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Hoornaert E, Clapuyt P, Dumitriu D, Niel O, Huybrechts S, Scheers I, Sokal E, Reding R, Stephenne X. Conservative management of congenital hepatic hemangioma complicated by ascites. Clin Case Rep 2022; 10:e05938. [PMID: 35846904 PMCID: PMC9281363 DOI: 10.1002/ccr3.5938] [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] [Received: 03/27/2022] [Revised: 04/28/2022] [Accepted: 05/23/2022] [Indexed: 11/10/2022] Open
Abstract
Involution of a rapidly involuting congenital hemangioma is an unknown cause of neonatal ascites. As involution phase is completed by 14 months after birth, conservative management with diuretics and drainage is possible and may avoid surgical resection.
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Affiliation(s)
- Emmy Hoornaert
- Division of Paediatric Gastroenterology and HepatologyDepartment of PaediatricsCliniques Universitaires Saint LucUniversité catholique de LouvainBrusselsBelgium
| | - Philippe Clapuyt
- Division of Paediatric RadiologyDepartment of RadiologyCliniques Universitaires Saint LucUniversité catholique de LouvainBrusselsBelgium
| | - Dana Dumitriu
- Division of Paediatric RadiologyDepartment of RadiologyCliniques Universitaires Saint LucUniversité catholique de LouvainBrusselsBelgium
| | - Olivier Niel
- Department of PaediatricsCentre Hospitalier du LuxembourgLuxembourgLuxembourg
| | - Sophie Huybrechts
- Department of PaediatricsCentre Hospitalier du LuxembourgLuxembourgLuxembourg
| | - Isabelle Scheers
- Division of Paediatric Gastroenterology and HepatologyDepartment of PaediatricsCliniques Universitaires Saint LucUniversité catholique de LouvainBrusselsBelgium
| | - Etienne Sokal
- Division of Paediatric Gastroenterology and HepatologyDepartment of PaediatricsCliniques Universitaires Saint LucUniversité catholique de LouvainBrusselsBelgium
| | - Raymond Reding
- Division of Paediatric SurgeryDepartment of SurgeryCliniques Universitaires Saint LucUniversité catholique de LouvainBrusselsBelgium
| | - Xavier Stephenne
- Division of Paediatric Gastroenterology and HepatologyDepartment of PaediatricsCliniques Universitaires Saint LucUniversité catholique de LouvainBrusselsBelgium
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Wannasai K, Settakorn J, Visrutaratna P, Sathitsamitphong L, Khorana J, Waroonkun S. A Case of Infantile Hepatic Hemangioendothelioma/Hemangioma at Maharaj Nakorn Chiang Mai Hospital. Cureus 2022; 14:e25240. [PMID: 35755522 PMCID: PMC9217672 DOI: 10.7759/cureus.25240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 11/05/2022] Open
Abstract
Infantile hepatic hemangioendothelioma/hemangioma is the most common benign hepatic vascular tumor of infancy, comprising approximately 1% of all childhood tumors. The tumor can present during the fetal or neonatal period as a hepatic mass. Common presentations include abdominal distension and a palpable hepatic mass. Clinico-radio-pathological correlation is essential for a definite diagnosis. Frequent complications such as congestive heart failure, thrombocytopenia, anemia, and Kasabach-Merritt syndrome should be investigated. Chemotherapy has been reported as an effective treatment option. Surgical resection has an essential role for symptomatic patients with medical treatment failure or other certain conditions such as refusal to take medication. Furthermore, prenatal diagnosis is essential for better patient outcomes due to prompt treatment in the neonatal period. We report a case of a female infant at 39 weeks of gestation who was delivered from a 32-year-old mother. The infant was in utero diagnosed by ultrasonography with a hepatic mass, most likely hemangioma. The mass was resected after birth and it was diagnosed as infantile hepatic hemangioendothelioma type II. The course of the disease was excellent and the patient was cured after treatment.
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Zavras N, Dimopoulou A, Machairas N, Paspala A, Vaos G. Infantile hepatic hemangioma: current state of the art, controversies, and perspectives. Eur J Pediatr 2020; 179:1-8. [PMID: 31758313 DOI: 10.1007/s00431-019-03504-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/11/2019] [Accepted: 10/09/2019] [Indexed: 12/13/2022]
Abstract
Infantile hepatic hemangioma (IHH) is a common vascular tumor, distinctive for its perinatal presentation, rapid growth during the first year of life, and subsequent involution. Although they generally follow a benign course, some tumors have been reported to undergo malignant transformation. The diagnosis of IHH is based on patient's medical history, physical examination, and imaging. Moreover, the management of this vascular tumor is based on clinical presentation and includes observational, medical, surgical, and radiological interventional treatment options. The present review presents the currently available data in the literature on the diverse aspects of the terminology, epidemiology, clinical presentation, pathogenesis, diagnosis, indications for surgery, malignant potential, and long-term outcomes of these tumors.Conclusion: No formal guidelines have yet been established for the treatment of these hepatic lesions, and the therapeutic strategies implemented vary widely from simple observation to medical, radiological, and surgical interventions in the prism of multidisciplinary teams.What is Known:• Infantile hepatic hemangioma is the most common benign tumor of the liver in infancy, but despite its benign nature, it can present with life-threatening complications.• The treatment strategies range from simple observation to a series of medical, surgical, and radiological interventions.What is New:• This review gives an overview of the developments and current status about the management of IHH.• The aim of this study is to clear up the confusion and controversy that exists about terminology, diagnosis, and treatment of IHH.
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Affiliation(s)
- Nikolaos Zavras
- Department of Paediatric Surgery, "ATTIKON" General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Dimopoulou
- Department of Paediatric Surgery, "ATTIKON" General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Nikolaos Machairas
- Third Department of Surgery, "ATTIKON" General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Paspala
- Third Department of Surgery, "ATTIKON" General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Vaos
- Department of Paediatric Surgery, "ATTIKON" General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Ernst L, Grabhorn E, Brinkert F, Reinshagen K, Königs I, Trah J. Infantile Hepatic Hemangioma: Avoiding Unnecessary Invasive Procedures. Pediatr Gastroenterol Hepatol Nutr 2020; 23:72-78. [PMID: 31988877 PMCID: PMC6966222 DOI: 10.5223/pghn.2020.23.1.72] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 09/30/2019] [Indexed: 11/14/2022] Open
Abstract
Infantile hepatic hemangioma, the most common vascular tumor of the liver in infancy, can occur with acute postnatal liver and congestive heart failure. Nevertheless, its course is often benign, and many children can be diagnosed and treated without surgical intervention. The distinction from malignant diseases is not always easy and it not clear whether invasive procedures for diagnosis and therapy should be performed. Here we report our experiences in our Center for Pediatric Liver Disease and postulate that large studies are needed to avoid unnecessary invasive procedures for these patients in the future.
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Affiliation(s)
- Lukas Ernst
- Department of Pediatrics, Hospital Barmherzige Brüder, Regensburg, Germany
| | - Enke Grabhorn
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Brinkert
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Konrad Reinshagen
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ingo Königs
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julian Trah
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Iacobas I, Phung TL, Adams DM, Trenor CC, Blei F, Fishman DS, Hammill A, Masand PM, Fishman SJ. Guidance Document for Hepatic Hemangioma (Infantile and Congenital) Evaluation and Monitoring. J Pediatr 2018; 203:294-300.e2. [PMID: 30244993 DOI: 10.1016/j.jpeds.2018.08.012] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/06/2018] [Accepted: 08/08/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To define the types of hepatic hemangiomas using the updated International Society for the Study of Vascular Anomalies classification and to create a set of guidelines for their diagnostic evaluation and monitoring. STUDY DESIGN We used a rigorous, transparent consensus protocol defined by an approved methodology, with input from multiple pediatric experts in vascular anomalies from hematology-oncology, surgery, pathology, radiology, and gastroenterology. RESULTS In the first section, we define the subtypes of hepatic hemangiomas based on the clinical course, histology, and radiologic characteristics. We recommend against using the term "hemangioma" for any vascular malformations affecting the liver or any hypervascular tumors that are not characterized by the approved definitions. We recommend against using the term "hemangioendothelioma" for infantile or congenital hemangioma. The following 2 sections dedicated to infantile hepatic hemangioma and to congenital hepatic hemangioma individually describe these subtypes in further detail, including complications to be considered during monitoring and respectively recommended screening evaluations. CONCLUSIONS Although institutional variations may exist for specific clinical details, a clear understanding of the diagnosis of hepatic hemangiomas affecting children and the possible complications that require screening during the monitoring period should be standard. As children with hepatic hemangiomas are managed by different medical and surgical specialties, we offer an expert opinion multidisciplinary consensus based on current literature and on data extracted from the liver hemangioma registry.
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Affiliation(s)
- Ionela Iacobas
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
| | - Thuy L Phung
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Denise M Adams
- Boston Children's Hospital, Harvard Medical School, Boston, MA
| | | | | | | | - Adrienne Hammill
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Prakash M Masand
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX
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Lewis D, Hachey K, Fitzgerald S, Vaidya R. Rapidly involuting congenital haemangioma of the liver. BMJ Case Rep 2018; 2018:bcr-2018-224337. [PMID: 29871961 DOI: 10.1136/bcr-2018-224337] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Rapidly involuting congenital haemangiomas (RICHs) are rare benign vascular tumours of infancy. They are generally asymptomatic, but can present with thrombocytopaenia and coagulopathy. Significant complications including life-threatening bleeding, high-output heart failure and liver failure, though rare, can occur. RICHs generally regress by 12-14 months of age and can be managed clinically with symptomatic treatment, watchful waiting and close monitoring of the size of the haemangioma. Medical management (corticosteroids, propranolol) has not shown to be effective, in contrast to infantile haemangioma which will not regress spontaneously and has been noted to respond to medical therapy. Awareness of this diagnosis is important to prevent unnecessary medical and surgical intervention. Here, we present a case of a full-term infant with RICH who presented with thrombocytopaenia and abnormal coagulation profile. The coagulopathy was treated symptomatically, while the lesion was observed with serial ultrasounds and gradually decreased in size.
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Affiliation(s)
- Deirdre Lewis
- Internal Medicine and Pediatrics, University of Massachusetts Medical School - Baystate, Springfield, MA, USA
| | - Kevin Hachey
- Internal Medicine and Pediatrics, University of Massachusetts Medical School - Baystate, Springfield, MA, USA
| | - Shannon Fitzgerald
- Pediatrics, University of Massachusetts Medical School - Baystate, Springfield, MA, USA
| | - Ruben Vaidya
- Pediatrics, University of Massachusetts Medical School - Baystate, Springfield, MA, USA
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Abstract
Hepatoblastoma (HB) is the most common primary liver cancer in children. The conventional serum marker for HB, alpha-fetoprotein (AFP), has its limitations. Novel serum markers need to be explored. Glypican 3 (GPC3) has been reported to be an excellent histological immunomarker for HB. However, the clinical value of serum GPC3 in patients with HB is unknown. A total of 184 serum samples were tested for both GPC3 by ELISA, and AFP by immunometric assay. Of these, 134 were from 32 patients with HB at three treatment stages, 30 from age-matched patients with benign hepatobiliary disorders (BHD) and 20 from age-matched “normal controls”(NC). We found that the GPC3 levels in HB pretreatment group were significantly higher than those in NC group and HB remission group but not statistically different from those in BHD group and HB during treatment group. In contrast, AFP showed significant differences among different groups. The areas under the receiver operating curve (AUROC) value, sensitivity and specificity of GPC3 for HB pretreatment group versus all controls were all significantly lower than those of AFP. Serum GPC3 levels were not associated with prognostic parameters. We concluded that GPC3 is inferior to AFP as a serum marker for HB.
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Mizejewski GJ. Physiology of Alpha-Fetoprotein as a Biomarker for Perinatal Distress: Relevance to Adverse Pregnancy Outcome. Exp Biol Med (Maywood) 2016; 232:993-1004. [PMID: 17720945 DOI: 10.3181/0612-mr-291] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The many physiologic roles of human alpha-fetoprotein (HAFP) and its correlation with perinatal distress/pregnancy outcome are rarely addressed together in the biomedical literature, even though HAFP has long been used as a biomarker for fetal birth defects. Although the well being of the fetus can be monitored by the measurement of gestational age–dependent HAFP in biologic fluid levels (serum, amniotic fluid, urine, and vaginal fluids) throughout pregnancy, the majority of clinical reports reflect largely second trimester and (less likely) first trimester testing due to regulatory clinical restrictions. However, reports of third-trimester and pregnancy term measurement of HAFP levels performed in clinical research and/or investigational settings have gradually increased over the years and have expanded our base knowledge of AFP-associated pregnancy disorders during these stages. The different structural forms of HAFP (isoforms, epitopes, molecular variants, etc.) detected in the various biologic fluid compartments have been limited by antibody recognition of specific epitopic sites developed by the kit manufacturers based on antibody specificity, sensitivity, and precision. Concomitantly, the advances in elucidating the various biologic actions of AFP are opening new vistas toward understanding the physiologic roles of AFP during pregnancy. The present review surveys HAFP as a biomarker for fetal distress during the perinatal period in view of its structural and functional properties. An attempt is then made to relate the AFP fluid levels to adverse pregnancy complications and outcomes. Hence, the present review was divided into two major sections: (I) AFP structure and function considerations and (II) the relationship of AFP levels to the distressed fetus during the third trimester and at term.
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Affiliation(s)
- Gerald J Mizejewski
- The Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA.
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Matkowskyj KA, Rao MS, Yang GY. Pathologic Features of Primary and Metastatic Hepatic Malignancies. Cancer Treat Res 2016; 168:257-293. [PMID: 29206377 DOI: 10.1007/978-3-319-34244-3_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In the mammalian liver, 60 % of the cellular components are hepatocytes while the remainder (35 %) includes biliary epithelium, Kupffer cells, endothelial cells, fat storing cells and connective tissue cells. Although neoplasms of hepatocytes are the most common, a significant number of both benign and malignant primary liver neoplasms arising from other cell types can develop, such as tumors of bile duct epithelium (Table 1). In addition, the liver is one of the most susceptible sites for metastatic tumors arising from other organs of the body. Not too long ago, liver tumors were left untreated because the liver was considered a complex and mysterious organ inaccessible to surgery. Advances in imaging procedures and surgical techniques over the past 40 years have revolutionized the approaches to the treatment of benign and malignant liver tumors. Subsegmentectomy, segmentectomy, lobectomy, and transplantation are routinely performed for the treatment of primary and metastatic liver tumors with minimal morbidity and mortality. Since accurate diagnosis remains the key to clinical and surgical management, the emphasis of this chapter is on classification, morphological features and differential diagnosis of malignant neoplasms of the liver.
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Hara K, Fukumura Y, Saito T, Arakawa A, Okabe H, Takeda S, Yao T. A giant cord hemangioma with extramedullary hematopoiesis and elevated maternal serum human chorionic gonadotropin: a case report and review of the literature. Diagn Pathol 2015; 10:154. [PMID: 26337640 PMCID: PMC4559187 DOI: 10.1186/s13000-015-0385-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 08/25/2015] [Indexed: 02/07/2023] Open
Abstract
A case of prenatally diagnosed, giant cord hemangioma is reported, which was accompanied by the elevation of maternal serum alpha-fetoprotein (MS-AFP) and human chorionic gonadotropin (MS-hCG) levels. A 30-year-old woman without a previous history of gravida or para, presented with intermittent abdominal pain at 26 weeks of gestation. Doppler studies showed the fetus developing heart failure as the tumor grew larger. Caesarian section was performed at 29 weeks of gestation. Macroscopic examination of the placenta revealed a 17.0 × 10.0 × 7.0 cm tumor localized at the placental end of the umbilical cord. Microscopically, the tumor was composed of small arborizing vessels proliferating in the myxoid background, and the tumor cells were positive for AFP by immunohistochemistry. Extramedullary hematopoiesis was seen in the tumor vascular channels. The present case is one of the largest umbilical cord hemangiomas reported in the literature, and the first hemangioma case with MS-hCG elevation, extramedullary hematopoiesis, and positive AFP staining in the cord hemangioma. Its clinical course and detailed pathological findings are presented along with a review of the related literature.
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Affiliation(s)
- Kieko Hara
- Department of Human Pathology, Juntendo University School of Medicine, Motomachi Bldg. 3F, Hongo 1-1-19, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Yuki Fukumura
- Department of Human Pathology, Juntendo University School of Medicine, Motomachi Bldg. 3F, Hongo 1-1-19, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Tsuyoshi Saito
- Department of Human Pathology, Juntendo University School of Medicine, Motomachi Bldg. 3F, Hongo 1-1-19, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Atsushi Arakawa
- Department of Human Pathology, Juntendo University School of Medicine, Motomachi Bldg. 3F, Hongo 1-1-19, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Hitomi Okabe
- Department of Obstetrics & Gynecology, Juntendo University School of Medicine, Tokyo, Japan.
| | - Satoru Takeda
- Department of Obstetrics & Gynecology, Juntendo University School of Medicine, Tokyo, Japan
| | - Takashi Yao
- Department of Human Pathology, Juntendo University School of Medicine, Motomachi Bldg. 3F, Hongo 1-1-19, Bunkyo-ku, Tokyo, 113-0033, Japan.
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Pan FS, Xu M, Wang W, Zhou LY, Xie XY. Infantile hepatic hemangioendothelioma in comparison with hepatoblastoma in children: clinical and ultrasound features. HEPATITIS MONTHLY 2013; 13:e11103. [PMID: 24171008 PMCID: PMC3800677 DOI: 10.5812/hepatmon.11103] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 04/24/2013] [Accepted: 05/03/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Infantile hepatic hemangioendothelioma (IHH) and hepatoblastoma (HBL) are respectively the most common benign and malignant liver tumors in children. OBJECTIVES To study the clinical manifestations and the ultrasound features of the pediatric patients for distinguishing IHH from HBL. PATIENTS AND METHODS Between 2002 and 2012, thirteen children with IHH and 38 children with HBL under the age of 10 years were included. We retrospectively reviewed the clinical and the ultrasound features of the two groups, especially including parameters as follows: age at diagnosis, gender, alpha-fetoprotein (AFP) elevation, venous involvement and Doppler ultrasound. RESULTS Compared with HBL group, the age of IHH group was much younger (5.8 months vs. 35.1 months, P = 0.000), the AFP elevation was less likely to be detected in IHH group (23.1% vs. 89.5%, P = 0.000). Although the color flow were the same commonly observed (61.5% vs. 52.6%, P > 0.05), the spectral Doppler showed IHH was less likely to appear as arterial flow with resistance index (RI) > 0.7(12.5% vs. 75.0%, P < 0.05), characterized by arterial flow with RI < 0.7 and/or venous flow. Combined the clinical features including age (< 6 months) and normal AFP level yielded high capability in differential diagnosis, with sensitivity, specificity and Youden index of 77% (10/13), 95% (36/38), and 0.72, respectively. When combined clinical features (age and AFP) and spectral Doppler as the diagnostic criterion for distinguishing these cases with positive color flow signals, the sensitivity, specificity, accuracy and Youden Index were 88%, 95%, 89% and 0.83, respectively. CONCLUSIONS The clinical features are effective indicators for distinguishing IHH from HBL, and the spectral Doppler may be a useful adjunct parameter for differential diagnosis.
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Affiliation(s)
- Fu-shun Pan
- Department of Medical Ultrasonic, The First Affiliated Hospital, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, Guangzhou, China
| | - Ming Xu
- Department of Medical Ultrasonic, The First Affiliated Hospital, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, Guangzhou, China
| | - Wei Wang
- Department of Medical Ultrasonic, The First Affiliated Hospital, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, Guangzhou, China
| | - Lu-yao Zhou
- Department of Medical Ultrasonic, The First Affiliated Hospital, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, Guangzhou, China
| | - Xiao-yan Xie
- Department of Medical Ultrasonic, The First Affiliated Hospital, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, Guangzhou, China
- Corresponding author: Xiao-yan Xie, Department of Medical Ultrasonic, The First Affiliated Hospital, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, 58 Zhong Shan Road 2, Guangzhou 510080, China. Tel: +86-2087765183, Fax: +86-2087765183, E-mail:
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Roebuck D, Sebire N, Lehmann E, Barnacle A. Rapidly involuting congenital haemangioma (RICH) of the liver. Pediatr Radiol 2012; 42:308-14. [PMID: 22302317 DOI: 10.1007/s00247-011-2268-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 08/14/2011] [Accepted: 08/28/2011] [Indexed: 01/12/2023]
Abstract
BACKGROUND Rapidly involuting congenital haemangioma (RICH) is a benign neoplasm that may occur in many locations in the body. When RICH occurs in the liver, it may be confused with other lesions. OBJECTIVE To present a case series from a single institution. MATERIALS AND METHODS Retrospective review of pathological and imaging findings in infants with biopsy-proven hepatic RICH treated at a single hospital. RESULTS Four children (2 days to 6 weeks of age) presented between 2002 and 2007 with a solitary hepatic lesion. Needle biopsy excluded the alternative possibility of infantile haemangioma by showing negativity for GLUT1. Serial imaging confirmed rapid involution in each child. CONCLUSION RICH should be suspected in neonates who present with a solitary liver lesion and normal-for-age serum alpha-fetoprotein. Serial US scans should be used to confirm a progressive shrinkage of the lesion. Corticosteroids and β2-adrenergic antagonists have no proven effect in treating RICH. If the lesion grows, percutaneous needle biopsy is recommended to exclude a malignant tumour and to direct further management. Infants with cardiac failure should be treated medically. Embolization (with or without needle biopsy) should only be performed when this strategy fails.
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Affiliation(s)
- Derek Roebuck
- Department of Radiology, Great Ormond Street Hospital for Sick Children, Great Ormond Street, London WC1N 3JH, UK.
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Bell D, Kozakewich HP, Fishman SJ, Kulungowski AM, Alomari AI. Liver hemangiomas and elevated serum α-fetoprotein: unsolved questions. Hum Pathol 2011; 42:1369-71; author reply 1371-2. [DOI: 10.1016/j.humpath.2011.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 05/14/2011] [Indexed: 10/17/2022]
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Kim EH, Koh KN, Park M, Kim BE, Im HJ, Seo JJ. Clinical features of infantile hepatic hemangioendothelioma. KOREAN JOURNAL OF PEDIATRICS 2011; 54:260-6. [PMID: 21949521 PMCID: PMC3174362 DOI: 10.3345/kjp.2011.54.6.260] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 02/26/2011] [Accepted: 04/05/2011] [Indexed: 11/27/2022]
Abstract
Purpose Infantile hepatic hemangioendothelioma (IHHE) is the most common type of hepatic vascular tumor in infancy. We conducted this study to review our clinical experience of patients with IHHE and to suggest management strategies. Methods We retrospectively analyzed the medical records of 23 IHHE patients (10 males, 13 females) treated at the Asan Medical Center between 1996 and 2009. Results Median age at diagnosis was 38 days (range, 1 to 381 days). Seven patients (30%) were diagnosed with IHHE based on sonographically detected fetal liver masses, 5 (22%) were diagnosed incidentally in the absence of symptoms, 5 (22%) had congestive heart failure, 3 (13%) had skin hemangiomas, 2 (9%) had abnormal liver function tests, and 1 (4%) had hepatomegaly. All diagnoses were based on imaging results, and were confirmed in three patients by histopathology analysis. Six patients were observed without receiving any treatment, whereas 12 received corticosteroids and/or interferon-alpha. One patient with congestive heart failure and a resectable unilobar tumor underwent surgical resection. Three patients with congestive heart failure and unresectable tumors were managed by hepatic artery embolization with/without medical treatment. At a median follow-up of 29 months (range, 1 to 156 months), 21 (91%) patients showed complete tumor disappearance or >50% decrease in tumor size. One patient died due to tumor-related causes. Conclusion IHHE generally has a benign clinical course with low morbidity and mortality rates. Clinical course and treatment outcome did not differ significantly between medically treated and non-treated groups. Surgically unresectable patients with significant symptoms may be treated medically or with hepatic artery embolization.
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Affiliation(s)
- Eun Hee Kim
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Chen TH, Lin JY, Chen WF, Su YC, Yang SN. Elevated serum α-fetoprotein in a neonate with cutaneous infantile hemangioendothelioma. Pediatr Int 2011; 53:258-61. [PMID: 21501314 DOI: 10.1111/j.1442-200x.2010.03242.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Tai-Heng Chen
- Department of Pediatrics and Pathology, Kaohsiung Medical University, Kaohsiung, Taiwan
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Sigamani E, Iyer VK, Agarwala S. Fine needle aspiration cytology of infantile haemangioendothelioma of the liver: a report of two cases. Cytopathology 2010; 21:398-402. [DOI: 10.1111/j.1365-2303.2010.00739.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Zhang Z, Chen HJ, Yang WJ, Bu H, Wei B, Long XY, Fu J, Zhang R, Ni YB, Zhang HY. Infantile hepatic hemangioendothelioma: A clinicopathologic study in a Chinese population. World J Gastroenterol 2010; 16:4549-57. [PMID: 20857525 PMCID: PMC2945486 DOI: 10.3748/wjg.v16.i36.4549] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate whether the clinicopathologic features of infantile hemangioendothelioma (IHE) of the liver in a Chinese population are similar to the features observed in other races.
METHODS: The clinical data, radiological findings, histopathological changes and outcome of 12 cases of IHE diagnosed by the Department of Pathology, West China Hospital over the last 10 years were analyzed retrospectively. Immunohistochemical studies were carried out using antibodies against CD31, CD34, Factor VIII, cytokeratin 8 and cytokeratin 18.
RESULTS: The 12 patients were aged from fetal to 5 years (three males and nine females). The tumor was presented with different clinical manifestations, mainly as an asymptomatic, palpable, upper abdominal mass, except for the two fetuses who were detected antenatally by ultrasound. In one patient, this presentation was accompanied by an initial severe pneumothorax. No symptoms of congestive heart failure were present and neither congenital abnormalities nor vascular tumors in the skin or other organs were found. Laboratory abnormalities included leukocytosis (40%), anemia (60%), thrombocytosis (60%), hyperbilirubinemia (16.7%), abnormal liver function (50%) and increased α-fetoprotein (80%). Based on radiological findings and gross specimens, the tumor presented as a solitary lesion or a multifocal space-occupying lesion. The tumor size ranged from 5.0 cm × 3.5 cm × 2.0 cm to 13.8 cm × 9.0 cm × 7.7 cm, and the 0.2-1.1 cm nodules were diffusely distributed within the multifocal tumor. Seven cases were surgically resected, three cases underwent biopsy and the two fetuses were aborted. Histologically, nine cases were classified as type I and three as type II, presenting aggressive morphologic features, immature vessels, active mitosis and necrosis. An inflammatory component, predominantly eosinophilic granulocytes, sometimes obscured the nature of the tumor. Ten patients are alive after a follow-up of 1-9 years. Based on immunohistochemistry, the endothelial cells in all cases were positive for CD31, CD34 and polyclonal factor VIII antigen, whereas the scattered hyperplasia bile ducts were positive for cytokeratin 8 and cytokeratin 18.
CONCLUSION: The clinical manifestations of IHE are non-specific. There is no significant correlation between histological type and prognosis. The clinicopathologic features of IHE in Chinese patients may provide a clue to further evidence-based studies.
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Chung EM, Cube R, Lewis RB, Conran RM. From the archives of the AFIP: Pediatric liver masses: radiologic-pathologic correlation part 1. Benign tumors. Radiographics 2010; 30:801-26. [PMID: 20462995 DOI: 10.1148/rg.303095173] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Benign hepatic tumors in children include lesions that are unique to the pediatric age group and others that are more common in adults. Infantile hemangioendothelioma, or infantile hepatic hemangioma, is a benign vascular tumor that may cause serious clinical complications. It is composed of vascular channels lined by endothelial cells. At imaging, large feeding arteries and draining veins and early, intense, peripheral nodular enhancement with centripetal filling on delayed images are characteristic features. Mesenchymal hamartoma of the liver occurs in young children and is characterized pathologically by mesenchymal proliferation with fluid-containing cysts of varying size and number. The mesenchymal component or cystic component may predominate; this predominance determines the imaging appearance of the tumor. Benign epithelial tumors that are common in adults may infrequently occur in childhood. These include focal nodular hyperplasia (FNH), hepatocellular adenoma, and nodular regenerative hyperplasia. All are composed of hyperplastic hepatocytes similar to surrounding liver parenchyma and may be difficult to discern at imaging. Preferential hepatic arterial phase enhancement helps distinguish FNH and hepatic adenoma from uninvolved liver. Hepatic adenoma often has intracellular fat and a propensity for intratumoral hemorrhage, neither of which are seen in FNH. Unlike adenoma, FNH often contains enough Kupffer cells to show uptake at sulfur colloid scintigraphy. Nodular regenerative hyperplasia is often associated with portal hypertension, which may be evident at imaging. Knowledge of how the pathologic features of these tumors affect their imaging appearances helps radiologists offer an appropriate differential diagnosis and management plan.
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Affiliation(s)
- Ellen M Chung
- Department of Radiology and Radiological Sciences, Edward F. Hebert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA.
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Seok JY, Kim YB. [Infantile hemangioendothelioma with increased serum alpha-fetoprotein]. THE KOREAN JOURNAL OF HEPATOLOGY 2010; 16:192-6. [PMID: 20606505 DOI: 10.3350/kjhep.2010.16.2.192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jae Yeon Seok
- Department of Pathology, Ajou University School of Medicine, Suwon, Korea
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Kim TJ, Lee YS, Song YS, Park CK, Shim SI, Kang CS, Lee KY. Infantile hemangioendothelioma with elevated serum alpha fetoprotein: report of 2 cases with immunohistochemical analysis. Hum Pathol 2010; 41:763-7. [PMID: 20153513 DOI: 10.1016/j.humpath.2009.05.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Revised: 04/23/2009] [Accepted: 05/13/2009] [Indexed: 01/06/2023]
Abstract
Infantile hemangioendothelioma is the most common benign mesenchymal tumor of the liver presenting during the first 6 months of life. Serum alpha fetoprotein is an important tumor marker for hepatoblastoma, hepatocellular carcinoma, and germ cell tumors. However, it is rarely elevated in patients with hepatic infantile hemangioendothelioma. In such cases, surgery may be done to rule out malignancies when alpha fetoprotein levels are high. The etiology of the elevated alpha fetoprotein level has not yet been elucidated. We report 2 cases of solitary hepatic infantile hemangioendothelioma and demonstrate immunohistochemically that hepatocytes near or entrapped within the tumor were the source of the increased serum levels of alpha fetoprotein explaining the unusual clinical presentation.
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Affiliation(s)
- Tae-Jung Kim
- Department of Hospital Pathology, College of Medicine, the Catholic University of Korea, 150-713 Seoul, Korea
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Increased type 3 iodothyronine deiodinase activity in a regrown hepatic hemangioma with consumptive hypothyroidism. Eur J Pediatr 2010; 169:215-21. [PMID: 19548001 DOI: 10.1007/s00431-009-1009-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2009] [Accepted: 06/03/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Infantile hepatic hemangioma with consumptive hypothyroidism is a rare condition. CASE REPORT A 4-month-old girl presented with diffuse hepatic hemangiomas during treatment of congenital hypothyroidism. Serum reverse triiodothyronine was elevated, and her hypothyroidism improved concomitant with involution of the hemangioma following prednisolone and interferon-alpha administration. At 20 months of age, 7 months after discontinuing prednisolone and interferon-alpha, a focal hemangioma regrew from one of the previous lesions and was surgically resected. The expression and activity of type 3 iodothyronine deiodinase (D3) were elevated in the resected tumor tissue compared with placenta. DISCUSSION Here, we describe a patient with consumptive hypothyroidism and diffuse infantile hepatic hemangiomas, one of which regrew after involution following pharmacotherapy. The etiology of elevated D3 activity is also discussed. CONCLUSION It is important to identify infantile hepatic hemangioma in patients with hypothyroidism refractory to hormone replacement therapy, who have low free triiodothyronine despite high thyrotropin and normal free thyroxine levels, and long-term follow-up will be needed for these patients.
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Abstract
BACKGROUND Infantile hepatic hemangioendothelioma (IHHE) is a rare disorder with only a few series reported in the medical literature. We reviewed our treatment experience with IHHE over 17 years. METHODS A retrospective analysis of patients with IHHE between 1991 and 2008 was performed. RESULTS Sixteen patients (median age 30 days) with IHHE were identified. A palpable abdominal mass was the most common presentation. All except two cases could be diagnosed radiologically. Thirteen patients had a unilobar single tumor and three patients had bilobar disease. Nine patients with symptoms and a resectable tumor underwent complete resection. Three patients with symptoms and unresectable tumor underwent medical treatment with steroids and interferon. Four asymptomatic patients were closely observed. Overall, 14 patients were cured and 1 patient died of postoperative bleeding. One patient is still on medication, and the tumor has greatly decreased in size. Two patients with bilobar disease showed elevated levels of serum alpha-fetoprotein at presentation. Histopathology confirmed type 1 IHHE in all of the 10 specimens. CONCLUSIONS The presence of clinical symptoms is a key element determining the treatment options. In symptomatic patients, primary surgical resection should be considered whenever feasible.
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Chao YH, Liang DC, Chen SH, Wang LY, Yeh TC, Liu HC. Interferon-alpha for alarming hemangiomas in infants: experience of a single institution. Pediatr Int 2009; 51:469-73. [PMID: 19400814 DOI: 10.1111/j.1442-200x.2008.02770.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hemangioma is the most common tumor in infancy. 'Alarming hemangiomas' refer to the lesions that potentially impair vital structures or cause life-endangering complications, and which warrant vigorous treatment. Interferon-alpha has been used for alarming hemangiomas at Mackay Memorial Hospital, Taipei, Taiwan, since 1994. METHODS The records of 21 consecutive infants treated between January 1994 and December 2005 were retrospectively reviewed. The initial dose of interferon-alpha was 50 000 IU/kg per day, which was increased to 100,000 IU/kg per day in the second week of therapy if tolerated. It was tapered depending on response, with total treatment lasting no longer than 12 months. Treatment response was evaluated depending on the size of the lesion and resolution of complications. RESULTS The duration of therapy ranged from 6 to 12 months. Six patients (29%) had a reduction in mass of > or =25% after 1 month of therapy. Twenty patients (95%) had achieved a decrease in size of 50% by 12 months, and 15 (71%) had total involution of lesions by a median age of 13.5 months (range 7-50 months). Only mild and transient adverse effects were encountered. No neurologic complications occurred. CONCLUSIONS Interferon-alpha appears to be an effective and well-tolerated treatment for alarming hemangiomas in infancy.
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Affiliation(s)
- Yu-Hua Chao
- Division of Pediatric Hematology and Oncology, Mackay Memorial Hospital, Taipei, Taiwan
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Focal nodular hyperplasia of the liver and elevated alpha fetoprotein level in an infant with isolated hemihyperplasia. J Pediatr Hematol Oncol 2008; 30:775-7. [PMID: 19011479 DOI: 10.1097/mph.0b013e3181812c7c] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A case of focal nodular hyperplasia of the liver in a 43-day-old baby girl with isolated hemihyperplasia and elevated serum alpha-fetoprotein is presented. The child referred to our hospital with bilateral renal masses detected by prenatal and postnatal ultrasonography. A mass lesion was detected in segment 6 of liver and was diagnosed as focal nodular hyperplasia. We present this case to emphasize the presence of focal nodular hyperplasia in a patient with isolated hemihypertrophy and elevated serum alpha-fetoprotein level.
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Araújo AR, Maciel I, Costa JC, Vieira A, Enes C, Santos Silva E. [Infantile hepatic hemangioendothelioma. A multifocal, bilobular and asymptomatic case with spontaneous regression]. An Pediatr (Barc) 2008; 68:507-10. [PMID: 18447999 DOI: 10.1157/13120052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Infantile hepatic hemangioendothelioma is a severe disease with a high mortality rate. Nevertheless these vascular lesions may experience spontaneous regression within 12 to 18 months. The decision of trying a specific treatment and the choice among the several therapeutic options remains controversial, particularly in those asymptomatic cases of multifocal, bilobular involvement. We describe a case of multifocal, bilobular and asymptomatic infantile hepatic hemangioendothelioma, untreated, and with spontaneous regression before 2 years of age.
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Affiliation(s)
- A R Araújo
- Servicio de Pediatría, Centro Hospitalar do Alto Minho, Viana do Castelo, Portugal.
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Adams DM, Wentzel MS. The role of the hematologist/oncologist in the care of patients with vascular anomalies. Pediatr Clin North Am 2008; 55:339-55, viii. [PMID: 18381090 DOI: 10.1016/j.pcl.2008.01.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Pediatric hematologist/oncologists have a critical role in the diagnosis and management of patients who have complex vascular anomalies. They provide the clinical and medical skills needed to diagnose, treat, and manage these patients. Hematologist/oncologists also provide support for clinical trials and drug development to further treatment options for these patients.
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Affiliation(s)
- Denise M Adams
- Division of Hematology/Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, MLC 7015, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
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