1
|
Putra J, Kim GE. Diagnostic approach to hepatic vascular lesions: a paediatric perspective. Histopathology 2024. [PMID: 38924138 DOI: 10.1111/his.15250] [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: 02/07/2024] [Revised: 06/04/2024] [Accepted: 06/08/2024] [Indexed: 06/28/2024]
Abstract
The pathological evaluation of hepatic vascular lesions in children requires special consideration. Inconsistent terminology, rarity of pathology specimens and overlapping pathological features between various lesions may pose a serious diagnostic challenge. In this review, we highlight the importance of using the International Society for the Study of Vascular Anomalies (ISSVA) classification scheme to characterise these lesions. Selected entities are discussed, including hepatic vascular tumours exclusively seen in the paediatric age group, hepatic infantile haemangioma and hepatic congenital haemangioma. Vascular malformations, with emphasis on their syndromic associations (venous malformation in blue rubber bleb naevus syndrome) and complications (hepatocellular nodules in Abernethy malformation) are also covered.
Collapse
Affiliation(s)
- Juan Putra
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Grace E Kim
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
2
|
Liu Z, Song D, Wang L, Zhou J, Wang C, Li J, Sun J, Zhang X, Guo L. Transarterial arterial sclerosing embolization for the treatment of propranolol-resistant subglottic hemangioma: Feasibility and effificacy. Front Oncol 2023; 13:1062510. [PMID: 36937450 PMCID: PMC10018163 DOI: 10.3389/fonc.2023.1062510] [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: 10/07/2022] [Accepted: 01/30/2023] [Indexed: 03/06/2023] Open
Abstract
Purpose To assess the effectiveness and safety of transcatheter arterial sclerosing embolization (TASE) for the treatment of subglottic hemangiomas that did not respond appreciably to propranolol. Materials and Methods This study was a retrospective analysis. Of the 101 patients with subglottic hemangiomas admitted to our center, 10 (4 male and 6 female) patients were included in this study. All these patients underwent arterial embolization using Pingyangmycin and polyvinyl alcohol particles (300-500 μm). All patients were examined 1 month after the last treatment and monthly thereafter. Results TASE treatment was technically successful in all patients. Ten lesions were located in the subglottic region. The blood supply included the superior thyroid artery, brachiocephalic trunk, facial artery, and ascending pharyngeal arteries. The median maximal diameter of the hemangiomas significantly decreased from 8.5 mm before treatment to 2 mm after TASE (P <.05). The degree of laryngeal obstruction improved in all patients. No serious complications were noted. One patient developed fever postoperatively, and three patients had a mild cough. Conclusions For even subglottic hemangiomas with suboptimal efficacy of propranolol, TASE significantly reduced the size of hemangiomas with minimal adverse effects. It had a positive effect on the improvement of airway stenosis caused by subglottic hemangioma with poor effect of oral propranolol.
Collapse
|
3
|
Walther A, Häberle B, Küppers J, Lurz E, Schmid I, Schmidt H, Dubinski I. Severe consumptive hypothyroidism in hepatic hemangioendothelioma. J Pediatr Endocrinol Metab 2022; 35:1560-1564. [PMID: 36190305 DOI: 10.1515/jpem-2022-0347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 08/16/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Consumptive hypothyroidism may occur in hepatic hemangioendothelioma. The altered expression of deiodinases inactivates peripheral thyroid hormones. As a result, serum levels of free triiodothyronine and free thyroxine are reduced to varying degrees. There are no established recommendations for the dosage of sirolimus for this particular indication. We describe for the first time the course of treatment with low-dose sirolimus. CASE PRESENTATION We present a 5-week-old infant with hepatic hemangioendothelioma and severe consumptive hypothyroidism. Due to hepatic infiltration he showed signs of right heart strain. Therapy of hemangioendothelioma was initiated with propranolol and, in the absence of response, methylprednisolone was added. Treatment was continued with low-dose sirolimus (due to side effects) and propranolol. Hypothyroidism was managed with levothyroxine and liothyronine. CONCLUSIONS Consumptive hypothyroidism due to cutaneous hemangioma and hepatic hemangioendothelioma can be managed with propranolol and low-dose sirolimus. Treatment of severe hypothyroidism may require a combinational therapy by substitution of both T3 and T4.
Collapse
Affiliation(s)
- Antonia Walther
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital Munich, LMU, Munich, Germany
| | - Beate Häberle
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, University Hospital Munich, LMU, Munich, Germany
| | - Julia Küppers
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, University Hospital Munich, LMU, Munich, Germany
| | - Eberhard Lurz
- Division of Pediatric Gastroenterology und Hepatology, Dr. von Hauner Children's Hospital, University Hospital Munich, LMU, Munich, Germany
| | - Irene Schmid
- Division of Pediatric Hematology and Oncology, Dr. von Hauner Children's Hospital, University Hospital Munich, LMU, Munich, Germany
| | - Heinrich Schmidt
- Division of Pediatric Endocrinology and Diabetology, Dr. von Hauner Children's Hospital, University Hospital Munich, LMU, Munich, Germany
| | - Ilja Dubinski
- Division of Pediatric Endocrinology and Diabetology, Dr. von Hauner Children's Hospital, University Hospital Munich, LMU, Munich, Germany
| |
Collapse
|
4
|
Moon SJ, Baek HJ, Kim BR, Park WJ, Kim J, Lee YY, Cho HJ, Kook H. Successful Management of Massive Congenital Hepatic Hemangioma and Systemic Hypertension With Sirolimus. J Pediatr Hematol Oncol 2022; 44:e424-e427. [PMID: 33735153 DOI: 10.1097/mph.0000000000002146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/12/2021] [Indexed: 11/26/2022]
Abstract
Congenital hepatic hemangioma (CHH) is a common benign vascular tumor of the liver, seen in infancy. The clinical manifestations vary from incidental findings to life-threatening complications. The authors present here a case of an infant with massive CHH who developed systemic hypertension because of compression of the right renal artery by the CHH and did not respond to other lines of treatment. After sirolimus therapy, the CHH size decreased and antihypertensive drugs were no longer necessary. In a critical situation, if the embolization and/or steroids do not seem to control the situation, then adding sirolimus may be considered as secondary therapy with good additive effects.
Collapse
Affiliation(s)
- So Jung Moon
- Department of Pediatrics, Chonnam National University Children's Hospital
| | - Hee Jo Baek
- Department of Pediatrics, Chonnam National University Medical School
- Department of Pediatrics
| | | | | | - Joheon Kim
- Department of Pathology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Yun Young Lee
- Department of Radiology, Chonnam National University Hospital, Gwangju
| | - Hwa Jin Cho
- Department of Pediatrics, Chonnam National University Children's Hospital
- Department of Pediatrics, Chonnam National University Medical School
| | - Hoon Kook
- Department of Pediatrics, Chonnam National University Medical School
- Department of Pediatrics
| |
Collapse
|
5
|
Ostojic A, Mrzljak A, Mikulic D. Liver transplantation for benign liver tumors. World J Hepatol 2021; 13:1098-1106. [PMID: 34630877 PMCID: PMC8473500 DOI: 10.4254/wjh.v13.i9.1098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/12/2021] [Accepted: 07/21/2021] [Indexed: 02/06/2023] Open
Abstract
Benign liver tumors are common lesions that are usually asymptomatic and are often found incidentally due to recent advances in imaging techniques and their widespread use. Although most of these tumors can be managed conservatively or treated by surgical resection, liver transplantation (LT) is the only treatment option in selected patients. LT is usually indicated in patients that present with life-threatening complications, when the lesions are diffuse in the hepatic parenchyma or when malignant transformation cannot be ruled out. However, due to the significant postoperative morbidity of the procedure, scarcity of available donor liver grafts, and the benign course of the disease, the indications for LT are still not standardized. Hepatic adenoma and adenomatosis, hepatic hemangioma, and hepatic epithelioid hemangioendothelioma are among the most common benign liver tumors treated by LT. This article reviews the role of LT in patients with benign liver tumors. The indications for LT and long-term outcomes of LT are presented.
Collapse
Affiliation(s)
- Ana Ostojic
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb 10000, Croatia
| | - Anna Mrzljak
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb 10000, Croatia
| | - Danko Mikulic
- Department of Surgery, University Hospital Merkur, Zagreb 10000, Croatia
| |
Collapse
|
6
|
Cîrstoveanu C, Bizubac AM, Mustea C, Manolache Ș, Istrate-Bârzan A, Sfrijan D, Marcu V, Iozsa DA, Spătaru RI. Antiproliferative therapy with sirolimus and propranolol for congenital vascular anomalies in newborns (Case reports). Exp Ther Med 2021; 22:1097. [PMID: 34504551 PMCID: PMC8383751 DOI: 10.3892/etm.2021.10531] [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: 05/31/2021] [Accepted: 06/30/2021] [Indexed: 11/20/2022] Open
Abstract
We present a series of four newborns diagnosed with complicated congenital vascular anomalies, with different localization: Congenital lymphatic malformation (CLM) on the left hemithorax extending on the left upper limb; congenital hepatic hemangioma (CHH) with important complications in the first 7 weeks of life; Kaposiform hemangioendothelioma (KHE) of the left lower limb complicated with Kasabach Merritt phenomenon (KMM) and most probable diffuse capillary malformation with overgrowth (DCMO). All patients were treated with combined antiproliferative therapy with sirolimus and propranolol. The initial dose of sirolimus was 0.45-0.5 mg/m2 with doses adjusted according to plasmatic levels. Therapeutic intervals of sirolimus were considered at plasmatic levels of 7-12 ng/ml. Our aim was to use the lowest therapeutic dose in order to avoid possible side effects. Propranolol was initiated in doses of 0.5-1.0 mg/kg/day and was increased up to 3.0 mg/kg/day depending on tolerability. Following two months, every patient showed a marked reduction in the size of the mass, improvement in overall appearance or even calcification in the liver vascular tumor. No patient showed life threatening side effects to the treatment. Hypertriglyceridemia was the only side effect noted in all patients. This is in accordance with several international studies, which try to demonstrate the importance of sirolimus in neonatal vascular malformations in monotherapy or combined with different drugs.
Collapse
Affiliation(s)
- Cătălin Cîrstoveanu
- Neonatal Intensive Care Unit, 'Marie S. Curie' Emergency Clinical Hospital for Children, 077120 Bucharest, Romania.,Department of Pediatrics, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Ana Mihaela Bizubac
- Neonatal Intensive Care Unit, 'Marie S. Curie' Emergency Clinical Hospital for Children, 077120 Bucharest, Romania.,Department of Pediatrics, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Cristina Mustea
- Neonatal Intensive Care Unit, 'Marie S. Curie' Emergency Clinical Hospital for Children, 077120 Bucharest, Romania
| | - Ștefan Manolache
- Neonatal Intensive Care Unit, 'Marie S. Curie' Emergency Clinical Hospital for Children, 077120 Bucharest, Romania
| | - Alexandra Istrate-Bârzan
- Neonatal Intensive Care Unit, 'Marie S. Curie' Emergency Clinical Hospital for Children, 077120 Bucharest, Romania
| | - Doinița Sfrijan
- Department of Pediatrics, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Oncology Department, 'Marie S. Curie' Emergency Clinical Hospital for Children, 077120 Bucharest, Romania
| | - Veronica Marcu
- Radiology Department, 'Marie S. Curie' Emergency Clinical Hospital for Children, 077120 Bucharest, Romania
| | - Dan-Alexandru Iozsa
- Pediatric Surgery Department, 'Marie S. Curie' Emergency Clinical Hospital for Children, 077120 Bucharest, Romania.,Department of Pediatric Surgery and Orthopedics, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Radu-Iulian Spătaru
- Pediatric Surgery Department, 'Marie S. Curie' Emergency Clinical Hospital for Children, 077120 Bucharest, Romania.,Department of Pediatric Surgery and Orthopedics, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| |
Collapse
|
7
|
Zhang J, Ye Z, Tan L, Luo J. Giant Hepatic Hemangioma Regressed Significantly Without Surgical Management: A Case Report and Literature Review. Front Med (Lausanne) 2021; 8:712324. [PMID: 34490301 PMCID: PMC8416894 DOI: 10.3389/fmed.2021.712324] [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: 05/20/2021] [Accepted: 07/16/2021] [Indexed: 11/13/2022] Open
Abstract
Hepatic hemangioma (HH) is a congenital vascular anomaly comprising networks of abnormal blood and/or lymphatic vessels with endothelial cell proliferation. Their pathophysiology is not fully understood, and no specific drug is available to treat them. Conservative management, which limits observation, is preferred for most patients. A HH larger than 4 cm is considered a giant HH that may be treated using surgery ranging from embolization to hepatic resection or liver transplantation. Here, we describe a case with multiple and giant HHs that regressed significantly after treatment with azithromycin (AZM). A systematic literature review of HH and the effects of AZM on angiogenesis was then conducted.
Collapse
Affiliation(s)
- Jingcong Zhang
- Department of Internal Medicine, Medical Intensive Care Unit and Division of Respiratory Diseases, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zuyang Ye
- Department of Nephrology, The Second Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Lei Tan
- Department of Medical Ultrasonic, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jinmei Luo
- Department of Internal Medicine, Medical Intensive Care Unit and Division of Respiratory Diseases, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
8
|
Watanabe S, Manabe M, Miyata M, Naoe A, Suzuki T. A case of neonate effectively treated with everolimus for giant hepatic hemangioma complicated with congenital duodenal atresia and Kasabach-Merritt syndrome. J Neonatal Perinatal Med 2020; 14:437-440. [PMID: 33325401 DOI: 10.3233/npm-200504] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Disseminated intravascular coagulation (DIC) with Kasabach-Merrit syndrome from a large hepatic hemangioma is life-threatening. We report a case of giant hepatic hemangioma of the newborn with KMS. RESULTS The patient was born at 37 gestational weeks and 2 days via cesarean section; weight at birth was 2952 g. Congenital duodenal atresia was noted during the fetal period. DIC developed after delivery and a giant liver hemangioma was diagnosed via abdominal CT. The cause of DIC was Kasabach-Merritt syndrome owing to a giant hepatic hemangioma. First, combination therapy of 2 mg/kg/day of prednisolone and 0.2 mg/kg/day of propranolol was initiated form enterostomy. However, the size of the hepatic hemangioma did not alter, as observed via image evaluation. Therefore, 0.3 mg/kg/day of everolimus was administered frorm enterostomy. Subsequently, the size of the hepatic hemangioma was assessed via image evaluation. Although it did not alter, blood flow to the hepatic hemangioma decreased and thrombocytopenia was also suppressed. We performed hepatic lateral segmentectomy, radical operation for duodenal atresia. The pathological diagnosis of the removed tumor was infantile hemangioma. CONCLUSION We report everolimus may be useful when PSL and propranolol are ineffective.
Collapse
Affiliation(s)
- S Watanabe
- Department of Pediatric Surgery, Fujita Health University Hospital, Aichi, Japan
| | - M Manabe
- Department of Pediatrics, Fujita Health University Hospital, Aichi, Japan
| | - M Miyata
- Department of Pediatrics, Fujita Health University Hospital, Aichi, Japan
| | - A Naoe
- Department of Pediatric Surgery, Fujita Health University Hospital, Aichi, Japan
| | - T Suzuki
- Department of Pediatric Surgery, Fujita Health University Hospital, Aichi, Japan
| |
Collapse
|
9
|
Guo L, Wu C, Song D, Wang L, Li J, Sun J, Zhang Y. Transcatheter Arterial Sclerosing Embolization for the Treatment of Giant Propranolol-Resistant Infantile Hemangiomas in the Parotid Region. J Vasc Interv Radiol 2020; 32:293-298. [PMID: 33221193 DOI: 10.1016/j.jvir.2020.09.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 09/22/2020] [Accepted: 09/29/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To report the effectiveness and safety of transcatheter arterial sclerosing embolization (TASE) for the treatment of parotid infantile hemangiomas that did not respond appreciably to propranolol. MATERIALS AND METHODS A total of 21 infants (12 male and 9 female) with large propranolol-resistant infantile hemangiomas in the parotid region were enrolled in this study. During TASE, the feeding arteries of the lesions were embolized using pingyangmycin-lipiodol emulsion and polyvinyl alcohol particles (300-500 μm) to reduce the blood flow rate. All children were followed up as outpatients at 2 weeks and monthly thereafter. The curative effect was evaluated at the 1- and 3-month follow-up visits. RESULTS Nine lesions were located on the right side of the parotid gland, whereas 12 were located on the left side. The feeding arteries in all patients originated from branches of the external carotid artery. TASE was technically successful in all patients. The mean (± SD) maximal diameter of the hemangiomas significantly decreased from 6.50 cm ± 2.28 before treatment to 3.56 cm ± 1.84 at 1 month after TASE (P <. 05). Three months after TASE, the mean maximal diameter further significantly decreased to 1.94 cm ± 1.58 (P <. 05). During the follow-up period, 16 cases were rated as excellent and 5 as good; no recurrence or serious complications were noted. Minor side effects, such as slight pain, mild fever, and tissue swelling, were observed. CONCLUSIONS TASE significantly decreased the size of the parotid hemangiomas with minor side effects during a short follow-up period.
Collapse
Affiliation(s)
- Lei Guo
- Department of Vascular Anomalies and Interventional Radiology, Qilu Children'sHospital of Shandong University, Room 23976, Jingshi Road, Jinan City, Shandong prov. CN 250022
| | - Changhua Wu
- Department of Vascular Anomalies and Interventional Radiology, Qilu Children'sHospital of Shandong University, Room 23976, Jingshi Road, Jinan City, Shandong prov. CN 250022
| | - Dan Song
- Department of Vascular Anomalies and Interventional Radiology, Qilu Children'sHospital of Shandong University, Room 23976, Jingshi Road, Jinan City, Shandong prov. CN 250022
| | - Liang Wang
- Department of Vascular Anomalies and Interventional Radiology, Qilu Children'sHospital of Shandong University, Room 23976, Jingshi Road, Jinan City, Shandong prov. CN 250022
| | - Jing Li
- Department of Vascular Anomalies and Interventional Radiology, Qilu Children'sHospital of Shandong University, Room 23976, Jingshi Road, Jinan City, Shandong prov. CN 250022
| | - Jiali Sun
- Department of Vascular Anomalies and Interventional Radiology, Qilu Children'sHospital of Shandong University, Room 23976, Jingshi Road, Jinan City, Shandong prov. CN 250022
| | - Yunkui Zhang
- Department of Stomatology, Qilu Children'sHospital of Shandong University, Room 23976, Jingshi Road, Jinan City, Shandong prov. CN 250022.
| |
Collapse
|
10
|
Abstract
Vascular liver tumors in the pediatric population can present a diagnostic dilemma. The most common hepatic vascular tumors are hepatic hemangiomas; however the differential diagnosis can also include other benign lesions and malignant masses. Management is unique to the type and nature of the specific lesion. Thus, correct diagnosis and timely intervention is critical. The work up, diagnosis, and management of the different hepatic lesions are discussed in this paper.
Collapse
|
11
|
Dávila-Osorio VL, Iznardo H, Roé E, Puig L, Baselga E. Propranolol-resistant infantile hemangioma successfully treated with sirolimus. Pediatr Dermatol 2020; 37:684-686. [PMID: 32323340 DOI: 10.1111/pde.14163] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 02/25/2020] [Accepted: 03/17/2020] [Indexed: 12/15/2022]
Abstract
Infantile hemangiomas are the most common benign vascular tumors in childhood. Propranolol is the first-line treatment for infantile hemangiomas, but failures may occur. Sirolimus, an mTOR inhibitor, is a promising drug for the treatment of vascular malformations and vascular tumors. We present the case of a child with multiple infantile hemangiomasthat was successfully treated with sirolimus and propranolol after failure of combined propranolol and prednisolone treatment.
Collapse
Affiliation(s)
| | - Helena Iznardo
- Department of Dermatology, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Esther Roé
- Department of Dermatology, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Lluis Puig
- Department of Dermatology, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Eulalia Baselga
- Department of Dermatology, Hospital Sant Joan de Deu, Barcelona, Spain
| |
Collapse
|
12
|
Eghlimi H, Arasteh P, Azade N, Vinnars E. Orthotopic liver transplantation for Management of a Giant Liver Hemangioma: a case report and review of literature. BMC Surg 2020; 20:142. [PMID: 32600292 PMCID: PMC7324977 DOI: 10.1186/s12893-020-00801-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/16/2020] [Indexed: 12/11/2022] Open
Abstract
Background Hepatic hemangioma (HH) is the most common benign tumor of the liver. In special conditions such as rapidly growing tumors, persistent pain, hemorrhage and when pressure effect on adjacent organs exist treatment is indicated. Surgical management is the most common treatment for HH. Case presentation A 38-year-old male patient was diagnosed with HH for 7 years. The initial presentation of the mass was progressive abdominal distention causing early satiety, gastro-esophageal reflux disease, vomiting, dysphagia and weight loss. Later, the patient developed bilateral lower extremity edema. Imaging with computed tomography (CT scan) showed a large mass measuring 32.4*26*3.1 cm which was considered unresectable. The patient underwent a deceased donor liver transplantation. The excised mass was 9 kg. After nine days of hospitalization the patient was discharged in good condition. Three months later, the patient was admitted due to fever and cytomegalovirus infection for which he received intravenous ganciclovir and was discharged. In the latest follow-up the patient had no liver or kidney dysfunction eight months after the transplantation. Conclusion With appropriate patient selection, liver transplantation can be considered as a treatment option for patients with huge HHs which are life-threatening and surgically unresectable.
Collapse
Affiliation(s)
- Hesameddin Eghlimi
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Arasteh
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nazanin Azade
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | |
Collapse
|
13
|
Abstract
Vascular tumors in pediatric patients are an important entity for the clinician to recognize and correctly diagnose. They may present at birth or develop at any point during infancy, childhood, or adolescence. Most are benign, but even benign lesions may have significant morbidity without proper intervention. Malignant vascular tumors are also rarely seen in the pediatric population, and may be associated with various syndromes.
Collapse
Affiliation(s)
- Harriet Bagnal Hinen
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Cameron C Trenor
- Division of Hematology/Oncology, Vascular Anomalies Center, Boston Children's Hospital, Boston, MA, United States
| | - Lara Wine Lee
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, SC, United States
| |
Collapse
|
14
|
|
15
|
Steinberger J, Nistal DA, Ghatan S. T3 infantile hemangioma: first case of a tumor involving epidural, intradural extramedullary, and intradural intramedullary spaces. J Neurosurg Pediatr 2019; 23:694-698. [PMID: 30849748 DOI: 10.3171/2018.12.peds18554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 12/14/2018] [Indexed: 11/06/2022]
Abstract
Infantile hemangiomas (IHs) are the most common benign neoplasm of the neonatal and newborn period, affecting approximately 5% of infants. However, true IHs presenting in the neuraxis are quite rare with only 15 documented cases in the literature. Management of IH consists of utilizing steroids and immunomodulatory therapies to reduce the size of the tumor and surgery to remove the tumor to decrease symptoms and the risk of bleeding. Operative management of epidural and intradural extramedullary spinal hemangiomas has been described; however, management of intradural intramedullary IH has not been detailed in the literature. In this report, the authors describe the case of a 3-year-old girl who presented with multiple hemangiomas involving the liver, lung, and spine, with one component of the tumor involving the posterior intramedullary aspect of the spinal cord at the level of T3. After medical therapies had failed, the patient underwent endovascular embolization of the spinal hemangioma followed by resection of the tumor. While there is extensive literature on IH throughout many organ systems, only a handful of cases involving the neuraxis have been described. Operative management of refractory IH seems to allow for the reduction of tumor burden and the prevention of hemorrhagic injury.
Collapse
|