DOI: 10.3389/fsurg.2022.831190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/22/2022] [Indexed: 11/21/2022] Open
Abstract
Background Kaposiform hemangioendothelioma (KHE) is a locally aggressive but non-metastatic vascular neoplasm. Most studies have been restricted to small case series of limited generalizability. Intracranial KHE is extremely rare with only three cases reported in the literature. Here, we report a case of congenital intracranial KHE who underwent surgical resection, and no lesion recurrence was seen during the follow-up period of 13 months. Case Description A 2-month-old boy initially presented with a left temporal mass following birth. Antenatal ultrasound at 36 weeks of gestation demonstrated a hyperechoic signal present in the left frontal lobe, with clear borders and irregular morphology. There were neither cutaneous abnormalities nor other neurologic examination abnormalities. No laboratory abnormality was identified. Computed tomography (CT) scans suggested that a massive hematoma was noted under the left frontal skull plate, with a little subdural hemorrhage in the adjacent temporal area. The adjacent meninges enhanced and thickened on contrasted T1 magnetic resonance (MR). After the multidisciplinary diagnostic assessment, the surgery was performed by the left frontotemporal craniotomy approach. The operation was extremely difficult. We completely removed the tumor, and the involved dura and brain tissue were resected with the lesion in a piecemeal fashion. On postoperative-day (POD) 3 and POD 14, the head CT re-examination revealed that cerebral perfusion improved gradually. The MRI of 6- and 12-month after operation showed no local recurrence or metastasis. Conclusions Intracranial KHE is difficult to diagnose early and the prognosis has been uniformly poor. We supposed that meticulous intraoperative hemostasis is the key for a successful operation, and the radical resection of the tumor and involved structures are essential to reduce recurrence.
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Affiliation(s)
- Yingjie Cai
- National Center for Children's Health, Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jiayi Li
- Graduate School, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Wei Yang
- National Center for Children's Health, Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Nan Zhang
- National Center for Children's Health, Department of Pathology, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Hailang Sun
- National Center for Children's Health, Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Weiping Zhang
- Graduate School, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
- *Correspondence: Weiping Zhang
| | - Ming Ge
- National Center for Children's Health, Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, Beijing, China
- Ming Ge
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4
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Dai S, Yang K, Qiu T, Zhou J, Zhang X, Chen S, Li L, Ji Y. Health-Related Quality of Life in Children With Kaposiform Hemangioendothelioma. Front Pediatr 2022; 10:720611. [PMID: 35281237 PMCID: PMC8907831 DOI: 10.3389/fped.2022.720611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 01/31/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Kaposiform hemangioendothelioma (KHE) is a rare, aggressive and borderline vascular tumor mainly occurring in infants and children. The aim of this study was to determine the health-related quality of life (HRQOL) in children with KHE. MEASURES A total of 91 children with KHE participated in this cross-sectional study. The HRQOL was assessed by the age-specific Pediatric Quality of Life Inventory Version 4.0 (PedsQL™ 4.0) Infant Scales, Family Information Form (FIF), Family Impact Module (FIM) and Generic Core Scales (GCS). For comparison, demographically matched healthy children were recruited as a control group. The main outcome measure of HRQOL was analyzed in the two groups. We determined related factors that influenced the HRQOL in children with KHE and their parents by using a stepwise multiple regression analysis. RESULTS The study found that the scores of each item in the family impact module (FIM) were lower than 75, which suggesting that KHE can make the parents of patients in a state of poor quality of life. The scores of physiological and psychosocial domains in all age groups of patients with KHE were lower than those of normal children (P < 0.01). Activity dysfunction is the factor influencing the physiological function score of all-age patients. KMP is the factor influencing the psychosocial function score of all-age patients. CONCLUSIONS The findings presented here suggest that patients with KHE have a poor HRQOL. KMP and activity dysfunction are risk factors for poor HRQOL in patients with KHE. However, lesion size, lesion location and education level of the mother and father were not related to the HRQOL.
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Affiliation(s)
- Shiyi Dai
- 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
| | - Tong Qiu
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Jiangyuan Zhou
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Xuepeng Zhang
- Pediatric Intensive Care Unit, Department of Critical Care Medicine, 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
| | - Lizhi Li
- Department of Pediatric Surgery, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Yi Ji
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
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5
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Tan X, Liu Z, Zhou S, Chen K, Zhang M, Xia J, Guo Y, Zhou Z. Analysis of angiographic characteristics of kaposiform hemangioendothelioma and investigation of the value of transcatheter arterial embolization therapy. Transl Pediatr 2021; 10:3194-3201. [PMID: 35070833 PMCID: PMC8753462 DOI: 10.21037/tp-21-486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to analyze the angiographic characteristics of kaposiform hemangioendothelioma (KHE) and investigate the value of transcatheter arterial embolization (TAE) therapy. METHODS The clinical data of infants diagnosed with KHE at the department from June 2013 to June 2020 were retrospectively analyzed. Of these, 34 infants received TAE therapy. The efficacy of the treatment was evaluated 4 weeks after the therapy. The angiographic characteristics were analyzed by comparing them with the angiographic characteristics of infantile hemangioma (IH), and the times of TAE therapy and the platelet level after each TAE therapy in infants with KHE were summarized. RESULTS The present study showed that the capillary blush of KHE was irregular with an obscure boundary and nonuniform distribution. Many fine feeding arteries were present. The diameter of the feeding arteries was disproportionate to the volume of the tumor blush. The normal arteries were usually embedded in the tumor blush. The angiography of common IH in infants also showed tumor blush, but it was usually round with a clear boundary and uniform staining, and was distributed on 1 side of the normal arterial trunk. The infants with KHE received TAE therapy for 2 to 5 times/case, with a total of 104.0 times, with an average of 3.1±0.8/case. Among which, the platelets continued to decline for 9 times after TAE therapy and the platelets increased to ≥100×109/L in 7.8±3.2 days for 95 times after TAE therapy, The average relapse time was 30.0±15.9 days. CONCLUSIONS The feeding arteries of KHE were numerous and fine and were not easily embolized. The application of TAE may rapidly improve the platelet level, but the long-term effect is poor.
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Affiliation(s)
- Xiaoyun Tan
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Interventional Therapy and Vascular Anomalies, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Zhenyin Liu
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Interventional Therapy and Vascular Anomalies, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Shaoyi Zhou
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Interventional Therapy and Vascular Anomalies, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Kunshan Chen
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Interventional Therapy and Vascular Anomalies, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Ming Zhang
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Interventional Therapy and Vascular Anomalies, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Jiejun Xia
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Interventional Therapy and Vascular Anomalies, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Yiqun Guo
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Interventional Therapy and Vascular Anomalies, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Zijun Zhou
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Interventional Therapy and Vascular Anomalies, Guangzhou Women and Children's Medical Center, Guangzhou, China
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Parashar G, Shankar G, Sahadev R, Santhanakrishnan R. Kaposiform Hemangioendothelioma with Kasabach-Merritt Phenomenon in a Neonate - Role of Dual Therapy: A Case Report and Review of Literature. J Indian Assoc Pediatr Surg 2020; 25:178-181. [PMID: 32581448 PMCID: PMC7302462 DOI: 10.4103/jiaps.jiaps_3_19] [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: 01/09/2019] [Revised: 01/10/2019] [Accepted: 08/24/2019] [Indexed: 11/30/2022] Open
Abstract
Kaposiform hemangioendothelioma (KHE) represents a rare, borderline vascular tumor with locally aggressive behavior. They are often associated with a potentially life-threatening coagulopathy known as Kasabach–Merritt phenomenon (KMP). Due to heterogeneous nature of the vascular lesion and lack of standardized treatment protocols, these patients pose a diagnostic dilemma and therapeutic challenge with morbidity and potential mortality. We report successful management of an infant with KHE and associated KMP. Difficulties encountered in diagnosis, initiation of therapy, and role of dual therapy with vincristine and steroids are discussed.
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Affiliation(s)
- Gaurav Parashar
- Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, South Hospital Complex, Bengaluru, Karnataka, India
| | - Gowri Shankar
- Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, South Hospital Complex, Bengaluru, Karnataka, India
| | - Ravindra Sahadev
- Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, South Hospital Complex, Bengaluru, Karnataka, India
| | - Ramesh Santhanakrishnan
- Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, South Hospital Complex, Bengaluru, Karnataka, India
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Wu Y, Qiu R, Zeng L, Liang L, Zhang J, Zhou J, Jiang W, Su J, Deng X. Effective surgical treatment of life-threatening huge vascular anomalies associated with thrombocytopenia and coagulopathy in infants unresponsive to drug therapy. BMC Pediatr 2020; 20:187. [PMID: 32340603 PMCID: PMC7187498 DOI: 10.1186/s12887-020-02093-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 04/20/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Systemic drug therapy is generally recommended for infant huge vascular anomalies associated with thrombocytopenia and coagulopathy, but some patients are not suitable due to drug unresponsiveness or life threatening conditions before the drug works, who will need to receive surgical treatment. This study retrospectively analyzed the clinical features, imaging features, and surgical outcomes of these patients. METHODS The clinical data of 4 infants with huge vascular anomalies (2 vein malformations (VMs) and 2 kaposiform hemangioendothelioma (KHE)) associated with thrombocytopenia and coagulopathy treated from June 2016 to December 2017 were retrospectively analyzed. All patients received glucocorticoids, propranolol, vincristine or sirolimus treatment before admission, but the treatment was ineffective. Skin petechia, thrombocytopenia and coagulopathy were present at the time of admission. CT scanning was performed before operation. The patient's general clinical data, hematological examination results, operation time, surgical bleeding volume, blood transfusion volume and surgical complications were collected for analysis. The patients were followed up for 10-26 months. RESULTS CT scanning results of 2 patients showed special CT features without detectable enhancement within the lesion after CT enhanced scanning and multiple phleboliths formation. Four patients underwent surgical treatment successfully. Two patients underwent complete resection of the lesion, and 2 underwent cytoreductive surgery. Preoperative clinical symptoms such as skin petechia, thrombocytopenia and coagulopathy were normal at 1 week after surgery. Postoperative pathological results showed 2 cases of KHE and 2 cases of VMs. All patients were discharged from hospital without physical dysfunction, recurrence, or death. CONCLUSIONS Timely and appropriate surgical intervention can achieve satisfactory results for infants with huge VMs and KHE who were unresponsive to drug therapy or suffering from life-threatening occasion before the drug become effective.
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Affiliation(s)
- Yaohao Wu
- Department of Pediatric Surgery, The Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, No. 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Ronglin Qiu
- Department of Pediatric Surgery, The Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, No. 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Lexiang Zeng
- Department of Pediatric Surgery, The Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, No. 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Liyang Liang
- Department of Pediatric, The Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jie Zhang
- Department of Pediatric Surgery, The Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, No. 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Jiajia Zhou
- Department of Pediatric Surgery, The Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, No. 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Wenli Jiang
- Department of Pediatric Surgery, The Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, No. 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Jianhang Su
- Department of Pediatric Surgery, The Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, No. 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Xiaogeng Deng
- Department of Pediatric Surgery, The Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, No. 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China.
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8
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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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9
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Abstract
Ongoing discovery regarding the origin and treatment of vascular anomalies requires standardized nomenclature which itself must undergo iterative updating. This article introduces the 2018 International Society for the Study of Vascular Anomalies (ISSVA) classification, emphasizing the biologic basis of vascular anomalies, summarizing the key features of commonly encountered entities, and serving as a foundation for subsequent articles presented herein. Vascular tumors are discussed to highlight their distinction from vascular malformations which will receive greater attention with respect to management and technical considerations within the issue.
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Affiliation(s)
- Eric J Monroe
- Department of Radiology, Seattle Children's Hospital, Seattle, WA; Department of Radiology, University of Washington, Seattle, WA.
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10
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How do we treat Kaposiform haemangioendothelioma? ANALES DE PEDIATRÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.anpede.2018.09.008] [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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11
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Huerta-Calpe S, Pinilla-González A, Juan Ribelles A, Gómez-Chacón Villalba J, Pérez-Tarazona S. ¿Cómo tratamos el hemangioendotelioma kaposiforme? An Pediatr (Barc) 2019; 91:122-124. [DOI: 10.1016/j.anpedi.2018.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/11/2018] [Accepted: 09/10/2018] [Indexed: 11/29/2022] Open
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Tole S, Price V, Pope E, Powell J, David M, Zwicker K, Kendrick V, Malic C, John PR, Somers GR, Dubois J, Brandão LR. Abnormal hemostasis in children with vascular anomalies, part I: Thrombocytopenias among different vascular anomalies. Thromb Res 2019; 196:626-634. [PMID: 31221393 DOI: 10.1016/j.thromres.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/31/2019] [Accepted: 06/09/2019] [Indexed: 12/18/2022]
Abstract
Long before the classification of vascular anomalies from the International Society for the Study of Vascular Anomalies (ISSVA) provided a framework to differentiate vascular anomalies, otherwise known as vascular birthmarks, it was recognized that patients with such lesions can present with acute life-threatening hemostatic and/or thrombotic complications, as well as chronic long-standing bleeding or thrombotic issues. Scenarios such as a rapidly growing vascular lesion with severe acute thrombocytopenia, a visceral hemorrhagic lesion, a lesion associated with repetitive and painful superficial thrombosis, and cases of unprovoked or post-procedural fatal pulmonary embolism highlight the wide spectrum of manifestations of abnormal coagulation in patients with vascular anomalies. The separation of vascular anomalies into two distinct groups, vascular tumors and vascular malformations, was followed by the characterization that their respective coagulopathies were due to either a derangement of platelets or to a disequilibrium of the patient's coagulation/fibrinolytic process. This configuration of coagulopathies will be the foundation for this two-chapter review series. In the initial review, coagulopathies where thrombocytopenia is the main feature will be characterized, whereas the second review will focus on vascular malformations that have a coagulation disorder secondary to some degree of coagulation consumption and/or fibrinolytic pathway derangement.
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Affiliation(s)
- Soumitra Tole
- Department of Paediatrics, Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Victoria Price
- Department of Paediatrics, Division of Haematology-Oncology, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Elena Pope
- Department of Paediatrics, Section of Dermatology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Julie Powell
- Department of Pediatrics, Division of Dermatology, Sainte-Justine University Hospital Center, University of Montreal, Montreal, QC, Canada
| | - Michèle David
- Department of Pediatrics, Division of Hematology, Sainte-Justine University Hospital Center, University of Montreal, Montreal, QC, Canada
| | - Kelley Zwicker
- Department of Paediatrics, Division of Community Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Victoria Kendrick
- Department of Pediatrics, Division of Community Pediatrics, Calgary, AB, Canada
| | - Claudia Malic
- Division of Plastic Surgery, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Philip R John
- Department of Diagnostic Imaging, Division of Interventional Radiology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Gino R Somers
- Department of Paediatric Laboratory Medicine, Division of Pathology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Josée Dubois
- Department of Medical Imaging, CHU Sainte-Justine Mother and Child University Hospital Center, University of Montreal, Montreal, QC, Canada
| | - Leonardo R Brandão
- Department of Paediatrics, Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.
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Li X, Wen MZ, Su LX, Yang XT, Han YF, Fan XD. Local suture ligation-assisted percutaneous sclerotherapy for Kasabach-Merritt phenomenon-associated kaposiform haemangioendothelioma. Oncol Lett 2019; 17:981-989. [PMID: 30655857 PMCID: PMC6313080 DOI: 10.3892/ol.2018.9661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 08/22/2018] [Indexed: 01/31/2023] Open
Abstract
Kaposiform haemangioendotheliomas (KHEs) complicated by the Kasabach-Merritt phenomenon (KMP) are rare and severe neoplastic lesions often associated with locally aggressive disease, consumption coagulopathy and high mortality rates. Current regimens have yet to achieve a satisfactory therapeutic effect. Thus, an effective and minimally invasive approach for treating complex KHE/KMP cases is necessary for clinical management. The present case series describes patients with KHE/KMP who underwent local suture ligation-assisted percutaneous sclerotherapy to minimise surgical trauma and ensure effective treatment. Between September 2015 and September 2017, 3 consecutive patients with KHE/KMP underwent staged local suture ligation-assisted percutaneous sclerotherapy. Of these patients, 2 presented with medical histories of corticosteroid treatment with unsatisfactory outcomes. The patients underwent a stepwise synthetic serial therapy programme consisting of percutaneous sclerotherapy and adjunctive pharmacotherapy accompanied by a suture ligation procedure. Clinical, radiological, pathological and laboratory data were analysed to evaluate the outcomes of the therapy. All patients were successfully managed with the proposed procedure. Significant relief of clinical symptoms and improvements in haematological indicators were achieved. No recurrence or complications were observed during regular follow-up (4, 19 and 28 months). In conclusion, local suture ligation-assisted percutaneous sclerotherapy was demonstrated to be a safe and effective treatment for KHE/KMP, being minimally invasive, involving simple manipulation and providing a clear treatment benefit in certain cases. Further studies involving larger sample sizes are required to thoroughly evaluate the procedure, which can potentially be used as a novel therapeutic option for KHE/KMP treatment.
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Affiliation(s)
- Xiao Li
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai 200011, P.R. China
| | - Ming-Zhe Wen
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai 200011, P.R. China
| | - Li-Xin Su
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai 200011, P.R. China
| | - Xi-Tao Yang
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai 200011, P.R. China
| | - Yi-Feng Han
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai 200011, P.R. China
| | - Xin-Dong Fan
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai 200011, P.R. China
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First Intracardiac Kaposiform Hemangioendothelioma in an Infant Resolved With Sirolimus: A Case Report. J Pediatr Hematol Oncol 2018; 40:536-540. [PMID: 30067556 DOI: 10.1097/mph.0000000000001275] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Kaposiform hemangioendothelioma (KHE) is a rare and aggressive vascular tumor that can be associated with a consumptive coagulopathy and thrombocytopenia (Kasabach-Merritt phenomenon). Only one case of an intracardiac KHE has been reported which was treated with surgical excision and then expectant management. CASE PRESENTATION We present a patient with an intracardiac KHE which presented as a large mass surrounding the atria, pulmonary veins, superior vena cava, and infiltrating the atrial septum with moderate compression of the superior vena cava and mild compression of the pulmonary veins. This tumor clinically presented as persistent tachypnea and was unresponsive to conventional therapy with vincristine and steroids but responded dramatically to Sirolimus with almost complete regression on follow-up. CONCLUSIONS None of the current treatments for KHE, alone or in combination therapy have been found to be effective in a uniform or reproducible manner. Well designed, preferably randomized trials are required for a better understanding of the appropriate dosage and duration as well as response to treatment and a consensus of first and second line therapies.
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Successful Management of Kaposiform Hemangioendothelioma with Long-Term Sirolimus Treatment: a Case Report and Review of the Literature. Mediterr J Hematol Infect Dis 2018; 10:e2018043. [PMID: 30002799 PMCID: PMC6039087 DOI: 10.4084/mjhid.2018.043] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 06/15/2018] [Indexed: 12/04/2022] Open
Abstract
Background Kaposiform Hemangioendothelioma (KHE) is a rare vascular tumour of the infancy and the first decade of life. It is locally aggressive and potentially life threatening when associated with consumptive coagulopathy, known as Kasabach-Merritt syndrome (KMS). No consensus or guideline for the therapy has been reached because of the lack of prospective trials, and the different standard care suggestions are based on retrospective case series. Case report We report the case of a 9-month-old male with KHE and KMS in which the initial response, obtained with prednisone and vincristine, was subsequently consolidated and strengthened by long-term treatment with sirolimus, a mTOR inhibitor. A summary of the published data is presented as well. Conclusions The inhibition of mTOR pathway represents the most important therapeutic innovation introduced in the last few years for KHE. Our case shows the effectiveness and good tolerance of long-term therapy with sirolimus.
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Ying H, Qiao C, Yang X, Lin X. A Case Report of 2 Sirolimus-Related Deaths Among Infants With Kaposiform Hemangioendotheliomas. Pediatrics 2018; 141:S425-S429. [PMID: 29610165 DOI: 10.1542/peds.2016-2919] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2017] [Indexed: 11/24/2022] Open
Abstract
Kaposiform hemangioendothelioma (KHE) is a rare infiltrative vascular tumor that is potentially life-threatening when presenting with Kasabach-Merritt phenomenon (KMP). KMP is clinically characterized as severe thrombocytopenia and hypofibrinogenemia and therefore is associated with a high mortality rate. There is no standard of cure for KHE currently. Potential medications, including corticosteroids, propranolol, and chemotherapy drugs such as sirolimus, are often used for alleviating KHE symptoms. Although some case reports of sirolimus treatment have shown promising results with recovered coagulant parameters, the off-target effects may cause severe problems. Here we describe 2 cases of infant patients with KHE and KMP who were scheduled to receive sirolimus on a long-term basis. However, both patients developed paroxysmal cough and tachypnea shortly after the onset of sirolimus treatment and succumbed to infection thereafter. This report reveals a potential risk of infection in sirolimus-treated infant patients. The fatal complication highlights the importance of antibiotic prophylaxis and serum sirolimus level monitoring to ensure the safe use of sirolimus in the treatment of infant patients with KHE.
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Affiliation(s)
- Hanru Ying
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital and School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Congzhen Qiao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital and School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xi Yang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital and School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoxi Lin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital and School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Mahajan P, Margolin J, Iacobas I. Kasabach-Merritt Phenomenon: Classic Presentation and Management Options. Clin Med Insights Blood Disord 2017; 10:1179545X17699849. [PMID: 28579853 PMCID: PMC5428202 DOI: 10.1177/1179545x17699849] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/16/2017] [Indexed: 11/25/2022]
Abstract
Kasabach-Merritt phenomenon (KMP) is a rare consumptive coagulopathy associated with specific vascular tumors, kaposiform hemangioendothelioma, and tufted angioma. Kasabach-Merritt phenomenon, characterized by profound thrombocytopenia, hypofibrinogenemia, elevated fibrin split products, and rapid tumor growth, can be life-threatening. Severe symptomatic anemia may also be present. With prompt diagnosis and management, KMP can resolve and vascular tumors have been shown to regress. This review highlights the clinical presentation, histopathology, management, and treatment of KMP associated with kaposiform hemangioendothelioma, and less frequently tufted angioma. A classic clinical case is described to illustrate the presentation and our management of a patient with KMP.
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Affiliation(s)
- Priya Mahajan
- Department of Pediatrics, Baylor College of Medicine, Vascular Anomalies Center at Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, TX, USA
| | - Judith Margolin
- Department of Pediatrics, Baylor College of Medicine, Vascular Anomalies Center at Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, TX, USA
| | - Ionela Iacobas
- Department of Pediatrics, Baylor College of Medicine, Vascular Anomalies Center at Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, TX, USA
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Kim JA, Choi YB, Yi ES, Lee JW, Sung KW, Koo HH, Yoo KH. Excellent outcome of medical treatment for Kasabach-Merritt syndrome: a single-center experience. Blood Res 2016; 51:256-260. [PMID: 28090488 PMCID: PMC5234231 DOI: 10.5045/br.2016.51.4.256] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/22/2016] [Accepted: 09/27/2016] [Indexed: 01/29/2023] Open
Abstract
Background Kasabach-Merritt syndrome (KMS) is a rare but life-threatening illness. The purpose of this study is to report our single-center experience with KMS. Methods We reviewed the medical records of 13 patients who were diagnosed with KMS between 1997 and 2012 at Samsung Medical Center. Treatment response was defined as follows: 1) hematologic complete response (HCR) – platelet count >130×109/L without transfusion; 2) clinical complete response (CCR) – complete tumor disappearance or small residual vascular tumor displaying lack of proliferation for at least 6 months after treatment discontinuation. Results Participants included 7 male and 6 female patients. The median initial hemoglobin levels and platelet counts were 9.7 g/dL (range, 6.6–11.6 g/dL) and 11×109/L (range, 3–38×109/L), respectively. Twelve patients received corticosteroid and interferon-alpha as initial treatment, and the remaining patient received propranolol instead of corticosteroid. Two patients with unsatisfactory response to the initial treatment received weekly vincristine. Successful discontinuation of medication was possible at a median of 301 days (range, 137–579) in all patients except one who was lost to follow-up. The median times to achieve HCR and CCR were 157 days and 332 days, respectively. The probabilities of achieving HCR and CCR were 77% and 54% at 1 year, and 88% and 86% at 2.5 years, respectively. Conclusion The prognosis of KMS in our cohort was excellent. Our data suggest that individualized treatment adaptation according to response may be very important for the successful treatment of patients with KMS.
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Affiliation(s)
- Jin Ah Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Bae Choi
- Department of Pediatrics, Chung-Ang University Hospital, Seoul, Korea
| | - Eun Sang Yi
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Won Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Hoe Koo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keon Hee Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.; Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea.; Stem Cell & Regenerative Medicine Institute, Samsung Medical Center, Seoul, Korea
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Management of a Kaposiform haemangioendothelioma of the kidney with Kasabach-Meritt phenomenon without chemotherapy. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2016. [DOI: 10.1016/j.phoj.2017.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Tan X, Chen M, Zhang J, Zhou S, Shen G, Liu Z, Jiang H, Xia J. Treatment of Corticosteroid-Resistant Vascular Tumors Associated with the Kasabach-Merritt Phenomenon in Infants: An Approach with Transcatheter Arterial Embolization Plus Vincristine Therapy. J Vasc Interv Radiol 2016; 27:569-75. [DOI: 10.1016/j.jvir.2015.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 12/11/2015] [Accepted: 12/12/2015] [Indexed: 11/17/2022] Open
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Haider Z, Idris M, Sajjad Z, Humayun S, Kashif N, Ali S. Intratumoral pseudoaneurysms in hepatocellular carcinoma: do they occur de novo without any prior intervention? A tertiary care center experience of 6 years. Acta Radiol 2015; 56:1027-33. [PMID: 25267920 DOI: 10.1177/0284185114549569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 07/29/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intratumoural pseudoaneurysms (ITPA) within hepatocellular carcinomas (HCC) usually arise as postprocedural complications of endovascular therapies or surgical procedures. Their de novo presence in HCC without any prior interventions has not been adequately described in medical literature. PURPOSE To evaluate and quantify the presence of intratumoural pseudoaneurysms (ITPA) within hepatocellular carcinomas (HCC) prior to any intervention. MATERIAL AND METHODS Retrospective cross-sectional review of 519 patients with HCC at a tertiary care university hospital with the purpose to evaluate and quantify the presence of ITPA present prior to any therapy. Patients' baseline data along with viral marker status, alpha fetoprotein (AFP) levels, imaging findings, and any prior treatment provided were recorded. Multi-detector computed tomography (MDCT) scans of selected patients were reviewed for presence of any ITPA and their incidence was calculated. RESULTS ITPAs without any prior therapy were found in 5% (25/519) of patients with HCC. Seventeen of 25 (68%) patients had liver cirrhosis while eight of 25 (32%) patients were non-cirrhotic on imaging. Multiple ITPAs were seen in 44% (11/25) of patients. Eight percent (2/25) of patients had pseudoaneurysm-associated hemorrhage, 20% (5/25) had lung metastasis, 12% (3/25) had portal vein thrombosis, 8% (2/25) had hepatic vein thrombosis, and 16% (4/25) had peritumoral hematoma. The incidence of de novo ITPAs occurring in patients with HCC without any prior therapy or intervention was 0.24%. CONCLUSION These cases provide a unique insight into an additional feature of HCC and usefulness of recognizing the ITPAs on imaging studies. Although de novo ITPAs in HCC are uncommon, occurring with an incidence rate of 0.24%, their presence in hypervascular hepatic lesion may point towards the diagnosis of HCC. Additionally, they should be accounted for in management planning as they can lead to complications of rupture and hemorrhage.
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Affiliation(s)
| | | | | | | | | | - Sajjad Ali
- Continental Medical College, Lahore, Pakistan
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Cheufou DH, Hager T, Welter S, Theegarten D, Stamatis G. Pulmonary manifestation of a condition resembling Kasabach-Merritt syndrome in a woman with abdominal angiomatosis associated with consumptive coagulopathy--surgical management: a case report. J Med Case Rep 2015; 9:107. [PMID: 25956942 PMCID: PMC4436809 DOI: 10.1186/s13256-015-0566-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 03/04/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Kasabach-Merritt syndrome is a benign condition characterized by hemangiomatosis, severely disseminated intravascular consumption coagulopathy, and thrombocytopenia. The mortality rate increases from 12% to 30% in hemorrhagic cases. In general, the symptoms primarily manifest in the gastrointestinal tract, the skin, and the subcutaneous tissue. There is no publication about pulmonary manifestation of angiomatosis in combination with vascular malformation and hemoptysis. This is the first description of a Kasabach-Merritt syndrome-like condition in the lung. CASE PRESENTATION We present the case of a 29-year-old German woman with angiomatosis and associated pulmonary vascular malformation in her lower left lobe with a Kasabach-Merritt syndrome like condition. It was detected after hemoptysis. We also present our case observations and management. CONCLUSION In a case of angiomatosis with an associated pulmonary lobar vascular malformation, lobectomy can be safely performed to prevent life-threatening bleeding.
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Affiliation(s)
| | - Thomas Hager
- Institute of Pathology and Neuropathology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany.
| | - Stefan Welter
- Department of Thoracic Surgery, Ruhrlandklinik-Essen, University of Duisburg-Essen, Essen, Germany.
| | - Dirk Theegarten
- Institute of Pathology and Neuropathology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany.
| | - Georgios Stamatis
- Department of Thoracic Surgery, Ruhrlandklinik-Essen, University of Duisburg-Essen, Essen, Germany.
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Li K, Tai M, Qin Z, Ge C. Clinical observations in mesh suture treatment for infants of Kasabach-Merritt phenomenon. J Paediatr Child Health 2015; 51:529-533. [PMID: 25316144 DOI: 10.1111/jpc.12743] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2014] [Indexed: 11/29/2022]
Abstract
AIM This study aims to evaluate the efficacy and adverse effects of the mesh suture treatment for infants of Kasabach-Merritt phenomenon and to report our treatment experience. METHODS Of the three patients, two of the cases occurred in the scalp and one occurred in the back of the chest, with platelet counts < 40 × 109 /L before the treatment, reduced fibrinogen levels and increased D-dimer levels. All the three patients underwent the mesh suture treatment of the tumour area. Post-treatment observations were made regarding the surface colour and texture of the tumours, periodic routine blood examination results, fibrinogen and D-dimer levels. RESULTS After treatment, the degree of swelling on the tumour surface was reduced, surface tension was decreased, the tumour colour turned pale red from dark red and the skin gradually returned to normal. Two days after treatment, the platelet counts increased to 70 × 109 /L or higher; the platelet count reached a normal level after 1 week in two cases. The fibrinogen level increased in varying degrees after treatment, whereas the D-dimer level was reduced. One case showed a small amount of exudate at the suture area, 1 month after the treatment; improvements were observed 3 days after changing the local dressing. All the patients were followed up for 6 months to 1 year, during which the patients showed complete regression of the lesion and relapse, normal platelet counts and normal fibrinogen and D-dimer levels. CONCLUSIONS We recommend the mesh suture treatment as the first treatment of choice for paediatric Kasabach-Merritt phenomenon.
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Affiliation(s)
- Kelei Li
- Department of Hemangioma Characteristic, LinYi Tumor Hospital, Linyi, China
| | - Maozhong Tai
- Department of Hemangioma Characteristic, LinYi Tumor Hospital, Linyi, China
| | - Zhongping Qin
- Department of Hemangioma Characteristic, LinYi Tumor Hospital, Linyi, China
| | - Chunxiao Ge
- Department of Hemangioma Characteristic, LinYi Tumor Hospital, Linyi, China
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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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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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Su L, Wang D, Fan X. Comprehensive Therapy for Hemangioma Presenting With Kasabach-Merritt Syndrome in the Maxillofacial Region. J Oral Maxillofac Surg 2015; 73:92-8. [DOI: 10.1016/j.joms.2014.07.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 07/28/2014] [Accepted: 07/28/2014] [Indexed: 11/29/2022]
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Aria D, Vatsky S, Towbin R, Schaefer CM, Kaye R. Interventional radiology in the neonate and young infant. Semin Ultrasound CT MR 2014; 35:588-607. [PMID: 25454054 DOI: 10.1053/j.sult.2014.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- David Aria
- Phoenix Children׳s Hospital, Phoenix, AZ
| | | | | | | | - Robin Kaye
- Phoenix Children׳s Hospital, Phoenix, AZ.
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Wang P, Zhou W, Tao L, Zhao N, Chen XW. Clinical analysis of Kasabach-Merritt syndrome in 17 neonates. BMC Pediatr 2014; 14:146. [PMID: 24920221 PMCID: PMC4088914 DOI: 10.1186/1471-2431-14-146] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 05/29/2014] [Indexed: 11/10/2022] Open
Abstract
Background Kasabach-Merritt syndrome (KMS) is characterized by giant hemangiomas and severe thrombocytopenia, which may result in life-threatening multi-organ hemorrhage. This study evaluated the clinical characteristics, treatments, and outcomes in neonates with KMS, in order to find out the optimal therapy. Methods The clinical data of 17 patients treated for KMS in the Department of Neonates, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, China from January 2007 to January 2012 were retrospectively analyzed. Results The patients were 13 males and 4 females, aged 17 hours to 28 days at admission. Four patients had visceral hemangiomas and 13 had cutaneous hemangiomas. All had thrombocytopenia and coagulation disorders. Intravenous steroid therapy was initially effective in 6 patients (of which 3 relapsed) and ineffective in 11. The 11 patients with a poor response to steroids and the 3 who relapsed underwent arterial embolization therapy, which was effective in 9 patients (of which 1 relapsed), ineffective in 4, and discontinued before completion in 1. Subsequently, four patients in whom arterial embolization therapy was ineffective and one with relapse were treated with vincristine. This was effective in four patients, and the other died of disseminated intravascular coagulation. Steroid therapy was effective in 35.3% of patients, but the relapse rate was 50%. Arterial embolization was effective in 64.3% of patients and vincristine was effective in 80%. Conclusions In patients with neonatal KMS, steroid therapy has a low rate of effectiveness and high rate of relapse. Arterial embolization has a good rate of effectiveness. Combined steroid and embolization therapy should be considered for first-line treatment of neonatal KMS. If this approach is ineffective, vincristine may be useful.
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Affiliation(s)
| | - Wei Zhou
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Jinan University, Renminzhong Road 318, Guangzhou 510120, China.
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Garcia-Monaco RD, Giachetti A. Infantile hemangioma or kaposiform hemangioendothelioma? J Vasc Interv Radiol 2014; 25:810. [PMID: 24745913 DOI: 10.1016/j.jvir.2014.01.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 01/21/2014] [Indexed: 11/29/2022] Open
Affiliation(s)
- Ricardo D Garcia-Monaco
- Section of Vascular and Interventional Radiology, Department of Radiology, Hospital Italiano de Buenos Aires, JD Peron 4190, Buenos Aires C1181ACH, Argentina
| | - Ana Giachetti
- Section of Vascular and Interventional Radiology, Department of Radiology, Hospital Italiano de Buenos Aires, JD Peron 4190, Buenos Aires C1181ACH, Argentina
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Kai L, Wang Z, Yao W, Dong K, Xiao X. Sirolimus, a promising treatment for refractory Kaposiform hemangioendothelioma. J Cancer Res Clin Oncol 2014; 140:471-6. [DOI: 10.1007/s00432-013-1549-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 11/11/2013] [Indexed: 12/31/2022]
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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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Yoon K, Lee YJ, Park DW, Park HK, Yun HS, Lee HJ. Transarterial embolization of a cervicofacial hemangioma associated with Kasabach-Merritt syndrome in a premature neonate. J Vasc Interv Radiol 2013; 24:1934-6. [PMID: 24267538 DOI: 10.1016/j.jvir.2013.08.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 08/30/2013] [Accepted: 08/31/2013] [Indexed: 11/25/2022] Open
Affiliation(s)
- Kibo Yoon
- Departments of Radiology (K.Y., Y.-J.L., D.W.P.) and
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Successful treatment of Kasabach-Merritt syndrome with transarterial embolization and corticosteroids. J Pediatr Surg 2013; 48:673-6. [PMID: 23480932 DOI: 10.1016/j.jpedsurg.2012.12.049] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 11/22/2012] [Accepted: 12/27/2012] [Indexed: 11/23/2022]
Abstract
Kasabach-Merritt syndrome (KMS) refers to the combination of large neonatal vascular tumors and thrombocytopenic coagulopathy. However, a standard treatment regimen for KMS has not yet been established. We report a case of a 6-week-old male infant with life-threatening KMS who was successfully treated with transarterial embolization and corticosteroids. One week after initiating the corticosteroid treatment, his platelet counts recovered, and the lesion growth halted. The approach with corticosteroid therapy resulted in an excellent response that was maintained long enough for us to perform transarterial embolization therapy. The combination of transarterial embolization and corticosteroid therapy should be considered as an option for Kasabach-Merritt syndrome.
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