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Gupta R, Bhandari A, Navarro OM. Pediatric Vascular Anomalies: A Clinical and Radiological Perspective. Indian J Radiol Imaging 2024; 34:103-127. [PMID: 38106867 PMCID: PMC10723972 DOI: 10.1055/s-0043-1774391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
According to the International Society for the Study of Vascular Anomalies (ISSVA) classification, vascular anomalies include a diverse range of pathologies, classified as either vascular tumors or vascular malformations. This classification, last revised in 2018, aims to explain the biological basis of vascular lesions and help clinicians to manage the anomalies. In vascular tumors, there are proliferative changes of endothelial cells, while vascular malformations primarily consist of structural vascular abnormalities. Infantile hemangioma is the most common soft-tissue vascular tumor. Vascular malformations are an extensive group of malformations of the arterial, venous, and lymphatic systems, either in isolation or in combination. Radiological evaluation plays a key part in the management of pediatric patients with these entities. The understanding of sonography and magnetic resonance imaging findings entails its correlation with clinical findings at the time of scanning.
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Affiliation(s)
- Rahul Gupta
- Department of Paediatric Surgery, SMS Medical College, JLN Marg, Jaipur, Rajasthan, India
| | - Anu Bhandari
- Department of Radiodiagnosis, SMS Medical College, JLN Marg, Jaipur, Rajasthan, India
| | - Oscar M. Navarro
- Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
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Bitar R, Ayoade O, Yekula A, Reddy V, Pantel H, Nassiri N. Direct stick embolization of a rectal venous malformation via transanal minimally invasive surgery. J Vasc Surg Cases Innov Tech 2023; 9:101124. [PMID: 37427040 PMCID: PMC10323409 DOI: 10.1016/j.jvscit.2023.101124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/26/2023] [Indexed: 07/11/2023] Open
Abstract
Rectal venous malformations (VMs) are rare clinical entities with variable patterns of presentation. Treatment requires unique, targeted strategies based on the symptoms, associated complications, and location, depth, and extent of the lesion. We present a rare case of a large, isolated rectal VM treated by direct stick embolization (DSE) using transanal minimally invasive surgery (TAMIS). A 49-year-old man had presented with a rectal mass incidentally detected on computed tomography urography. Magnetic resonance imaging and endoscopy revealed an isolated rectal VM. Elevated D-dimer levels concerning for localized intravascular coagulopathy warranted the use of prophylactic rivaroxaban. To avoid invasive surgery, DSE using TAMIS was performed successfully without complications. His postoperative recovery was uneventful, aside from a self-limiting and expected course of postembolization syndrome. To the best of our knowledge, this is the first reported case of TAMIS-assisted DSE of a colorectal VM. TAMIS shows promise for more widespread use in the minimally invasive, interventional management of colorectal vascular anomalies.
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Affiliation(s)
- Ryan Bitar
- Division of Interventional Radiology, Department of Radiology, Yale University School of Medicine, New Haven, CT
| | - Oluwaseun Ayoade
- Division of Colorectal Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Anudeep Yekula
- Division of Colorectal Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Vikram Reddy
- Division of Colorectal Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Haddon Pantel
- Division of Colorectal Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Naiem Nassiri
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
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Somashekhar M, Patil N, Shetty J, Kadamba P, Kalpana Kumari MK. Metachronous venous malformation masquerading as an obscure gastrointestinal bleed. J Indian Assoc Pediatr Surg 2022; 27:112-114. [PMID: 35261527 PMCID: PMC8853603 DOI: 10.4103/jiaps.jiaps_290_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/06/2020] [Accepted: 11/27/2020] [Indexed: 11/25/2022] Open
Abstract
Vascular malformation of the gastrointestinal (GI) tract along with metachronous lesions elsewhere in the body is extremely rare. We report an unusual case of a female child, with a history of venous malformation excision over the right leg presenting with severe iron-deficiency anemia. Although venous malformations of the small bowel are a rare cause of occult GI bleed, in the presence of cutaneous vascular lesions, there should be a high index of suspicion of a vascular malformation, along with the other causes of GI bleed in children.
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Zamora AK, Barry WE, Nowicki D, Ourshalimian S, Navid F, Miller JM, Zeinati C, Anselmo DM. A multidisciplinary approach to management of abdominal lymphatic malformations. J Pediatr Surg 2021; 56:1425-1429. [PMID: 33526253 DOI: 10.1016/j.jpedsurg.2020.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/18/2020] [Accepted: 10/10/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND/PURPOSE Abdominal lymphatic malformations (LM) are a rare subset of vascular anomaly caused by abnormal development of the lymphatic system. They are classified as macrocystic, microcystic or combination macrocystic and microcystic. Surgical resection, percutaneous sclerotherapy, and medical therapy are all employed to treat these complex and often symptomatic lesions. No standardized treatment algorithm exists currently. The purpose of this study was to establish a multidisciplinary treatment approach to abdominal LMs. METHODS A retrospective observational study was conducted from 2013 to 2019 on patients with abdominal LMs at a single tertiary children's hospital vascular anomalies center. Demographics, imaging, and treatment modality were recorded. Clinical and/or radiographic response to the primary treatment modality as well as complications was the outcomes measured. RESULTS Nineteen patients (12 macrocystic, 5 microcystic and 2 combined) were identified, with a median age at diagnosis of 2.2 years (range 0.1-20.8 years). Sclerotherapy was the most common primary treatment, followed by surgical resection and sirolimus. No difference in clinical response (p = 0.58) or complications (p = 0.31) was observed based on primary treatment or subtypes. CONCLUSIONS Based on our institutional experience, we propose an LM subtype-based treatment algorithm for abdominal LMs. It employs a multidisciplinary approach, and results in satisfactory patient outcomes with minimal complications. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Abigail K Zamora
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA; Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
| | - Wesley E Barry
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA; Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Danuta Nowicki
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA
| | | | - Fariba Navid
- Division of Hematology and Oncology, Cancer and Blood Diseases Institute, Children's Hospital Los Angeles, Los Angeles, CA; Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Joseph M Miller
- Division of Interventional Radiology, Children's Hospital Los Angeles, Los Angeles, CA; Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Chadi Zeinati
- Division of Interventional Radiology, Children's Hospital Los Angeles, Los Angeles, CA; Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Dean M Anselmo
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA; Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
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Diociaiuti A, Rotunno R, Caldaro T, Rossi S, Carnevale C, Torroni F, Paolantonio G, Capriati T, El Hachem M. Cutaneous venous malformations as a clue for possible gastrointestinal tract involvement: Diagnosis and treatment of six cases. Dermatol Ther 2021; 34:e14932. [PMID: 33751718 DOI: 10.1111/dth.14932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 02/23/2021] [Accepted: 03/07/2021] [Indexed: 12/13/2022]
Abstract
Venous malformation (VM) is the most common type among vascular malformations classified by the International Society for the Study of Vascular Anomalies. Most VMs are sporadic (94%), caused in 40% of cases by somatic mutation of TEK gene. VMs can be cutaneous, visceral, or combined. Visceral involvement is rare, and gastrointestinal (GI) tract is the most common localization. Visceral VMs, usually asymptomatic, may manifest with bleeding, anemia, and consumptive coagulopathy, which sometimes require an emergency treatment. Our aim is to study the possible GI involvement in patients with only one cutaneous VM. We analyzed a series of six patients who presented with a single cutaneous VM and have subsequently manifested intestinal involvement at our reference center for vascular anomalies since 2010. In our patients, cutaneous VMs were located on lower or upper limbs, and GI involvement manifested from 3 to 10 years after skin diagnosis. Our experience urges to early diagnose a GI involvement also in patients with only one skin VM and to prevent severe complications. A multidisciplinary approach is mandatory for the diagnosis and treatment of these patients.
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Affiliation(s)
- Andrea Diociaiuti
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,VASCERN VASCA and ERN-Skin European Reference Centre, Rome, Italy
| | - Roberta Rotunno
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,VASCERN VASCA and ERN-Skin European Reference Centre, Rome, Italy
| | - Tamara Caldaro
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sabrina Rossi
- Pathology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Claudia Carnevale
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,VASCERN VASCA and ERN-Skin European Reference Centre, Rome, Italy
| | - Filippo Torroni
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Guglielmo Paolantonio
- Interventional Radiology Unit, Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Teresa Capriati
- Artificial Nutrition Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - May El Hachem
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,VASCERN VASCA and ERN-Skin European Reference Centre, Rome, Italy
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Abstract
Overgrowth syndromes represent a diverse group of disorders with overlapping features. Interdisciplinary management by a team of experts in vascular anomalies is crucial for establishing the correct diagnosis and optimizing outcomes for these patients. Unique management considerations include increased risk for thrombosis and in some cases, cancer. In recent years, research has demonstrated that these disorders are primarily caused by somatic mutations in growth pathways, particularly the PI3K-mTOR pathway. This improved understanding had led to promising new therapies for this group of patients.
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Affiliation(s)
- Whitney Eng
- Cancer and Blood Disorders Center, Division of Hematology/Oncology, Dana Farber Cancer Institute and Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Adrienne M Hammill
- Cancer and Blood Diseases Institute, Division of Hematology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, OH, United States.
| | - Denise M Adams
- Cancer Center, Division of Oncology, Director Comprehensive Vascular Anomalies Program, Children's Hospital of Philadelphia, Department of Pediatrics and University of Pennsylvania Medical Center, Philadelphia, PA, United States
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Driessen F, Cushing T, Baines SJ. Retroperitoneal lymphatic malformation in a dog. Acta Vet Scand 2020; 62:8. [PMID: 32007092 PMCID: PMC6995647 DOI: 10.1186/s13028-020-0506-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 01/21/2020] [Indexed: 12/15/2022] Open
Abstract
Background Lymphatic vascular malformations are rare findings in canine patients with six reports available in veterinary literature. Retroperitoneal cystic lymphatic malformations have not been described previously in canine patients and neither has the use of immunohistochemistry to determine their origin, i.e. vascular versus lymphatic. Case presentation An 8-year-old neutered female Cocker spaniel was referred for pollakiuria, dysuria and a painful abdomen. Computed tomography scanning of the abdomen showed a fluid filled structure adjacent to the urinary bladder. During surgical exploration, a thin walled cystic structure with sero-haemorrhagic fluid was found, extending from the retroperitoneal space into the abdomen. The mass was excised and submitted for histopathology, revealing a cystic mass lined by a fibrovascular capsule within the retroperitoneal/mesenteric adipose tissue. The inner surface of the cyst was lined by a single layer of bland, flattened spindle cells. Intramural blood vessels were well differentiated, with perivascular haemorrhage. On recurrence 11 months later, the mass was excised for the second time and a PleuralPort (Norfolk Animal products) was placed. Fifteen months after initial presentation, progression occurred with haemorrhagic fluid in the cystic space, pleural- and abdominal cavities and the owners opted for euthanasia. Histopathology and positive immunohistochemistry for lymphatic markers lymphatic vessel endothelial hyaluronic acid receptor-1 (LYVE-1) and prospero homeobox protein-1 (PROX-1) confirmed a lymphatic vascular origin of the cystic structure. Conclusions To our experience, a definitive diagnosis of retroperitoneal cystic malformation of lymphatic origin could be done only by combining the clinical presentation, advanced imaging, histopathology and LYVE-1 and PROX-1 immunohistochemistry. This is the first report of a vascular malformation in a dog where immunohistochemistry was used to make a final diagnosis. A lymphatic malformation, even if rare, should be added on the list of the differential diagnosis in a patient with a retroperitoneal cystic structure containing serohaemorrhagic fluid. Results of this case report can aid in diagnosis of future cases, however, further studies on therapy and management are needed to provide additional information about optimal treatment of these patients.
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Li HB, Lv JF, Lu N, Lv ZS. Mechanical intestinal obstruction due to isolated diffuse venous malformations in the gastrointestinal tract: A case report and review of literature. World J Clin Cases 2020; 8:157-167. [PMID: 31970182 PMCID: PMC6962082 DOI: 10.12998/wjcc.v8.i1.157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 10/31/2019] [Accepted: 11/15/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Isolated gastrointestinal venous malformations (GIVMs) are extremely rare congenital developmental abnormalities of the venous vasculature. Because of their asymptomatic nature, the diagnosis is often quite challenging. However, as symptomatic GIVMs have nonspecific clinical manifestations, misdiagnosis is very common. Here, we report a case of isolated diffuse GIVMs inducing mechanical intestinal obstruction. A literature review was also conducted to summarize clinical features, diagnostic points, treatment selections and differential diagnosis in order that doctors may have a comprehensive understanding of this disease.
CASE SUMMARY A 50-year-old man presented with recurrent painless gastrointestinal bleeding for two months and failure to pass flatus and defecate with nausea and vomiting for ten days. Digital rectal examination found bright red blood and soft nodular masses 3 cm above the anal verge. Computed tomography showed that part of the descending colon and rectosigmoid colon was thickened with phleboliths in the intestinal wall. Colonoscopy exhibited bluish and reddish multinodular submucosal masses and flat submucosal serpentine vessels. Endoscopic ultrasonography showed anechoic cystic spaces within intestinal wall. The lesions were initially thought to be isolated VMs involving part of the descending colon and rectosigmoid colon. Laparoscopic subtotal proctocolectomy, pull-through transection and coloanal anastomosis and ileostomy were performed. Histopathology revealed intact mucosa and dilated, thin-walled blood vessels in the submucosa, muscularis, and serosa involving the entire colorectum. The patient recovered with complete symptomatic relief during the 52-mo follow-up period.
CONCLUSION The diagnosis of isolated GIVMs is challenging. The information presented here is significant for the diagnosis and management of symptoms.
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Affiliation(s)
- Han-Bo Li
- Department of General Surgery, Tianjin General Surgery Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
- Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
| | - Jing-Fang Lv
- Department of General Surgery, Tianjin General Surgery Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Ning Lu
- Department of General Surgery, Tianjin General Surgery Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Zong-Shun Lv
- Department of Gastroenterology, Tianjin Medical University General Hospital, Tianjin 300052, China
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Wang KL, Ma SF, Pang LY, Zhang MN, Hu LY, Liu MJ, Zou LP. Sirolimus alternative to blood transfusion as a life saver in blue rubber bleb nevus syndrome: A case report. Medicine (Baltimore) 2018; 97:e9453. [PMID: 29465551 PMCID: PMC5841973 DOI: 10.1097/md.0000000000009453] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 12/03/2017] [Accepted: 12/05/2017] [Indexed: 12/20/2022] Open
Abstract
RATIONALE Blue rubber bleb nevus syndrome (BRBNS) is a rare disease characterized by multiple venous malformations. The gastrointestinal bleeding and secondary iron deficiency anemia are the most common complications. There are currently no effective treatments for BRBNS. Here, we report a case of successful treatment with a small dose of sirolimus of a BRBN patient with a de novo gene mutation. PATIENT CONCERNS A 12-year-old female was admitted to our hospital with multiple hemangiomas for 12 years. The patient often displayed melena; she recently received transfusion of 2 units of red blood cells once every 2 weeks. Multiple fist-sized hemangiomas were piled up on both sides and back of the neck, and were also noted on the arms, legs, chest, back, and on the tip of the tongue. The laboratory findings demonstrated severe anemia. Blood sample sequencing detected a heterozygous de novo mutation c.2545C > Tin the TEK gene. DIAGNOSES Based on these findings, final diagnosis of Blue rubber bleb nevus syndrome (BRBNS) was made. INTERVENTIONS After the diagnosis, low-dose sirolimus was orally administered. OUTCOMES The patient's hemoglobin was increased after treatment with sirolimus for 1 month. Since the initial treatment with sirolimus, she had not received any blood transfusions. The skin and mucosal hemangioma decreased significantly, and new digestive tract hemorrhage, muscle hematoma, or adverse drug reactions were not observed. LESSONS we report a case of a mutation in exon 15 of the TEK gene leading to BRBN. It was successfully treated with a small dose of sirolimus as an alternative to blood transfusion in order to save the of BRBN patient's life.
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Transcatheter embolization of persistent embryonic veins in venous malformation syndromes. J Vasc Surg Venous Lymphat Disord 2017; 5:749-755. [DOI: 10.1016/j.jvsv.2017.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/01/2017] [Indexed: 01/19/2023]
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Staged endovascular and surgical treatment of a hemorrhagic colorectal venous malformation. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Syndromes hypertrophiques secondaires aux mutations de PIK3CA. Nephrol Ther 2017; 13 Suppl 1:S155-S156. [DOI: 10.1016/j.nephro.2017.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 02/09/2017] [Indexed: 01/19/2023]
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Kim SH, Cho YH, Kim HY. Vascular malformations of the small intestine manifesting as chronic anemia: Two pediatric cases managed by single-site umbilical laparoscopic surgery. Int J Surg Case Rep 2017; 31:233-236. [PMID: 28189987 PMCID: PMC5304240 DOI: 10.1016/j.ijscr.2017.01.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 01/23/2017] [Accepted: 01/26/2017] [Indexed: 02/07/2023] Open
Abstract
Vascular malformation of gastrointestinal tract manifested as a chronic anemia due to obscure gastrointestinal bleeding in girls. Vascular malformation of the small intestine in pediatric patient is uncommon finding. Despite of limitations of diagnosis, a selective angiography and CT enterogram with angiography was helpful to diagnose. Successfully managed two cases of vascular malformation identified at jejunum by a single-site umbilical laparoscopic surgery.
Introduction Vascular malformations affecting abdominal viscera, especially the gastrointestinal tract, are less common than that in other body segments. Nonetheless, it seems to be one of the important causes of gastrointestinal bleeding in not only adults but also children as well. It occurs during the development stage of vascular system, and may increase in severity as the child grows. Presentation of case We present here two cases of lesions developed at the small intestine in an 8-year-old girl and 3-year-old girl, which were identified during the management for chronic anemia. Although there were some limitations associated with diagnosis, a histology confirmed the presence of arteriovenous malformations in both cases, they were successfully treated with surgical resection, especially minimal invasive procedure. Discussion Vascular malformations of abdominal viscera, especially the small intestine, are rare clinical manifestations in pediatric patients but are among the important causes of acute massive or chronic obscure LGI bleeding. Unless there is significant GI bleeding, patients are usually treated for anemia with obscure LGI bleeding. In the present study, selective angiography was useful in one case and CT enterogram with angiography was useful in the other case. Conclusion Considering the rarity and possibility of gastrointestinal bleeding due to vascular malformations, it is necessary to be regarded as one of differential diagnosis when managing a lower gastrointestinal bleeding in pediatric patients. Besides, a minimal invasive procedure could be suggested as a good surgical option when necessary.
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Affiliation(s)
- Soo-Hong Kim
- Division of Pediatric Surgery, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Yong-Hoon Cho
- Division of Pediatric Surgery, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
| | - Hae-Young Kim
- Division of Pediatric Surgery, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
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Martinez-Lopez A, Blasco-Morente G, Perez-Lopez I, Herrera-Garcia JD, Luque-Valenzuela M, Sanchez-Cano D, Lopez-Gutierrez JC, Ruiz-Villaverde R, Tercedor-Sanchez J. CLOVES syndrome: review of a PIK3CA-related overgrowth spectrum (PROS). Clin Genet 2016; 91:14-21. [PMID: 27426476 DOI: 10.1111/cge.12832] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/05/2016] [Accepted: 07/08/2016] [Indexed: 01/19/2023]
Abstract
Overgrowth syndromes are characterized by global or localized disproportionate growth associated with other anomalies, including vascular malformations and neurological and/or visceral disorders. CLOVES (Congenital Lipomatous asymmetric Overgrowth of the trunk with lymphatic, capillary, venous, and combined-type Vascular malformations, Epidermal naevi, Scoliosis/Skeletal and spinal anomalies) is an overgrowth syndrome caused by mosaic activating mutation in gene PIK3CA, which gives rise to abnormal PI3K-AKT-mTOR pathway activation. These mutations are responsible for the clinical manifestations of the syndrome, which include low- and high-flow vascular malformations, thoracic lipomatous hyperplasia, asymmetric growth, and visceral and neurological disorders. These common anomalies are illustrated with figures from two personal cases. Identification of the clinical and genetic characteristics of CLOVES syndrome is crucial for the differential diagnosis with other overgrowth syndromes, such as Proteus or Klippel-Trenaunay (K-T) syndromes, and for the therapeutic management of the different anomalies. In this context, a new entity comprising different syndromes with phenotypic mutations in PIK3CA has been proposed, designated PIK3CA-related overgrowth spectrum (PROS), with the aim of facilitating clinical management and establishing appropriate genetic study criteria.
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Affiliation(s)
- A Martinez-Lopez
- Dermatology Unit, Complejo Hospitalario Universitario, Granada, Spain
| | - G Blasco-Morente
- Dermatology Unit, Complejo Hospitalario Universitario, Granada, Spain
| | - I Perez-Lopez
- Dermatology Unit, Complejo Hospitalario Universitario, Granada, Spain
| | | | | | - D Sanchez-Cano
- Internal Medicine Unit, Complejo Hospitalario Universitario, Granada, Spain
| | | | - R Ruiz-Villaverde
- Dermatology Unit, Complejo Hospitalario Universitario, Granada, Spain
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Abstract
Overgrowth syndromes with vascular anomalies encompass entities with a vascular anomaly as the predominant feature vs those syndromes with predominant somatic overgrowth and a vascular anomaly as a more minor component. The focus of this article is to categorize these syndromes phenotypically, including updated clinical criteria, radiologic features, evaluation, management issues, pathophysiology, and genetic information. A literature review was conducted in PubMed using key words "overgrowth syndromes and vascular anomalies" as well as specific literature reviews for each entity and supportive genetic information (e.g., somatic mosaicism). Additional searches in OMIM and Gene Reviews were conducted for each syndrome. Disease entities were categorized by predominant clinical features, known genetic information, and putative affected signaling pathway. Overgrowth syndromes with vascular anomalies are a heterogeneous group of disorders, often with variable clinical expression, due to germline or somatic mutations. Overgrowth can be focal (e.g., macrocephaly) or generalized, often asymmetrically (and/or mosaically) distributed. All germ layers may be affected, and the abnormalities may be progressive. Patients with overgrowth syndromes may be at an increased risk for malignancies. Practitioners should be attentive to patients having syndromes with overgrowth and vascular defects. These patients require proactive evaluation, referral to appropriate specialists, and in some cases, early monitoring for potential malignancies. Progress in identifying vascular anomaly-related overgrowth syndromes and their genetic etiology has been robust in the past decade and is contributing to genetically based prenatal diagnosis and new therapies targeting the putative causative genetic mutations.
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Affiliation(s)
- Francine Blei
- Vascular Anomalies Program, Lenox Hill Hospital/Manhattan Eye Ear and Throat Hospital, North Shore-LIJ Healthcare System, New York, NY
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16
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Blei F. Update December 2014. Lymphat Res Biol 2014. [DOI: 10.1089/lrb.2014.1242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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