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Nwagha TU, Okoye HC, Ugwu AO, Duru AN, Menuba IE, Ugwu EO, Ezebialu IU, Ugwu AO, Eze SC. Multidisciplinary approach to obstetric disseminated intravascular coagulopathy management in low-income country: A survey. Int J Gynaecol Obstet 2024. [PMID: 38940184 DOI: 10.1002/ijgo.15758] [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: 01/12/2024] [Revised: 06/08/2024] [Accepted: 06/17/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE To assess the uptake of a multidisciplinary team approach in obstetric disseminated intravascular coagulopathy (DIC) management in a low- to middle-income country. METHODS A cross-sectional observational study, in which a semi-structured and pre-tested questionnaire was used to collect data on the uptake by Nigerian obstetricians of the multidisciplinary team approach to obstetric DIC management. RESULTS A total of 171 obstetricians responded, 82 (48.0%) were consultants and 89 (52.0%) were specialist registrars. Most (165; 96.5%) practiced in tertiary healthcare facilities and the multidisciplinary team approach was the most preferred (162; 94.7%) management approach. In all, 142 (83.0%) supported the invitation of hematologists always in the management whereas 115 (67.3%) participants recommended that involvement of specialists in the treatment should be when clinical presentation was suggestive of DIC. No significant association existed between years of obstetric practice and adoption of a multidisciplinary team-based approach (χ2 = 9.590; P = 0.252). CONCLUSION A multidisciplinary approach is widely adopted in the management of obstetric DIC, with hematologists being a key member of the team.
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Affiliation(s)
- Theresa U Nwagha
- Department of Haematology and Immunology, College of Medicine, University of Nigeria Ituku Ozalla Campus, Enugu, Nigeria
| | - Helen C Okoye
- Department of Haematology and Immunology, College of Medicine, University of Nigeria Ituku Ozalla Campus, Enugu, Nigeria
| | - Angela O Ugwu
- Department of Haematology and Immunology, College of Medicine, University of Nigeria Ituku Ozalla Campus, Enugu, Nigeria
| | - Augustine N Duru
- Department of Haematology and Immunology, College of Medicine, University of Nigeria Ituku Ozalla Campus, Enugu, Nigeria
| | - Ifeanyi E Menuba
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria Ituku Ozalla Campus, Enugu, Nigeria
| | - Emmanuel O Ugwu
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria Ituku Ozalla Campus, Enugu, Nigeria
| | - Ifeanyichukwu U Ezebialu
- Department of Obstetrics and Gynaecology, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Anambra State, Nigeria
| | - Aloysius O Ugwu
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
| | - Stephen C Eze
- Department of Obstetrics and Gynaecology, Federal Medical Center Abuja, Abuja, Nigeria
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2
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Farahani M, Hashemi SA, Goodarzi S, Hajikarimloo B, Pour-Ghazi F, Noori S, Alijani S, Khavandegar A. A rare case report of cervical hemangioma and a comprehensive literature review of 137 cases of cervical and uterine hemangiomas. Int J Gynaecol Obstet 2024; 164:421-435. [PMID: 37382400 DOI: 10.1002/ijgo.14961] [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] [Received: 04/04/2023] [Revised: 06/01/2023] [Accepted: 06/08/2023] [Indexed: 06/30/2023]
Abstract
The cervix of the uterus is a rare site for cavernous hemangiomas. Cervical hemangiomas are slow-growing tumors with characteristic histological findings, including dilated vessels with increased endothelial cells. Although their pathophysiology remains unclear, hormones are believed to play an important role in the development of these vascular tumors. They may be asymptomatic due to their small size, but they can cause gynecological and obstetrical complications, including abnormal uterine bleeding and impaired fertility. Due to their small size, conservative treatment is the first line of management. Hysterectomy is considered for refractory cases or for patients who are not of childbearing age. In this study, firstly, we presented a case of a 60-year-old postmenopausal female without any gynecological-related signs or symptoms with a polypoid nodule hanging over the anterior cervical wall through its stalk. The surgical biopsy revealed no signs of neoplastic changes, with the only notable finding being a benign vascular lesion representing a cavernous hemangiomatous cervical polyp. The patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy and she is currently healthy without any further abnormal findings. Additionally, we provided a comprehensive review of 137 cases in the literature since 1883, detailing their characteristics, signs and symptoms, and pathology.
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Affiliation(s)
- Maasomeh Farahani
- Department of Gynecology and Obstetrics Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Seyyed-Ali Hashemi
- Department of Pathology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Sogand Goodarzi
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Bardia Hajikarimloo
- Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Pour-Ghazi
- Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrzad Noori
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
| | - Saba Alijani
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
| | - Armin Khavandegar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
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3
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Daviskiba S, Shuman H, Ayyash M, Vadlamudi G, Smietana S, Goyert G. A multidisciplinary approach to caring for a pregnant patient with blue rubber bleb nevus syndrome: A case report. Case Rep Womens Health 2022; 34:e00403. [PMID: 35299692 PMCID: PMC8920868 DOI: 10.1016/j.crwh.2022.e00403] [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] [Received: 02/06/2022] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 11/12/2022] Open
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare vascular disorder characterized by recurrent, multifocal venous malformations throughout the skin, soft tissue, and numerous internal organs. Pregnant women with BRBNS are at high risk of morbidity and mortality, and thus their care requires careful planning and surveillance. This report highlights the case of a 21-year-old woman, gravida 1, para 0, with BRBNS who was cared for by a multidisciplinary team of providers in obstetrics, maternal-fetal medicine, obstetric anesthesia, hematology, dermatology, gastroenterology, and otorhinolaryngology. The report provides a comprehensive guide to the multidisciplinary management of pregnancy and delivery for patients with BRBNS. Blue rubber bleb nevus syndrome increases morbidity and mortality in pregnancy. Management requires a multidisciplinary approach to prenatal and intrapartum care. Careful planning and surveillance by multiple specialties is recommended.
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4
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Hult M, Halldorsdottir H, Vladic Stjernholm Y, Hein A, Jörnvall H. Blue Rubber Bleb Nevus Syndrome in the Obstetric Patient: A Case Report of Anesthetic Implications and Management. A A Pract 2021; 15:e01517. [PMID: 34428772 DOI: 10.1213/xaa.0000000000001517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare systemic syndrome characterized by venous malformations usually found in the skin and visceral organs. To date, 11 case reports describing BRBNS during pregnancy have been published. To our knowledge, this is the first report describing intracranial, airway, epidural, and birth canal involvement of venous malformations in the same parturient. Key lessons learned include clinical presentation, workup, team management, and care of obstetric patients with this disorder.
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Affiliation(s)
- Martin Hult
- From the Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Halla Halldorsdottir
- Department of Anesthesia and Intensive Care, Danderyd University Hospital, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Ylva Vladic Stjernholm
- Department of Women's and Children´s Health, Karolinska University Hospital, Stockholm, Sweden
| | - Anette Hein
- Department of Anesthesia and Intensive Care, Danderyd University Hospital, Stockholm, Sweden
| | - Henrik Jörnvall
- From the Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
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5
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Liu YL, Jiang YP, Du J. Pulmonary embolism during pregnancy in a case of blue rubber bleb nevus syndrome. Chin Med J (Engl) 2019; 132:1499-1501. [PMID: 31205114 PMCID: PMC6629321 DOI: 10.1097/cm9.0000000000000268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Indexed: 11/26/2022] Open
Affiliation(s)
- Yan-Li Liu
- Department of Obstetrics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
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6
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Galey J, Bharadwaj S, Crimmins S, Hong CM, Malinow AM. Anesthetic Implications of an Obstetric Patient with Blue Rubber Bleb Nevus Syndrome. ACTA ACUST UNITED AC 2016; 6:146-9. [PMID: 26579613 DOI: 10.1213/xaa.0000000000000265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Blue rubber bleb nevus syndrome, a syndrome of multifocal venous malformations, has been reported rarely during pregnancy. This syndrome has been associated with airway lesions in some patients and neuraxial abnormalities in other patients. We report the anesthetic and obstetric management of a patient with an extensive distribution of both airway and neuraxial lesions.
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Affiliation(s)
- Jessica Galey
- From the Departments of *Anesthesiology and †Obstetrics/Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
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7
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Busca A, Parra-Herran C. Hemangiomas of the uterine cervix: Association with abnormal bleeding and pain in young women and hormone receptor expression. Report of four cases and review of the literature. Pathol Res Pract 2016; 212:532-8. [PMID: 27067810 DOI: 10.1016/j.prp.2016.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 03/09/2016] [Accepted: 03/15/2016] [Indexed: 11/29/2022]
Abstract
Hemangiomas of the uterine cervix are rare with only about 55 cases reported in the literature. Increased awareness of this unusual cervical lesion can lead to early diagnosis and conservative therapeutic approaches. We present a series of four patients with cervical hemangioma with an extensive review of the existing literature on the subject. All four cervical hemangiomas were diagnosed incidentally in hysterectomy specimens performed for persistent menorrhagia or pain. The mean age at presentation was 34 years. The mean lesion size was 2.1cm and the dominant location was posterior cervix (3 cases). Immunohistochemistry for estrogen and progesterone receptors showed expression of both markers in endothelial cells and stroma, the latter marker showing a stronger and more diffuse pattern. No other significant uterine abnormality was identified in two cases. The vast majority of cervical hemangiomas reported are in reproductive age women. In addition, these lesions express hormone receptors, indicating that their growth is at least in part due to sex hormone stimulation. Although most lesions are symptomatic (mostly bleeding), the diagnosis is frequently unsuspected. Cervical hemangiomas are benign with no recurrences or adverse outcomes reported to date. Conservative treatments are usually successful, and spontaneous remission has been observed. This entity should be included in the differential diagnosis of patients with abnormal vaginal bleeding, particularly in patients of reproductive age with no other clinical and radiologic findings that would explain the symptoms.
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Affiliation(s)
- Aurelia Busca
- Department of Pathology and Laboratory Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
| | - Carlos Parra-Herran
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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8
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Terata M, Kikuchi A, Kanasugi T, Fukushima A, Sugiyama T. Association of blue rubber bleb nevus syndrome and placenta previa: report of a case. JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41:517-520. [PMID: 23055293 DOI: 10.1002/jcu.22000] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Accepted: 09/07/2012] [Indexed: 06/01/2023]
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare disorder characterized by multiple recurrent vascular malformations. Herein we report the case of a patient with BRBNS and placenta previa. Sonography and MRI clearly identified several hemangiomas located adjacent to the uterus with none adjacent to the anterior lower uterine segment. This preoperative information helped us perform the uterine wall incision safely during the cesarean delivery. The presence and location of hemangiomas adjacent to the uterus should be carefully examined in a pregnant woman with BRBNS prior to elective or emergency cesarean delivery.
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Affiliation(s)
- Miyuki Terata
- Departments of Obstetrics and Gynecology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate 020-8505, Japan
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9
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Bouchghoul H, Nizard J. Pregnancy and blue rubber bleb nevus syndrome. Eur J Obstet Gynecol Reprod Biol 2013; 169:415-6. [PMID: 23816222 DOI: 10.1016/j.ejogrb.2013.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 04/05/2013] [Accepted: 05/19/2013] [Indexed: 01/10/2023]
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10
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Familial blue rubber bleb nevus syndrome in pregnancy with spinal epidural involvement. Case Rep Obstet Gynecol 2013; 2013:141506. [PMID: 23762681 PMCID: PMC3665244 DOI: 10.1155/2013/141506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 04/19/2013] [Indexed: 12/20/2022] Open
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare vascular disorder characterized by multiple venous malformations (VMs) of the skin, gastrointestinal tract, and other organs. To date, several cases of sporadic BRBNS involving various parts of the pregnant woman's body have been reported; however, BRBNS in pregnancy with spinal epidural involvement has not been reported. Here, we describe the clinical features and management of familial BRBNS in pregnancy. The patient presented with multiple VMs on her head, neck, floor of the mouth, trunk, leg, foot, and vulva and spinal epidural lesions. The patient's mother and sister also exhibited multiple VMs similar lesions, indicating a familial form of BRBNS. Cesarean section under general anesthesia was performed, and a healthy male neonate was delivered. The mother's postoperative course was uneventful and her VMs decreased in size after delivery. Physicians should consider the possibility of systemic diseases and familial inheritance in cases of VMs.
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11
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Vaginal vascular malformation mimicking pelvic organ prolapse requiring serial embolizations. Int Urogynecol J 2013; 24:1985-7. [PMID: 23430075 DOI: 10.1007/s00192-013-2060-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 01/19/2013] [Indexed: 10/27/2022]
Abstract
Vaginal vascular malformation (VVM) is rare. There are, in fact, less than ten cases reported to date. VVM often presents as a mass protruding from the vagina, mimicking pelvic organ prolapse (POP). It can coexist with POP, thereby usually exaggerating the severity of POP. We report a case of VVM in a premenopausal woman who presented as severe POP and urinary incontinence. The diagnosis was confirmed with computed tomography (CT) scan and angiography. The patient underwent conservative management with embolization. These procedures had to be repeated three times in 1.5 years due to lesion recurrence. In mitigation, conservative treatment eliminates the risks associated with surgery, e.g. massive hemorrhage and visceral injuries. It does, however, require a long course of treatment and follow-up.
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12
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Abstract
The occurrence of the vascular tumors in the female genital tract, particularly in the uterine cervix, is extremely rare. This kind of tumor has mainly been reported as either cavernous hemangiomas or capillary hemangiomas. To date, no Kaposiform hemangioendothelioma has been reported in this site. Here we presented a case of Kaposiform hemangioendothelioma without Kasabach-Merritt syndrome in the cervix of a 5-year-old girl.
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Affiliation(s)
- Hongkai Zhang
- Department of Pathology, Beijing Fu Xing Hospital, the Capital Medical University, Beijing, China.
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13
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Cauldwell M, Kyle P, Treharne I, Wong T, Holden ST, Nelson-Piercy C. Venous malformations of the anterior abdominal wall in blue rubber bleb naevus syndrome: implications for antenatal and intrapartum management. Obstet Med 2011; 4:37-8. [PMID: 27579096 DOI: 10.1258/om.2010.100070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2010] [Indexed: 01/10/2023] Open
Abstract
Blue rubber bleb naevus syndrome (BRBNS) is a rare vascular disorder characterized by rubbery blue-purple cutaneous nodules that are histologically thin-walled dilated vascular spaces. The exact inheritance of the disease in unknown but in cases of familial recurrence, there appears to be a pattern of autosomal dominant inheritance. The vascular lesions may manifest in any organ system but tend to predominate in the gastrointestinal tract (GI). There are only a handful of cases reported in the literature, but reported complications arising from the naevi include sponatenous GI bleeding requiring laparotomy and blood transfusion and the development of large naevi in the cervix thus preventing vaginal delivery. In this case we describe a patient with known BRBNS who developed symptomatic anaemia during her pregnancy which required antenatal admission and blood transfusion. She was managed expectantly in a multidisciplinary setting by obstetricians, gastroenterologists and an obstetric physician with the aim of a vaginal delivery. Nevertheless, she had an elective caesarean section at term for breech presentation. Surgery was complicated by the unexpected finding of venous malformations within the abdominal wall musculature and subcutaneous fat that resulted in a primary haemorrhage and required urgent blood transfusion. The patient made a good postoperative recovery and had a healthy male infant who at birth displayed no external features of BRBNS. This report demonstrates for the first time the appearance of naevi in the abdominal wall and the important considerations that need to be made regarding mode of delivery and future pregnancies.
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Affiliation(s)
| | | | | | | | - Simon T Holden
- Clinical Genetics, Guy's and St Thomas' NHS Foundation Trust , London , UK
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14
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Reggiani Bonetti L, Boselli F, Lupi M, Bettelli S, Schirosi L, Bigiani N, Sartori G, Rivasi F. Expression of estrogen receptor in hemangioma of the uterine cervix: reports of three cases and review of the literature. Arch Gynecol Obstet 2009; 280:469-72. [PMID: 19148658 DOI: 10.1007/s00404-009-0928-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Accepted: 01/03/2009] [Indexed: 12/21/2022]
Abstract
The occurrence of hemangioma in the female genital tract, particularly in uterine cervix, is rare. The majority of them show asymptomatic behavior. Surgical excision remains curative in most of the cases. Conservative therapies such as sclerosing agents, cryotherapy, and CO(2) laser excision may be alternatively applied. We present three cases of hemangiomas of the cervix in asymptomatic women, diagnosed as cavernous hemangioma in two cases and capillary hemangioma in one. All tumors were immunoreactive for CD31, CD34, factor-VIII-related antigen. Focal expression of estrogen receptors was detected. No positivity was obtained with progesterone receptor antibodies. The presence of estrogen receptor in the endothelial cells of the hemangioma of the cervix suggests a direct role of this hormone in the hemangioma development. A possible target therapy is discussed.
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Affiliation(s)
- Luca Reggiani Bonetti
- Dipartimento Integrato Servizi Diagnostici e di Laboratorio e di Medicina Legale, Sezione di Anatomia Patologica, Università degli studi di Modena e Reggio Emilia, Modena, Italy.
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