The horizon for treating cutaneous vascular lesions

Soft tissue sarcoma mimicking an arteriovenous malformation - A case report and review of literature

INTRODUCTION AND IMPORTANCE

Arteriovenous malformation (AVM) is a rare condition affecting less than 5/10,000 people, with high misdiagnosis due to its heterogeneity, inconsistent nomenclature, and diverse diagnostic criteria. Understanding its prevalence in this age group is crucial for effective treatment. Here we present a case report of a patient with AVM. IRB approval and patient consent were obtained. This study was done based on SCARE criteria.

CASE PRESENTATION

A 53-year-old female patient was diagnosed with a right hip vascular mass suggestive of AVM. The patient reported painless swelling on the right hip for five years, initially increasing in size but significantly increasing in the last six months. The patient had no history of trauma, neurological or pelvic symptoms, or constitutional symptoms. An examination of the lower limbs revealed a firm, non-tender mass measuring approximately 15 × 15 cm. A thigh MRI revealed a sizable, well-rounded, lobulated soft tissue mass with a stromal structure and pronounced vascularity, indicative of a soft tissue tumor.

CLINICAL DISCUSSION

AVMs misdiagnosis is a significant issue, with 40 % of soft tissue sarcomas still misdiagnosed delaying care and leading to unnecessary measures. A 2015 study found 42.5 % of AMV patients were misdiagnosed, and 71 % were misdiagnosed as hemangiomas. Management involves multidisciplinary approaches, including radiology, sclerotherapy, surgical resection, and chemo/radiotherapy. Sirolimus may improve AVM prognosis.

CONCLUSION

Misdiagnosis of AVMs is a significant issue, with 40 % of soft tissue sarcomas still misdiagnosed. Management involves multidisciplinary approaches, including interventional radiology, sclerotherapy, surgical resection, and chemo/radiotherapy.

A Case of Unilateral, Segmental Vascular Lesions: An Unusual Presentation

We present a case of a diffuse, vascular eruption localized to the left thigh and left abdomen in an otherwise apparently healthy 63-year-old male. The patient reported that the eruption was not bothersome and had been present for as long as he could remember. Due to its benign appearance in nature, the patient declined a biopsy or further follow-up. While reports of diffuse vascular eruptions have been associated with many genetic diseases, this case offers an example of a diffuse vascular eruption in a healthy patient. Further research is needed to understand the potential genetic or environmental factors contributing to the development of such lesions in healthy patients.

A retrospective review of cutaneous vascular lesions referred to a teledermatology clinic

INTRODUCTION Most cutaneous vascular lesions are benign and do not require treatment. Many are referred to specialist dermatologists from primary care. AIM This study aimed to investigate the characteristics of cutaneous vascular lesions and the reasons for their referral from primary care. METHODS Lesions diagnosed as cutaneous vascular abnormalities or dermatoses were retrospectively selected from a database of patients attending the Waikato Virtual Lesion Clinic. Demographic data, diagnosis and clinic outcome were recorded for each imaged lesion. Primary care referrals were reviewed to determine the reasons for referral. RESULTS In total, 229 referrals for vascular lesions were received between January 2010 and February 2019. Patient ages ranged from 6 to 95 years and 64.2% of patients were female. Nearly half the lesions (47.2%) were located on the head and neck; 64.1% had a dermatological diagnosis of a vascular tumour and 18.7% had a malformation. The most common reason for referral was pigmentation (45.7%) and bleeding was least common (8.2%). No diagnosis was given in 34.2% of referrals and less than one-quarter had a correct diagnosis. Malignancy was suspected in 40.2% of referrals; however, the dermatologists found that 95.2% of patients did not require further treatment. Half of excisions (n=2) were for bleeding and all were histologically benign. DISCUSSION Diagnostic uncertainty and suspected malignancy commonly result in referral of benign cutaneous vascular lesions to public dermatology services. This study highlights the usefulness of teledermatology in the timely access of specialist input, minimising the need for intervention or excision.

Surgical correction for patients with port-wine stains and facial asymmetry

BACKGROUND

The refractory port-wine stains are often associated with soft and hard tissue hypertrophy leading to facial asymmetry and psychological problems.

AIMS

The authors describe and illustrate a surgical strategy for the treatment of both hard and soft tissue malformations in patients with port-wine stains to restore facial symmetry.

METHODS

The medical records, photographs of two patients with soft and hard tissue hypertrophy were reviewed. After physical examinations, 3-dimensional computed tomography was conducted to evaluate bony asymmetry. The surgical strategy was designed according to individual malformation and requests.

RESULTS

Both patients had congenital port-wine stains that were resistant to laser therapy. As they grew up, they developed both soft and hard tissue hypertrophy. Zygoma, maxilla, nose, and lips are involved, causing facial asymmetry, deviated nose, increased dental show and malocclusion. To correct bony malformation, orthognathic surgery, and facial bone contouring including zygomatic reduction, mandibular angles osteotomy and genioplasty were performed. After the correction of the bony factor, soft tissue symmetry was improved via resection, autologous fat grafting, liposuction, and rhinoplasty. Both patients were satisfied with the surgical result.

CONCLUSIONS

To acquire facial symmetry, surgical correction is inevitable for patients with port-wine stains associated with soft and hard tissue hypertrophy. The authors describe the successive correction of bony and soft tissue asymmetry to achieve harmonious surgical outcomes.