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Walter A, Calite E, Müller A, Kalff JC, Meyer C, Geipel A, Gembruch U, Schreiner C. Prenatal diagnosis and management of a giant intrahepatic arteriovenous malformation—Sonographic findings, clinical implications, and treatment. Clin Case Rep 2022; 10:e6175. [PMID: 35937027 PMCID: PMC9347331 DOI: 10.1002/ccr3.6175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Adeline Walter
- Department of Obstetrics and Prenatal Medicine University Hospital Bonn Bonn Germany
| | - Elina Calite
- Department of Obstetrics and Prenatal Medicine University Hospital Bonn Bonn Germany
| | - Andreas Müller
- Department of Neonatology and Pediatric Intensive Care Medicine University Hospital Bonn Bonn Germany
| | - Jörg C. Kalff
- Department of Surgery Bonn University Hospital, University Hospital Bonn Bonn Germany
| | - Carsten Meyer
- Department of Diagnostic and Interventional Radiology Bonn University Hospital, University Hospital Bonn Bonn Germany
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine University Hospital Bonn Bonn Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine University Hospital Bonn Bonn Germany
| | - Christine Schreiner
- Department of Neonatology and Pediatric Intensive Care Medicine University Hospital Bonn Bonn Germany
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ZHANG D, WANG J. [Prenatal diagnosis and management of fetal hepatic hemangioma]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2019; 48:439-445. [PMID: 31901050 PMCID: PMC8800699 DOI: 10.3785/j.issn.1008-9292.2019.08.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 05/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To review the application of medical imaging in diagnosis and management of fetal hepatic hemangioma. METHODS Clinical data and imaging findings of 14 cases of fetal hepatic hemangioma, who were diagnosed prenatally and followed up in Women's Hospital of Zhejiang University School of Medicine from February 2014 to September 2018 were retrospective reviewed. RESULTS The fetal hepatic hemangiomas were single lesions in all 14 cases, and most of them were located in the right lobe of the liver (13/14). Ultrasound images were mainly hypoechoic with heterogeneity, the honeycomb-like or grid-like anechoic regions were presented in 9 lesions and circumferential blood flow was observed with low to moderate blood flow resistance index. MRI findings showed well-defined lesions with low signal intensity on T1WI, and high or slightly high signal intensity on T2WI. Among 14 cases, there were 8 cases of induced labor and 6 cases of continuing pregnancy. In 6 cases of successful delivery, 2 were treated with propranolol, 4 cases were followed-up without treatment. The growth and development of 6 children were normal. The lesions of hepatic hemangioma showed no significant changes in 3 children and were reduced in the other 3 children, of whom the lesion was complete disappeared in 1 case. CONCLUSIONS Fetal hepatic hemangiomas present relatively typical imaging characteristics, and prenatal diagnosis can be made with ultrasound and MRI. If there are no complications, the fetus with hepatic hemangioma can be delivered at full term with a good outcome.
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Affiliation(s)
| | - Junmei WANG
- 王军梅(1973—), 女, 博士, 主任医师, 主要从事妇产科超声诊断及胎儿出生缺陷筛查研究; E-mail:
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https://orcid.org/0000-0002-9150-4540
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3
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Abstract
Although liver tumors are rare in the pediatric population, they are common in the setting of children with specific risk factors requiring increased awareness and, in some instances, screening. The evaluation of a liver mass in children is largely driven by the age at diagnosis, the presence of any medical comorbidities, and initial testing with alpha fetoprotein and imaging. Specific guidelines for the management of different tumors have been implemented in recent years such that a multidisciplinary approach is ideal and care should be provided by centers with experience in their management.
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Affiliation(s)
- Kenneth Ng
- Department of Pediatrics, Johns Hopkins School of Medicine, 600 North Wolfe Street, CMSC 2-117, Baltimore, MD 21287, USA
| | - Douglas B Mogul
- Department of Pediatrics, Johns Hopkins School of Medicine, 600 North Wolfe Street, CMSC 2-117, Baltimore, MD 21287, USA.
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4
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The changing face of complicated infantile hemangioma treatment. Pediatr Radiol 2016; 46:1494-506. [PMID: 27450406 DOI: 10.1007/s00247-016-3643-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 02/11/2016] [Accepted: 05/17/2016] [Indexed: 01/16/2023]
Abstract
Infantile hemangiomas are the most common vascular tumors of infancy. A multidisciplinary approach including dermatologists, otolaryngologists, plastic surgeons, hematologists/oncologists and interventional/diagnostic radiologists is crucial for appropriate management of children with complicated infantile hemangiomas. Since its unforeseen discovery in 2008, propranolol has become the first-line treatment for infantile hemangiomas, eclipsing systemic corticosteroids and radiologic intervention. There are still, however, uncommon indications for more aggressive interventional management. We review the 2014-updated International Society for the Study of Vascular Anomalies (ISSVA) classification for vascular anomalies. Additionally, we suggest management algorithms for complicated lesions, including recommendations for radiologic and surgical intervention.
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Botha T, Rasmussen O, Carlan SJ, Greenbaum L. Congenital Hepatic Arteriovenous Malformation. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2016. [DOI: 10.1177/8756479304263512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hepatic arteriovenous malformation (AVM) is a rare developmental vascular disorder characterized by direct arterial connection to a fistulous venous drainage system within the liver. The condition results in a high-flow, low-resistance shunt that can cause high-output cardiac failure and hydrops. Prenatal diagnosis is possible when sonography detects multiple engorged vascular channels in the fetal liver. Current treatment options include postnatal obliteration of the arterial feeder vessels by surgical ligation or percutaneous transcatheter embolization with detachable coils. The authors present a case of a prenatally diagnosed hepatic AVM complicated by fetal distress, high-output cardiac failure, and consumptive coagulopathy that had recanalization of feeder vessels noted two weeks after initial successful coil placement.
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Affiliation(s)
- Tracey Botha
- Department of Obstetrics and Gynecology, Fetal Diagnostic Center, Arnold Palmer Hospital for Children and Women, Orlando, Florida
| | - Olga Rasmussen
- Department of Obstetrics and Gynecology, Fetal Diagnostic Center, Arnold Palmer Hospital for Children and Women, Orlando, Florida
| | - S. J. Carlan
- Department of Obstetrics and Gynecology, Fetal Diagnostic Center, Arnold Palmer Hospital for Children and Women, Orlando, Florida,
| | - Lennard Greenbaum
- Department of Obstetrics and Gynecology, Fetal Diagnostic Center, Arnold Palmer Hospital for Children and Women, Orlando, Florida
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6
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Visscher MO, Burkes SA, Adams DM, Gupta A, Wickett RR. Biomechanical properties of infantile hemangiomas: clinical stage and effect of age. Skin Res Technol 2016; 22:487-496. [PMID: 27264201 DOI: 10.1111/srt.12290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Infantile hemangiomas (IHs) are benign vascular neoplasms with rapid capillary proliferation shortly after birth and slow involution with diminishing capillary proliferative activity, fibrosis, and fatty replacement over 7-10 years. METHODS Hemangiomas and contralateral control sites in 88 subjects were measured using a suction device, 6-mm probe and 200 mbar negative pressure. Mechanical properties were assessed vs. controls and effects of body site, depth, clinical stage, histology diagnosis, and time. RESULTS Biological elasticity, overall elasticity, net elasticity, total recovery, and elastic recovery were lower for IH vs. controls (P < 0.001). IH total deformation, elastic deformation, viscoelastic creep, and residual deformation were higher than controls (P < 0.001). Involuting IHs had lower viscoelasticity than proliferating and stable lesions (P < 0.001) and lower viscoelastic creep than stable IHs (P = 0.04). IH viscoelasticity was higher at 2.3 than 12.9, 23.7, and 61.0 months and at 4.9 and 8.1 than 61.0 months. IH elastic recovery varied by body site with larger differences vs. control for abdomen and leg. Elastic recovery differences from control were smaller at younger vs. older ages. CONCLUSIONS Measurement of biomechanical properties may be useful to characterize IH progression and treatment response in clinical settings.
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Affiliation(s)
- M O Visscher
- Skin Sciences Program, Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. .,Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - S A Burkes
- Skin Sciences Program, Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA
| | - D M Adams
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Hemangioma and Vascular Malformation Center, Cincinnati, OH, USA
| | - A Gupta
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Hemangioma and Vascular Malformation Center, Cincinnati, OH, USA
| | - R R Wickett
- James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA
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Vohra V, Gupta P, Malik PK, Pathak A. Propranolol therapy in a case of capillary hemangioma. Oman J Ophthalmol 2016; 8:191-3. [PMID: 26903730 PMCID: PMC4738669 DOI: 10.4103/0974-620x.169907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Capillary hemangioma is one the most common tumors of eyelid and orbit reported in pediatric age group. Oral propranolol therapy is latest addition to the armamentarium of treatment options available to ophthalmologists in treating capillary hemangiomas. We report the successful response to propranolol therapy to a 5-year-old child with capillary hemangioma involving lids, orbit, and the paranasal sinuses. A long-term follow-up is necessary for the prognostic efficacy of the therapy.
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Affiliation(s)
- Vishal Vohra
- Department of Ophthalmology, PGIMER, Dr. RML Hospital, New Delhi, India
| | - Pulkit Gupta
- Department of Ophthalmology, PGIMER, Dr. RML Hospital, New Delhi, India
| | - Praveen K Malik
- Department of Ophthalmology, PGIMER, Dr. RML Hospital, New Delhi, India
| | - Ashok Pathak
- Department of Ophthalmology, PGIMER, Dr. RML Hospital, New Delhi, India
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9
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Su W, Ke Y, Xue J. Beneficial effects of early treatment of infantile hemangiomas with a long-pulse Alexandrite laser. Lasers Surg Med 2014; 46:173-9. [PMID: 24391080 DOI: 10.1002/lsm.22221] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVE There is an increasing interest in treating vascular lesions with a long-pulse Alexandrite laser. However, it is difficult to search information in the literature about infantile hemangiomas (IH) treated with long-pulse Alexandrite laser. This article aims to determine whether 755 nm long-pulse Alexandrite laser is effective and safe for early intervention of IH and provides some new data on this issue. MATERIALS AND METHODS This is a retrospective study of 48 infants with IH treated with long-pulse Alexandrite laser during a 1.5-year period. Patients received a series of 1-7 treatment sessions with long-pulse Alexandrite laser at settings of 3 milliseconds pulse duration, 6-8 mm spot, 45-70 J/cm(2) fluences, and with dynamic cooling device (DCD) spray duration of 90 milliseconds and delay of 80 milliseconds, given at 4- to 6-week intervals. RESULTS This study demonstrated that IH responded favorably to the treatment of a long-pulse Alexandrite laser while accompany with relatively few complications. The difference between the original untreated and post-treatment scores of all IH and two subgroups were statistically significant, respectively (P < 0.01). The difference of the degree of improvement between the two subgroups was not significant (P > 0.05). It was observed that IH on the trunk and extremities improved more effectively and more quickly than those on the face, neck, and perineum. Besides, age at the first treatment, the sex of the patients and the presence of proliferation were not significantly correlated with the degree of improvement. Adverse effects were seen in 11 patients (22.91%): blistering (n = 9), marked edema and erosion without subsequent residual scarring (n = 1), and hypopigmentation (n = 1), which improved gradually with time. Fortunately, there was no incidence of scarring or ulceration in this case series of IH. CONCLUSIONS It was clinically effective and safe for early treatment of IH, including the thick/deep ones, with a long-pulse Alexandrite laser, which indicated be able to reduce the possibility that the IH will reach its full size. In this way it can prevent several complications connected to the rapid proliferation of IH.
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Affiliation(s)
- Wenting Su
- Department of Dermatology, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou Children's Hospital, Wenzhou, 325027, Zhejiang Province, China
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Abstract
Liver tumors seldom occur in the perinatal period. Hepatic hemangiomas are the most common tumors of the liver diagnosed during fetal and neonatal life. The diagnosis can be suspected antenatally by ultrasound and MR scan. The differential diagnosis is often challenging. While small hepatic hemangiomas are usually asymptomatic, large tumors can lead to complications such as high-output congestive heart failure, consumptive thrombocytopenic coagulopathy and hemorrhage after tumor rupture. We describe a case of hepatic hemangioma presenting as a solid abdominal mass with several cystic areas on an obstetric ultrasound and report on the contribition fetal MR imaging to the diagnosis.
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Affiliation(s)
- Halil Aslan
- Department of Maternal Fetal Medicine, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
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Zou HX, Jia J, Zhang WF, Sun ZJ, Zhao YF. Propranolol inhibits endothelial progenitor cell homing: a possible treatment mechanism of infantile hemangioma. Cardiovasc Pathol 2013; 22:203-10. [DOI: 10.1016/j.carpath.2012.10.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 10/04/2012] [Accepted: 10/05/2012] [Indexed: 12/17/2022] Open
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Bharti V, Singh J. Capillary hemangioma of palatal mucosa. J Indian Soc Periodontol 2012; 16:475-8. [PMID: 23162351 PMCID: PMC3498726 DOI: 10.4103/0972-124x.100935] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 04/16/2012] [Indexed: 11/28/2022] Open
Abstract
Hemangiomas are common tumors characterized microscopically by proliferation of blood vessels. The congenital hemangioma is often present at birth and may become more apparent throughout life. They are probably developmental rather than neoplastic in origin. Despite their benign origin and behavior, hemangiomas in the oral cavity are always of clinical importance to the dental profession and require appropriate clinical management. This case report presents a case of capillary hemangioma of anterior palatal mucosa in a 13-year-old female.
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Affiliation(s)
- Vipin Bharti
- Department of Periodontology, Government Dental College and Hospital, Patiala, Punjab, India
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Awadein A, Fakhry MA. Evaluation of intralesional propranolol for periocular capillary hemangioma. Clin Ophthalmol 2011; 5:1135-40. [PMID: 21887095 PMCID: PMC3162293 DOI: 10.2147/opth.s22909] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the use of intralesional propranolol injection in the management of periocular capillary hemangioma. METHODS A prospective study was performed in 22 consecutive patients with periocular hemangioma. Twelve patients underwent intralesional propranolol injection and ten patients underwent intralesional triamcinolone injection. The size of the lesion was measured serially every week during the first month, every 2 weeks for the second month, and then monthly for another 2 months. The refractive error and degree of ptosis if present were measured before injection and at the end of the study. RESULTS There was reduction in the size of hemangioma, astigmatic error, and degree of ptosis in both groups. The difference in outcome between both groups was not statistically significant. Rebound growth occurred in 25% of the propranolol group and 30% of the steroid group but responded to reinjection. No adverse effects were reported during or after intralesional propranolol injection. CONCLUSION Intralesional propranolol injection is an alternative and effective method for treatment of infantile periocular hemangioma.
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Abstract
This review shall familiarize the readers with various fundamental aspects of angiogenesis. Angiogenesis is a feature of a limited number of physiological processes like wound healing, ovulation, development of the corpus luteum, embryogenesis, lactating breast, during immune response, and during Inflammation. It is driven by a cocktail of growth factors and pro-angiogenic cytokines and is tempered by an equally diverse group of inhibitors of neovascularization. The properties and biological functions of angiogenic growth factors such as VEGF, FGF-2, nitric oxide, MMP, angiopoietin, TGF-β as well as various inhibitors such as angiostatin, endostatin, thrombospondin, canstatin, DII4, PEDF are discussed in this review with respect to their impact on angiogenic process. In recent years, it has become increasingly evident that excessive, insufficient, or abnormal angiogenesis contributes to the pathogenesis of many more disorders. A long list of disorders is characterized or caused by excessive or insufficient angiogenesis whereas several congenital or inherited diseases are also caused by abnormal vascular remodeling. It may be possible in the future to develop specific anti-angiogenic agents that offer a potential therapy for cancer and angiogenic diseases.
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Affiliation(s)
- Shraddha V Bhadada
- Institute of Pharmacy, Nirma University, Sarkhej-Gandhinagar Highway, Chharodi, Ahmedabad-382 481, Gujarat, India.
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Tumores vasculares en la infancia. An Pediatr (Barc) 2010; 72:143.e1-143.e15. [DOI: 10.1016/j.anpedi.2009.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Revised: 10/12/2009] [Accepted: 10/13/2009] [Indexed: 12/12/2022] Open
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Ranalli NJ, Huang JH, Lee EB, Zhang PJL, Siegelman ES, Zager EL. Hemangiomas of the brachial plexus: a case series. Neurosurgery 2009; 65:A181-8. [PMID: 19927066 DOI: 10.1227/01.neu.0000335643.41581.1d] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Hemangiomas of the brachial plexus are very rare, and there has not been a collection of multiple cases published in the literature to date. Extraneural brachial plexus hemangiomas typically present with similar signs and symptoms as nerve sheath tumors, including pain, paresthesia, and occasionally weakness, in addition to nonspecific imaging findings, making their diagnosis difficult. Exploratory surgery can lead to significant bleeding and nerve injury when a hemangioma or an associated aneurysm is encountered intraoperatively. We present 5 cases of extraneural hemangiomas causing brachial plexopathy, including pre-, intra-, and postoperative decision making, with an emphasis on diagnostic and management issues as well as outcomes. METHODS A retrospective review was performed of 5 patients who underwent surgery at a university teaching hospital between 1995 and 2007 for exploration of brachial plexus lesions that were confirmed to be hemangiomas at pathological examination. RESULTS All 5 patients presented with findings on history, physical examination, imaging, and electromyography suggesting a diagnosis of nerve sheath tumor. Two patients had biopsies (1 needle, 1 open), both of which were nondiagnostic. Three patients underwent digital subtraction angiography with successful preoperative embolization. Each patient had a complete or a radical subtotal tumor resection, and all were intact neurologically after surgical resection. Pathological evaluation identified 3 venous hemangiomas, 1 hemangioma with arteriovenous malformation features, and 1 Masson hemangioma associated with a large aneurysm. CONCLUSION Extraneural hemangiomas of the brachial plexus are very rare, but a high index of suspicion and appropriate preoperative evaluation, including angiography with the option for embolization, can result in decreased intraoperative hemorrhage and better patient outcomes.
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Affiliation(s)
- Nathan J Ranalli
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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Fernández Y, Bernabeu-Wittel M, García-Morillo JS. Kaposiform hemangioendothelioma. Eur J Intern Med 2009; 20:106-13. [PMID: 19327597 DOI: 10.1016/j.ejim.2008.06.008] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Revised: 06/03/2008] [Accepted: 06/09/2008] [Indexed: 12/14/2022]
Abstract
Kaposiform hemangioendothelioma (KHE) is a rare, locally aggressive vascular neoplasm that mainly occurs during childhood. It generally originates on the skin, usually affecting deeper tissue by infiltrative growth. It appears as one or multiple masses, and in most cases is associated to consumptive coagulopathy (Kasabach-Merritt syndrome), and lymphangiomatosis. Although visceral involvement is very uncommon, several cases with bone, retroperitoneal, or mediastinal involvement have been described. These tumors tend to be locally invasive, but are not known to produce distant metastases. The development of KHE in adolescents or in adults is very rare, but cases have also been described. Several factors are associated with the outcome of patients with KHE: accessibility to surgical excision, location (cutaneous versus visceral), size of tumoral mass, clinical response to interferon and glucocorticoids, and the absence of lymphangiomatosis and Kasabach-Merritt syndrome, may result in partial remissions. On the other hand, bulk visceral masses lead to a 40-50% mortality rate, mainly due to progressive failure of the infiltrated organ(s), in spite of interferon, glucocorticoids, and combined chemotherapy. In conclusion, the onset of a consumptive coagulopathy following the presence of a vascular tumor, in children as well as in older patients, should spark suspicion of KHE, among other entities.
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Affiliation(s)
- Y Fernández
- Medical Oncology Department, Hospitales Universitarios Virgen del Rocío, Sevilla, Spain.
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Stepansky F, Hecht EM, Rivera R, Hirsh LE, Taouli B, Kaur M, Lee VS. Dynamic MR angiography of upper extremity vascular disease: pictorial review. Radiographics 2007; 28:e28. [PMID: 17967936 DOI: 10.1148/radiol.e28] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Unlike peripheral lower extremity vascular disease, upper extremity vascular disease is relatively uncommon. While atherosclerosis and embolic disease are the most common causes of upper extremity ischemia, a wide variety of systemic diseases and anatomic abnormalities can affect the upper extremity. Upper extremity ischemia poses a significant diagnostic and therapeutic challenge for both clinicians and radiologists. Although history and physical examination remain the mainstays of diagnosis, imaging can be vital in confirming suspected disease and guiding treatment planning. Digital subtraction angiography is often the preferred method for detection of upper extremity vascular disease, particularly for characterization of complex arteriovenous anatomy such as in vascular malformations and for evaluation of dialysis fistulas and grafts. However, this modality is invasive, requires iodinated contrast agents and radiation, and may fail to demonstrate significant extraluminal disease. More recently, magnetic resonance (MR) angiography techniques have made important advances, permitting higher temporal and spatial resolution that is preferable for diagnosing upper extremity vascular disorders. In this review, the authors present an overview of upper extremity MR angiography techniques and protocols, revisit the often variable vascular anatomy of the arm and hand, and offer examples of various pathologic entities diagnosed with MR angiography. Finally, several imaging pitfalls that one must be aware of for accurate diagnosis are illustrated and reviewed.
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Affiliation(s)
- Flora Stepansky
- Department of Radiology, 560 First Avenue, TCH-HW-202, New York University Medical Center, New York, NY 10016, USA
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Affiliation(s)
- Michael J Sundine
- Aesthetic & Plastic Surgery Institute, University of California-Irvine, Orange, California 92868-3298, USA
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Xia B, Dorsman JC, Ameziane N, de Vries Y, Rooimans MA, Sheng Q, Pals G, Errami A, Gluckman E, Llera J, Wang W, Livingston DM, Joenje H, de Winter JP. Fanconi anemia is associated with a defect in the BRCA2 partner PALB2. Nat Genet 2006; 39:159-61. [PMID: 17200672 DOI: 10.1038/ng1942] [Citation(s) in RCA: 344] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2006] [Accepted: 11/27/2006] [Indexed: 11/08/2022]
Abstract
The Fanconi anemia and BRCA networks are considered interconnected, as BRCA2 gene defects have been discovered in individuals with Fanconi anemia subtype D1. Here we show that a defect in the BRCA2-interacting protein PALB2 is associated with Fanconi anemia in an individual with a new subtype. PALB2-deficient cells showed hypersensitivity to cross-linking agents and lacked chromatin-bound BRCA2; these defects were corrected upon ectopic expression of PALB2 or by spontaneous reversion.
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Affiliation(s)
- Bing Xia
- Dana-Farber Cancer Institute and Harvard Medical School, 44 Binney Street, Boston, Massachusetts 02115, USA
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Birchler MT, Schmid S, Holzmann D, Stallmach T, Gysin C. Kaposiform hemangioendothelioma arising in the ethmoid sinus of an 8-year-old girl with severe epistaxis. Head Neck 2006; 28:761-4. [PMID: 16721737 DOI: 10.1002/hed.20414] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Epistaxis is very common during childhood. It occurs primarily in boys and is usually self-limiting. Trauma and nose picking are among the most common causes. In general, epistaxis can be easily treated with anterior nasal packing or electrocoagulation. METHODS We report a case of an 8-year-old girl with severe unilateral epistaxis. RESULTS The bleeding originated from a kaposiform hemangioendothelioma arising in the left nasal cavity and ethmoid sinus. The feeding vessels originating from the maxillary artery were first embolized. The tumor was then surgically removed through a combined external ethmoidectomy and endonasal approach. The postoperative course was uneventful. MRI at 6 months after surgery showed no tumor recurrence. CONCLUSIONS We report a previously undescribed cause of epistaxis in children, namely, a kaposiform hemangioendothelioma. To our knowledge, this is the first such case in the English-language literature. The differential diagnosis of severe unilateral nasal bleeding among the pediatric population should include the possibility of a kaposiform hemangioendothelioma.
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Affiliation(s)
- Manfred T Birchler
- Department of Otolaryngology, University Children's Hospital Zurich, Switzerland
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Muzaffar AR, Friedrich JB, Lu KK, Hanel DP. Infantile fibrosarcoma of the hand associated with coagulopathy. Plast Reconstr Surg 2006; 117:81e-86e. [PMID: 16641700 DOI: 10.1097/01.prs.0000206314.29607.2b] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Large congenital neoplasms of the extremities may be associated with coagulopathies and significant hemorrhage in the neonatal period. At times, the differences between coagulation derangements can be very subtle, leading to errors in diagnosis. Infants with vascular lesions and coagulopathies are often found to have the Kasabach-Merritt phenomenon, which is a platelet-trapping coagulopathy. However, other neoplasms or vascular malformations can be accompanied by disseminated intravascular coagulation. It is important to obtain accurate diagnoses of the neoplasm and the coagulopathy because the treatments of similar-appearing tumors and coagulopathies can be markedly different. METHODS The authors report the case of a newborn with a congenital tumor of the left hand that was accompanied by a coagulopathy that caused significant bleeding. RESULTS A presumption was made by the neonatal critical care physicians and hematologists that the infant had a kaposiform hemangioendothelioma along with the Kasabach-Merritt phenomenon. However, steroid treatment did not reduce the size of the mass or correct the coagulopathy. Only after obtaining consultation with a hand surgeon and a tissue diagnosis was it learned that the patient had an infantile fibrosarcoma that was accompanied by disseminated intravascular coagulation. Limb-sparing resection of the lesion along with chemotherapy markedly improved the patient's condition. CONCLUSIONS Large congenital neoplasms presenting with attendant bleeding diatheses must be rapidly and accurately diagnosed with both a biopsy-proven tissue diagnosis and a hematologic characterization of the nature of the coagulopathy. The differential diagnosis of a vascular-appearing mass in the extremity can be subtle, and presumptive diagnosis, as occurred in this case, can lead to incorrect or delayed treatment. Specifically, kaposiform hemangioendothelioma must be differentiated from infantile fibrosarcoma. The principles of infantile fibrosarcoma treatment are limb-sparing resection and chemotherapy.
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Affiliation(s)
- Arshad R Muzaffar
- Division of Plastic Surgery, Department of Orthopedics, Children's Hospital and Regional Medical Center, University of Washington, Seattle, Washington 98104-2499, USA
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Leon-Villapalos J, Wolfe K, Kangesu L. GLUT-1: an extra diagnostic tool to differentiate between haemangiomas and vascular malformations. ACTA ACUST UNITED AC 2005; 58:348-52. [PMID: 15780229 DOI: 10.1016/j.bjps.2004.05.029] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2003] [Accepted: 05/27/2004] [Indexed: 10/26/2022]
Abstract
The differential diagnosis between juvenile haemangiomas, vascular malformations, pyogenic granulomas and normally proliferative endothelium (granulation tissue) on the basis of histology alone is sometimes difficult. This is important because haemangiomas, are self-limiting and vascular malformations are not. We report our experience of using the immunohistochemical marker GLUT-1 to distinguish haemangiomas from vascular malformations following the initial report by North and Colleagues (1998). We studied a total of 50 specimens from patients with vascular anomalies, and found that GLUT-1 reactivity was positive in 18 out of 19 juvenile haemangiomas, negative in two out of two noninvoluting congenital haemangiomas (NICH) and negative in 29 out of 29 vascular malformations, that included capillary malformations, lymphatic malformations, venous malformations and arteriovenous malformations (95% sensitivity, 100% specificity). Pyogenic granulomas (n = 4) and granulation tissue samples (n = 4) were used as negative controls. Placenta tissue was used as positive control. GLUT-1 accurately distinguishes haemangiomas from vascular malformations, and as a result from this work, we use this technique in routine histopathological differentiation of vascular anomalies.
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Affiliation(s)
- J Leon-Villapalos
- Department of Plastic and Reconstructive Surgery, St Andrews Centre for Plastic Surgery and Burns, Court Road, Broomfield, Chelmsford CM1 7ET, UK
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Abstract
Primary tumors of the heart are uncommon in the fetus and neonate. Nevertheless, the widespread use of new imaging techniques has contributed significantly to earlier diagnosis, treatment, and thus improved survival. The clinical findings, imaging studies, pathology, and outcome of 224 fetuses and neonates with cardiac tumors collected from the literature are evaluated and discussed. Most tumors are benign, and of these rhabdomyoma is the most common, followed by teratoma, fibroma, oncocytic cardiomyopathy, vascular tumors, and myxoma. Malignant and metastatic tumors are described but are rare. Murmurs, arrhythmias, cyanosis, respiratory distress, and cardiac failure are the main presenting signs of cardiac tumors in the perinatal period. Disturbances in hemodynamic function are correlated with the size and location of the tumor. Cardiac vascular tumors have the best outcome, whereas malignant tumors have the worst. The purpose of this review is to concentrate on the fetus and neonate in an attempt to determine the various ways cardiac tumors differ clinically and morphologically in this age group from those occurring in older children and adults and to show that certain types of tumors have a better prognosis than others.
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Affiliation(s)
- H Isaacs
- Department of Pathology, Children's Hospital San Diego, 3020 Children's Way, MC 5007, San Diego, CA 92123, USA.
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Kassarjian A, Zurakowski D, Dubois J, Paltiel HJ, Fishman SJ, Burrows PE. Infantile hepatic hemangiomas: clinical and imaging findings and their correlation with therapy. AJR Am J Roentgenol 2004; 182:785-95. [PMID: 14975986 DOI: 10.2214/ajr.182.3.1820785] [Citation(s) in RCA: 157] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study was undertaken to determine different imaging patterns in infantile hepatic hemangiomas and to explore the relationship between clinical presentations, imaging findings, and response to therapy. MATERIALS AND METHODS The imaging studies and clinical records of all patients with infantile hepatic hemangiomas from two tertiary children's hospitals were reviewed. Univariate and multivariate stepwise logistic regression techniques were used to determine whether clinical presentation and imaging variables differentiated the type of treatment required. RESULTS Typical hemangiomas appeared as focal or multifocal T2-hyperintense spheres with centripetal contrast enhancement and dilated feeding and draining vessels. Three atypical patterns included focal mass lesions with central varix with or without direct shunts, focal mass with central necrosis or thrombosis, and massive hemangiomatous involvement of the liver with abdominal vascular compression. In general, patients with focal lesions without high flow needed no treatment, and those with central varix and direct shunts developed severe high-output cardiac failure that responded quickly to embolization. The pattern of massive replacement of liver was associated with hypothyroidism, abdominal compartment syndrome, and a high mortality rate. Multivariate analysis of 55 patients indicated that congestive heart failure was the only independent predictor of treatment (p = 0.005). The presence of a shunt was the only independent factor associated with embolization or surgery (p = 0.002). CONCLUSION Although the imaging features of infantile hepatic hemangiomas vary to some extent, MRI features are typical in most patients and certain imaging findings are predictive of the clinical course. MRI is the technique of choice in diagnosing infantile hepatic masses.
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Affiliation(s)
- Ara Kassarjian
- Department of Radiology, Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, USA
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Abstract
As novas classificações disponíveis e os modernos recursos diagnósticos por imagem não só permitiram a diferenciação entre os tumores e as malformações vasculares, mas também modificaram de forma substancial a abordagem e o tratamento dessas anomalias. O hemangioma da infância, o mais comum dos tumores vasculares dessa faixa etária e objeto deste trabalho, é revisto do ponto de vista de suas características clínicas e laboratoriais, diagnóstico diferencial e opções terapêuticas. Embora a conduta expectante permaneça como o tratamento de escolha para a maioria dos casos, o julgamento crítico é crucial para o emprego de outras modalidades terapêuticas.
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Kush ML, Weiner CP, Harman CR, Baschat AA. Lethal progression of a fetal intracranial arteriovenous malformation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2003; 22:645-648. [PMID: 12795562 DOI: 10.7863/jum.2003.22.6.645] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Fetal intracranial vascular tumors present unique clinical challenges. Accurate diagnosis of the lesion, as well as an understanding of the local and systemic impacts, will guide the antenatal surveillance and the treatment plan and will determine the prognosis. Management will be altered by and dependent on intrauterine progression, gestational age, and fetal condition at birth. In addition, large vascular tumors can lead to the development of the Kasabach-Merritt sequence in the fetus and to either fetal or maternal hemodynamic impairment. Vascular tumors are either malformations or neoplasms. Color and pulsed wave Doppler sonography are useful for the identification of vascular lesions and help narrow the differential diagnosis. Once a vascular malformation is identified, a comprehensive anatomic survey is mandatory to determine whether there are coexistent malformations that impact either the diagnosis or prognosis. These lesions can have local mass effects, systemic hemodynamic effects, or both. Therefore, longitudinal assessment of the fetus is focused on the detection of lesion progression and on any fetal or maternal status changes. We report the prenatal diagnosis of an intracranial arteriovenous malformation (AVM) with a dramatic progression affecting both mother and fetus.
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Affiliation(s)
- Michelle L Kush
- Center for Advanced Fetal Care, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland Baltimore, 405 W Redwood St, Fourth Floor, Baltimore, MD 21201, USA.
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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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George M, Singhal V, Sharma V, Nopper AJ. Successful surgical excision of a complex vascular lesion in an infant with Kasabach-Merritt syndrome. Pediatr Dermatol 2002; 19:340-4. [PMID: 12220282 DOI: 10.1046/j.1525-1470.2002.t01-1-00097.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Kasabach-Merritt syndrome, the association of a vascular lesion and consumptive coagulopathy, can represent a diagnostic and therapeutic challenge to clinicians. We describe an infant with a large complex vascular lesion of the left forearm that was successfully surgically excised. We propose surgical excision as an appropriate therapeutic option for some cases of Kasabach-Merritt syndrome.
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Affiliation(s)
- Manju George
- Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, Missouri 64108, USA
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Dubois J, Garel L, David M, Powell J. Vascular soft-tissue tumors in infancy: distinguishing features on Doppler sonography. AJR Am J Roentgenol 2002; 178:1541-5. [PMID: 12034635 DOI: 10.2214/ajr.178.6.1781541] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We describe the sonographic appearance and vascularization of three types of vascular tumors, including hemangioendothelioma, tufted angioma, and infantile myofibromatosis, and we determine whether vessel density and peak systolic shift can distinguish these tumors from angiomas and differentiate between the subtypes of these three entities. SUBJECTS AND METHODS Our study included 16 infants with vascular tumors, other than hemangiomas, who were to undergo biopsy. We used gray-scale sonography to identify calcifications, to evaluate the borders of the lesions to determine whether they were poorly defined or well defined, and to determine the echogenicity relative to the surrounding soft tissue. Doppler sonography served to determine the number of vessels per square centimeter and the peak arterial Doppler shift. Sonographic findings were compared with the final diagnoses established by biopsy. RESULTS The final diagnoses included five hemangioendotheliomas, six tufted angiomas, and five infantile myofibromatoses. Hemangioendotheliomas and tufted angiomas were ill defined compared with infantile myofibromatoses that were well defined. Only one vascular tumor, a hemangioendothelioma, fulfilled the diagnostic criteria of hemangioma. Tufted angiomas and infantile myofibromatoses were the least vascularized, with the lowest vessel density (zero to two vessels per square centimeter) and a relatively low systolic Doppler shift (0.7-1.0 kHz). CONCLUSION The vascular tumors-hemangioendotheliomas, tufted angiomas, and infantile myofibromatoses-were distinguishable from hemangiomas on Doppler sonography in all cases except one hemangioendothelioma. Unlike hemangiomas, these lesions should be investigated by biopsy or excision.
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Affiliation(s)
- Josée Dubois
- Department of Medical Imaging, Hôpital Sainte-Justine and University of Montreal, 3175 Côte Ste-Catherine, Montreal, Quebec, H3T 1C5 Canada
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Gembruch U, Baschat AA, Gloeckner-Hoffmann K, Gortner L, Germer U. Prenatal diagnosis and management of fetuses with liver hemangiomata. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2002; 19:454-460. [PMID: 11982977 DOI: 10.1046/j.1469-0705.2002.00689.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVES To study the relationship between prenatal appearance and perinatal outcome of fetuses with hepatic hemangiomata with special emphasis on criteria that may help to improve perinatal management. METHODS In a tertiary referral center six fetuses with hepatic hemangiomata were evaluated by gray-scale, color, and pulsed wave Doppler ultrasound between 1994 and 2000. Fetal blood sampling was performed in four cases. All data (computerized files and video tapes) were analyzed retrospectively. RESULTS Two fetuses showed very similar sonographic findings. They had an isolated large ('giant') round hepatic hemangioma (diameter 43 and 68 mm, respectively) supplied by one hepatic artery and drained by one hepatic vein, both of them showing high velocity and low pulsatility blood flow. Fetal blood count and coagulation parameters were normal in one case, whereas the other fetus showed a Kasabach-Merritt sequence with severe thrombocytopenia (10 platelets/nL) and mild disseminated intravascular coagulation. Intrauterine platelet transfusion was performed immediately prior to planned Cesarean delivery. Rapid platelet consumption continued postnatally, requiring several thrombocyte transfusions. Platelet counts stabilized only after tumor resection on the second day of life. One fetus with diffuse neonatal hemangiomatosis developed high-output cardiac failure with hydrops in addition to Kasabach-Merritt sequence (15 platelets/nL), and died following premature delivery. Three fetuses, however, showing an isolated small hyperechogenic hepatic hemangioma (5, 5, and 6 mm in diameter, respectively) did not develop any perinatal complications. CONCLUSION Large fetal liver hemangiomata and diffuse hemangiomatosis may cause severe perinatal complications, particularly high-output cardiac failure and/or Kasabach-Merritt sequence with severe consumption of platelets and clotting factors and hemolytic anemia. Fetal blood sampling enables the prenatal detection of these potential complications, allowing critical modification of perinatal management such as intrauterine platelet transfusion, especially directly before delivery. In contrast, isolated small hyperreflexic hepatic hemangiomata do not appear to be associated with any of these fetal and postnatal sequelae.
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Affiliation(s)
- U Gembruch
- Department of Obstetrics and Gynecology, Medical University, Lübeck, Germany.
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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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37
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Abstract
Many surgeons who operate on nasal tip hemangiomas find a central vertical scar frustrating. Alternatives such as open rhinoplasty provide great exposure, but the redraping leaves unsightly scars along the alar rim and columella. Therefore, a new aesthetic incision was needed to allow hemangioma reduction in both the horizontal and vertical dimensions while providing adequate access to the lower lateral cartilage for soft-tissue reduction and/or suturing. The subunit incision, based on the pioneering work of Burget and Menick, was developed to provide both excellent exposure and cosmesis. By designing the incision to lie along the contour lines of the nasal subunits, the senior author (B.M.Z.) believed that the border scars would reflect lines of light and cast linear shadows that would mimic the normal ridges and valleys that separate the topographic subunits of the nose. Based on the results of nine recent cases, the authors believe the subunit incision is currently the best approach to correcting nasal tip hemangiomas.
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Affiliation(s)
- Stephen M Warren
- Laboratory of Developmental Biology and Repair, Institute of Plastic and Reconstructive Surgery, New York University School of Medicine, New York, NY, USA
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38
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Mason KP, Neufeld EJ, Karian VE, Zurakowski D, Koka BV, Burrows PE. Coagulation abnormalities in pediatric and adult patients after sclerotherapy or embolization of vascular anomalies. AJR Am J Roentgenol 2001; 177:1359-63. [PMID: 11717083 DOI: 10.2214/ajr.177.6.1771359] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The purpose of our study was to examine the coagulation status in patients with vascular anomalies who had undergone sclerotherapy or embolization. SUBJECTS AND METHODS Ours was a prospective pilot study of 29 patients who had undergone sclerotherapy or embolization of large vascular anomalies. Fibrinogen, platelet, and d-dimer levels and prothrombin time were obtained before, immediately after, and on the day after the procedure. RESULTS Five patients with venous malformations had positive d-dimer levels before the procedure. A subgroup analysis revealed a relationship between the type of agent used and the change in coagulation status. Specifically, a positive relationship was found between the use of dehydrated alcohol or sodium tetradecyl sulfate and a disruption in coagulation profiles as evidenced by a decrease in platelets and fibrinogen, an increase in prothrombin time, and a conversion from negative to positive d-dimers. In contrast, sclerotherapy or embolization with cyanoacrylic, polyvinyl alcohol foam particles, or platinum microcoils was not associated with coagulation disturbances. CONCLUSION The coagulation disturbances that occur in response to dehydrated alcohol or sodium tetradecyl sulfate sclerotherapy or embolization could compromise the patient's clotting ability. Patients who receive dehydrated alcohol or sodium tetradecyl sulfate during a preoperative sclerotherapy or embolization may experience coagulation disturbances that could increase the risk of bleeding, thrombosis, or hematoma. This patient population may benefit from the use of glue, foam, or coils as a substitute for dehydrated alcohol or sodium tetradecyl sulfate.
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Affiliation(s)
- K P Mason
- Department of Anesthesia, Children's Hospital, 300 Longwood Ave., Boston, MA 02115-5737, USA
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Rodriguez-Galindo C, Hill DA, Onyekwere O, Pin N, Rao BN, Hoffer FA, Kun LE, Pappo AS, Santana VM. Neonatal alveolar rhabdomyosarcoma with skin and brain metastases. Cancer 2001; 92:1613-20. [PMID: 11745240 DOI: 10.1002/1097-0142(20010915)92:6<1613::aid-cncr1487>3.0.co;2-n] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Approximately 5-10% of patients with rhabdomyosarcomas (RMS) are diagnosed during the first year of life, and their clinical characteristics have been well documented. However, because RMS rarely occurs during the neonatal period, little is known about neonatal RMS. METHODS Four patients with neonatal RMS were treated at St. Jude Children's Research Hospital between 1962 and 1999. The authors report the results of a review of these patients and of cases described in the literature. Clinical, radiologic, and pathologic features of these patients and their outcomes were evaluated. RESULTS One patient with embryonal RMS was treated successfully with a combination of systemic chemotherapy and local control measures. The other three patients had alveolar RMS. Two of them had multiple skin and subcutaneous metastatic nodules at the time of diagnosis and developed brain metastases early in their course. In one of these patients, the PAX3-FKHR fusion transcript was detected. Three other similar cases of neonatal alveolar RMS with metastases to the skin and brain have been reported in the literature. CONCLUSIONS A distinct syndrome of neonatal RMS is described. This syndrome is characterized by alveolar histology, multiple skin and subcutaneous metastases, and fatal outcome as the result of early brain metastasis.
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Affiliation(s)
- C Rodriguez-Galindo
- Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, USA.
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Moore J, Lee M, Garzon M, Soffer S, Kim E, Saouaf R, del Toro G, Yamashiro D, Kandel J. Effective therapy of a vascular tumor of infancy with vincristine. J Pediatr Surg 2001; 36:1273-6. [PMID: 11479875 DOI: 10.1053/jpsu.2001.25793] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Vascular tumors are common in infancy, affecting as many as 10% of children. These lesions often follow a benign course, with an initial proliferative phase followed by spontaneous involution, and require no therapy. Others manifest explosive early growth and Kasabach-Merritt phenomenon, requiring therapeutic intervention. Occasionally, some bulky tumors threaten life or vision because of mass effect, also mandating intervention. Steroids are the mainstay of therapy, but often are ineffective. Interferon alpha (2a and 2b) has been used as second-line therapy in cases of steroid failure. However, interferon therapy has been associated with a significant incidence of spastic diplegia. The authors present the case of a 3-month-old girl in whom respiratory distress secondary to tracheal compression developed. Magnetic resonance imaging and magnetic resonance angiography showed a large cervicothoracic lesion encasing the great vessels and displacing the airway. She did not display associated Kasabach-Merritt phenomenon. The lesion proved refractory to standard steroid therapy, but responded dramatically to 4 cycles of vincristine (0.05 mg/kg). Although this agent has been used in children with life-threatening Kasabach-Merritt phenomenon, this is the first time it has been described in the setting of compromised vital function. Vinca alkaloids recently have been shown to have potent antiangiogenic activities in experimental models. Given the low predicted incidence of side effects at this dose, vincristine used as an antiangiogenic agent may prove an attractive alternative therapy for patients with life-threatening vascular tumors of infancy.
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Affiliation(s)
- J Moore
- Division of Pediatric Surgery, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Affiliation(s)
- G W Hall
- Paediatric Haematology/Oncology Unit, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 DU9, UK.
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Current diagnostics in office practice evaluation and nonoperative management of vascular malformations. Curr Opin Otolaryngol Head Neck Surg 2000. [DOI: 10.1097/00020840-200012000-00002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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