1
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Gong X, Chang SJ, Xiong P, Lin X, Wang L. Usefulness of Ultrasound in Verrucous Venous Malformation: a Series of 103 Cases. Dermatol Surg 2023; 49:1006-1011. [PMID: 37738289 DOI: 10.1097/dss.0000000000003922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
BACKGROUND Verrucous venous malformation (VVM), previously called "verrucous hemangioma," is a rare type of vascular malformation. OBJECTIVE Little is known about the ultrasonographic characteristics of VVM. The present study aimed to show the conventional US and elastographic features of a VVM. MATERIALS AND METHODS The US findings in 103 patients with VVMs were retrospectively evaluated. RESULTS On gray-scale ultrasound images, 98 (95.1%) lesions showed subcutaneous fat infiltration from skin across muscle to deep fascia. The other 5 (4.9%) sat in the subcutaneous layer with no skin involvement. Most (96.1%) lesions were hyperechoic. Furthermore, 71.8% of lesions were heterogeneous, 68.9% of which were with ill-defined margins. Calcifications and visible vessels were present in 5.7% and 10.7% of the VVM cases, respectively. By color Doppler ultrasound, all lesions were found with low vascular density and 4.9% showed enhanced blood flow after compression. Venous spectrum was observed in 67.0% of lesions. The elasticity score was 2.66 ± 0.48. CONCLUSION Diagnosis of a VVM is challenging in the clinic. However, we found that most VVM lesions present distinctive ultrasound imaging characteristics. These ultrasound findings may well contribute to the accuracy of VVM diagnosis, especially in those with the absence of epidermal changes and the lack of dermal involvement.
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Affiliation(s)
- Xia Gong
- Department of Ultrasound, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P. R. China
| | - Shih-Jen Chang
- Department of Plastic and Reconstruction Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P. R. China
| | - Ping Xiong
- Department of Ultrasound, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P. R. China
| | - Xiaoxi Lin
- Department of Plastic and Reconstruction Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P. R. China
| | - Lizhen Wang
- Department of Pathology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P. R. China
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2
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Sharma S, Rayamajhi A, Chapagain A, Shrestha J. Management of an extensive form of verrucous hemangioma with staged skin grafting: A case report. Clin Case Rep 2022; 10:e6724. [PMID: 36514462 PMCID: PMC9734275 DOI: 10.1002/ccr3.6724] [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] [Received: 04/29/2022] [Revised: 09/25/2022] [Accepted: 11/26/2022] [Indexed: 12/14/2022] Open
Abstract
A 20-year-old male presented with large and extensive lesions of verrucous hemangioma involving the left lower extremity. The lesions were excised in the supra-fascial plane. After 10 days, the split-thickness skin graft was applied over the raw area resulting in good graft take.
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Affiliation(s)
- Samit Sharma
- Department of Plastic Surgery and BurnsTribhuvan University Teaching HospitalKathmanduNepal
| | - Aadesh Rayamajhi
- Maharajgunj Medical CampusTribhuvan University, Institute of MedicineKathmanduNepal
| | - Abhishek Chapagain
- Maharajgunj Medical CampusTribhuvan University, Institute of MedicineKathmanduNepal
| | - Jayan Man Shrestha
- Department of Plastic Surgery and BurnsTribhuvan University Teaching HospitalKathmanduNepal
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3
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Phung TL. Histopathology of Vascular Malformations. Dermatol Clin 2022; 40:345-355. [DOI: 10.1016/j.det.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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4
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Schmidt BAR, El Zein S, Cuoto J, Al-Ibraheemi A, Liang MG, Paltiel HJ, Anderson ME, Labow BI, Upton J, Fishman SJ, Mulliken JB, Greene AK, Warman ML, Kozakewich H. Verrucous Venous Malformation-Subcutaneous Variant. Am J Dermatopathol 2021; 43:e181-e184. [PMID: 33899768 DOI: 10.1097/dad.0000000000001963] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Verrucous venous malformation (VVM), previously called "verrucous hemangioma," typically involves the dermis and the subcutaneous fat. We have encountered patients with VVM confined to the hypodermis. MATERIALS AND METHODS During a nearly 20-year period, 13 patients, aged 2-17 years, presented with a subcutaneous mass in the limb without clinically obvious epidermal alterations. Consequently, operative excisions did not include the skin. RESULTS Histopathologically, the specimens were composed of blood-filled channels with morphologic characteristics of capillaries and veins that infiltrated adipose tissue. Aggregates often formed nodules with variable fibrosis and a component of large and radially oriented vessels. A diagnosis of VVM was supported by endothelial immunopositivity for GLUT-1 (25%-75% immunopositive channels in 16/16 specimens); D2-40 (1%-25% channels in 14/15 specimens); and Prox-1 (1%-50% of channels in 14/16 specimens). A MAP3K3 mutation was identified by droplet digital PCR in 3 of the 6 specimens. CONCLUSIONS Diagnosis of VVM in this uncommon location is challenging because of absence of epidermal changes and lack of dermal involvement. Imaging is not pathognomonic, and mimickers are many. Appropriate immunohistochemical stains and molecular analysis contribute to the correct diagnosis.
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Affiliation(s)
- Birgitta A R Schmidt
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | | | - Javier Cuoto
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Alyaa Al-Ibraheemi
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Marilyn G Liang
- Department of Dermatology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Harriet J Paltiel
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Megan E Anderson
- Department of Orthopaedics, Beth Israel Deaconess Medical Center, Boston, MA
| | - Brian I Labow
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Joseph Upton
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Steven J Fishman
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; and
| | - John B Mulliken
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Arin K Greene
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Mathew L Warman
- Department of Orthopedics, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Harry Kozakewich
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA
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5
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Wu J, Zhou F, Gao Y. Efficacy Evaluation of 755-nm Long-Pulse Alexandrite Laser Combined with 0.5% Timolol Maleate Eye Drops in the Treatment of Thicker Infantile Hemangioma. Clin Cosmet Investig Dermatol 2021; 14:1621-1628. [PMID: 34785921 PMCID: PMC8590841 DOI: 10.2147/ccid.s330411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/12/2021] [Indexed: 11/23/2022]
Abstract
Purpose Assessment of the clinical effectiveness and safety of 755-nm long-pulse alexandrite laser combined with 0.5% timolol maleate eye drops in treating thicker infantile hemangioma (IH). Materials and Methods Retrospective analysis of IH treated with 755-nm long-pulse alexandrite laser and topical timolol in the Second Affiliated Hospital of Wenzhou Medical University from October 2019 to October 2020. Seventy-eight cases were included, with a five-week laser treatment interval. Treatment status was documented during the 35 weeks before each treatment, the effect was assessed at the visual analog scale (VAS), and side effects were recorded. During the 6-month follow-up period, the recurrence and residual skin lesions were monitored. The relationship between IH thickness, treatment duration and VAS was analyzed. Results Among the 78 children with hemangioma, 4 children were treated with a combination of propranolol, fractional laser and cinnamyl alcohol injection due to poor curative effect. Finally, the lesions were effectively alleviated. At the 5th, 15th, 25th, and 35th weeks of treatment, the average VAS of 74 children were 3.56 ± 1.20, 4.61 ± 1.43, 5.63 ± 1.60, and 6.63 ± 1.72, respectively. We analyzed VAS in different thickness groups with Repeated Measures Analysis of Variance(RMANOVA). The results show that the VAS of the thickness 2–3 mm and 3–5mm groups were higher than the 5–7mm and 7–8mm groups (F group = 440.54, P <0.05, F time = 448.31, P <0.05). During the 6-month follow-up period, none of the 74 children relapsed and the residual skin lesions gradually vanished. Conclusion Combined treatment of IHs with a 755-nm long-pulse alexandrite laser and 0.5% timolol maleate eye drops which has apparent clinical efficacy and safety reduce residual skin lesions and decrease the IH recurrence rate.
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Affiliation(s)
- Jianming Wu
- Department of Dermatological, Yuying Children's Hospital, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, People's Republic of China
| | - Fangyan Zhou
- Department of Dermatological, Yuying Children's Hospital, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, People's Republic of China
| | - Yu Gao
- Department of Dermatological, Yuying Children's Hospital, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, People's Republic of China
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6
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Venous Malformations in Childhood: Clinical, Histopathological and Genetics Update. Dermatopathology (Basel) 2021; 8:477-493. [PMID: 34698142 PMCID: PMC8544485 DOI: 10.3390/dermatopathology8040050] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/17/2021] [Accepted: 09/19/2021] [Indexed: 01/10/2023] Open
Abstract
Our knowledge in vascular anomalies has grown tremendously in the past decade with the identification of key molecular pathways and genetic mutations that drive the development of vascular tumors and vascular malformations. This has led us to better understand the pathogenesis of vascular lesions, refine their diagnosis and update their classification while also exploring the opportunity for a targeted molecular treatment. This paper aims to provide an overview of venous malformations (VM) in childhood. Specific entities include common VMs, cutaneo-mucosal VM, blue rubber bleb nevus syndrome or Bean syndrome, glomuvenous malformation, cerebral cavernous malformation, familial intraosseous vascular malformation and verrucous venous malformation. The clinicopathological features and the molecular basis of each entity are reviewed.
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7
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PAOLACCI S, MATTASSI RE, CAVALCA D, MICHELINI S, ZULIAN A, CRISTOFOLI F, MANARA E, MARCEDDU G, BERTELLI M. Genetic testing in vascular and lymphatic malformations. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2021. [DOI: 10.23736/s1824-4777.21.01487-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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8
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Leeds DR, Reddy S, Mamlouk MD, Lee P, McCullough WP. MRI in verrucous venous malformation: role in diagnosis and treatment. Clin Imaging 2021; 76:156-159. [PMID: 33607419 DOI: 10.1016/j.clinimag.2021.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 01/26/2021] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
Verrucous venous malformation (VVM), recently reclassified from verrucous hemangioma, is a rare congenital vascular anomaly that is traditionally diagnosed on histopathologic analysis of deep tissue biopsy. This case report documents the utility of magnetic resonance imaging in confirming VVM diagnosis, characterizing lesion extent and guiding therapy.
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Affiliation(s)
- David R Leeds
- Kaiser Permanente Santa Clara Medical Center, Department of Radiology, 700 Lawrence Expwy, Santa Clara, CA 95051, United States of America; Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, United States of America
| | - Shriya Reddy
- Kaiser Permanente Santa Clara Medical Center, Department of Radiology, 700 Lawrence Expwy, Santa Clara, CA 95051, United States of America; Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, United States of America
| | - Mark D Mamlouk
- Kaiser Permanente Santa Clara Medical Center, Department of Radiology, 700 Lawrence Expwy, Santa Clara, CA 95051, United States of America
| | - Pristine Lee
- Kaiser Permanente Santa Clara Medical Center, Department of Dermatology, 700 Lawrence Expwy, Santa Clara, CA 95051, United States of America
| | - William P McCullough
- Kaiser Permanente Santa Clara Medical Center, Department of Radiology, 700 Lawrence Expwy, Santa Clara, CA 95051, United States of America.
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9
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Kilmister EJ, Hansen L, Davis PF, Hall SRR, Tan ST. Cell Populations Expressing Stemness-Associated Markers in Vascular Anomalies. Front Surg 2021; 7:610758. [PMID: 33634164 PMCID: PMC7900499 DOI: 10.3389/fsurg.2020.610758] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/31/2020] [Indexed: 12/31/2022] Open
Abstract
Treatment of vascular anomalies (VAs) is mostly empirical and, in many instances unsatisfactory, as the pathogeneses of these heterogeneous conditions remain largely unknown. There is emerging evidence of the presence of cell populations expressing stemness-associated markers within many types of vascular tumors and vascular malformations. The presence of these populations in VAs is supported, in part, by the observed clinical effect of the mTOR inhibitor, sirolimus, that regulates differentiation of embryonic stem cells (ESCs). The discovery of the central role of the renin-angiotensin system (RAS) in regulating stem cells in infantile hemangioma (IH) provides a plausible explanation for its spontaneous and accelerated involution induced by β-blockers and ACE inhibitors. Recent work on targeting IH stem cells by inhibiting the transcription factor SOX18 using the stereoisomer R(+) propranolol, independent of β-adrenergic blockade, opens up exciting opportunities for novel treatment of IH without the β-adrenergic blockade-related side effects. Gene mutations have been identified in several VAs, involving mainly the PI3K/AKT/mTOR and/or the Ras/RAF/MEK/ERK pathways. Existing cancer therapies that target these pathways engenders the exciting possibility of repurposing these agents for challenging VAs, with early results demonstrating clinical efficacy. However, there are several shortcomings with this approach, including the treatment cost, side effects, emergence of treatment resistance and unknown long-term effects in young patients. The presence of populations expressing stemness-associated markers, including transcription factors involved in the generation of induced pluripotent stem cells (iPSCs), in different types of VAs, suggests the possible role of stem cell pathways in their pathogenesis. Components of the RAS are expressed by cell populations expressing stemness-associated markers in different types of VAs. The gene mutations affecting the PI3K/AKT/mTOR and/or the Ras/RAF/MEK/ERK pathways interact with different components of the RAS, which may influence cell populations expressing stemness-associated markers within VAs. The potential of targeting these populations by manipulating the RAS using repurposed, low-cost and commonly available oral medications, warrants further investigation. This review presents the accumulating evidence demonstrating the presence of stemness-associated markers in VAs, their expression of the RAS, and their interaction with gene mutations affecting the PI3K/AKT/mTOR and/or the Ras/RAF/MEK/ERK pathways, in the pathogenesis of VAs.
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Affiliation(s)
| | - Lauren Hansen
- Gillies McIndoe Research Institute, Wellington, New Zealand
| | - Paul F. Davis
- Gillies McIndoe Research Institute, Wellington, New Zealand
| | | | - Swee T. Tan
- Gillies McIndoe Research Institute, Wellington, New Zealand
- Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital, Wellington, New Zealand
- Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
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10
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Beijnen UEA, Saldanha F, Ganske I, Upton J, Taghinia AH. Verrucous venous malformations of the hand. J Hand Surg Eur Vol 2019; 44:850-855. [PMID: 31042103 DOI: 10.1177/1753193419845271] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Verrucous venous malformation is a rare vascular anomaly that presents as a deep purple skin stain and evolves into a larger scaly, keratotic lesion that can bleed and cause pain. Because of its similarity to other vascular lesions, it is often misdiagnosed and treated incorrectly. Ten patients with hand verrucous venous malformations evaluated between 1990 and 2017 were reviewed. Diagnosis was confirmed with histopathology. Six patients were initially misdiagnosed and two patients were incorrectly treated. Eight patients had excision procedures. Immunostaining for glucose transporter 1 protein was positive in all specimens that underwent staining. Most (three of four) of the patients with isolated small lesions remained disease free postoperatively, but those with larger lesions experienced recurrence or continued growth. Early recognition of verrucous venous malformation is important because nonsurgical ablative techniques are ineffective; the optimal treatment is surgery. Level of evidence: IV.
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Affiliation(s)
- Usha E A Beijnen
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, USA
| | - Francesca Saldanha
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, USA
| | - Ingrid Ganske
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, USA
| | - Joseph Upton
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, USA
| | - Amir H Taghinia
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, USA
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11
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Paolacci S, Zulian A, Bruson A, Manara E, Michelini S, Mattassi RE, Lee BB, Amato B, Bertelli M. Vascular anomalies: molecular bases, genetic testing and therapeutic approaches. INT ANGIOL 2019; 38:157-170. [DOI: 10.23736/s0392-9590.19.04154-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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12
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Boccara O, Ariche-Maman S, Hadj-Rabia S, Chrétien-Marquet B, Frassati-Biaggi A, Zazurca F, Brunelle F, Soupre V, Bodemer C, Fraitag S. Verrucous hemangioma (also known as verrucous venous malformation): A vascular anomaly frequently misdiagnosed as a lymphatic malformation. Pediatr Dermatol 2018; 35:e378-e381. [PMID: 30216519 DOI: 10.1111/pde.13671] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Verrucous hemangioma or verrucous venous malformation is a superficial venous malformation frequently misdiagnosed as a lymphatic malformation because of its classical hyperkeratotic appearance. Clinical characteristics of VVM were studied in patients with a histologically confirmed VVM, and validated in a prospective study of 18 patients. VVM was made of separated vascular elements with irregular shape, in a linear disposition, with variable thickness and keratosis. Its specific vascular pattern consisting of an erythematous patch with scattered small red to violet dots was easily identified using dermoscopy. In many cases, the typical clinical presentation of verrucous hemangioma is sufficient to establish the diagnosis and a biopsy may not be required.
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Affiliation(s)
- Olivia Boccara
- Department of Dermatology and Reference center for genodermatoses and rare skin diseases (MAGEC), Institut Imagine, APHP, Hôpital Universitaire Necker-Enfants Malades, Université Paris Descartes - Sorbonne Paris Cité, Paris, France
| | - Sonia Ariche-Maman
- Department of Pediatric Radiology, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Smail Hadj-Rabia
- Department of Dermatology and Reference center for genodermatoses and rare skin diseases (MAGEC), Institut Imagine, APHP, Hôpital Universitaire Necker-Enfants Malades, Université Paris Descartes - Sorbonne Paris Cité, Paris, France
| | - Bertrand Chrétien-Marquet
- Department of plastic and maxillo-facial surgery, Institut Imagine, APHP, Hôpital Universitaire Necker-Enfants Malades, Université Paris Descartes - Sorbonne Paris Cité, Paris, France
| | - Annonciade Frassati-Biaggi
- Department of Pathology, Institut Imagine, APHP, Hôpital Universitaire Necker-Enfants Malades, Université Paris Descartes - Sorbonne Paris Cité, Paris, France
| | - Frédéric Zazurca
- Department of plastic and maxillo-facial surgery, Institut Imagine, APHP, Hôpital Universitaire Necker-Enfants Malades, Université Paris Descartes - Sorbonne Paris Cité, Paris, France
| | - Francis Brunelle
- Department of Pediatric Radiology, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Veronique Soupre
- Department of plastic and maxillo-facial surgery, Institut Imagine, APHP, Hôpital Universitaire Necker-Enfants Malades, Université Paris Descartes - Sorbonne Paris Cité, Paris, France
| | - Christine Bodemer
- Department of Dermatology and Reference center for genodermatoses and rare skin diseases (MAGEC), Institut Imagine, APHP, Hôpital Universitaire Necker-Enfants Malades, Université Paris Descartes - Sorbonne Paris Cité, Paris, France
| | - Sylvie Fraitag
- Department of Pathology, Institut Imagine, APHP, Hôpital Universitaire Necker-Enfants Malades, Université Paris Descartes - Sorbonne Paris Cité, Paris, France
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13
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Abstract
This overview of mesenchymal tumors presenting in the skin and/or subcutis in children brings together the range of neoplasms and hamartomas which are seen in this age-group. It is not surprising from the perspective of the pediatric or general surgical pathologist that vascular anomalies, including true neoplasms and vascular malformations, are the common phenotypic category. Since there is considerable morphologic overlap among these lesions, clinicopathologic correlation may be more important than for many of the other mesenchymal tumors. The skin and subcutis are the most common sites of clinical presentation for the infantile myofibroma which is the most common of fibrous mesenchymal tumors in children. Several of the other mesenchymal tumors are more common adults-like dermatofibrosarcoma protuberans, but nonetheless have an important presence in children, even as a congenital neoplasm. A lipomatous tumor in a young child should be considered as a possible manifestation of an overgrowth syndrome.
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Affiliation(s)
- Louis P Dehner
- 1 Lauren V. Ackerman Laboratory of Surgical Pathology, St. Louis Children's Hospital, Washington University Medical Center, St. Louis, Missouri.,2 Dermatopathology Center and Division of Dermatology, Washington University Medical Center, St. Louis, Missouri
| | - Alejandro A Gru
- 3 Department of Pathology, University of Virginia, Charlottesville, Virginia.,4 Department of Dermatology, University of Virginia, Charlottesville, Virginia
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14
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Dhanta A, Chauhan P, Meena D, Hazarika N. Linear verrucous hemangioma-a rare case and dermoscopic clues to diagnosis. Dermatol Pract Concept 2018; 8:43-47. [PMID: 29445574 PMCID: PMC5808371 DOI: 10.5826/dpc.0801a09] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 11/21/2018] [Indexed: 11/23/2022] Open
Abstract
Verrucous hemangioma (VH) is a rare, congenital and localized vascular malformation, which usually presents as warty, bluish, vascular papules, plaques, or nodules, mainly on the lower extremities. Linear presentation of the disease is rare. A deep biopsy is necessary to confirm the clinical diagnosis by histopathological examination, with dermoscopy acting as a useful tool for evaluating the precise vascular structure. Here, we report on a 13-year-old female child with linear VH presenting over her foot since infancy and dermoscopic findings of VH along with the clinical-pathologic features.
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Affiliation(s)
- Aditi Dhanta
- Department of Dermatology, Venereology & Leprology, All India Institute of Medical Sciences, Rishikesh, India
| | - Payal Chauhan
- Department of Dermatology, Venereology & Leprology, All India Institute of Medical Sciences, Rishikesh, India
| | - Dilip Meena
- Department of Dermatology, Venereology & Leprology, All India Institute of Medical Sciences, Rishikesh, India
| | - Neirita Hazarika
- Department of Dermatology, Venereology & Leprology, All India Institute of Medical Sciences, Rishikesh, India
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15
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Borkar NB, Sahoo M, Kashyap N, Mohanty D. Hyperkeratotic Plaque over the Ankle. Indian Dermatol Online J 2017; 8:365-366. [PMID: 28979874 PMCID: PMC5621201 DOI: 10.4103/idoj.idoj_213_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Manas Sahoo
- Department of Trauma and Emergency, AIIMS, Raipur, Chhattisgarh, India
| | - Nitin Kashyap
- Department of Trauma and Emergency, AIIMS, Raipur, Chhattisgarh, India
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16
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Utility and tolerability of the long-pulsed 1064-nm neodymium:yttrium-aluminum-garnet (LP Nd:YAG) laser for treatment of symptomatic or disfiguring vascular malformations in children and adolescents. J Am Acad Dermatol 2017; 77:473-479. [DOI: 10.1016/j.jaad.2017.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 04/11/2017] [Accepted: 04/13/2017] [Indexed: 12/26/2022]
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17
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The utility of GLUT1 as a diagnostic marker in cutaneous vascular anomalies: A review of literature and recommendations for daily practice. Pathol Res Pract 2017; 213:591-597. [DOI: 10.1016/j.prp.2017.04.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 04/08/2017] [Accepted: 04/09/2017] [Indexed: 11/20/2022]
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18
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Putra J, Gupta A. Kaposiform haemangioendothelioma: a review with emphasis on histological differential diagnosis. Pathology 2017; 49:356-362. [PMID: 28438388 DOI: 10.1016/j.pathol.2017.03.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 02/03/2017] [Accepted: 03/21/2017] [Indexed: 12/25/2022]
Abstract
Kaposiform haemangioendothelioma (KHE) is a rare, locally aggressive/borderline vascular tumour primarily seen in neonates and children. KHE is occasionally associated with Kasabach-Merritt phenomenon and tends to have a poor clinical prognosis. While the histological features of tufted angiomas and KHE overlap, some believe tufted angiomas are a milder, benign, more localised counterpart of KHE. The other histological differential diagnoses of KHE include infantile haemangioma, congenital haemangioma, spindle cell haemangioma, verrucous malformation/haemangioma, and Kaposi sarcoma. Microscopically, KHE is characterised by confluent nodules of neoplastic spindled endothelial cells involving multiple planes of tissue which are positive for endothelial, lymphatic, and smooth muscle markers. Resection, once thought to be the definitive treatment for KHE, is often unattainable due to the extent of the lesion; thus, single or combination chemotherapies have been used to treat these patients. Sirolimus has recently been reported to be a successful agent to treat refractory and complicated cases of KHE.
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Affiliation(s)
- Juan Putra
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States.
| | - Anita Gupta
- Department of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
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19
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Yamamoto T, Hirano M, Ueda K. Eccrine Angiomatous Hamartoma in a Patient with Nevus Depigmentosus and Nevus Spilus. Indian J Dermatol 2017; 62:99-100. [PMID: 28216737 PMCID: PMC5286766 DOI: 10.4103/0019-5154.198034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan. E-mail:
| | - Maki Hirano
- Department of Plastic Surgery, Fukushima Medical University, Fukushima, Japan
| | - Kazuki Ueda
- Department of Plastic Surgery, Fukushima Medical University, Fukushima, Japan
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20
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Histopathology and Pathogenesis of Vascular Tumors and Malformations. VASCULAR TUMORS AND DEVELOPMENTAL MALFORMATIONS 2016. [DOI: 10.1007/978-1-4939-3240-5_1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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21
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Nagarajan K, Banushree CS. Usefulness of MRI in Delineation of Dermal and Subcutaneous Verrucous Hemangioma. Indian J Dermatol 2015; 60:525. [PMID: 26538751 PMCID: PMC4601472 DOI: 10.4103/0019-5154.164453] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Magnetic resonance imaging (MRI) has established itself as diagnostic modality of choice of soft tissue and musculoskeletal lesions but dermatological lesions have been diagnosed mainly by clinical examination. We present MRI features of dermal and subcutaneous verrucous hemangioma involving the dorsum of foot in a 20-year-old male and its usefulness in differentiating it from angiokeratoma with similar clinical features.
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Affiliation(s)
- K Nagarajan
- Department of Radiology, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry, India
| | - C S Banushree
- Department of Pathology, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry, India
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22
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Wassef M, Blei F, Adams D, Alomari A, Baselga E, Berenstein A, Burrows P, Frieden IJ, Garzon MC, Lopez-Gutierrez JC, Lord DJE, Mitchel S, Powell J, Prendiville J, Vikkula M. Vascular Anomalies Classification: Recommendations From the International Society for the Study of Vascular Anomalies. Pediatrics 2015; 136:e203-14. [PMID: 26055853 DOI: 10.1542/peds.2014-3673] [Citation(s) in RCA: 748] [Impact Index Per Article: 83.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/27/2015] [Indexed: 12/13/2022] Open
Abstract
Vascular anomalies represent a spectrum of disorders from a simple "birthmark" to life- threatening entities. Incorrect nomenclature and misdiagnoses are commonly experienced by patients with these anomalies. Accurate diagnosis is crucial for appropriate evaluation and management, often requiring multidisciplinary specialists. Classification schemes provide a consistent terminology and serve as a guide for pathologists, clinicians, and researchers. One of the goals of the International Society for the Study of Vascular Anomalies (ISSVA) is to achieve a uniform classification. The last classification (1997) stratified vascular lesions into vascular malformations and proliferative vascular lesions (tumors). However, additional disease entities have since been identified that are complex and less easily classified by generic headings, such as capillary malformation, venous malformation, lymphatic malformation, etc. We hereby present the updated official ISSVA classification of vascular anomalies. The general biological scheme of the classification is retained. The section on tumors has been expanded and lists the main recognized vascular tumors, classified as benign, locally aggressive or borderline, and malignant. A list of well-defined diseases is included under each generic heading in the "Simple Vascular Malformations" section. A short definition is added for eponyms. Two new sections were created: one dealing with the malformations of individually named vessels (previously referred to as "truncular" malformations); the second groups lesions of uncertain or debated nature (tumor versus malformation). The known genetic defects underlying vascular anomalies are included in an appendix. This classification is meant to be a framework, acknowledging that it will require modification as new scientific information becomes available.
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Affiliation(s)
- Michel Wassef
- Assistance Publique-Hopitaux de Paris, Lariboisière Hospital, Department of Pathology, Paris Diderot University, Paris, France;
| | - Francine Blei
- Vascular Birthmark Program, Lenox Hill Hospital of North Shore Long Island Jewish Healthcare System, New York, New York
| | - Denise Adams
- Cincinnati Children's Hospital Medical Center, Cancer and Blood Disease Institute, University of Cincinnati, Cincinnati, Ohio
| | - Ahmad Alomari
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Eulalia Baselga
- Pediatric Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Patricia Burrows
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ilona J Frieden
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Maria C Garzon
- Department of Dermatology, Columbia University, New York, New York
| | | | - David J E Lord
- Interventional Radiology, Sydney Children's Hospitals Network, Sydney, Australia
| | - Sally Mitchel
- Departments of Radiology, Surgery, and Pediatrics, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Julie Powell
- Division of Dermatology (Pediatrics), Centre Hospithalier Universitaire Sainte-Justine, University of Montreal, Montreal, Canada
| | - Julie Prendiville
- Pediatric Dermatology, University of British Columbia, Vancouver, Canada; and
| | - Miikka Vikkula
- Laboratory of Human Molecular Genetics, Christian de Duve Institute of Cellular Pathology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
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23
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Couto JA, Vivero MP, Kozakewich HPW, Taghinia AH, Mulliken JB, Warman ML, Greene AK. A somatic MAP3K3 mutation is associated with verrucous venous malformation. Am J Hum Genet 2015; 96:480-6. [PMID: 25728774 DOI: 10.1016/j.ajhg.2015.01.007] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 01/09/2015] [Indexed: 11/30/2022] Open
Abstract
Verrucous venous malformation (VVM), also called "verrucous hemangioma," is a non-hereditary, congenital, vascular anomaly comprised of aberrant clusters of malformed dermal venule-like channels underlying hyperkeratotic skin. We tested the hypothesis that VVM lesions arise as a consequence of a somatic mutation. We performed whole-exome sequencing (WES) on VVM tissue from six unrelated individuals and looked for somatic mutations affecting the same gene in specimens from multiple persons. We observed mosaicism for a missense mutation (NM_002401.3, c.1323C>G; NP_002392, p.Iso441Met) in mitogen-activated protein kinase kinase kinase 3 (MAP3K3) in three of six individuals. We confirmed the presence of this mutation via droplet digital PCR (ddPCR) in the three subjects and found the mutation in three additional specimens from another four participants. Mutant allele frequencies ranged from 6% to 19% in affected tissue. We did not observe this mutant allele in unaffected tissue or in affected tissue from individuals with other types of vascular anomalies. Studies using global and conditional Map3k3 knockout mice have previously implicated MAP3K3 in vascular development. MAP3K3 dysfunction probably causes VVM in humans.
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Affiliation(s)
- Javier A Couto
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Matthew P Vivero
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Harry P W Kozakewich
- Vascular Anomalies Center, Boston Children's Hospital, Boston, MA 02115, USA; Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Amir H Taghinia
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA; Vascular Anomalies Center, Boston Children's Hospital, Boston, MA 02115, USA
| | - John B Mulliken
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA; Vascular Anomalies Center, Boston Children's Hospital, Boston, MA 02115, USA
| | - Matthew L Warman
- Vascular Anomalies Center, Boston Children's Hospital, Boston, MA 02115, USA; Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA; Department of Genetics, Harvard Medical School, Boston, MA 02115, USA; Howard Hughes Medical Institute, Boston Children's Hospital, Boston, MA 02115, USA
| | - Arin K Greene
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA; Vascular Anomalies Center, Boston Children's Hospital, Boston, MA 02115, USA.
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24
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Wang L, Gao T, Wang G. Verrucous hemangioma: a clinicopathological and immunohistochemical analysis of 74 cases. J Cutan Pathol 2014; 41:823-30. [PMID: 25263605 DOI: 10.1111/cup.12385] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 07/26/2014] [Accepted: 09/01/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Lei Wang
- Department of Dermatology; Xijing Hospital, Fourth Military Medical University; Xian China
| | - Tianwen Gao
- Department of Dermatology; Xijing Hospital, Fourth Military Medical University; Xian China
| | - Gang Wang
- Department of Dermatology; Xijing Hospital, Fourth Military Medical University; Xian China
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25
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Requena L, Torrelo A. Paediatric vascular tumours other than infantile haemangioma. Br J Dermatol 2014; 171:464-5. [DOI: 10.1111/bjd.12917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L. Requena
- Department of Dermatology Fundación Jiménez Díaz Universidad Autónoma Avda. Reyes Católicos 2 28040 Madrid Spain
| | - A. Torrelo
- Department of Dermatology Hospital del Niño Jesús Universidad Autónoma Madrid Spain
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26
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Abstract
Angiokeratoma is a rare, usually acquired muco-cutaneous wart-like vascular lesion that is frequently reported in the scrotum. Bleeding may occur if angiokeratoma is excoriated or traumatized. We report an exceedingly rare solitary eyelid angiokeratoma in an otherwise normal middle aged male. Our case represents the second case in the English peer reviewed literature since 1966, when the first case of eyelid angiokeratoma was reported.
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Affiliation(s)
- Ramadan S Hussein
- Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hala Kfoury
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Yasser H Al-Faky
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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27
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Hoeger P, Colmenero I. Vascular tumours in infants. Part I: benign vascular tumours other than infantile haemangioma. Br J Dermatol 2014; 171:466-73. [DOI: 10.1111/bjd.12650] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2013] [Indexed: 11/28/2022]
Affiliation(s)
- P.H. Hoeger
- Department of Paediatric Dermatology Catholic Children's Hospital Wilhelmstift Hamburg Germany
| | - I. Colmenero
- Histopathology Department Birmingham Children's Hospital Birmingham U.K
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28
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Haskins SM, Shields NN. Verrucous Hemangioma of the Plantar Surface of the Foot: A Case Report. JBJS Case Connect 2014; 4:e10. [PMID: 29252556 DOI: 10.2106/jbjs.cc.m.00132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Scott M Haskins
- 929 North South Francis Street, University of Kansas-Wichita, Wichita, KS 67214
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29
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Willard KJ, Cappel MA, Kozin SH, Abzug JM. Congenital and infantile skin lesions affecting the hand and upper extremity, part 1: vascular neoplasms and malformations. J Hand Surg Am 2013; 38:2271-83. [PMID: 23707594 DOI: 10.1016/j.jhsa.2013.03.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 03/08/2013] [Accepted: 03/09/2013] [Indexed: 02/02/2023]
Abstract
Many dermatologic conditions may be present on a newborn infant's upper extremity that can evoke concern for parents and/or primary caregivers. Although the pediatrician typically remains the first care provider, often these children are referred to specialists to diagnose and treat these lesions. Hand surgeons should be familiar with different infantile skin lesions on an upper extremity. Some lesions are best observed, whereas others require treatment with nonoperative measures, lasers, or surgical interventions. A 2-part series is presented to aid the hand surgeon in becoming familiar with these lesions. This part 1 article focuses on vascular neoplasms and malformations. Particular attention is paid to the multiple types of hemangiomas and hemangioendotheliomas, telangiectasias, angiokeratomas, as well as capillary, venous, and lymphatic malformations. Diagnostic tips and clinical photographs are provided to help differentiate among these lesions. In addition, the recommended treatment for each is discussed.
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Affiliation(s)
- Katherine J Willard
- Department of Dermatology, Mayo Clinic Florida, Jacksonville, Florida; Shriners Hospital for Children of Philadelphia, Philadelphia, Pennsylvania; and the Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
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30
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Chen S, Xiong L, Wang S, Wang TT, Wang L, Gurung D. Eccrine angiomatous hamartoma causing walking difficulties. Australas J Dermatol 2013; 54:e33-6. [PMID: 23582001 DOI: 10.1111/j.1440-0960.2011.00847.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Eccrine angiomatous hamartoma (EAH) is a rare tumoral lesion that consists of vascular and eccrine malformation and often occurs in the distal extremities of children. Although EAH is benign, a therapeutic excision may be required for symptomatic or cosmetic considerations. We hereby report a typical case of EAH presenting as a painful and rapidly growing plaque on the right thigh. The associated symptoms of pain, hyperhidrosis and local hypertrichosis caused walking difficulties until the patient was cured by two excisional surgeries.
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Affiliation(s)
- Shuang Chen
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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31
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Trindade F, Torrelo A, Requena L, Tellechea Ó, Del Pozo J, Sacristán F, Esteve-Martínez A, de Unamuno B, de Miquel VA, Colmenero I. An immunohistochemical study of verrucous hemangiomas. J Cutan Pathol 2013; 40:472-6. [DOI: 10.1111/cup.12123] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 12/20/2012] [Accepted: 01/25/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Felicidade Trindade
- Department of Dermatology; Hospital de Cascais Dr. José de Almeida; Lisbon; Portugal
| | - Antonio Torrelo
- Department of Dermatology; Hospital Infantil Universitario Niño Jesús; Madrid; Spain
| | - Luis Requena
- Department of Dermatology; Fundación Jiménez Díaz; Madrid; Spain
| | - Óscar Tellechea
- Department of Dermatology; Hospital Universitário de Coimbra; Coimbra; Portugal
| | - Jesus Del Pozo
- Department of Dermatology; Complexo Hospitalario Universitario A Coruña; Coruña; Spain
| | - Felipe Sacristán
- Department of Dermatology; Complexo Hospitalario Universitario A Coruña; Coruña; Spain
| | - Altea Esteve-Martínez
- Department of Dermatology; Consorcio Hospital General Universitário de Valencia; Valencia; Spain
| | - Blanca de Unamuno
- Department of Dermatology; Consorcio Hospital General Universitário de Valencia; Valencia; Spain
| | - Víctor Alegre de Miquel
- Department of Dermatology; Consorcio Hospital General Universitário de Valencia; Valencia; Spain
| | - Isabel Colmenero
- Department of Pathology; Hospital Infantil Universitario Niño Jesús; Madrid; Spain
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32
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Laing EL, Brasch HD, Steel R, Jia J, Itinteang T, Tan ST, Day DJ. Verrucous hemangioma expresses primitive markers. J Cutan Pathol 2013; 40:391-6. [PMID: 23379586 DOI: 10.1111/cup.12078] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 12/07/2012] [Accepted: 12/16/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Verrucous hemangioma (VH) presents clinically as a vascular malformation but has similar histopathologic features to infantile hemangioma. This study characterized the cell population within VH. MATERIAL AND METHODS Paraffin-embedded sections from two male patients with VH were processed for immunohistochemistry. The expression of SMA, CD34, glucose transporter-1 (Glut-1), D2-40, brachyury, angiotensin converting enzyme (ACE), Oct-4, hemoglobin ζ chain (HBZ), Wilms tumor protein (WT-1) and CD45 was examined. RESULTS The lymphatic marker, D2-40, was not expressed in VH, whereas Glut-1 was widely expressed in infantile hemangioma, it was only focally expressed by the endothelium of VH. The endothelium of VH expressed the primitive markers, Oct-4, brachyury and ACE. The primitive marker, WT-1, was expressed predominantly on the pericyte layer of both VH and infantile hemangioma. However, HBZ was only expressed in infantile hemangioma. CD45, a mature hematopoetic marker, was expressed by cells within the interstitium, away from the endothelium of VH and infantile hemangioma. DISCUSSION The expression of the primitive markers, Oct-4, brachyury and ACE on the endothelium, and WT-1 predominantly on the pericyte layer of VH shows a primitive microvascular phenotype similar to infantile hemangioma. However, the absence of the embryonic marker, HBZ, expressed only in first trimester placenta and in proliferating infantile hemangioma, suggests a different cellular origin. HBZ could be used to distinguish between the two conditions.
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Affiliation(s)
- Emma L Laing
- Gillies McIndoe Research Institute, Wellington, New Zealand
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33
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Affiliation(s)
| | - Grace Sun
- Baylor College of Medicine; Houston; TX; USA
| | - Karen Eldin
- Baylor College of Medicine; Houston; TX; USA
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34
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Del Pozo J, Gómez-Tellado M, López-Gutiérrez J. Malformaciones vasculares en la infancia. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:661-78. [DOI: 10.1016/j.ad.2011.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 12/18/2011] [Accepted: 12/25/2011] [Indexed: 12/20/2022] Open
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35
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Vascular Malformations in Childhood. ACTAS DERMO-SIFILIOGRAFICAS 2012. [DOI: 10.1016/j.adengl.2012.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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36
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Bruder E, Alaggio R, Kozakewich HPW, Jundt G, Dehner LP, Coffin CM. Vascular and perivascular lesions of skin and soft tissues in children and adolescents. Pediatr Dev Pathol 2012; 15:26-61. [PMID: 22420724 DOI: 10.2350/11-11-1119-pb.1] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Vascular anomalies in children and adolescents are the most common soft tissue lesions and include reactive, malformative, and neoplastic tumefactions, with a full spectrum of benign, intermediate, and malignant neoplasms. These lesions are diagnostically challenging because of morphologic complexity and recent changes in classification systems, some of which are based on clinical features and others on pathologic findings. In recent decades, there have been significant advances in clinical diagnosis, development of new therapies, and a better understanding of the genetic aspects of vascular biology and syndromes that include unusual vascular proliferations. Most vascular lesions in children and adolescents are benign, although the intermediate locally aggressive and intermediate rarely metastasizing neoplasms are important to distinguish from benign and malignant mimics. Morphologic recognition of a vasoproliferative lesion is straightforward in most instances, and conventional morphology remains the cornerstone for a specific diagnosis. However, pathologic examination is enhanced by adjunctive techniques, especially immunohistochemistry to characterize the type of vessels involved. Multifocality may cause some uncertainty regarding the assignment of "benign" or "malignant." However, increased interest in vascular anomalies, clinical expertise, and imaging technology have contributed greatly to our understanding of these disorders to the extent that in most vascular malformations and in many tumors, a diagnosis is made clinically and biopsy is not required for diagnosis. The importance of close collaboration between the clinical team and the pathologist cannot be overemphasized. For some lesions, a diagnosis is not possible from evaluation of histopathology alone, and in a subset of these, a specific diagnosis may not be possible even after all assembled data have been reviewed. In such instances, a consensus diagnosis in conjunction with clinical colleagues guides therapy. The purpose of this review is to delineate the clinicopathologic features of vascular lesions in children and adolescents with an emphasis on their unique aspects, use of diagnostic adjuncts, and differential diagnosis.
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Affiliation(s)
- Elisabeth Bruder
- Institute for Pathology, Hospital of the University of Basel, Basel, Switzerland
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37
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Laser treatment for verrucous hemangioma. Lasers Med Sci 2011; 27:681-4. [PMID: 21975688 DOI: 10.1007/s10103-011-1000-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 09/15/2011] [Indexed: 10/17/2022]
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38
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Clairwood MQ, Bruckner AL, Dadras SS. Verrucous hemangioma: a report of two cases and review of the literature. J Cutan Pathol 2011; 38:740-6. [DOI: 10.1111/j.1600-0560.2011.01733.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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39
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Abstract
Venous malformation results from an error in vascular morphogenesis. Although this condition is present at birth, it may not become evident until childhood or adolescence when it has grown large enough to cause a visible deformity or symptoms. This article discusses the types, diagnosis, and the nonoperative and operative management of venous malformations.
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Affiliation(s)
- Arin K Greene
- Department of Plastic and Oral Surgery, Vascular Anomalies Center, Children's Hospital Boston, Harvard Medical College, Boston, MA 02115, USA.
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40
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Abstract
The aim of this review was to discuss the current knowledge on aetiopathogenesis, diagnosis and therapeutic management of venous malformations (VMs). VMs are slow-flow vascular anomalies. They are simple, sporadic or familial (cutaneomucosal VMs or glomuvenous malformations), combined (e.g. capillaro-venous and capillaro-lymphaticovenous malformations) or syndromic (Klippel-Trenaunay, blue rubber bleb naevus and Maffucci). Genetic studies have identified causes of familial forms and of 40% of sporadic VMs. Another diagnostic advancement is the identification of elevated D-dimer level as the first biomarker of VMs within vascular anomalies. Those associated with pain are often responsive to low-molecular-weight heparin, which should also be used to avoid disseminated intravascular coagulopathy secondary to intervention, especially if fibrinogen level is low. Finally, development of a modified sclerosing agent, ethylcellulose-ethanol, has improved therapy. It is efficient and safe, and widens indications for sclerotherapy to sensitive and dangerous areas such as hands, feet and periocular area.
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Affiliation(s)
- Anne Dompmartin
- Université de Caen Basse Normandie, CHU Caen, Department of Dermatology, Caen (France)
| | - Miikka Vikkula
- Université catholique de Louvain, de Duve Institute, Laboratory of Human Molecular Genetics, B-1200 Brussels, Belgium
| | - Laurence M Boon
- Université catholique de Louvain, de Duve Institute, Laboratory of Human Molecular Genetics, B-1200 Brussels, Belgium
- Université catholique de Louvain, Cliniques universitaires St Luc, Center for Vascular Anomalies, Division of Plastic Surgery, B-1200 Brussels, Belgium
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41
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Lara-Corrales I, Somers GR, Ho N. Verrucous Hemangioma: A Challenging Vascular Lesion. J Cutan Med Surg 2010; 14:144-6. [DOI: 10.2310/7750.2009.08093] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: We present a case of a 13-year-old girl with a congenital vascular lesion in her right ankle. Results and Conclusions: Clinical and pathologic examinations led to the diagnosis of a verrucous hemangioma, a distinct, uncommon vascular lesion. The appearance of verrucous hemangiomas evolves with time and may represent a diagnostic challenge. We present this case report and a review of the literature.
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Affiliation(s)
- Irene Lara-Corrales
- From the Department of Paediatrics, Section of Dermatology, and Department of Pathology, The Hospital for Sick Children, Toronto, ON
| | - Gino R. Somers
- From the Department of Paediatrics, Section of Dermatology, and Department of Pathology, The Hospital for Sick Children, Toronto, ON
| | - Nhung Ho
- From the Department of Paediatrics, Section of Dermatology, and Department of Pathology, The Hospital for Sick Children, Toronto, ON
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Cheong SH, Lim JY, Kim SY, Choi YW, Choi HY, Myung KB. A case of eccrine angiomatous hamartoma associated with verrucous hemangioma. Ann Dermatol 2009; 21:304-7. [PMID: 20523811 DOI: 10.5021/ad.2009.21.3.304] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Accepted: 02/20/2009] [Indexed: 11/08/2022] Open
Abstract
Eccrine angiomatous hamartomas are benign vascular and eccrine malformations often accompanied by hyperhidrosis or pain, increased eccrine glands, and aggregates of vessels. Verrucous hemangiomas are congenital vascular malformations presenting as unilateral grouped papules. Histologically, they show verrucous epidermal change and proliferation of capillaries in the dermis. We report a case of a 47-year-old woman with a red keratotic patch overlying a bluish plaque on the right sole, which had been present since birth. It was accompanied by pain and hyperhidrosis. Histologically, there were verrucous changes in the epidermis, numerous dilated capillaries in the papillary dermis, and increased eccrine glands with angiomatous foci in the deep dermis. The epithelial cells of the eccrine glands were positive for CEA, and the endothelial cells were positive for CD31 and GLUT-1. Eccrine angiomatous hamartomas have been reported in conjunction with other vascular tumors in only a few instances. We report an interesting case of an eccrine angiomatous hamartoma associated with a verrucous hemangioma.
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Affiliation(s)
- Seung Hyun Cheong
- Department of Dermatology, School of Medicine, Ewha Womans University, Seoul, Korea
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43
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del Pozo J, Tellado M, López-Gutiérrez J. Hemangioma verrugoso frente a malformación linfática microquística. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s0001-7310(09)71266-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Garrido-Ríos A, Miranda-Romero A. Réplica a «Hemangioma verrugoso frente a malformación linfática microquística». ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s0001-7310(09)71267-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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45
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Frieden IJ, Rogers M, Garzon MC. Conditions masquerading as infantile haemangioma: Part 1. Australas J Dermatol 2009; 50:77-97; quiz 98. [DOI: 10.1111/j.1440-0960.2009.00514_1.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Garrido-Ríos A, Miranda-Romero A. Response to «Verrucous Hemangioma Versus Microcystic Lymphatic Malformation». ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s1578-2190(09)70096-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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47
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del Pozo J, Tellado M, López-Gutiérrez J. Verrucous Hemangioma Versus Microcystic Lymphatic Malformation. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s1578-2190(09)70095-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Boixeda P, Carmona LP, Vano-Galvan S, Jaén P, Lanigan SW. Advances in treatment of cutaneous and subcutaneous vascular anomalies by pulsed dual wavelength 595- and 1064-nm application. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.mla.2008.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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50
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Akyol I, Jayanthi VR, Luquette MH. Verrucous Hemangioma of the Glans Penis. Urology 2008; 72:230.e15-6. [DOI: 10.1016/j.urology.2007.11.120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Revised: 11/12/2007] [Accepted: 11/20/2007] [Indexed: 11/28/2022]
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