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Rikhotso RE, Alharbi AA. Management of Refractory Mandibular Kaposiform Hemangioendothelioma with Sirolimus: A Case Report and Review of the Literature. J Oral Maxillofac Surg 2021; 79:2086.e1-2086.e8. [PMID: 34153244 DOI: 10.1016/j.joms.2021.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
Kaposiform hemangioendothelioma (KHE) is a rare vascular neoplasm of intermediate malignancy that generally occurs in infancy and early childhood. Typically, the lesion arises from superficial or deep soft tissues of the extremities, trunk and retroperitoneum. The paucity of reported cases of head and neck KHEs is evidence of the rarity of the disease in this region. We report on the presentation and treatment of KHE in an 11-month-old boy who presented with a mandibular lesion. We include a brief discussion about the differential diagnosis of KHE. Management involved preoperative interventional radiology, surgical excision and chemotherapeutic treatment with Sirolimus. The lesion resolved without evidence of relapse 12 months later.
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Affiliation(s)
- Risimati Ephraim Rikhotso
- Department Head, Department of Maxillofacial and Oral Surgery, Wits School of Oral Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Abdulaziz Abdullah Alharbi
- Consultant, Department of Maxillofacial and Oral Surgery, Faculty of Dentistry, Taif University, Alhawiah, Saudi Arabia
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Radović SV, Kolinović M, Ljubić D. Propranolol in the preoperative treatment of Kasabach-Merritt syndrome: a case report. J Med Case Rep 2017; 11:308. [PMID: 29073926 PMCID: PMC5658992 DOI: 10.1186/s13256-017-1475-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 09/21/2017] [Indexed: 12/31/2022] Open
Abstract
Background Kasabach–Merritt syndrome represents the association of hemangioma with thrombocytopenia and consumptive coagulopathy. We present a case of Kasabach–Merritt syndrome treatment with orally administered propranolol. Case presentation A 4.5-month-old caucasian female infant with congenital giant hemangioma in the posterior region of her neck presented to our Institute for Childhood Diseases where she underwent clinical, laboratory, and radiological investigations. A low blood platelet count indicated the use of corticosteroids and blood components as first-line therapy. The lack of therapeutic response induced the introduction of orally administered propranolol as additive therapy. A 3-week treatment led to a reduction in the size of hemangioma and a rise in platelet count which enabled surgical treatment and definite healing. Conclusion Orally administered propranolol as monotherapy or in combination with other therapeutic modalities may play a key role in the treatment of Kasabach–Merritt syndrome.
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Affiliation(s)
- Saša V Radović
- Pediatric Surgery Clinic, Institute for Childhood Diseases, Clinical Centre of Montenegro, Kruševac nn, 81000, Podgorica, Montenegro
| | - Marija Kolinović
- Pediatric Surgery Clinic, Institute for Childhood Diseases, Clinical Centre of Montenegro, Kruševac nn, 81000, Podgorica, Montenegro.
| | - Darja Ljubić
- Pediatric Clinic, Institute for Childhood Diseases, Clinical Centre of Montenegro, Podgorica, Montenegro
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O'Rafferty C, O'Regan GM, Irvine AD, Smith OP. Recent advances in the pathobiology and management of Kasabach-Merritt phenomenon. Br J Haematol 2015; 171:38-51. [PMID: 26123689 DOI: 10.1111/bjh.13557] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Kasabach-Merritt Phenomenon (KMP) refers to the clinical constellation of thrombocytopenia, consumptive coagulopathy and purpura associated with Kaposiform haemangioedothelioma or tufted angioma, but not the more common infantile haemangioma. It shows a variable and unpredictable response to traditional pharmacological agents, such as steroids, vincristine or interferon alpha 2a or 2b. More recently, the interaction between platelets and endothelial cells and the proangiogenic phenotype that results has been recognized to underly the pathogenesis of this disorder. Recent efforts have attempted to target the platelet by using antiplatelet agents and by the withholding of platelet transfusions even in those patients who have significant thrombocytopenia and laboratory evidence of coagulopathy. Excellent response rates and prompt results have been achieved by combining antiplatelet therapy with vincristine, without the need for steroid use. This synergistic approach moves away from the conventional wisdom of treating the underlying lesion to control the coagulopathy. Sirolimus, which is directed against the PI3/AKT/mTOR downstream signalling pathway involved in lymphangiogenesis, has also shown promising results, although further study is needed.
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Affiliation(s)
- Ciara O'Rafferty
- Department of Haematology, Our Lady's Children's Hospital, Dublin, Ireland
| | - Grainne M O'Regan
- Department of Dermatology, Our Lady's Children's Hospital, Dublin, Ireland
| | - Alan D Irvine
- Department of Dermatology, Our Lady's Children's Hospital, Dublin, Ireland.,Trinity College, Dublin, Dublin, Ireland
| | - Owen P Smith
- Department of Haematology, Our Lady's Children's Hospital, Dublin, Ireland.,Trinity College, Dublin, Dublin, Ireland
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4
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[Congenital prenatal hemangioma: diagnosis and treatment]. Arch Pediatr 2010; 17:383-6. [PMID: 20189370 DOI: 10.1016/j.arcped.2010.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2008] [Revised: 02/18/2009] [Accepted: 01/09/2010] [Indexed: 11/20/2022]
Abstract
An echogenic tumor (22 x 22 mm) isolated from the anterior part of the left leg at 27 WA of pregnancy suggested an angiomatous structure. This mass appeared to be well vascularized on Doppler examination. Three-dimensional imaging showed connections with adjacent tissues. The limbs were mobile. Delivery of a 3990-g-boy occurred normally. On the anterior part of the left leg, there was a plate-shaped mass with a pink hole at the superior part. Excision under general anesthesia was performed at the first month because of the risk of rupture and bleeding. The dissection was easy with the deep plane. Healing was complete 10 days after the surgical procedure and the aesthetic aspect was good 1 year later. Histological findings of the suspect mass emphasize the vascular aspect of the tumor. A hemangioma capillary with venous structures in the dermal hypodermic area was found.
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Aslan A, Meyer Zu Vilsendorf A, Kleine M, Bredt M, Bektas H. Adult Kasabach-Merritt Syndrome due to Hepatic Giant Hemangioma. Case Rep Gastroenterol 2009; 3:306-312. [PMID: 21103246 PMCID: PMC2988922 DOI: 10.1159/000242420] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Cavernous hemangiomas are the most common benign tumors of the liver. They can reach enormous sizes and cause various complications. Kasabach-Merritt syndrome is a rare but serious complication characterized by consumptive coagulopathy caused by the hemangioma; mortality rate ranges between 10 and 37%. More than 80% of cases occur within the first year of life. Goals of the treatment are to control the coagulopathyand thrombocytopenia as well as to eradicate the hemangioma. Different nonsurgical treatment regimens are performed, includingsystemic corticosteroids, irradiation and various chemicals. Surgery should be limited to symptomatic or complicated cases. Although difficult, resection of the tumor is usually curative. Here we present a 44-year-old woman with giant hepatic hemangioma causing Kasabach-Merritt syndrome managed by enucleation.
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Affiliation(s)
- Ahmet Aslan
- Department of General Surgery, Faculty of Medicine, Mustafa Kemal University, Antakya-Hatay, Turkey
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Leong E, Bydder S. Use of radiotherapy to treat life-threatening Kasabach-Merritt syndrome. J Med Imaging Radiat Oncol 2009; 53:87-91. [DOI: 10.1111/j.1754-9485.2009.02042.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kwok-Williams M, Perez Z, Squire R, Glaser A, Bew S, Taylor R. Radiotherapy for life-threatening mediastinal hemangioma with Kasabach-Merritt syndrome. Pediatr Blood Cancer 2007; 49:739-44. [PMID: 16453298 DOI: 10.1002/pbc.20767] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Kasabach-Merritt Syndrome (KMS) originally referred to a hemangioma associated with life-threatening thrombocytopenia and a consumption coagulopathy. Treatment includes surgery, steroids, and alpha interferon. However response may be unsatisfactory and mortality rates of 10-37% have been reported. We report a case of a 4-month-old male whose disease had not responded to steroids and alpha interferon. He required ventilation, and his condition was deteriorating. It was thought that he would probably die of his condition. He was treated with 9 Gy in three fractions weekly of radiotherapy (RT). Clinical response was good and he is well and free from progression 4 years and 7 months after RT. A review of the literature on the role of RT in the management of hemangiomas is presented.
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Affiliation(s)
- P Le Nouail
- Service de Dermatologie et Vénéréologie, CHU Sud, Amiens
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Enjolras O, Picard A, Soupre V. Hémangiomes congénitaux et autre tumeurs vasculaires infantiles rares. ANN CHIR PLAST ESTH 2006; 51:339-46. [PMID: 16997442 DOI: 10.1016/j.anplas.2006.07.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A number of infantile tumours, far less frequent than infantile haemangiomas, were long assimilated to them. Today they are clearly individualised, based on distinctive clinical and pathologic features, and this difference has been supported by the discovery of new immunophenotypic markers such as GLUT1. GLUT1 stains 100% of infantile haemangiomas and none of the other infantile vascular tumours. Congenital haemangiomas represent a group of vascular tumours still under evaluation as they have slightly heterogeneous presentation. Their prognosis is better appraised and their therapeutic management has improved. They are all fully grown in utero and they do not experience postnatal proliferation like haemangiomas do. Some of them (RICH--Rapidly Involuting Congenital Haemangioma) undergo spontaneous involution during the first year. Others (NICH--Non Involuting Congenital Haemangioma) persist lifelong. Tufted angioma and kaposiform haemangioendothelioma are histopathologically well characterized; in addition they are now considered as part of a same spectrum of vascular tumours, with the contribution of lymphatic endothelial cells in their proliferation. Both are clearly the tumours able to create platelet trapping, thrombocytopenia and the life-threatening Kasabach-Merritt syndrome. However they may occur as isolated tumours, without thrombocytopenia but with cosmetic, and sometimes function-impairing, consequences.
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Affiliation(s)
- O Enjolras
- Consultations des angiomes, service du Professeur-Marie-Paule-Vazquez, hôpital d'enfants Armand-Trousseau, Inserm U714, université Paris-VI, Assistance-publique-Hôpitaux de Paris, 75571 Paris cedex 12, France.
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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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Braun-Falco O, Plewig G, Wolff HH, Burgdorf WHC. Disorders of Hemostasis. Dermatology 2000. [DOI: 10.1007/978-3-642-97931-6_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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