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Huang YT, Ou CY, Lee WT, Hsu HJ. Three Cases of Parotid Hemangiomas in Adults. EAR, NOSE & THROAT JOURNAL 2024; 103:NP422-NP426. [PMID: 34904445 DOI: 10.1177/01455613211067834] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hemangiomas account for only 0.4% to 0.6% of all parotid tumors, making them extremely rare in adults. Unlike pediatric parotid hemangiomas, those in adults typically present as asymptomatic swellings of the parotid, have no skin discoloration, and usually do not regress spontaneously. Therefore, an accurate diagnosis of parotid hemangiomas in adults before surgical excision is generally challenging. Herein, we present 3 cases of adult parotid hemangiomas. The patients all received parotidectomies with tumor resection. Histopathological analysis of the resected specimens revealed numerous dilated, thin- or thick-walled (small, large, or variably sized) vessels lined with flattened endothelial cells. A diagnosis of cavernous hemangioma of the parotid gland was established only after the histopathological analysis. Parotid cavernous hemangiomas in adults are rare and often misdiagnosed before surgical resection. Clinical presentation and imaging features on ultrasonography, computed tomography, magnetic resonance imaging, and angiography may support an accurate preoperative diagnosis. Surgical resection proved a suitable treatment approach for our 3 cases.
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Affiliation(s)
- Yi-Ting Huang
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Yen Ou
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ting Lee
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Heng-Jui Hsu
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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2
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Alanazi FM, Alqahtani S, Alruwaili SH, Alzamil AA, AlGhamdi FR. Cavernous Hemangioma in the Parotid Gland of an Adult: A Case Report and Review of Literature. Cureus 2024; 16:e52285. [PMID: 38357088 PMCID: PMC10865161 DOI: 10.7759/cureus.52285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
Hemangiomas are benign vascular tumors and are classified into cavernous, capillary, and mixed, with the head and neck area as the most common site. Hemangiomas are common in pediatrics and rare in adults. Diagnosing cavernous hemangioma is challenging and requires a complete history, proper physical examination, and several radiological modalities to improve diagnostic accuracy because it is uncommon in adults. Herein, we present a case of a 66-year-old female Saudi patient with cavernous hemangioma from the diagnosis until the surgical treatment. No previous studies are reported in Saudi Arabia and this is a rare presentation of cavernous hemangioma at this age. Cavernous hemangioma in the parotid gland in adults is uncommon and is difficult to diagnose. Therefore, a thorough physical examination and several radiological modalities are required to improve diagnostic accuracy. The most effective treatment of cavernous hemangioma in adults is surgical resection.
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Affiliation(s)
- Farhan M Alanazi
- Otolaryngology-Head and Neck Surgery, Prince Sultan Military Medical City, Riyadh, SAU
- Otolaryngology-Head and Neck Surgery, Prince Mohammed Medical City, Jouf, SAU
| | - Saeed Alqahtani
- Otolaryngology-Head and Neck Surgery, Prince Sultan Military Medical City, Riyadh, SAU
| | | | | | - Fareed R AlGhamdi
- Otolaryngology-Head and Neck Surgery, Prince Sultan Military Medical City, Riyadh, SAU
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3
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Kabagenyi F, Anena SP, Seguya A. 19 Months Toddler with a Giant Oral Capillary Hemangioma, a Case Report. Int Med Case Rep J 2023; 16:287-291. [PMID: 37213705 PMCID: PMC10198171 DOI: 10.2147/imcrj.s406901] [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: 02/02/2023] [Accepted: 05/09/2023] [Indexed: 05/23/2023] Open
Abstract
Head and neck vascular tumors are common in children. Capillary hemangiomas are often easily confused with pyogenic granulomas due to histopathological resemblance. Furthermore, predisposing factors to pyogenic granulomas include an existing hemangioma, which may be co-existing entities. Surgical excision of large unsightly tumors causing functional deficits is a feasible management option. We report a case of a rapidly growing oral lesion in a toddler with feeding difficulties and anemia. It triggered a diagnostic dilemma as it was clinically consistent with a pyogenic granuloma but histologically diagnosed as a capillary hemangioma. It was successfully excised with no recurrence after 6 months.
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Affiliation(s)
- Fiona Kabagenyi
- Department of Ear Nose and Throat, Makerere University, Kampala, Uganda
| | | | - Amina Seguya
- Department of Ear Nose and Throat, Mulago National Referral Hospital, Kampala, Uganda
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4
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Abstract
Infrared thermography is a useful adjunct for the clinical monitoring of infantile hemangioma (IH) activity with or without treatment. There is a dearth or reporting on the ideal tissue for standardizing temperature readings from IH. This case illustrates the use of mean medial canthal temperatures and the differential hemangioma temperatures for monitoring of facial IH.
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Affiliation(s)
- Afieharo I Michael
- Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Plastic, Reconstructive and Aesthetic Surgery, University College Hospital, Ibadan, Nigeria
- Correspondence address. Department of Surgery, College of Medicine, University of Ibadan, Ibadan P.M.B. 1156, Oyo State, Nigeria. Tel: +234-7059238585; E-mail:
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5
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Cordier F, Hoorens A, Van Dorpe J, Creytens D. Pediatric vascular tumors of the liver: Review from the pathologist’s point of view. World J Hepatol 2021; 13:1316-1327. [PMID: 34786168 PMCID: PMC8568580 DOI: 10.4254/wjh.v13.i10.1316] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/10/2021] [Accepted: 08/27/2021] [Indexed: 02/06/2023] Open
Abstract
Differential diagnosis of pediatric vascular liver tumors can be challenging due to inconsistent nomenclature, histologic overlap and the rarity of some entities. Here we give an up-to-date overview of the most important entities. We discuss the clinic, histology and pathophysiology of hepatic congenital and infantile heman gioma, hepatic epithelioid hemangioendothelioma and hepatic angiosarcoma.
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Affiliation(s)
- Fleur Cordier
- Department of Pathology, Ghent University Hospital, Ghent University, Ghent 9000, Belgium
| | - Anne Hoorens
- Department of Pathology, Ghent University Hospital, Ghent University, Ghent 9000, Belgium
| | - Jo Van Dorpe
- Department of Pathology, Ghent University Hospital, Ghent University, Ghent 9000, Belgium
| | - David Creytens
- Department of Pathology, Ghent University Hospital, Ghent University, Ghent 9000, Belgium
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6
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Derindağ G, Sarıca İ, Çağlayan F. Examination of oral hemangiomas by intraoral ultrasonography. Oral Radiol 2021; 37:687-692. [PMID: 33656695 DOI: 10.1007/s11282-021-00511-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Oral hemangioma is a benign vascular tumor characterized by the presence of numerous blood vessels. We aimed to examine the clinical and ultrasonographic findings of patients diagnosed with oral hemangioma in our ultrasonography (USG) archive, retrospectively. METHODS This study was conducted by examining 20 patients diagnosed with oral hemangioma and underwent USG examination in the Department of Oral and Maxillofacial Radiology of Atatürk University Faculty of Dentistry from 2016 to 2020. All patients had intraoral and radiographic examinations. Patients pre-diagnosed clinically oral hemangioma were evaluated as intraoral with USG. The intraoral USG examinations were performed using both the B-mode and the color Doppler mode. RESULTS The mean age of the patients was 42.4 ± 19.14 years; 16 patients were female and four were male. The lesions were mostly observed on the alveolar mucosa (30%), followed by the buccal mucosa (25%), the lower lip (15%), the mouth floor (15%), the tongue (15%). In intraoral USG examinations of all oral hemangiomas, we detected submucosal located, well-defined, lobulated, non-capsule, hypo-isoechoic, heterogeneous lesion areas. Additionally, while we detected only peripheral blood flow in 6 (30%) of 20 patients, we detected both internal and peripheral blood flow in 14 (70%). CONCLUSIONS In our study, the examination of the oral hemangiomas with the intraoral probe and the color Doppler mode was very helpful in the differential diagnosis. Although histopathology has an important place in definitive diagnosis, particularly intraoral USG can provide sufficient information for the diagnosis of oral hemangiomas.
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Affiliation(s)
- Gözde Derindağ
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Pamukkale University, Denizli, Turkey.
| | - İrfan Sarıca
- Health Cares Vocational School, Bezmialem Vakıf University, İstanbul, Turkey
| | - Fatma Çağlayan
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Ataturk University, Erzurum, Turkey
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7
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Tolentino EDS, Faria LOD, Vargas RM, Camarini C, Santin GC, Chicarelli da Silva M. Monoethanolamine oleate sclerotherapy for the treatment of intraoral vascular anomalies: retrospective study and suggestion for a clinical guideline. Br J Oral Maxillofac Surg 2020; 58:416-420. [DOI: 10.1016/j.bjoms.2020.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 01/22/2020] [Indexed: 10/25/2022]
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8
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Jin WW, Tong Y, Wu JM, Quan HH, Gao Y. Observation on the effects of 595- nm pulsed dye laser and 755- nm long-pulsed alexandrite laser on sequential therapy of infantile hemangioma. J COSMET LASER THER 2020; 22:159-164. [PMID: 32588671 DOI: 10.1080/14764172.2020.1783452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Infantile hemangioma (IH) can lead to severe complications. The 595-nm pulsed dye laser is poorly effective on thick and deep IH. Long-pulsed alexandrite laser has the proper wavelength of 755 nm and a relatively deep penetration. Thus, this may be a safe and effective treatment method for relatively deep or thick IH. AIMS AND OBJECTIVES This study aims to determine whether 595-nm pulsed dye laser and 755-nm long-pulsed alexandrite laser in sequential therapy are safer and more effective for relatively deep or thick hemangioma. MATERIALS AND METHODS This was a prospective study. A total of 194 infantile IH patients (thickness greater than 2 mm and less than 8 mm) were randomly divided into two groups: control group (treated using 595-nm pulsed dye laser) and experimental group (treated by sequential therapy with 755-nm long-pulsed alexandrite laser and 595-nm dye laser). RESULTS The control group had a total effective rate of 36.1%, while the experimental group had a total effective rate of 76.3%. Enumeration data were compared by X2 -test. The results were considered statistically significant at P < .05. CONCLUSION Sequential therapy with 755-nm pulsed dye laser and 595-nm long-pulsed alexandrite laser is a safe and effective treatment approach for relatively deep or thick hemangioma.
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Affiliation(s)
- Wan-Wan Jin
- Department of Dermatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University , Wenzhou, Zhejiang, China
| | - Yi Tong
- Department of Dermatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University , Wenzhou, Zhejiang, China
| | - Jian-Ming Wu
- Department of Dermatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University , Wenzhou, Zhejiang, China
| | - He-He Quan
- Department of Dermatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University , Wenzhou, Zhejiang, China
| | - Yu Gao
- Department of Dermatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University , Wenzhou, Zhejiang, China
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Abstract
Hamartomas are benign lesions composed of aberrant disorganized growth of mature tissues. Choristomas are similar, except that they are composed of tissues not normally found at the anatomic site in which the lesion is arising. A wide range of hamartomas and choristomas can arise in the skin and soft tissue. Some of these may cause diagnostic difficulty and potentially be mistaken for neoplasms. Some neoplasms may resemble hamaratomas. Here we review the current clinical and pathologic features of these lesions, both common and rare, and discuss how to distinguish them from other entities in the differential diagnosis.
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Affiliation(s)
- B Joel Tjarks
- Departments of Laboratory Medicine and Dermatology, Geisinger Health System, Danville, PA, United States
| | - Jerad M Gardner
- Departments of Pathology and Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Nicole D Riddle
- Department of Pathology and Cell Biology - USF Health, Ruffolo, Hooper, and Associates, Tampa, FL, United States.
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10
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Fernandes DT, Elias RA, Santos-Silva AR, Vargas PA, Lopes MA. Benign oral vascular lesions treated by sclerotherapy with ethanolamine oleate: A retrospective study of 43 patients. Med Oral Patol Oral Cir Bucal 2018; 23:e180-e187. [PMID: 29476682 PMCID: PMC5911356 DOI: 10.4317/medoral.22253] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 12/25/2017] [Indexed: 11/07/2022] Open
Abstract
Background Although sclerotherapy is a common treatment for benign oral vascular lesions, there is no well-standardized protocol for this purpose. The aim of the present study was to describe the clinical characteristics of patients treated by sclerotherapy with ethanolamine oleate (EO), in order to contribute to a better understanding of this technique. Material and Methods Medical records and images of 90 patients treated by the same sclerotherapy protocol were retrieved and analysed. Thus, 43 cases with complete information were selected and described. Results The most affected age group was 41–70 years, with a female predominance and 86% of patients being Caucasian. Lips were the most affect site (70%) followed by the tongue (16%). Regarding clinical appearance, approximately 90% of lesions were classified as nodules, and 90% of patients reported no pain. Approximately 40% of lesions were 0.5–1.0 cm in size. In 58% of the patients, only one application of ethanolamine oleate was necessary. The application doses varied according to the lesion size and number of applications. Complete clinical regression occurred in 91% of cases, whereas 9% showed partial regression. Conclusions Sclerotherapy with EO is an acceptable, effective and affordable treatment for benign oral vascular lesions. Key words:Hemangioma, vascular malformations, varicose veins, sclerotherapy.
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Affiliation(s)
- D-T Fernandes
- Faculdade de Odontologia de Piracicaba - UNICAMP, Departamento de Diagnóstico Oral - Semiologia, Av. Limeira, 901 CEP 13.414-903, Piracicaba, São Paulo, Brasil,
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11
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Chen YZ, Bai N, Bi JH, Liu XW, Xu GQ, Zhang LF, Li XQ, Huo R. Propranolol inhibits the proliferation, migration and tube formation of hemangioma cells through HIF-1α dependent mechanisms. ACTA ACUST UNITED AC 2017; 50:e6138. [PMID: 28977119 PMCID: PMC5625545 DOI: 10.1590/1414-431x20176138] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 08/15/2017] [Indexed: 12/11/2022]
Abstract
The aim of this study was to investigate the mechanism of propranolol on the regression of hemangiomas. Propranolol-treated hemangioma tissues were collected and the expression of hypoxia inducible factor-1α (HIF-1α) was examined. We also established HIF-1α overexpression and knockdown hemangioma cells, and determined the effects of HIF-1α on the hemangioma cells proliferation, apoptosis, migration and tube formation. Significantly increased HIF-1α level was found in the hemangioma tissues compared to that in normal vascular tissues, whereas propranolol treatment decreased the HIF-1α level in hemangioma tissues in a time- and dose-dependent manner. Moreover, propranolol treatment significantly decreased cell proliferation, migration and tube formation as well as promoted cell apoptosis in HIF-1α overexpression and knockdown hemangioma cells. Propranolol suppressed the cells proliferation, migration and tube formation of hemangioma cells through HIF-1α dependent mechanisms. HIF-1α could serve as a novel target in the treatment of hemangiomas.
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Affiliation(s)
- Y Z Chen
- Department of Aesthetic, Plastic, and Burn Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China.,Department of Aesthetic, Plastic, and Burn Surgery, Linyi People's Hospital, Linyi, Shandong, China
| | - N Bai
- Department of Aesthetic, Plastic, and Burn Surgery, Linyi People's Hospital, Linyi, Shandong, China
| | - J H Bi
- Department of Aesthetic, Plastic, and Burn Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - X W Liu
- Department of Aesthetic, Plastic, and Burn Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - G Q Xu
- Department of Aesthetic, Plastic, and Burn Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - L F Zhang
- Department of Aesthetic, Plastic, and Burn Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - X Q Li
- Department of Aesthetic, Plastic, and Burn Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - R Huo
- Department of Aesthetic, Plastic, and Burn Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
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12
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da Silva Filho TJ, de Oliveira DHIP, Brasil VLM, Nonaka CFW, da Silveira ÉJD, Queiroz LMG. An update of 77 cases diagnosed as oral hemangiomas based on GLUT-1 positivity. Exp Mol Pathol 2017; 103:9-13. [PMID: 28545938 DOI: 10.1016/j.yexmp.2017.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 04/15/2017] [Accepted: 05/20/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To evaluate cases diagnosed as "oral hemangiomas" based on the immunohistochemical expression of human glucose transporter protein (GLUT-1) and on histopathological features, and to investigate whether the classification proposed by the ISSVA was used correctly to classify these lesions. MATERIAL AND METHODS All cases stored in the archives of an Oral Pathology Service and diagnosed as "oral hemangiomas" were reviewed. Seventy-seven cases were analyzed regarding the expression of GLUT-1. GLUT-1(+) specimens were classified as true infantile hemangioma (IH) and GLUT-1(-) specimens were reclassified based on their histopathological features. The nomenclature of these lesions was evaluated and some cases were reclassified. RESULTS Only 26 (33.8%) of the specimens were indeed IHs. Among the GLUT-1(-) specimens, 20 (26.0%) were reclassified as pyogenic granulomas (PGs) and 31 (40.2%) as vascular malformations. Considering the previously applied nomenclature, only 47.5% of the cases initially diagnosed as "hemangiomas" were IHs. In the group of "capillary hemangiomas", most cases (56.2%) were PGs. Among the three "cellular hemangiomas", two were PGs and one was IH. Most (88.8%) "cavernous hemangiomas" were vascular malformations. CONCLUSION Careful and parameterized review of cases of vascular anomalies is necessary using auxiliary tools such as GLUT-1, since the exclusive use of histopathological findings might be insufficient to differentiate some anomalies. CLINICAL RELEVANCE Accurate clinical examination and the use of biomarkers such as GLUT-1 are essential for the diagnosis.
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13
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Efficacy of Topical Timolol as Primary Monotherapy in Cutaneous Facial Infantile Hemangiomas. J Craniofac Surg 2016; 27:e516-20. [DOI: 10.1097/scs.0000000000002849] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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14
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Abstract
Hemangiomas are the most common tumor of infancy, and the vast majority occur in the head and neck region. In children, laryngeal hemangiomas typically occur below the level of the true vocal folds, in the region of the subglottis, and other sites are exceedingly rare. We present four cases of hemangiomas located in the postcricoid region of the hypopharynx. Because of the location of these lesions, children may present with obstructive symptoms such as dysphagia, intermittent aspiration, hypersalivation, or recurrent respiratory infections. Clinical diagnosis is relatively easily made with flexible laryngoscopy, as the lesions have a propensity to enlarge with crying or straining. When these patients are examined under general anesthesia in a relaxed state, however, the lesions are typically much smaller, and can even go unnoticed. Unlike other reported cases, the postcricoid hemangiomas in our patients were not causing any symptoms and were simply incidental findings. Thus, we believe that the true incidence of postcricoid hemangiomas is likely higher than reports suggest. To our knowledge, we report the longest follow-up (6 years) of a patient with a postcricoid hemangioma and are the first to describe the natural course of such a lesion.
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Affiliation(s)
- Ramez J Awwad
- Department of Otolaryngology and Communication Sciences, State University of New York Upstate Medical University, Syracuse, New York 13210, USA
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15
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Keller RG, Patel KG. Evidence-Based Medicine in the Treatment of Infantile Hemangiomas. Facial Plast Surg Clin North Am 2016. [PMID: 26208774 DOI: 10.1016/j.fsc.2015.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Over the past decade, the treatment of infantile hemangiomas has undergone dramatic breakthroughs. This review critically evaluates the latest literature that supports the myriad treatment options for infantile hemangiomas. It chronicles the fading role of steroid therapy and evolution of propranolol use as the major treatment modality. Although propranolol is helping this disease become more of a medical disease and less of a surgical dilemma, the report also reveals a continued search to find nonsystemic treatment options. In summary, this is an evidence-based medicine review for the treatment of infantile hemangiomas.
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Affiliation(s)
- Robert G Keller
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC 29425, USA
| | - Krishna G Patel
- Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC 29425, USA.
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16
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González-Arriagada WA, Dias MA, Dias PDS, Martínez-Martínez M, Sena-Filho M, de Almeida OP. Oral encapsulated vascular malformation: An undescribed presentation in the mouth. J Clin Exp Dent 2016; 8:e84-8. [PMID: 26855712 PMCID: PMC4739374 DOI: 10.4317/jced.52698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 09/05/2015] [Indexed: 01/03/2023] Open
Abstract
Vascular lesions have been classified in two broad categories, hemangiomas and malformations. Encapsulated vascular lesions have not been reported in the oral cavity, but they were described in other sites, mainly in the orbit. Herein, we present a case of an oral encapsulated vascular lesion located in the right buccal mucosa of a 69-year-old male, including histological and immunohistochemical description and a literature review.
Key words:Buccal mucosa, hemangioma, vascular malformation, oral cavity.
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Affiliation(s)
| | - Márcio-Américo Dias
- DDS. Stomatology, Faculdade de Odontologia do INAPOS, Pouso Alegre, Minas Gerais, Brazil
| | | | - Marisol Martínez-Martínez
- DDS, MSc, PhD. Oral Diagnosis Department, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, Sao Paulo, Brazil
| | - Marcondes Sena-Filho
- DDS, MSc, PhD. Oral Diagnosis Department, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, Sao Paulo, Brazil
| | - Oslei-Paes de Almeida
- DDS, MSc, PhD. Oral Diagnosis Department, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, Sao Paulo, Brazil
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17
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Konda P, Bavle RM, Makarla S, Muniswamappa S. Intramuscular sinusoidal haemangioma with secondary Masson's phenomenon. BMJ Case Rep 2016; 2016:bcr-2013-201457. [PMID: 26729822 DOI: 10.1136/bcr-2013-201457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Intramuscular haemangiomas (IMHs) are rare benign vascular neoplasms that account for approximately 0.8% of all haemangiomas. The histology of IMHs can reveal cavernous dilated spaces. We report an interesting case of haemangioma in the deep skeletal muscle of the right labial mucosa in a young man involving the orbicularis oris muscle which showed additional features of sinusoidal arrangement with a secondary Masson's phenomenon.
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Affiliation(s)
- Paremala Konda
- Department of Oral Pathology, Krishnadevaraya College of Dental Sciences, Bangalore, Karnataka, India
| | - Radhika M Bavle
- Department of Oral Pathology, Krishnadevaraya College of Dental Sciences, Bangalore, Karnataka, India
| | - Soumya Makarla
- Department of Oral Pathology, Krishnadevaraya College of Dental Sciences, Bangalore, Karnataka, India
| | - Sudhakara Muniswamappa
- Department of Oral Pathology, Krishnadevaraya College of Dental Sciences, Bangalore, Karnataka, India
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18
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Chalya PL, Kayange NM, Rambau PF, Manyama M, Gilyoma JM. Surgical management of vascular anomalies in children at a tertiary care hospital in a resource-limited setting: a Tanzanian experience with 134 patients. BMC Res Notes 2015; 8:732. [PMID: 26621505 PMCID: PMC4666117 DOI: 10.1186/s13104-015-1718-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 11/18/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Vascular anomalies pose major diagnostic and therapeutic challenges among pediatricians and pediatric surgeons practicing in resource limited countries. There is paucity of published data regarding this subject in Tanzania and Bugando Medical Centre in particular. This study describes our experiences on the challenges and outcome of surgical management of childhood vascular anomalies in our environment. METHODS Between January 2009 and December 2013, a prospective study on the surgical management of vascular anomalies was undertaken at Bugando Medical Centre. RESULTS A total of 134 patients (M; F = 1:2.5) were studied. The median age at presentation was 6 years. Of the 134 patients, 101 (75.4%) were diagnosed as having vascular tumors and 33 (24.6%) had vascular malformations. The head and the neck were the most frequent anatomical site recorded as having a tumor (56.7% of patients). Out of 134 patients, 129 (96.3%) underwent surgical treatment. Failure to respond to non-operative treatment (86.8%), huge disfiguring/obstructing mass (4.7%), infection (3.1%), ulceration (3.1%) and hemorrhage (2.3%) were indications for surgical intervention. Tumor excision and primary wound closure was the most common type of surgical procedure performed in 80.6% of patients. Surgical site infection was the most frequent complications accounting for 33.8% of cases. Mortality rate was 1.5%. Tumor excision and primary wound closure gave better outcome compared with other surgical options (p < 0.001). Outcome of injection sclerotherapy in 3 (3.7%) children, serial ligation of feeder vessels employed in 2 (1.6%), and conservative treatment in 5 (3.7%), were poor and required conversion to surgical excision. Despite low mortality rate recorded in this study, but ugly scar, 14 (20.6%) and limb deformity, 6 (8.8%) were problems. The overall result of surgical treatment at the end of follow up period was excellent in 108 (87.1%) patients. CONCLUSION Surgical excision and primary wound closure gave good outcome which could be employed in complicated and vascular anomalies which failed to respond to other treatment in regions with limited resources.
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Affiliation(s)
| | - Neema M Kayange
- Department of Paediatrics, Bugando Medical Centre, Mwanza, Tanzania.
| | - Peter F Rambau
- Department of Pathology, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania.
| | - Mange Manyama
- Department of Anatomy, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania.
| | - Japhet M Gilyoma
- Department of Surgery, Bugando Medical Centre, Mwanza, Tanzania.
- Department of Otorhinolaryngology, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania.
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Moodley ST, Hudson DA, Adams S, Adams KG. Shouldn't Propranolol Be Used to Treat All Haemangiomas? Aesthetic Plast Surg 2015; 39:963-7. [PMID: 26377820 DOI: 10.1007/s00266-015-0557-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 07/07/2015] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Infantile haemangioma is the most common childhood tumour. These tumours can cause significant functional and cosmetic problems. While there are many treatment modalities, propranolol is increasingly being recognised as the first-line treatment of problematic haemangiomas. This study investigates the use of oral propranolol for the treatment of all haemangiomas at a tertiary children's hospital. METHOD This is a retrospective study evaluating 15 children (3 boys and 12 girls) presenting at a tertiary children's hospital with infantile haemangioma during a 24-month period. The protocol consisted of pre-treatment ultrasonic evaluation of the lesion, followed by the commencement of propranolol therapy (2 mg/kg orally in two divided doses), with repeat imaging performed at 16-24 weeks in order to document the dimensional changes. Adverse effects of propranolol were documented. Intralesional bleomycin was utilised as a second-line modality of treatment for large or problematic haemangiomas with inadequate regression in size after oral propranolol therapy. RESULT Fifteen (15) patients with a mean age of 7 months (Range: 3-14 months) presented with haemangiomas. Ten patients presented with lesions affecting the head and neck region (67%). Three patients presented with an ulcerated haemangioma, which responded to propranolol and simple dressings and all healed completely. The average decrease in size between the ultrasonography procedures was 48.87%. Only one patient showed no improvement. No side effects were reported. Concomitant bleomycin treatment was reserved for large problematic haemangiomas and proved successful at speeding up the involution process. CONCLUSION This study suggests that propranolol become the first-line treatment of choice for all haemangiomas. It has proven to be effective and safe for reducing the size of all haemangiomas during the proliferative phase. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Morris GA, Stratchko L, Sabri M. Intestinal hemangioma presenting as recurrent hematochezia in a 6-week-old male. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Silva Filho TJD, Oliveira DHIPD, Moura IDS, Medeiros LKDS, Gonzaga AKG, Brasil VLM, Queiroz LMG. Importance of GLUT1 in differential diagnosis of vascular anomalies. J Vasc Bras 2015. [DOI: 10.1590/1677-5449.0069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Vascular anomalies (VAs) include a group of distinct lesions, such as vascular system congenital malformations, as well as benign and malignant vascular tumors. These lesions may present similar clinical and histopathological features, leading to mistaken diagnoses and incorrect treatment choices. It is important that professionals responsible for monitoring the development of VAs conduct precise investigations and use the appropriate terminology. The human glucose transporter protein isoform 1 (GLUT1) has been proposed as a tool to aid in differential diagnosis between different VAs, given that it is a sensitive and specific marker for identification of infantile hemangiomas (HIs) in any organ. This article presents a review of the literature on this protein as an effective tool for identification and possible differential diagnosis between several VAs.
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Hemangioma mimicking dorsal nasal hump. J Craniofac Surg 2015; 25:e501-2. [PMID: 25148616 DOI: 10.1097/scs.0000000000000947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A 24-year-old female patient with a dorsal nasal hemangioma mimicking a prominent dorsal nasal hump, which was noticed during the rhinoplasty operation, is presented.
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Wang HH, Yeh TT, Lin YC, Huang GS. Imaging features of an intraosseous arteriovenous malformation in the tibia. Singapore Med J 2015; 56:e21-5. [PMID: 25715860 DOI: 10.11622/smedj.2015028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Primary intraosseous arteriovenous malformations (AVMs) are rare and have only been occasionally reported. We herein report a histologically proven case of primary intraosseous AVM in the tibia, which mimicked a fibrous tumour on radiography. This presentation carries a risk of triggering acute large haemorrhage through unnecessary biopsy. In intraosseous AVM, the magnetic resonance (MR) imaging features typical of a soft tissue AVM are absent, making diagnosis difficult. In this report, peculiar MR features in the presence of a connecting vessel between the normal deep venous system of the lower extremity and the tumour provide a clue for the early diagnosis of primary intraosseous AVM.
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Affiliation(s)
| | | | | | - Guo-Shu Huang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, No 325, Sec 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan, Republic of China.
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Consider obstructive sleep apnea in patients with oropharyngeal vascular malformations. J Craniomaxillofac Surg 2014; 43:1937-41. [PMID: 26427617 DOI: 10.1016/j.jcms.2014.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 11/07/2014] [Accepted: 11/17/2014] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Patients with oropharyngeal vascular malformations with complaints of upper airway obstruction were referred to a sleep specialist to investigate the existence of obstructive sleep apnea (OSA). METHODS Demography, complaints, localization, and extent of the malformation were noted. The Epworth Sleeping Scale (ESS) and a polysomnography were performed to analyze the existence of OSA. RESULTS Thirteen patients with vascular malformations in the upper oropharyngeal tract were referred, with a mean age of 49 years (range, 20-77 years). The male: female ratio was 7:6. In 2 patients the ESS was missed, and in the other 11 patients the mean ESS was 11.7 (range, 4-23). After polysomnography, 11 of the 13 patients (85%) were diagnosed with OSA, of whom 7 patients had severe OSA. CONCLUSION Patients with oropharyngeal vascular malformations with complaints of upper airway obstruction have a high risk of OSA, and should be referred to a sleep specialist.
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Lara-Sánchez H, Peral-Cagigal B, Madrigal-Rubiales B, Verrier-Hernández A. Cavernous hemangioma of the parotid gland in adults. J Clin Exp Dent 2014; 6:e592-4. [PMID: 25674332 PMCID: PMC4312692 DOI: 10.4317/jced.51750] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 06/15/2014] [Indexed: 01/05/2023] Open
Abstract
Hemangiomas account for 0.4-0.6% of all tumors of the parotid gland and most of them occur in children, nevertheless in adults hemangiomas are very rare. We report the case of a 62 year old woman with a mass in the parotid right tail associated with fluctuating swelling episodes unrelated to meals and with a slowly progressive growth. The provisional diagnosis was a pleomorphic adenoma, so a right superficial parotidectomy was performed. During surgery, the macroscopic appearance makes suspect a vascular lesion. The histopathological result was a cavernous hemangioma. The classic clinical presentation of a parotid hemangioma is an intraglandular mass associated or not with skin lesions characterized by reddish macules and/or papules, and a vibration or pulsation when palpating the parotid region. In imaging tests, phleboliths could be observed which are very suggestive of a hemangioma or a vascular malformation. In the absence of these signs, the diagnosis could be difficult, particularly in an adult due to its low prevalence, with about 50 cases reported worldwide. However a hemangioma should be considered in the differential diagnosis of parotid tumors in adults. Key words:Cavernous hemangioma, parotid gland, superficial parotidectomy, pleomorphic adenoma.
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Affiliation(s)
- Hugo Lara-Sánchez
- M.D, ENT Resident. Otolaryngology Head and Neck Surgery Department. Río Hortega University Hospital.Valladolid, Spain
| | - Beatriz Peral-Cagigal
- M.D, Oral and Maxillofacial Surgeon. Oral and Maxillofacial Surgery Department. Río Hortega University Hospital. Valladolid, Spain
| | | | - Alberto Verrier-Hernández
- Chief of Oral and Maxillofacial Surgery. Oral and Maxillofacial Surgery Department. Río Hortega University Hospital. Valladolid, Spain
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Glucose transporter isoform-1 receptor-positive infantile capillary hemangiomas: case report and literature review. Can J Ophthalmol 2014; 49:e156-8. [PMID: 25433755 DOI: 10.1016/j.jcjo.2014.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/28/2014] [Accepted: 09/08/2014] [Indexed: 11/21/2022]
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Werdich XQ, Jakobiec FA, Curtin HD, Fay A. A clinical, radiologic, and immunopathologic study of five periorbital intraosseous cavernous vascular malformations. Am J Ophthalmol 2014; 158:816-826.e1. [PMID: 25034115 DOI: 10.1016/j.ajo.2014.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 07/01/2014] [Accepted: 07/03/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To correlate the clinical, radiographic, histopathologic, and immunohistochemical features of 5 primary periorbital intraosseous cavernous vascular malformations. DESIGN Retrospective interventional case series. METHODS Clinical and operative records and radiographic images were reviewed. Histopathologic slides were evaluated with hematoxylin-eosin, trichrome, and elastin stains. Immunohistochemical studies were performed with a spectrum of monoclonal antibodies directed at antigens of vascular cells. RESULTS Three men and 2 women ranged in age from 36 to 64 years. Vision was unaffected and there was no proptosis or globe displacement. The slow-growing lesions measured 13-25 mm in greatest diameter (mean 16.4 mm). Computed tomographic studies revealed that 2 lesions were situated in the maxillary bone, 2 in the frontal, and 1 in the zygoma, all anteriorly and with circumscribed, lucent, honeycombed, or sunburst characteristics. Histopathologically the lesions were composed of cavernous or telangiectatic channels; 1 showed advanced fibrotic vascular involution. Immunohistochemistry demonstrated CD31/34 positivity for vascular endothelium and D2-40 negativity for lymphatic endothelium. A typically thin mural myofibroblastic cuff was smooth muscle actin positive, weakly calponin positive, and desmin negative. Glucose transporter-1 and Ki-67 were negative in the endothelium. CONCLUSIONS Intraosseous vascular lesions resemble orbital cavernous venous malformations (not true hemangiomas), except that their vascular walls are thinner owing to the constraints imposed by neighboring bone spicules, which limit the amount of interstitium from which mural myofibroblasts can be recruited. The bony trabeculae conferred the honeycomb or sunburst appearances observed radiographically. En bloc excision of these lesions was successful and avoided complications (mean follow-up, 46 months).
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Affiliation(s)
- Xiang Q Werdich
- David G. Cogan Laboratory of Ophthalmic Pathology, Boston, Massachusetts; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Frederick A Jakobiec
- David G. Cogan Laboratory of Ophthalmic Pathology, Boston, Massachusetts; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Hugh D Curtin
- Department of Radiology, Boston, Massachusetts; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Aaron Fay
- Ophthalmic Plastic Surgery, Boston, Massachusetts; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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MRI molecular imaging using GLUT1 antibody-Fe3O4 nanoparticles in the hemangioma animal model for differentiating infantile hemangioma from vascular malformation. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2014; 11:127-35. [PMID: 25168935 DOI: 10.1016/j.nano.2014.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 07/14/2014] [Accepted: 08/13/2014] [Indexed: 02/02/2023]
Abstract
The purpose of this study is to evaluate the efficacy of glucose transporter protein 1 (GLUT1) antibody-conjugated iron oxide nanoparticles (Fe3O4 NPs) as magnetic resonance imaging (MRI) molecular imaging agents for differentiating infantile hemangioma from vascular malformation in the hemangioma animal model. The conjugation of Fe3O4 NPs with anti-GLUT1 antibodies leads to a significantly increased uptake of NPs by human umbilical vein endothelial cells. MRI imaging following the intravenous injection of GLUT1 antibody-Fe3O4 NPs yielded a significantly lower signal intensity than did unconjugated Fe3O4 NPs. Upon histological examination of the GLUT1 antibody-Fe3O4 NPs, Prussian blue-stained NPs were identified in CD31-positive endothelial cells of hemangioma. In contrast, when treated with unconjugated Fe3O4 NPs, Prussian blue-stained NPs were found in macrophages rather than in endothelial cells. GLUT1 antibody conjugation can effectively target the injected Fe3O4 NPs to GLUT1-positive tumor cells in infantile hemangioma.
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Nayak SK, Nayak P. Intramuscular hemangioma of the oral cavity - a case report. J Clin Diagn Res 2014; 8:ZD41-2. [PMID: 25302283 PMCID: PMC4190810 DOI: 10.7860/jcdr/2014/8305.4756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 04/22/2014] [Indexed: 11/24/2022]
Abstract
Haemangiomas are the most common benign soft tissue tumor of the oral cavity. It often presents at birth or soon after, and appears as a soft and vascular swelling in lip, tongue, or buccal mucosa. This article reports a rare case of intra muscular haemangioma of the buccal mucosa in a 27-year-old female patient.
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Affiliation(s)
- Sushruth K Nayak
- Reader, Department of Oral and Maxillofacial Pathology & Microbiology, Chattisgarh Dental College and Research Institute, Rajnandgaon, Chhattisgarh, India
| | - Prachi Nayak
- Faculty, Department of Oral and Maxillofacial Pathology & Microbiology, Chattisgarh Dental College and Research Institute, Rajnandgaon, Chhattisgarh, India
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Abstract
VASCULAR ANOMALIES ARE DIVIDED INTO TWO MAIN GROUPS tumors and malformations. Vascular tumors are a large and complex group of lesions, especially for clinicians with none or little experience in this field. In the past, these lesions caused a great deal of confusion because many appear analogous to the naked eye. Thankfully, recent advances in diagnostic techniques have helped the medical community to enhance our comprehension, accurately label, diagnose, and treat these lesions. In this article, we will review the most frequent vascular tumors and provide the reader with the tools to properly label, diagnose, and manage these complex lesions.
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Affiliation(s)
- Abel Sepulveda
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
| | - Edward P Buchanan
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
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Sharma VK, Fraulin FO, Dumestre DO, Walker L, Harrop AR. Beta-blockers for the treatment of problematic hemangiomas. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2014; 21:23-8. [PMID: 24431932 DOI: 10.1177/229255031302100103] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine treatment indications, efficacy and side effects of oral beta-blockers for the treatment of problematic hemangiomas. METHODS A retrospective review of patients with hemangiomas presenting to the Alberta Children's Hospital Vascular Birthmark Clinic (Calgary, Alberta) between 2009 and 2011 was conducted. The subset of patients treated with oral beta-blockers was further characterized, investigating indication for treatment, response to treatment, time to resolution of indication, duration of treatment, occurrence of rebound growth and side effects of therapy. RESULTS Between 2009 and 2011, 311 new patients with hemangiomas were seen, of whom 105 were treated with oral beta-blockers. Forty-five patients completed beta-blocker treatment while the remainder continue to receive therapy. Indications for treatment were either functional concerns (68.6%) or disfigurement (31.4%). Functional concerns included ulceration (29.5%), periocular location with potential for visual interference (28.6%), airway interference (4.8%), PHACES syndrome (3.8%), auditory interference (0.95%) and visceral location with congestive heart failure (0.95%). The median age at beta-blocker initiation was 3.3 months; median duration of therapy was 10.6 months; and median maximal treatment dose was 1.5 mg/kg/day for propranolol and 1.6 mg/kg/day for atenolol. Ninety-nine patients (94.3%) responded to therapy with size reduction, colour changes, softened texture and/or healing of ulceration. Rebound growth requiring an additional course of therapy was observed in 23 patients. Side effects from beta-blockers included cool extremities (26.7%), irritability (17.1%), lower gastrointestinal upset (14.3%), emesis (11.4%), hypotension (10.5%), poor feeding (7.6%), lethargy (4.8%), bronchospasm (0.95%) and rash (0.95%). Side effects did not result in complete discontinuation of beta-blocker treatment in any case; however, they prompted a switch to a different beta-blocker preparation in some cases. Resolution of the primary indication, requiring a median time of three months, occurred in 87 individuals (82.9%). CONCLUSIONS Treatment of infantile hemangiomas with oral beta-blocker therapy is highly effective and well tolerated, with more than 94% of patients demonstrating a response to treatment and 90% showing resolution of the primary functional indication for treatment.
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Affiliation(s)
| | - Frankie Og Fraulin
- Department of Surgery: Section of Plastic Surgery; ; Section of Pediatric Surgery
| | | | - Lori Walker
- Department of Pediatrics, University of Calgary, Alberta Children's Hospital, Calgary, Alberta
| | - A Robertson Harrop
- Department of Surgery: Section of Plastic Surgery; ; Section of Pediatric Surgery
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Su W, Ke Y, Xue J. Beneficial effects of early treatment of infantile hemangiomas with a long-pulse Alexandrite laser. Lasers Surg Med 2014; 46:173-9. [PMID: 24391080 DOI: 10.1002/lsm.22221] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVE There is an increasing interest in treating vascular lesions with a long-pulse Alexandrite laser. However, it is difficult to search information in the literature about infantile hemangiomas (IH) treated with long-pulse Alexandrite laser. This article aims to determine whether 755 nm long-pulse Alexandrite laser is effective and safe for early intervention of IH and provides some new data on this issue. MATERIALS AND METHODS This is a retrospective study of 48 infants with IH treated with long-pulse Alexandrite laser during a 1.5-year period. Patients received a series of 1-7 treatment sessions with long-pulse Alexandrite laser at settings of 3 milliseconds pulse duration, 6-8 mm spot, 45-70 J/cm(2) fluences, and with dynamic cooling device (DCD) spray duration of 90 milliseconds and delay of 80 milliseconds, given at 4- to 6-week intervals. RESULTS This study demonstrated that IH responded favorably to the treatment of a long-pulse Alexandrite laser while accompany with relatively few complications. The difference between the original untreated and post-treatment scores of all IH and two subgroups were statistically significant, respectively (P < 0.01). The difference of the degree of improvement between the two subgroups was not significant (P > 0.05). It was observed that IH on the trunk and extremities improved more effectively and more quickly than those on the face, neck, and perineum. Besides, age at the first treatment, the sex of the patients and the presence of proliferation were not significantly correlated with the degree of improvement. Adverse effects were seen in 11 patients (22.91%): blistering (n = 9), marked edema and erosion without subsequent residual scarring (n = 1), and hypopigmentation (n = 1), which improved gradually with time. Fortunately, there was no incidence of scarring or ulceration in this case series of IH. CONCLUSIONS It was clinically effective and safe for early treatment of IH, including the thick/deep ones, with a long-pulse Alexandrite laser, which indicated be able to reduce the possibility that the IH will reach its full size. In this way it can prevent several complications connected to the rapid proliferation of IH.
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Affiliation(s)
- Wenting Su
- Department of Dermatology, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou Children's Hospital, Wenzhou, 325027, Zhejiang Province, China
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Vascular anomalies of the extremities. CURRENT ORTHOPAEDIC PRACTICE 2013. [DOI: 10.1097/bco.0b013e3182961675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Santecchia L, Valassina MFB, Maggiulli F, Spuntarelli G, De Vito R, Zama M. Early Surgical Excision of Giant Congenital Hemangiomas of the Scalp in Newborns: Clinical Indications and Reconstructive Aspects. J Cutan Med Surg 2013; 17:106-13. [DOI: 10.2310/7750.2012.11113] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Infantile hemangioma is the most common vascular tumor in newborns, with an incidence from 12 to 23% among preterm infants with low weight at birth and a female to male ratio of 3:1. The head and neck is the most frequently affected area (60%), and the scalp is a typical site for such large lesions. Objective: We describe some clinical and medical aspects in comparison with the surgical approach to giant infantile hemangioma of the scalp. Methods: The indications to treatment are discussed. An outcome basis evaluation, by reviewing some clinical cases, is provided to help readers better understand when and how to undergo surgery safely. Conclusion: Early excision of huge infantile hemangioma of the scalp is the treatment of choice if feasible within 5 months of age.
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Affiliation(s)
- Luigino Santecchia
- From the Plastic and Maxillofacial Surgery Unit and Clinical Laboratories Department, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Federica Maggiulli
- From the Plastic and Maxillofacial Surgery Unit and Clinical Laboratories Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Giorgio Spuntarelli
- From the Plastic and Maxillofacial Surgery Unit and Clinical Laboratories Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Rita De Vito
- From the Plastic and Maxillofacial Surgery Unit and Clinical Laboratories Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Mario Zama
- From the Plastic and Maxillofacial Surgery Unit and Clinical Laboratories Department, Bambino Gesù Children's Hospital, Rome, Italy
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Propranolol induces regression of hemangioma cells through HIF-1α-mediated inhibition of VEGF-A. Ann Surg 2012; 256:146-56. [PMID: 22580939 DOI: 10.1097/sla.0b013e318254ce7a] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To investigate the mechanism of propranolol on regression of infantile hemangiomas. BACKGROUND Propranolol has been found to be effective in treatment of severe hemangiomas of infancy. However, its mechanism of action is as yet unknown. METHODS Cultured proliferating and involuting hemangioma endothelial cells were treated with varying concentrations of propranolol for up to 4 days. Analysis was performed using cell viability, migration, and tubulogenesis assays, as well as quantitative RT-PCR and flow cytometry. Western blots and ELISA assays were used to assess protein expression. RESULTS Treatment with propranolol led to a dose dependent cytotoxic effect in hemangioma endothelial cells with decreased cell viability, migration, and tubulogenesis. This cytotoxic effect was VEGF (vascular endothelial growth factor) dependent, as demonstrated by decreased VEGF, VEGF-R1, and VEGF-R2 production. Decreased signaling through the VEGF pathway resulted in downregulation of PI3/Akt and p38/MAPK activity. Decreased VEGF activity was mediated through the hypoxia inducible factor (HIF)-1α pathway but not through NF-κβ signaling. CONCLUSIONS Collectively, these data suggest that propranolol exerts its suppressive effects on hemangiomas through the HIF-1α-VEGF-A angiogenesis axis, with effects mediated through the PI3/Akt and p38/MAPK pathways. These findings provide a plausible mechanism of action of propranolol on regression of infantile hemangiomas.
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Liu B, Liu JY, Zhang WF, Jia J. Pediatric parotid tumors: clinical review of 24 cases in a Chinese population. Int J Pediatr Otorhinolaryngol 2012; 76:1007-11. [PMID: 22503446 DOI: 10.1016/j.ijporl.2012.03.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Revised: 03/16/2012] [Accepted: 03/20/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate the incidence, types, and treatment outcomes of pediatric parotid tumors in Chinese population. METHODS Pediatric salivary gland tumors treated at Stomatolgy Hospital, of Wuhan University, from 1990 to 2010, were analyzed retrospectively. RESULTS One hundred and two patients 18 years old or younger were diagnosed as parotid mass, of which 24 (23.5%) were parotid tumors. Of these patients, 11 (45.8%) were benign and 13 (54.2%) malignant. Hemangioma was the most frequent no-epithelial tumor. The most common benign epithelial tumor was pleomorphic adenoma (63.6%), and the most common malignant epithelial tumor was mucoepidermoid carcinoma (38.5%), with both of them showing a female to male predominance. The most common treatment was parotidectomy (83.3%). CONCLUSIONS Although pediatric parotid masses are unusual, they can represent a variety of pathological diagnoses, including malignancy. The intralesional injection can treat parotid hemangiomas in pediatric population effectively. Parotidectomy remains the mainstay treatment for both pediatric parotid gland benign and malignancies of epithelial cell origin. Adjuvant radiotherapy should be used judiciously in pediatric patients due to the higher risk of post-irradiation complications.
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Affiliation(s)
- Bing Liu
- Department of Oral and Maxillofacial Surgery, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
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Haugen TW, Wood WE, Helwig C. Postcricoid vascular abnormalities: hemangiomas, venous malformations, or anatomic variant. Int J Pediatr Otorhinolaryngol 2012; 76:805-8. [PMID: 22424609 DOI: 10.1016/j.ijporl.2012.02.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 02/13/2012] [Accepted: 02/14/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Ten children with pressure-dependent postcricoid masses (PDPCM) previously referred to in the literature as hemangiomas or vascular malformations are presented. We propose these lesions represent an anatomic variant. We review previously reported cases, and report the presentation, diagnosis, and management of the patients in our series, the largest series to date. METHODS Ten patients, aged five weeks to nine months, were diagnosed, and treated or observed. Of the patients undergoing intervention, one was treated with a gastrostomy tube, fundoplication, and Propranolol therapy; and the other with CHARGE association underwent a tracheotomy. RESULTS No PDPCMs demonstrated significant interval change in size or appearance, and eight of ten patients did well with observation. CONCLUSION Based on current information, the majority of PDPCMs likely represent an anatomic variant rather than a hemangioma or vascular malformation. Diagnosis is most readily made with awake flexible fiberoptic laryngoscopy. Because the incidence of synchronous airway pathology is high, direct laryngoscopy and bronchoscopy without routine biopsy is recommended for symptomatic patients. Imaging should be individualized and may be helpful for ambiguous cases. Although numerous treatment modalities have been advocated based on the presumptive diagnosis of a hemangioma, treatment of PDPCMs is not necessary in the majority of cases, as most patients may be safely observed.
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Affiliation(s)
- Thorsen W Haugen
- Pediatric Otolaryngology Head and Neck Surgery, Geisinger Medical Center, Danville, PA 17822, USA.
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NAM SUBONG, CHOI SOOJONG, LEE JAEWOO, KIM JOOHYOUNG, SONG JISUN, BAE YONGCHAN. Role of protein kinase Cμ isoform expression in dimethylhydrazine-induced vascular endothelial proliferation. Mol Med Rep 2012; 6:399-404. [DOI: 10.3892/mmr.2012.932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 05/23/2012] [Indexed: 11/06/2022] Open
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Jacobs BJ, Anzarut A, Imbriglia JE, Gordillo G, Imbriglia JE. Vascular anomalies of the upper extremity. J Hand Surg Am 2010; 35:1703-9; quiz 1709. [PMID: 20888510 PMCID: PMC4643689 DOI: 10.1016/j.jhsa.2010.08.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 08/03/2010] [Indexed: 02/02/2023]
Abstract
The topic of vascular anomalies is uncommon in the hand surgery literature, but hand surgeons do diagnose and treat patients with hemangiomas and vascular malformations. These are separate entities and require different treatment strategies. Proper diagnosis will lead to timely and appropriate treatment.
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Phleboliths and the Vascular Maxillofacial Lesion. J Oral Maxillofac Surg 2010; 68:1973-6. [DOI: 10.1016/j.joms.2010.04.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Revised: 02/08/2010] [Accepted: 04/04/2010] [Indexed: 11/21/2022]
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Could local delivery of bisphosphonates be a new therapeutic choice for hemangiomas? Med Hypotheses 2009; 73:495-7. [DOI: 10.1016/j.mehy.2009.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Revised: 06/03/2009] [Accepted: 06/08/2009] [Indexed: 11/20/2022]
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Angiero F, Benedicenti S, Benedicenti A, Arcieri K, Bernè E. Head and Neck Hemangiomas in Pediatric Patients Treated with Endolesional 980-nm Diode Laser. Photomed Laser Surg 2009; 27:553-9. [DOI: 10.1089/pho.2008.2362] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Francesca Angiero
- University of Milan-Bicocca, Pathological Anatomy, Ospedale S Gerardo Monza, Monza, Italy
| | - Stefano Benedicenti
- Department of Biophysical, Medical and Stomatological Science and Technology, University of Genoa, Italy
| | - Alberico Benedicenti
- Department of Biophysical, Medical and Stomatological Science and Technology, University of Genoa, Italy
| | - Katia Arcieri
- Ospedale S Pio X, Clinica Villa Cimarosa, Milan, Italy
| | - Enrico Bernè
- Ospedale S Pio X, Clinica Villa Cimarosa, Milan, Italy
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Antonopoulos C, Karagianni M, Zolindaki C, Anagnostou E, Vagianos C. Cavernous hemangioma of infrahyoid carotid sheath and review of the literature on carotid sheath tumors. Head Neck 2009; 31:1381-6. [PMID: 19260115 DOI: 10.1002/hed.21012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Carotid sheath may include a variety of lesions such as neurogenic or vascular, tumors originating from extra-adrenal chromaphil cells, squamous cell carcinomas, and lymphomas. Hemangiomas are benign congenital neoplasms, which, when located in the head and neck region, may be easily misdiagnosed due to their infrequent localization. METHODS AND RESULTS We report an unusual case of cavernous hemangioma of the infrahyoid carotid sheath presenting as palpable mass in a 51-year-old woman with no prior medical history. A review of the literature was performed to investigate the radiological and histopathological characteristics and highlight the treatment of carotid sheath lesions. CONCLUSIONS CT, MRI, and MR angiography would help to locate hemangiomas of carotid sheath, but only surgical excision and histopathology can reveal their true nature.
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Chang LC, Haggstrom AN, Drolet BA, Baselga E, Chamlin SL, Garzon MC, Horii KA, Lucky AW, Mancini AJ, Metry DW, Nopper AJ, Frieden IJ. Growth characteristics of infantile hemangiomas: implications for management. Pediatrics 2008; 122:360-7. [PMID: 18676554 DOI: 10.1542/peds.2007-2767] [Citation(s) in RCA: 406] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Infantile hemangiomas often are inapparent at birth and have a period of rapid growth during early infancy followed by gradual involution. More precise information on growth could help predict short-term outcomes and make decisions about when referral or intervention, if needed, should be initiated. The objective of this study was to describe growth characteristics of infantile hemangioma and compare growth with infantile hemangioma referral patterns. METHODS A prospective cohort study involving 7 tertiary care pediatric dermatology practices was conducted. Growth data were available for a subset of 526 infantile hemangiomas in 433 patients from a cohort study of 1096 children. Inclusion criteria were age younger than 18 months at time of enrollment and presence of at least 1 infantile hemangioma. Growth stage and rate were compared with clinical characteristics and timing of referrals. RESULTS Eighty percent of hemangioma size was reached during the early proliferative stage at a mean age of 3 months. Differences in growth between hemangioma subtypes included that deep hemangiomas tend to grow later and longer than superficial hemangiomas and that segmental hemangiomas tended to exhibit more continued growth after 3 months of age. The mean age of first visit was 5 months. Factors that predicted need for follow-up included ongoing proliferation, larger size, deep component, and segmental and indeterminate morphologic subtypes. CONCLUSIONS Most infantile hemangioma growth occurs before 5 months, yet 5 months was also the mean age at first visit to a specialist. Recognition of growth characteristics and factors that predict the need for follow-up could help aid in clinical decision-making. The first few weeks to months of life are a critical time in hemangioma growth. Infants with hemangiomas need close observation during this period, and those who need specialty care should be referred and seen as early as possible within this critical growth period.
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Affiliation(s)
- Linda C Chang
- Department of Dermatology, University of California, San Francisco, California, USA
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Successful treatment of extensive infantile hemangiomatosis of the small bowel in a 3-month-old with thalidomide and somatostatin analog. J Pediatr Gastroenterol Nutr 2008; 46:593-7. [PMID: 18493217 DOI: 10.1097/mpg.0b013e31814794ce] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Kang GCW, Song C. Forty-one Cervicofacial Vascular Anomalies and Their Surgical Treatment –
Retrospection and Review. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2008. [DOI: 10.47102/annals-acadmedsg.v37n3p165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Introduction: Haemangiomas in children usually involute spontaneously and surgical treatment is exceptional. Vascular malformations do not regress spontaneously and resection may become necessary. We present a series of surgically treated face and neck vascular anomalies during a 9-year period, assessing the epidemiology, presenting signs and symptoms, diagnostic modalities, indications for surgery, treatment methods and clinical outcome post-treatment.
Materials and Methods: The medical and pathological records of all patients with cervicofacial vascular anomalies treated surgically at our department from 1997 to 2005 were retrospectively reviewed in relation to current evidence.
Results: Forty-one patients were identified. Of these, 9 patients had haemangiomas and the remaining 32 had a variety of vascular malformations. Cervicofacial vascular anomalies were most commonly located at the lip. Atypical looking vascular anomalies like masseteric intramuscular haemangiomas and parotid malformations were diagnostic problems. All 41 had surgical excision of their vascular anomalies for troubling symptoms, cosmesis or diagnostic purpose. For cervicofacial arteriovenous malformations, 28% were classified as Schobinger stage I, 50% stage II, and the remainder stage III. Combined embolisation-resection was used to treat 6 arteriovenous malformations (stage II to III) and of these, 3 required flap reconstruction.
Conclusions: Accurate diagnosis distinguishing between cervicofacial haemangiomas and vascular malformations is key to best treatment. The diagnosis can usually be made by history and physical examination aided by early magnetic resonance imaging (MRI). Although cervicofacial haemangiomas can be managed conservatively or with medical therapy, surgery is indicated for preventing psychological distress and in cases of chronic aesthetic alteration resulting from partial regression. Aesthetic concerns and prevention of psychosocial distress point to early excision of venous malformation as the treatment of choice. Lymphatic malformations are best treated by excision. Outcome after excision of localised cervicofacial haemangiomas and low-flow vascular malformations is excellent. Large extensive low-flow malformations as well as those located at the lips may require multiple procedures including reconstruction; patients should be informed that the outcome is generally not as good. Combined embolisation-resection is definitive treatment for arteriovenous malformations and flap reconstruction may prevent their recurrence. Tissue expansion is a useful reconstructive tool after the excision of large vascular anomalies.
Key words: Face and neck, Haemangioma, Single institution outcome, Vascular malformation
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Emsen IM. Preoperative treatment of a parotid hemangioma with 100% ethyl alcohol. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2008; 16:239-40. [PMID: 19949507 DOI: 10.1177/229255030801600408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hemangiomas are one of the most common childhood neoplasms, occurring in approximately 12% of infants younger than one year of age. The lesions typically appear shortly after birth, increase in size over the first year and characteristically regress over the next decade. Because hemangiomas can be visible during an important stage of a child's social development, numerous authors have pursued alternative treatment strategies to avoid or reduce this lengthy involution process. Unfortunately, no effective medical treatment has been reported for children with large, deforming hemangiomas of the parotid gland and overlying cheek. In the present case, a patient with a large parotid hemangioma was treated preoperatively with an intralesional injection of 100% ethyl alcohol solution to reduce the size of the mass. The mass was removed 28 days later with no major postoperative complications.
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Affiliation(s)
- Ilteris Murat Emsen
- Numune State Hospital, Department of Plastic and Reconstructive Surgery, Erzurum, Turkey
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