Soft-tissue vascular malformations and tumors. Part 2: low-flow lesions

Soft Tissue Vascular Anomalies of the Extremities: A Proposed Diagnostic Approach

This narrative review aims to summarise the classification of vascular anomalies, their clinical presentation, and their radiological features to propose a diagnostic algorithm to approach patients with suspected soft tissue vascular anomalies of the extremities. The management of vascular anomalies necessitates a multidisciplinary approach. Clinical presentation and physical examination are sufficient in most cases to achieve a correct diagnosis. This is especially true for small congenital lesions of the skin and subcutaneous tissue. Imaging is used for accurate characterization of these lesions, especially in cases of atypical or vague clinical presentation, and to assess extension in cases of lesions that are larger and localized in deeper tissues.

Concurrent Occurrence of Lobular Capillary Haemangioma and Port-Wine Stain: A Case Report and Literature Review

A port-wine stain is a type of non-neoplastic hamartomatous malformation of capillary blood vessels, resulting from ectatic capillaries present from birth. Lobular capillary hemangioma is a form of capillary hemangioma that occurs from hamartomatous malformation of capillaries. In our report, we discuss the rare case of both port-wine stain and capillary haemangioma on the gingiva in a 22- year-old young male.

Vascular malformation of tongue with phlebothrombosis/phlebolith in a young patient: an unusual presentation

Venous malformations (VMs) are a type of vascular malformation formed by abnormally developed venous channels, with variations in size, pathway and thickness and are therefore a condition which can predispose to thrombosis. We present the case of a VM associated with phlebothrombosis/phlebolith, located on the lingual dorsum of a 20-year-old female patient. Clinical examination revealed a nodule of approximately 5 mm in diameter involving the anterior third of lingual dorsum, with a firm, compressible and non-pulsatile consistency. Histopathologically, the lesion revealed a VM with evidence of phlebothrombosis and phlebolith development. Although VMs manifest infrequently in this age group, they should be considered in the differential diagnosis of other lesions with similar characteristics in young people.

Sirolimus: A Rescue Drug to Control Complications of Extensive Venous Malformation

Venous malformations represent a major sector of vascular anomalies. Most cases are asymptomatic or subclinical; however, large extensive lesions can cause severe disability and sometimes mortality. In this report, we present a successful case of sirolimus treatment in managing an extensive venous malformation in the pelvis of a 21-month-old boy who presented with life-threatening complications. With a history dating since the day 2 of life, the patient suffered from chronic bleeding due to scrotal skin ulcerations, in addition to recurrent attacks of severe bleeding per rectum necessitating hospital admission and blood transfusion (three attacks since the age of 7 months). Pelvic magnetic resonance image showed the typical findings of extensive venous malformation involving the pelvis, perineum, scrotum, and extending to the gluteal region. The lesion was seen totally encasing the anorectum with marked thickening of their walls almost occluding their lumen.

Oral sirolimus (2 mg/m ² ) was started with a target blood trough level of 5 to 10 ng/mL. Over a follow-up period of 5 months, there was obvious clinical improvement that included healing of skin lesions (scrotal ulcer) with complete re-epithelialization, absence of bleeding per rectum with improvement of constipation, and rise of hemoglobin level from 7.5 to 11.5 g/dL.