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Venegas LF, Pohlmann PR, Balbinot AL, Schuck E, Oliveira CTMD, Frank KJ, Dillemburg CF, Costa MSBD, Rivero LFR, Pütten ACK. Primary splenic angiosarcoma: case report and literature review. REVISTA BRASILEIRA DE CANCEROLOGIA 2022. [DOI: 10.32635/2176-9745.rbc.1998v44n1.2800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This paper describes a case of an aggressive primary splenic angiosarcoma in a 29-year-old man and makes a review of its clinicai findings, pathologic reports, treatment and prognosis. Angiosarcomas comprise less than 1% of soft tissue sarcomas, and only a small percentage of these tumors arise in the spleen. These tumors usually represent a diagnostic challenge for the pathologist in view of its variegated histology, and the development of new immu-nohistochemical markers for vascular tumors like CD31 (platelet-endothelial cell adhesion molecule) helps to rule out other diagnoses. There is no standard chemotherapy treatment for angiosarcomas, and the prognosis of splenic angiosarcoma is particularly poor.
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Ettlinger JJ, Fleming PJ, Joffe HS, Kennedy CT. Cavernous Haemangioma with Kasabach-Merritt Syndrome: Treatment with Alpha-Interferon. J R Soc Med 2018; 89:55P-6P. [PMID: 8709089 PMCID: PMC1295647 DOI: 10.1177/014107689608900117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A small number of patients with haemangioma need treatment for serious complications such as Kasabach-Merritt syndrome, cardiac failure and obstruction of the airway. We report on the management of an infant with Kasabach-Merritt syndrome.
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Affiliation(s)
- J J Ettlinger
- Department of Neonatal and Intensive Care Medicine, Royal Hospital for Sick Children, Bristol, England
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Adjuvant Antiangiogenic Treatment for Aggressive Giant Cell Lesions of the Jaw: A 20-Year Experience at Massachusetts General Hospital. J Oral Maxillofac Surg 2017; 75:105-118. [DOI: 10.1016/j.joms.2016.06.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/06/2016] [Accepted: 06/06/2016] [Indexed: 01/08/2023]
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Allen P. Invited Review : Three New Vascular Tumors—Tufted Angioma, Kaposiform Infantile Hemangioendothelioma, and Proliferative Cutaneous Angiomatosis. Int J Surg Pathol 2016. [DOI: 10.1177/106689699400200111] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The features of tufted angioma (Nakagawa), Kaposiform infantile hemangioendotheli oma, and proliferative cutaneous angiomatosis are reviewed. Tufted angioma, which usually appears before the age of ten years, is a large, poorly demarcated, macular, cutaneous and subcutaneous lesion most commonly located on the neck or trunk. Histologically, there is a "cannon ball" pattern of concentrically whorled lobules and tufts of endothelial and perithelial cells. Tufted angioma is difficult to excise and usually persists throughout life but causes no serious symptoms. Kaposiform infantile heman gioendothelioma is a rare, aggressive vascular tumor of the deep soft tissues, bone, and skin that presents during the first year of life and is often complicated by Kasabach- Merritt syndrome. Histologically, there is a Kaposiform pattern, but some cells may be arranged in nodules and tufts indistinguishable from tufted angioma. Kaposiform infantile hemangioendothelioma responds to interferon therapy. On the basis of the few cases so far recognized, proliferative cutaneous angiomatosis is a large, diffuse, mainly superficial angioma that grows insidiously and is biopsied in the second or third decade of life. Histologically, there are irregular, interconnecting cords and sheets of endothelial cells that form anastomosing spaces. Extravasated red cells and endothe lial hemosiderosis are prominent. The superficial location, older age, and the distinctive histology suggest that proliferative cutaneous angiomatosis differs from Kaposiform infantile hemangioendothelioma. Int J Surg Pathol 2(1):63-72, 1994
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Abstract
We describe the cases of two children who both presented in infancy with recurrent severe pulmonary hypertensive crises. Exhaustive clinical work-up failed to identify an underlying aetiology. The patients had no clinical response to steroids, immunoglobulins, or pulmonary vasodilators. Post-mortem examination revealed extensive invasive pulmonary capillary haemangiomatosis. There was no evidence of pulmonary venous occlusive disease. Given the lethal nature of this condition, early consideration of referral to a lung transplant centre should be considered in selected patients.
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Lackner H, Karastaneva A, Schwinger W, Benesch M, Sovinz P, Seidel M, Sperl D, Lanz S, Haxhija E, Reiterer F, Sorantin E, Urban CE. Sirolimus for the treatment of children with various complicated vascular anomalies. Eur J Pediatr 2015; 174:1579-84. [PMID: 26040705 DOI: 10.1007/s00431-015-2572-y] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 05/17/2015] [Accepted: 05/21/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED Vascular anomalies include a heterogeneous group of disorders that are categorized as vascular tumors or vascular malformations. Treatment options include resection, embolization, laser therapy, and sclerotherapy or medical treatment such as propranolol, steroids, interferon, and cytostatic chemotherapy. Mammalian target of rapamycin seems to play a key role in the signal pathway of angiogenesis and subsequently in the development of vascular anomalies. Recently, the successful use of sirolimus has been reported in children with lymphatic malformations and kaposiform hemangioendotheliomas. We report on six patients with different vascular anomalies (kaposiform hemangioendothelioma n = 2, combined lymphatico-venous malformation n = 2, pulmonary lymphangiectasia n = 1, and orbital lymphatic malformation n = 1) who were treated with peroral sirolimus. Three of the children initially presented with a Kasabach-Merrit phenomenon. Median duration of treatment was 10 months; two children are still on treatment. Three children each achieved complete and partial remission. Kasabach-Merrit phenomenon resolved within 1 month in all patients. Treatment with sirolimus was tolerated well; only mild reversible leukopenia was observed. CONCLUSION Sirolimus proved to be effective in children with complicated lymphatic or lymphatico-venous malformations and kaposiform hemangioendotheliomas. Treatment was tolerated well with acceptable side effects. The optimum length of treatment and possible long-term side effects have to be evaluated. WHAT IS KNOWN • Vascular anomalies including vascular tumors and vascular malformations may lead to life-threatening conditions.• Some patients are refractory to established treatment and/or are not available for local invasive procedures. WHAT IS NEW • We reviewed the literature focusing treatment of vascular anomalies inc hildren and adolescents.• Our data support recent studies that sirolimus is an effective treatment option in patients with complicated vascular tumors andmalformations
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Affiliation(s)
- Herwig Lackner
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology/Oncology, Medical University of Graz, Graz, Austria.
| | - Anna Karastaneva
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology/Oncology, Medical University of Graz, Graz, Austria.
| | - Wolfgang Schwinger
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology/Oncology, Medical University of Graz, Graz, Austria.
| | - Martin Benesch
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology/Oncology, Medical University of Graz, Graz, Austria.
| | - Petra Sovinz
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology/Oncology, Medical University of Graz, Graz, Austria.
| | - Markus Seidel
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology/Oncology, Medical University of Graz, Graz, Austria.
| | - Daniela Sperl
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology/Oncology, Medical University of Graz, Graz, Austria.
| | - Sofia Lanz
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology/Oncology, Medical University of Graz, Graz, Austria.
| | - Emir Haxhija
- Department of Pediatric and Adolescence Surgery, Medical University of Graz, Graz, Austria.
| | | | - Erich Sorantin
- Division of Pediatric Radiology, Medical University of Graz, Graz, Austria.
| | - Christian E Urban
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology/Oncology, Medical University of Graz, Graz, Austria.
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Ma L, Bao R. Pulmonary capillary hemangiomatosis: a focus on the EIF2AK4 mutation in onset and pathogenesis. APPLICATION OF CLINICAL GENETICS 2015; 8:181-8. [PMID: 26300654 PMCID: PMC4536836 DOI: 10.2147/tacg.s68635] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Pulmonary capillary hemangiomatosis (PCH) is a pulmonary vascular disease that mainly affects small capillaries in the lung, and is often misdiagnosed as pulmonary arterial hypertension or pulmonary veno-occlusive disease due to similarities in their clinical presentations, prognosis, and management. In patients who are symptomatic, there is a high mortality rate with median survival of 3 years after diagnosis. Both idiopathic and familial PCH cases are being reported, indicating there is genetic component in disease etiology. Mutations in the eukaryotic translation initiation factor 2α kinase 4 (EIF2AK4) gene were identified in familial and idiopathic PCH cases, suggesting EIF2AK4 is a genetic risk factor for PCH. EIF2AK4 mutations were identified in 100% (6/6) of autosomal recessively inherited familial PCH and 20% (2/10) of sporadic PCH cases. EIF2AK4 is a member of serine/threonine kinases. It downregulates protein synthesis in response to a variety of cellular stress such as hypoxia, viral infection, and amino acid deprivation. Bone morphogenetic protein receptor 2 (BMPR2) is a major genetic risk factor in pulmonary arterial hypertension and EIF2AK4 potentially connects with BMPR2 to cause PCH. L-Arginine is substrate of nitric oxide synthase, and L-arginine is depleted during the production of nitric oxide, which may activate EIF2AK4 to inhibit protein synthesis and negatively regulate vasculogenesis. Mammalian target of rapamycin and EIF2α kinase are two major pathways for translational regulation. Mutant EIF2AK4 could promote proliferation of small pulmonary arteries by crosstalk with mammalian targets of the rapamycin signaling pathway. EIF2AK4 may regulate angiogenesis by modulating the immune system in PCH pathogenesis. The mechanisms of abnormal capillary angiogenesis are suggested to be similar to that of tumor vascularization. Specific therapies were developed according to pathogenesis and are proved to be effective in reported cases. Targeting the EIF2AK4 pathway may provide a novel therapy for PCH.
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Affiliation(s)
- Lijiang Ma
- Department of Pediatrics and Medicine, Division of Molecular Genetics, Columbia University Medical Center, New York, NY, USA
| | - Ruijun Bao
- The Children's IBD Center, Mount Sinai Hospital, New York, NY, USA
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Abstract
Vascular sarcomas are soft-tissue tumors that arise from the endothelium with a malignant potential. This review discusses the management of epithelioid hemangioendothelioma (EHE) and angiosarcoma. EHE is a vascular tumor of intermediate malignant potential with an indolent course. EHE arising from the liver, lung, or bone tends to be multifocal and the rate of progression is slow and often unpredictable. Treatment should be considered in patients with significant symptomatic deterioration and/or progressive disease on imaging studies. Various cytotoxic and targeted therapies are available for management, with disease stabilization as the most common outcome. Angiosarcoma is an aggressive vascular tumor with a high malignant potential. Multidisciplinary care is critical for the management of localized disease, and the best outcomes are often observed in patients when a combination of systemic and local therapy options is used. Metastatic angiosarcoma is treated primarily with systemic therapy, and several cytotoxic and targeted therapies are available, alone or in combination. The choice of therapy depends on several factors, such as cutaneous location of the tumor, performance status of the patient, toxicity of the treatment, and patient goals.
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Affiliation(s)
- Vinod Ravi
- Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 450, Houston, TX 77030, USA.
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Maftzir G, Aharonov O, Benezra D. Influence of interferons corneal angiogenesis induced by basic fibroblast growth factor and lipopolysaccharide. Ocul Immunol Inflamm 2012; 1:143-50. [PMID: 22827206 DOI: 10.3109/09273949309086551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A controlled and reproducible angiogenic stimulus was induced in the rabbit cornea by Elvax-40 implants sequestering either 500 ng of lipopolysaccharide (LPS) or 500 ng of basic fibroblast growth factor (bFGF). The effect of IFNα and IFN(β) on angiogenesis was studied by inserting implants sequestering 500 ng of these cytokines (approximately 10(4) Units/implant) adjacent to the LPS or bFGF implants. Interferon-α or γ did not inhibit the bFGF-induced angiogenesis, and in most of these experiments an enhancing effect was observed. This enhancement was not statistically significant. The LPS-induced angiogenesis, however, was slightly inhibited in the presence of either interferon-α or γ but these differences were not statistically significant with p=0.1 only. Both cytokines were non angiogenic and there was no detectable difference between them regarding their effect on the angiogenic process induced by either bFGF or LPS.
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Affiliation(s)
- G Maftzir
- Pediatric and Immuno Ophthalmology Unit, Department of Ophthalmology, Hadassah University Hospital, Jerusalem, Israel
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11
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Abstract
BACKGROUND Infantile hemangioma is the most common tumor of infancy. The majority of cases are managed conservatively, but intervention is necessary in approximately 10 percent of cases because of the threat to life or function or because of tissue distortion or destruction. The mainstay treatment for these problematic proliferating infantile hemangiomas is pharmacologic therapy, mostly discovered serendipitously. METHODS This review examines the rational basis of the hitherto empirical pharmacologic therapies for the enigmatic infantile hemangioma, in light of new knowledge regarding its biology, including the critical roles of stem cells and the renin-angiotensin system. RESULTS Steroids have remained the first-line therapy for problematic infantile hemangioma for over 40 years despite their known side effects and failure rates. Vincristine has emerged as an alternative to interferon for steroid-resistant cases because of interferon's adverse effects, especially neurotoxicity. β-Blockers are now the preferred first-line therapy for problematic cases. There is increasing evidence that infantile hemangioma is a disorder of aberrant proliferation and differentiation of primitive mesoderm-derived neural crest phenotypic cells. This primitive phenotype that gives rise to a hemogenic endothelium intermediate has the ability to undergo primitive erythropoiesis and terminal mesenchymal differentiation. CONCLUSIONS The recent discovery of the crucial role of stem cells and the inferred role of the renin-angiotensin system in the biology of infantile hemangioma underscores the possibility of even more targeted therapies, by using modulators of the renin-angiotensin system, on infantile hemangioma. The observation of the potential role of these traditional antihypertensive agents in stem cell biology may lead to better understanding of developmental biology and tumor stem cell growth.
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Recurrent Pulmonary Capillary Hemangiomatosis After Bilateral Lung Transplantation. J Thorac Imaging 2010; 25:W89-92. [DOI: 10.1097/rti.0b013e3181adebc7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ivy DD, Feinstein JA, Humpl T, Rosenzweig EB. Non-congenital heart disease associated pediatric pulmonary arterial hypertension. PROGRESS IN PEDIATRIC CARDIOLOGY 2009; 27:13-23. [PMID: 21852894 DOI: 10.1016/j.ppedcard.2009.09.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Recognition of causes of pulmonary hypertension other than congenital heart disease is increasing in children. Diagnosis and treatment of any underlying cause of pulmonary hypertension is crucial for optimal management of pulmonary hypertension. This article discusses the available knowledge regarding several disorders associated with pulmonary hypertension in children: idiopathic pulmonary arterial hypertension (IPAH), pulmonary capillary hemangiomatosis, pulmonary veno-occlusive disease, hemoglobinopathies, hepatopulmonary syndrome, portopulmonary hypertension and HIV. Three classes of drugs have been extensively studied for the treatment of IPAH in adults: prostanoids (epoprostenol, treprostinil, iloprost, beraprost), endothelin receptor antagonists (bosentan, sitaxsentan, ambrisentan), and phosphodiesterase inhibitors (Sildenafil, tadalafil). These medications have been used in treatment of children with pulmonary arterial hypertension, although randomized clinical trial data is lacking. As pulmonary vasodilator therapy in certain diseases may be associated with adverse outcomes, further study of these medications is needed before widespread use is encouraged.
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Affiliation(s)
- D D Ivy
- University of Colorado Denver School of Medicine and The Children's Hospital, United States
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14
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Could local delivery of bisphosphonates be a new therapeutic choice for hemangiomas? Med Hypotheses 2009; 73:495-7. [DOI: 10.1016/j.mehy.2009.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Revised: 06/03/2009] [Accepted: 06/08/2009] [Indexed: 11/20/2022]
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Classification of Vascular Anomalies and the Comprehensive Treatment of Hemangiomas. Plast Reconstr Surg 2009; 124:69e-81e. [DOI: 10.1097/prs.0b013e3181aa1015] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Segall L, Cohen-Kerem R, Ngan BY, Forte V. Aneurysmal bone cysts of the head and neck in pediatric patients: a case series. Int J Pediatr Otorhinolaryngol 2008; 72:977-83. [PMID: 18433882 DOI: 10.1016/j.ijporl.2008.02.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Revised: 02/25/2008] [Accepted: 02/28/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To characterize aneurysmal bone cysts (ABCs) of the head and neck as seen at a tertiary care center. DESIGN A case series. METHODS A retrospective chart review of pediatric patients with aneurysmal bone cyst of the head and neck treated at the Hospital for Sick Children during the years 1994-2006 was carried out. RESULTS Nine patients with ABC were treated. The average age at diagnosis was 9.3 years (range: 5 months-15 years), six males and three females. Four cysts originated in the paranasal sinuses, two in the mandible, one in the zygoma, one in the mastoid and one in the parietal bone. Two cases were associated with a previous localized trauma (mandible, zygoma). 5/9 presented with pain, 4/9 presented as an asymptomatic mass, 2/9 were associated with proptosis and nasal obstruction, 2/9 with nasal obstruction and 1/9 presented with an aural polyp. Seven cysts were successfully excised while one (in the pterygomaxillary fossa) is being followed conservatively. In one case the ABC was found to be secondary to an extensive osteoblastoma and this child continuous to be problematic. Follow-up time ranged from 2 years and 6 months to 10 years. CONCLUSIONS ABC of the head and neck may vary in presentation and severity. Surgical removal is the treatment of choice at our institution and may provide a satisfying outcome. ABC may be secondary to an underlying bone pathology (e.g., osteoblastoma) which may make it refractory to treatment.
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Affiliation(s)
- Lorne Segall
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Kaban LB, Troulis MJ, Wilkinson MS, Wilkinson MJ, Ebb D, Dodson TB. Adjuvant Antiangiogenic Therapy for Giant Cell Tumors of the Jaws. J Oral Maxillofac Surg 2007; 65:2018-24; discussion 2024. [PMID: 17884531 DOI: 10.1016/j.joms.2007.03.030] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Accepted: 03/01/2007] [Indexed: 11/19/2022]
Abstract
PURPOSE To further evaluate a novel treatment protocol for the management of aggressive giant cell lesions (GCLs) consisting of enucleation followed by adjuvant subcutaneous interferon alpha therapy. PATIENTS AND METHODS Using a retrospective case series study design, a sample of patients with aggressive GCLs was enrolled between April 1995 and June 2006. Lesions were enucleated with preservation of vital structures. Postoperatively, the patients received daily subcutaneous interferon alpha (3 million units/m2 of body surface area). Interferon treatment continued with regular clinical and radiographic follow-up until the surgical defects filled in with bone, as demonstrated by panoramic radiographs and confirmed by computed tomography. Side effects, such as fever, fatigue, weight loss, decreased white blood cell count, decreased platelet count and elevated liver enzymes, were monitored. After completion of interferon therapy, patients followed for 2 years without evidence of recurrence were considered cured of disease. RESULTS The study sample was comprised of 26 subjects (65% female) with a mean age of 18.5 years. At the time of this writing, 16 of the subjects have completed the protocol and are cured of disease, 6 are in remission, and 4 are in active treatment. Four subjects experienced significant side effects from the interferon, requiring modification of treatment. CONCLUSIONS Enucleation of aggressive GCLs with preservation of vital structures and adjuvant interferon is an excellent strategy for managing aggressive GCLs. Approximately 15% of subjects developed significant side effects limiting interferon administration and necessitating alternative therapies.
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Affiliation(s)
- Leonard B Kaban
- Department of Oral & Maxillofacial Surgery, Harvard School of Dental Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
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Wilson MW, Hoehn ME, Haik BG, Rieman M, Reiss U. Low-Dose Cyclophosphamide and Interferon Alfa 2a for the Treatment of Capillary Hemangioma of the Orbit. Ophthalmology 2007; 114:1007-11. [PMID: 17337066 DOI: 10.1016/j.ophtha.2006.11.031] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2006] [Revised: 11/06/2006] [Accepted: 11/08/2006] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To report the use of a combination of low-dose cyclophosphamide and interferon alfa 2a (IFNalpha2a) for the treatment of orbital juvenile capillary hemangioma. DESIGN Retrospective case series. PARTICIPANTS Five patients with juvenile capillary hemangiomas of the orbit. METHODS Five patients with a median age of 9 weeks presented with a rapidly enlarging orbital mass. Two patients also had involvement of the upper eyelid obstructing the visual axis. Patients underwent biopsy to confirm the diagnosis before starting combination therapy with low-dose oral cyclophosphamide (10 mg/kg per day for 3 days repeated every 2 weeks) and subcutaneous IFNalpha2a (3 million units/m2 per day once daily) for a maximum treatment time of 4 to 6 months. Patients underwent serial ophthalmic, hematologic, and neurologic evaluations. MAIN OUTCOME MEASURE Regression of lesions after combination therapy. RESULTS Four of 5 patients had marked regression of the hemangioma by 40% to 60% with subsequent reduction in proptosis, corneal exposure, and obstruction of the visual axis. None of the 4 patients developed amblyopia. Side effects included mild neutropenia and uncomplicated infections. There was no neurologic toxicity after a median follow-up of 10 months. One patient failed to respond to treatment and required further treatment with intralesional steroid injections. CONCLUSIONS Combination of low-dose cyclophosphamide with IFNalpha2a for a short period of time induced early and lasting regression of orbital juvenile capillary hemangiomas with minimal side effects. This regimen may be a suitable alternative that avoids the toxicity of long-term administration of interferon only. However, the experience reported here does not show if cyclophosphamide alone may be sufficient and allow complete avoidance of interferon and its potential serious side effects, and longer follow-up is needed to determine if cyclophosphamide causes any long-term harm.
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Affiliation(s)
- Matthew W Wilson
- Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA.
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Lima ASD, Martynychen MG, Florêncio RT, Rabello LM, Barros JAD, Escuissato DL. Linfangiomatose pulmonar: relato de dois casos. J Bras Pneumol 2007; 33:229-33. [DOI: 10.1590/s1806-37132007000200020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2006] [Accepted: 04/25/2006] [Indexed: 11/21/2022] Open
Abstract
A linfangiomatose, doença rara e de origem controversa, ocorre em indivíduos de todas as faixas etárias, predominando entre os mais jovens, sem predileção por sexo. Comumente cursa com envolvimento torácico, porém órgãos como ossos, baço e fígado podem ser acometidos. Histologicamente, o envolvimento pulmonar cursa com proliferação, anastomoses complexas e dilatação secundária do sistema linfático. Clinicamente, a apresentação é variável. Os achados radiográficos podem ser sugestivos e o diagnóstico é definido pela histologia. Relatamos dois casos da doença; uma das pacientes era oligossintomática e encontra-se em tratamento; na outra, a doença foi mais agressiva e o diagnóstico muito tardio, culminando em óbito.
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Abukawa H, Kaban LB, Williams WB, Terada S, Vacanti JP, Troulis MJ. Effect of interferon-alpha-2b on porcine mesenchymal stem cells. J Oral Maxillofac Surg 2006; 64:1214-20. [PMID: 16860212 DOI: 10.1016/j.joms.2006.04.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2004] [Indexed: 11/30/2022]
Abstract
PURPOSE Patients undergoing enucleation and adjuvant interferon therapy for giant cell jaw tumors have been observed to exhibit exuberant bone formation in the resultant defects. We hypothesize that interferon promotes bone formation by enhancing mesenchymal stem cell (MSC) differentiation and by stimulating osteoblasts. This is a preliminary study to determine the effects of interferon on porcine mesenchymal stem cells (pMSCs) in culture. MATERIALS AND METHODS Isolated pMSCs were grown under the following conditions: 1) MSCs alone (negative control); 2) MSCs + osteogenic supplements (positive control); and 3) MSCs + interferon (experimental). Cell cultures were evaluated morphologically, by quantitative DNA analysis, and quantitative and qualitative alkaline phosphatase analysis. RESULTS Cells treated with interferon exhibited a slower but constant proliferation rate, did not clump, and produced more alkaline phosphatase as compared with the negative control. CONCLUSION The data indicate that interferon may act to differentiate MSCs into osteoblasts and to stimulate metabolic activity while not increasing the proliferation rate.
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Affiliation(s)
- Haru Abukawa
- Skeletal Biology Research Center, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA 02114, USA
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Rampini E, Occella C, Rampini P, Bleidl D. Interferon α 2B for treatment of complex cutaneous haemangiomas of infancy. J Eur Acad Dermatol Venereol 2006. [DOI: 10.1111/j.1468-3083.1997.tb00249.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Talon I, Becmeur F, Kauffmann I, Moog R, Schultz A, Grandadam S. Hémangiome vaginal révélé par un saignement chez une petite fille : à propos de 1 cas. Arch Pediatr 2006; 13:361-3. [PMID: 16531022 DOI: 10.1016/j.arcped.2006.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2004] [Accepted: 01/19/2006] [Indexed: 11/21/2022]
Abstract
We report on the case of a 9-year-old girl who presented vaginal bleeding which led to the diagnosis of vaginal hemangioma. Such localisation is rare, and requires a clinical follow-up by vaginoscopy. A spontaneous regression can be expected but, at this time, the progress of puberty and future fertility are unknown.
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Affiliation(s)
- I Talon
- Service de Chirurgie Pédiatrique, Hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
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Omidvari S, Nezakatgoo N, Ahmadloo N, Mohammadianpanah M, Mosalaei A. Role of Intralesional Bleomycin in the Treatment of Complicated Hemangiomas: Prospective Clinical Study. Dermatol Surg 2006; 31:499-501. [PMID: 15962730 DOI: 10.1111/j.1524-4725.2005.31150] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hemangioma is the most common tumor of infancy. Although it has a basically benign nature and usually spontaneously regresses, a small percentage (5%) have complications that need treatment. Many different therapeutic modalities can be used in this tumor. OBJECTIVE To investigate the effect of a new method of treatment (intralesional bleomycin injection) in complicated hemangiomas. MATERIALS AND METHODS In the Department of Radiation Oncology at Nemazee Hospital in Shiraz, Iran, from April 1992 to October 1998, 32 patients with complicated hemangioma were treated with four to six courses of direct injection of bleomycin into the lesion. RESULTS After a minimum follow-up of 6 years, there was 70 to 100% regression in 18 patients, 50 to 70% in 7 cases, and less than 50% reduction in 7 patients. CONCLUSION Intralesional injection of bleomycin is an easy, safe, and effective therapeutic modality in complicated cutaneous hemangiomas.
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Affiliation(s)
- Shapour Omidvari
- Department of Radiation Oncology, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
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26
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de Queiroz AM, Silva RAB, Margato LC, Nelson-Filho P. Dental Care Management of a Young Patient with Extensive Lymphangioma of the Tongue: A Case Report. SPECIAL CARE IN DENTISTRY 2006; 26:20-4. [PMID: 16703930 DOI: 10.1111/j.1754-4505.2006.tb01505.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Lymphangiomas are benign tumors resulting from a congenital malformation of the lymphatic system. Relatively uncommon, lymphangiomas are usually diagnosed at birth and develop within the first years of life. When these tumors occur in the oral cavity, the tongue is the most frequently affected site. Lymphangioma of the tongue is a common cause of macroglossia in children, which may lead to a dry/cracked tongue with ulcerating secondary infections, difficulty in swallowing and mastication, speech disturbances, exclusive nasal breathing, airway obstruction, mandibular prognathism and other possible deformities of maxillofacial structures. This paper discusses the most relevant features, clinical manifestations, disease-related impairments and treatment options for lymphangioma of the tongue. It presents the case report of a five-year-old child diagnosed with this lesion, including a description of the patient's dental care management.
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Affiliation(s)
- Alexandra Mussolino de Queiroz
- Department of Pediatric, Preventive and Social Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, SP, Brazil
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Affiliation(s)
- Helen Fryssira
- University of Athens Medical School, Aghia Sophia Children's Hospital, Greece
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28
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Abstract
Hemangiomas of infancy are common in the general pediatric population, are usually easily diagnosed, and generally do not require treatment. However, a small but significant percentage of hemangiomas of infancy may develop complications, including infection or ulceration. In addition, hemangiomas located in some anatomic regions may be associated with other anomalies and therefore require more careful monitoring and earlier intervention to prevent permanent sequelae. This review focuses on distinguishing hemangiomas from vascular malformations and delineates the natural history of hemangiomas of infancy, with an emphasis on identifying those hemangiomas that require additional evaluation and closer follow-up. Current treatment modalities, including the use of systemic steroids and the pulsed-dye laser, are discussed. In addition, several conditions that often present with cutaneous hemangiomas are described, including PHACES syndrome and neonatal hemangiomatosis. Finally, an assessment is made of the current understanding of the biology of hemangioma proliferation and involution, including the role of endothelial growth factors and GLUT1, a new marker for hemangiomas of infancy.
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Affiliation(s)
- Kara N Smolinski
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, PA 19104, USA
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29
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Abstract
Thoracic complications of lymphatic disorders can culminate in respiratory failure and death and should be considered in any patient with a lymphatic disease and clinical or radiographic evidence of chest disease. Congenital lymphatic disorders are being increasingly recognized in the adult population. The spectrum of thoracic manifestations of lymphatic disorders ranges from incidental radiographic findings to diffuse lymphatic disease with respiratory failure. This article serves to review some recent advances that allow improved diagnosis and management of thoracic lymphatic disorders. Herein, we describe their anatomical and physiologic effects, the time course of their progression, and the therapies that are currently available. The management of malignant (cancerous) lymphatic disorders of the thorax is beyond the scope of this paper.
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Affiliation(s)
- Kala K Davis
- Division of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Stanford, California 94305-5236, USA
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30
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Schultz K, Rosenberg AE, Ebb DH, Mankin HJ. Lower-extremity lymphangiomatosis. A case report with a seventeen-year follow-up. J Bone Joint Surg Am 2005; 87:162-7. [PMID: 15634828 DOI: 10.2106/jbjs.d.01892] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Karl Schultz
- Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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31
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Bartyik K, Bede O, Tiszlavicz L, Onozo B, Virag I, Turi S. Pulmonary capillary haemangiomatosis in children and adolescents: report of a new case and a review of the literature. Eur J Pediatr 2004; 163:731-7. [PMID: 15365825 DOI: 10.1007/s00431-004-1527-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Pulmonary capillary haemangiomatosis (PCH) in childhood is a rarity, characterised by the uncontrolled proliferation of pulmonary microvessels which may invade pulmonary, bronchial and vascular structures, resulting in diffuse alveolar haemorrhage, manifesting clinically in haemoptysis, dyspnoea and symptoms of pulmonary hypertension (PH). A 14-year-old boy with some particular features (pericardial effusion and thrombocytopenia) is presented and 14 paediatric/adolescent cases from the literature are surveyed. The diagnostic problems and difficulties are discussed, including the importance of imaging (high-resolution CT) and histopathological studies, with the aim of providing a clear-cut distinction of PCH from other conditions such as primary PH (PPH). The literature data can be regarded as ambiguous: both similarities and relatively sharp distinctions between PCH and PPH are to be found. New developments in the field of genetics are also discussed. The early coexistence of PCH and other (vascular) disorders and associations, involving focal or diffuse, disseminated forms is summarised briefly. Conclusion. The diagnosis of this progressive disorder may lead to effective therapy. Treatment possibilities include the rapidly evolving field of anti-angiogenic therapy, but at present lung transplantation is universally accepted as the final definitive treatment for pulmonary capillary haemangiomatosis.
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Affiliation(s)
- Katalin Bartyik
- Department of Paediatrics, Albert Szent-Györgyi Medical and Pharmaceutical Centre, Faculty of Medicine, University of Szeged, 14-15 Koranyi fasor, 6720 Szeged, Hungary.
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32
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Massoud OI, Youssef WI, Mullen KD. Resolution of hereditary hemorrhagic telangiectasia and anemia with prolonged alpha-interferon therapy for chronic hepatitis C. J Clin Gastroenterol 2004; 38:377-9. [PMID: 15087700 DOI: 10.1097/00004836-200404000-00015] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Hereditary hemorrhagic telangiectasia is a group of autosomal dominant disorders, characterized by telangiectases that develop in the skin, mucous membranes, and visceral organs. Currently, there is no satisfactory treatment of hereditary hemorrhagic telangiectasia. Interferon has never been used for the treatment of hereditary hemorrhagic telangiectasia. In this case, we report disappearance of hereditary hemorrhagic telangiectasia lesions after 12 months of treatment with interferon-alpha for chronic hepatitis C. Further studies are warranted to evaluate its role and potential use in the treatment of hereditary hemorrhagic telangiectasia.
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Affiliation(s)
- Omar I Massoud
- Department of Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
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33
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Leibovitch I, Loewenstein A, Alster Y, Rosenblatt I, Lazar M, Yassur Y, Rubinstein A. Interferon Alpha-2a for Proliferative Diabetic Retinopathy After Complete Laser Panretinal Photocoagulation Treatment. Ophthalmic Surg Lasers Imaging Retina 2004. [DOI: 10.3928/1542-8877-20040101-05] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Justová E, Pazdera J, Mihál V, Nekula J. Haemangiomas of the orbit. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2003; 147:43-9. [PMID: 15034604 DOI: 10.5507/bp.2003.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The authors describe their experience with systemic therapy of cavernous haemangiomas making use of interferon alpha. They have successfully used the method in treating two female patients with cavernous haemangiomas in the orbit. In the first patient, the IFN therapy was followed by surgical removal of the tumour. In the second patient, surgical operation was not suitable. After the IFN therapy, the patient's state improved both subjectively and objectively. Decreased level of bFGF in urine prove to be the criterion for successful treatment by IFN. The authors also stress the risk of complications in sucklings. When choosing the method of treatment, they emphasize the necessity of interdisciplinary cooperation.
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Affiliation(s)
- Eva Justová
- Clinic of Oral and Maxillofacial Surgery, Faculty of Medicine, Palacký University, Olomouc, Czech Republic
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35
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Abstract
Oral lesions in very young children usually have a benign presentation, and only rarely contribute to significant aerodigestive symptomatology. Management begins with early recognition of the pathology and appropriate diagnosis. Hemangiomas, lymphangiomas, and teratomas may present with airway compromise or feeding difficulties, necessitating early intervention.
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Affiliation(s)
- Nalin J Patel
- Division of Pediatric Otolaryngology, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, PO. Box 1997, 9000 West Wisconsin Avenue, Milwaukee, WI 53201, USA.
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36
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Almagro P, Julià J, Sanjaume M, González G, Casalots J, Heredia JL, Martínez J, Garau J. Pulmonary capillary hemangiomatosis associated with primary pulmonary hypertension: report of 2 new cases and review of 35 cases from the literature. Medicine (Baltimore) 2002; 81:417-24. [PMID: 12441898 DOI: 10.1097/00005792-200211000-00002] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Pulmonary capillary hemangiomatosis (PCH) is a rare cause of primary pulmonary hypertension characterized by thin-walled microvessels infiltrating the peribronchial and perivascular interstitium, the lung parenchyma, and the pleura. These proliferating microvessels are prone to bleeding, resulting in accumulation of hemosiderin-laden macrophages in alveolar spaces. Here we report 2 cases of PCH with pulmonary hypertension, 1 of them associated with mechanical intravascular hemolysis, a feature previously reported in other hemangiomatous diseases, but not in PCH. Case 2 was diagnosed by pulmonary biopsy; to our knowledge the patient is the second adult to be treated with interferon alpha-2a. Review of the literature identified 35 patients with PCH and pulmonary hypertension. The prognosis is poor and median survival was 3 years from the first clinical manifestation. Dyspnea and right heart failure are the most common findings of the disease. Hemoptysis, pleural effusion, acropachy, and signs of pulmonary capillary hypertension are less common. Chest X-ray or computed tomography scan usually shows evidence of interstitial infiltrates, pulmonary nodules, or pleural effusion. Hemodynamic features include normal wedge pressures. Radiologic and hemodynamic findings are undifferentiated from those of pulmonary veno-occlusive disease but differ from other causes of primary pulmonary hypertension. Epoprostenol therapy, considered the treatment of choice in patients with primary pulmonary hypertension, may produce pulmonary edema and is contraindicated in patients with PCH. Regression of lesions was reported in 1 patient treated with interferon therapy and 2 other patients stabilized, including our second patient. PCH was treated successfully by lung transplantation in 5 cases. Early recognition of PCH in patients with suspected primary pulmonary hypertension is possible based on clinical and radiologic characteristics. Diagnosis by pulmonary biopsy is essential for allowing appropriate treatment.
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Affiliation(s)
- Pedro Almagro
- Service of Internal Medicine, Hospital Mútua de Terrassa, University of Barcelona, Catalonia, Spain.
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37
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Kaban LB, Troulis MJ, Ebb D, August M, Hornicek FJ, Dodson TB. Antiangiogenic therapy with interferon alpha for giant cell lesions of the jaws. J Oral Maxillofac Surg 2002; 60:1103-11; discussion 1111-3. [PMID: 12378481 DOI: 10.1053/joms.2002.34975] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Giant cell tumors are classified and treated based on their biologic behavior. We hypothesize that they are proliferative vascular lesions and would be expected to respond to antiangiogenic therapy. The purpose of this report is to present a treatment protocol consisting of enucleation, with preservation of vital structures, followed by subcutaneous interferon alpha. MATERIALS AND METHODS Patients with a biopsy-confirmed giant cell lesion satisfying criteria for "aggressive giant cell tumor" were included. Instead of wide en bloc resection, lesions were enucleated and the patients started on interferon alpha-2 or beta (3,000,000 units/m(2)) 48 to 72 hours postoperatively. The subjects were followed by clinical examination and radiography, immediately after surgery and every 3 months until the bone cavity completely healed. Thereafter, follow-up was every 6 months. RESULTS Eight patients (7 females), with a mean age of 18.7 +/- 11.1 years, have been enrolled. Six tumors were in the posterior mandible, and 2 were in the anterior maxilla. The mean size was 29.0 mm (range, 15 to 70 mm). All patients underwent enucleation. There were no postoperative complications, and all patients tolerated interferon. There was no evidence of tumor growth during treatment. Seven of 8 patients have completed interferon therapy, and there have been no recurrences during 1 to 6 years of follow-up. The other patient continues on treatment with no evidence of disease. CONCLUSION Antiangiogenic therapy, in combination with curettage, is a promising strategy for treatment of aggressive giant cell tumors. Combined treatment results in a high rate of tumor control with decreased operative morbidity compared with conventional treatment.
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Affiliation(s)
- Leonard B Kaban
- Walter C. Guralnick Professor and Chairman, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston 02114, USA.
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38
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Abstract
Mulliken and Glowacki categorized vascular anomalies as either hemangiomas or malformations, with the former being the most common tumor of infancy. Despite distinct clinical, radiologic, and histologic findings, the two major types of vascular lesions are often confused. This complicates both patient care and interpretation of the medical literature. A thorough understanding of the presentation, natural history, treatment, and complications of vascular tumors (hemangiomas) and vascular malformations is essential to their proper management. A comprehensive review outlining the diagnosis and treatment of hemangiomas in presented.
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Affiliation(s)
- Thomas J Gampper
- Department of Plastic and Reconstructive Surgery, University of Virginia Health System, Charlottesville 22908, USA.
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39
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Abrahams NA, Colby TV, Pearl RH, Chipps BE, Juris AL, Leslie KO. Pulmonary hemangiomas of infancy and childhood: report of two cases and review of the literature. Pediatr Dev Pathol 2002; 5:283-92. [PMID: 12007021 DOI: 10.1007/s10024-001-0151-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pulmonary hemangiomas are exceptionally rare in childhood and more so in infancy. They may involve the airways or the parenchyma, and may be localized or multifocal. We present two cases of pulmonary capillary hemangiomas. The first case is a localized form of capillary hemangioma that was resected from an 8-week-old infant with signs of respiratory distress. A computed tomography scan showed a cystic mass initially thought to be an intrapulmonary bronchogenic cyst. A segmental resection was performed and examination revealed a localized capillary hemangioma without cystic or cavernous features. The second case is an example of a multifocal capillary hemangioma from a 9-year-old child who presented clinically with clubbing of fingers and toes and radiologically had multiple discrete nodules localized to the right lung. The clinical and pathological features of the cases are discussed together with a review of the literature. The distinction from other vascular neoplasms of childhood is briefly described. Although rare, pulmonary hemangiomas should be entertained in the diagnosis of both solid and cystic intrapulmonary lesions of childhood and infancy.
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Affiliation(s)
- Neil A Abrahams
- Department of Anatomic Pathology, Cleveland Clinic Foundation L-2 5, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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40
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Deb G, Donfrancesco A, Ilari I, De Sio L, Milano GM, Ghitti C, Fontana G, Sandri A, Helson L. Hemangioendothelioma: successful therapy with interferon-alpha: a study in Association with the Italian Pediatric Haematology/Oncology Society (AIEOP). MEDICAL AND PEDIATRIC ONCOLOGY 2002; 38:118-9. [PMID: 11813178 DOI: 10.1002/mpo.1284] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Giovanni Deb
- Divisione di Oncologia, Ospedale Pediatrico Bambino Gesù-Roma, Italy.
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41
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Marler JJ, Rubin JB, Trede NS, Connors S, Grier H, Upton J, Mulliken JB, Folkman J. Successful antiangiogenic therapy of giant cell angioblastoma with interferon alfa 2b: report of 2 cases. Pediatrics 2002; 109:E37. [PMID: 11826247 DOI: 10.1542/peds.109.2.e37] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We describe 2 cases of angioblastoma, a rare, destructive pediatric tumor, treated with interferon alfa 2b (IFNalpha2b). The first patient is a 10-month-old male who presented with an ulcerated palatal neoplasm that could not be completely resected. The second is a male neonate with a congenital tumor of the right hand that invaded the hypothenar eminence, destroying the fourth and fifth metacarpals. Biopsy in both patients was interpreted as giant cell angioblastoma. Angioblastoma is rare; there is only 1 reported case that necessitated amputation of an upper extremity, also initially recommended for our patient. Because there is little experience with chemotherapy, permission was granted to employ an antiangiogenic regimen of IFNalpha2b. The angiogenic protein, basic fibroblast growth factor (bFGF), was abnormally elevated in both patients. Both patients received IFNalpha2b. In the first child, it was used after incomplete resection, because biopsy-proven tumor was present at the margin and in the nasopharynx. Biopsies 15 months after initiation of IFN2alphab were negative for tumor. Therapy was stopped after 3 years. Eighteen months later, the patient remains disease-free. In the second child, IFNalpha2b was started after debridement of the ulcerated tumor. Over 11 months, the tumor completely regressed and there was bony regeneration of the metacarpals. The fifth digit was amputated because of damage to the metacarpophalangeal joint by the tumor. IFNalpha2b therapy was discontinued after 1 year of treatment, and the child remains disease-free 2 years and 8 months later. In conclusion, this report demonstrates that: 1) a bFGF-overexpressing low-grade tumor can respond to IFNalpha2b in a manner similar to life-threatening infantile hemangiomas, 2) urinary bFGF levels can help guide IFNalpha dosage in such patients, and 3) although bFGF-mediated tumor angiogenesis is inhibited by IFNalpha, physiologic angiogenesis seems to be unaffected.
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Affiliation(s)
- Jennifer J Marler
- Department of Surgery, Children's Hospital, Boston, Massachusetts 02115, USA
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43
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Abstract
Biologic response modifiers are becoming an important addition to surgery, chemotherapy, and radiotherapy in the management of cancer. As this field of research grows and expands, more biologic response modifiers will be incorporated into therapeutic regimens. By stimulating the immune system to eradicate minimal residual disease, these agents may improve the disease-free and long-term survival rates of patients with a variety of malignancies. The challenge is to incorporate biologic response modifiers into the treatment armamentarium in ways that will maximize their tumorigenicity.
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Affiliation(s)
- L L Worth
- Department of Pediatrics, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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44
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Sedlacek HH. Pharmacological aspects of targeting cancer gene therapy to endothelial cells. Crit Rev Oncol Hematol 2001; 37:169-215. [PMID: 11248576 DOI: 10.1016/s1040-8428(00)00113-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Targeting cancer gene therapy to endothelial cells seems to be a rational approach, because (a) a clear correlation exists between proliferation of tumor vessels and tumor growth and malignancy, (b) differences of cell membrane structures between tumor endothelial cells and normal endothelial cells exist which could be used for targeting of vectors and (c) tumor endothelial cells are accessible to vector vehicles in spite of the peculiarities of the transvascular and interstitial blood flow in tumors. Based on the knowledge on the pharmacokinetics of macromolecules it can be concluded that vectors targeting tumor endothelial cells should own a long blood residence time after intravascular application. This precondition seems to be fulfilled best by vectors exhibiting a slight anionic charge. A long blood residence time would allow the formation of a high amount of complexes between tumor endothelial cells and vector particles. Such high amount of complexes should enable a high transfection rate of tumor endothelial cells. In view of their pharmacokinetic behavior nonviral vectors seem to be more suitable for in vivo targeting tumor endothelial cells than viral vectors. Specific binding of nonviral vectors to tumor endothelial cells should be enhanced by multifunctional ligands and the transduction efficiency should be improved by cationic carriers. Effector genes should encode proteins potent enough to induce reactions which eliminate the tumor tissue. To be effective to that degree such proteins should induce self-amplifying antitumor reactions. Examples for proteins which have the potential to induce such self-amplifying tumor reactions are proteins endowed with antiangiogenic and antiproliferative activity, enzymes which convert prodrugs into drugs and possibly also proteins which induce embolization of tumor vessels. The pharmacological data for such examples are discussed in detail.
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Affiliation(s)
- H H Sedlacek
- Aventis Pharma Deutschland GmbH, Central Biotechnology, PO Box 1140, 35001, Marburg, Germany.
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45
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Justová E, Pazdera J, Mihál V. Contemporary possibilities of treating vasoformative tissue tumours. ACTA UNIVERSITATIS PALACKIANAE OLOMUCENSIS FACULTATIS MEDICAE 2001; 143:37-42. [PMID: 11144116 DOI: 10.5507/bp.2000.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The authors present a review of up-to-date methods of vasoformative tissue tumours treatment. The necessity to choose the best therapy and the risks of single therapeutical procedures are pointed out.
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Affiliation(s)
- E Justová
- Clinic of Oral and Maxillofacial Surgery, Faculty of Medicine, Palacký University, Olomouc, Czech Republic
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46
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Garmendía G, Miranda N, Borroso S, Longchong M, Martínez E, Ferrero J, Porrero P, López-Saura P. Regression of infancy hemangiomas with recombinant IFN-alpha 2b. J Interferon Cytokine Res 2001; 21:31-8. [PMID: 11177578 DOI: 10.1089/107999001459132] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Interferon-alpha (IFN-alpha) has antitumor and antiangiogenic effects. The purpose of this work was to evaluate its efficacy and safety in the treatment of infancy hemangioma and to monitor the appearance of anti-IFN antibodies in these patients. Thirty-nine children (29 girls) aged 1.5-158 months, with 19 younger than 1 year and 9 older than 5, were treated with 3 x 10(6) IU/m(2) IFN-alpha 2b, subcutaneously (s.c.) daily. Inclusion criteria were life-threatening or life-limiting hemangioma and parents' informed consent. Regression was considered if tumor size diminished by 50% or more. Of the 38 patients who completed 6 months of treatment, 27 (71.1%) had regression and 11 (28.9%) had stable disease. No patient experienced progression. Regression was more frequent (100%) among patients between 1 and 5 years old, but it was particularly important (68%) among those under 1 year old, when spontaneous regression is rare. The main side effects were the IFN-related flulike syndrome (79%), increase in serum alanine aminotransferase (ALT) (28%), anorexia (19%), and mild inflammation at the injection site (19%). There was no effect on psychomotor or physical development. On the contrary, 1 patient with neurologic symptoms improved remarkably, including seizure disappearance. Eight patients developed anti-IFN-alpha 2 neutralizing antibodies, and 7 of them responded to IFN treatment. IFN-alpha 2b is a safe and efficacious treatment of infancy hemangioma. Further work should look for other treatment schedules and ways of administration and carefully monitor anti-IFN neutralizing antibodies, which does not seem to interfere with response.
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Affiliation(s)
- G Garmendía
- Juan Manuel Márquez Pediatric University Hospital, La Habana, Cuba
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47
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Abstract
Diffuse duodeno-jejunal hemangiomatosis in children is a rare cause of bilious vomiting. In the clinical approach to bilious vomiting, tumors of the duodenum come at the end of the differential list--not to mention the rarity of hemangiomatosis. To our knowledge, isolated duodeno-jejunal hemangiomatosis as a cause of bilious vomiting in children is being reported for the first time. We analyse the various imaging modalities available to reach a clinical diagnosis.
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Affiliation(s)
- B Lakhkar
- Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal
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48
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Nocini PF, Fior A, Tolo C, Bertossi D. Arteriovenous malformation of the nasal ala: a case report. J Oral Maxillofac Surg 2000; 58:1303-9. [PMID: 11078146 DOI: 10.1053/joms.2000.16636] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- P F Nocini
- Department of Maxillo-Facial Surgery, University of Verona, Policlinic G.B. Rossi Piazzale L. Scuro, Italy
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49
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Ulrich L, Krause M, Brachmann A, Franke I, Gollnick H. Successful treatment of angiosarcoma of the scalp by intralesional cytokine therapy and surface irradiation. J Eur Acad Dermatol Venereol 2000; 14:412-5. [PMID: 11305388 DOI: 10.1046/j.1468-3083.2000.00111.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
An 88-year-old woman presented to us with angiosarcoma of the scalp that had developed over a 6-month period following previous trauma. Despite explicit information concerning the extremely malignant potential of the tumour the patient refused any surgical intervention. However, she agreed to receive local, intralesional interferon alpha-2b and interleukin-2 therapy. After partial remission of the tumour, the intralesional cytokine injections were combined with surface radiotherapy. This combination therapy led to a 2-year remission of both the tumour and sonographically suspicious cervical lymph nodes. Apart from the typical, moderate side-effects of interferon alpha-2b and interleukin-2 the therapy was well tolerated. In conclusion, in our limited experience intralesional cytokine therapy--alone as well as in combination with surface irradiation--seems to be an alternative therapeutic option for patients who is not a candidate for surgery.
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Affiliation(s)
- L Ulrich
- Department of Dermatology and Venereology, Otto von Guericke University, Magdeburg, Germany.
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Affiliation(s)
- J B Mulliken
- Harvard Medical School, Boston, Massachusetts, USA
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