1
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Metry D, Copp HL, Rialon KL, Iacobas I, Baselga E, Dobyns WB, Drolet B, Frieden IJ, Garzon M, Haggstrom A, Hanson D, Hollenbach L, Keppler-Noreuil KM, Maheshwari M, Siegel DH, Waseem S, Dias M. Delphi Consensus on Diagnostic Criteria for LUMBAR Syndrome. J Pediatr 2024; 272:114101. [PMID: 38759778 DOI: 10.1016/j.jpeds.2024.114101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/02/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVE To develop consensus on diagnostic criteria for LUMBAR syndrome, the association of segmental infantile hemangiomas that affect the Lower body with Urogenital anomalies, Ulceration, spinal cord Malformations, Bony defects, Anorectal malformations, Arterial anomalies and/or Renal anomalies. STUDY DESIGN These diagnostic criteria were developed by an expert multidisciplinary and multi-institutional team based on analysis of peer-reviewed data, followed by electronic-Delphi consensus of a panel of 61 international pediatric specialists. RESULTS After 2 Delphi rounds, a 92% or higher level of agreement was reached for each Delphi statement. 98% of panelists agreed with the diagnostic criteria, and 100% agreed the criteria would be useful in clinical practice. The diagnosis of LUMBAR requires the presence of a segmental, or patterned, infantile hemangioma of the lumbosacral, sacrococcygeal, or pelvic cutaneous regions plus one additional criterion of the urogenital, spinal, bony, anorectal, arterial, or renal organ systems. CONCLUSIONS These diagnostic criteria will enhance clinical care by improving screening, detection, and overall awareness of this poorly understood neurocutaneous disorder. The criteria can be utilized by a wide variety of pediatric subspecialists. In addition, formal criteria will improve phenotypic uniformity among LUMBAR syndrome cohorts and a patient registry, allowing investigators to assess clinical features, long-term outcomes, and results of genetic sequencing in a standardized manner. Finally, these criteria will serve as a starting point for prospective studies to establish formal screening and management guidelines.
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Affiliation(s)
- Denise Metry
- Department of Dermatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Hillary L Copp
- Department of Urology, University of California-San Francisco, San Francisco, CA
| | - Kristy L Rialon
- Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Ionela Iacobas
- Department of Pediatrics, Cancer and Hematology Centers, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Eulalia Baselga
- Department of Dermatology, Hospital San Joan de Deu, Barcelona, Spain
| | - William B Dobyns
- Department of Genetics, University of Minnesota, Minneapolis, MN
| | - Beth Drolet
- Department of Dermatology, University of Wisconsin, Madison, WI
| | - Ilona J Frieden
- Department of Dermatology and Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Maria Garzon
- Department of Dermatology and Pediatrics, Columbia University, New York, NY
| | - Anita Haggstrom
- Department of Dermatology, Indiana University, Indianapolis, IN
| | - Darrell Hanson
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX
| | - Laura Hollenbach
- Department of Gynecology, University of Arkansas, Fayetteville, AR
| | | | - Mohit Maheshwari
- Department of Radiology, Medical College of Wisconsin, Madison, WI
| | - Dawn H Siegel
- Department of Dermatology, Stanford University, Stanford, CA
| | - Shamaila Waseem
- Department of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN
| | - Mark Dias
- Department of Neurosurgery, Pennsylvania State College of Medicine, Hershey, PA
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2
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AbdullGaffar B, Keloth T. Rhabdomyomatous Mesenchymal Hamartoma: Report of 4 Cases With Histochemical and Immunohistochemical Findings and Emphasis on Potential Pitfalls. Am J Dermatopathol 2024; 46:365-372. [PMID: 38683676 DOI: 10.1097/dad.0000000000002719] [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: 05/02/2024]
Abstract
ABSTRACT Rhabdomyomatous mesenchymal hamartoma (RMH) typically presents as a congenital midline head and neck cutaneous polyp in infants. Perianal and mucocutaneous lesions have been reported, and recently, acquired adult-onset variants have been proposed. This makes the true prevalence, etiopathogenesis, and clinicopathologic distribution and classification of RMHs in children compared with those in adults uncertain. We performed a retrospective review to highlight the salient histopathologic, histochemical, and immunohistochemical features in RMHs and to emphasize their specific clinicopathologic criteria to avoid diagnostic pitfalls. We found 4 (0.3%) infants [2 female infants and 2 male infants, average age: 4 months] with mental, nasal, lingual, and perianal midline RMHs (average size: 1.0 cm) of 1303 patients with cutaneous polypoid lesions. Three were isolated, and 1 was associated with Goldenhar syndrome. The cutaneous polyps demonstrated intermixed skeletal muscle, adipose, and fibrocollagenous core stroma that extended into the dermis and around the dermal appendages. The lingual lesion demonstrated skeletal muscle and fibrocollagenous stroma with prominent nerve bundles and little adipose tissue. All showed interstitial loose mesenchyme. Masson trichome demarcated the triphasic stromal components. Alcian blue demonstrated the loose myxoid mesenchyme. Elastic van Gieson did not show elastic fibers. Desmin demonstrated the skeletal muscle bundles, S100 highlighted the adipose tissue lobules and the nerve bundles, and CD34 displayed the mesenchymal stroma. Ki67 showed a low proliferation index in the loose mesenchyme. Smooth muscle actin did not reveal smooth muscle bundles, but with CD31, they highlighted the thick blood vessels. CD117 revealed prominent mast cells. From our retrospective review series, 4 cases that originally diagnosed as RMHs were excluded. Likewise, we found some examples of the reported cases in the English literature that might have been mistaken for RMHs. This is because they did not fulfill the diagnostic clinicopathologic criteria. RMH constitutes a rare entity with specific clinicopathologic features. Most lesions are isolated. Some are associated with congenital anomalies and syndromes. Strict clinicopathologic diagnostic criteria should be applied to avoid mislabeling look-alike lesions for RMHs.
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3
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Braun M, Frieden IJ, Siegel DH, George E, Hess CP, Fox CK, Chamlin SL, Drolet BA, Metry D, Pope E, Powell J, Holland K, Ulschmid C, Liang MG, Barry KK, Ho T, Cotter C, Baselga E, Bosquez D, Jain SN, Bui JK, Lara-Corrales I, Funk T, Small A, Baghoomian W, Yan AC, Treat JR, Hogrogian GS, Huang C, Haggstrom A, List M, McCuaig CC, Barrio V, Mancini AJ, Lawley LP, Grunnet-Satcher K, Horii KA, Newell B, Nopper A, Garzon MC, Scollan ME, Mathes EF. Multicenter Study of Long-Term Outcomes and Quality of Life in PHACE Syndrome after Age 10. J Pediatr 2024; 267:113907. [PMID: 38218370 DOI: 10.1016/j.jpeds.2024.113907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/23/2023] [Accepted: 01/09/2024] [Indexed: 01/15/2024]
Abstract
OBJECTIVE To characterize long-term outcomes of PHACE syndrome. STUDY DESIGN Multicenter study with cross-sectional interviews and chart review of individuals with definite PHACE syndrome ≥10 years of age. Data from charts were collected across multiple PHACE-related topics. Data not available in charts were collected from patients directly. Likert scales were used to assess the impact of specific findings. Patient-Reported Outcomes Measurement Information System (PROMIS) scales were used to assess quality of life domains. RESULTS A total of 104/153 (68%) individuals contacted participated in the study at a median of 14 years of age (range 10-77 years). There were infantile hemangioma (IH) residua in 94.1%. Approximately one-half had received laser treatment for residual IH, and the majority (89.5%) of participants were satisfied or very satisfied with the appearance. Neurocognitive manifestations were common including headaches/migraines (72.1%), participant-reported learning differences (45.1%), and need for individualized education plans (39.4%). Cerebrovascular arteriopathy was present in 91.3%, with progression identified in 20/68 (29.4%) of those with available follow-up imaging reports. Among these, 6/68 (8.8%) developed moyamoya vasculopathy or progressive stenoocclusion, leading to isolated circulation at or above the level of the circle of Willis. Despite the prevalence of cerebrovascular arteriopathy, the proportion of those with ischemic stroke was low (2/104; 1.9%). PROMIS global health scores were lower than population norms by at least 1 SD. CONCLUSIONS PHACE syndrome is associated with long-term, mild to severe morbidities including IH residua, headaches, learning differences, and progressive arteriopathy. Primary and specialty follow-up care is critical for PHACE patients into adulthood.
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Affiliation(s)
- Mitchell Braun
- University of California San Francisco, School of Medicine, San Francisco, CA; Department of Dermatology, University of California San Francisco, San Francisco, CA
| | - Ilona J Frieden
- Department of Dermatology, University of California San Francisco, San Francisco, CA
| | - Dawn H Siegel
- Department of Dermatology, Stanford University, Palo Alto, CA
| | - Elizabeth George
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Christopher P Hess
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Christine K Fox
- Department of Neurology and Pediatrics, University of California San Francisco, San Francisco, CA
| | - Sarah L Chamlin
- Department of Dermatology, Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Beth A Drolet
- Department of Dermatology, University of Wisconsin Madison, Madison, WI
| | - Denise Metry
- Department of Dermatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Elena Pope
- Division of Pediatric Dermatology, Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Julie Powell
- Division of Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, Quebec, Canada
| | - Kristen Holland
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI
| | - Caden Ulschmid
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI
| | - Marilyn G Liang
- Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Kelly K Barry
- Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Tina Ho
- Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Chantal Cotter
- Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Eulalia Baselga
- Department of Dermatology, Hospital de la Sant Pau, Barcelona, Spain
| | - David Bosquez
- Department of Dermatology, Hospital de la Sant Pau, Barcelona, Spain
| | | | - Jordan K Bui
- Department of Dermatology, Stanford University, Palo Alto, CA
| | - Irene Lara-Corrales
- Division of Pediatric Dermatology, Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Tracy Funk
- Departments of Dermatology and Pediatrics, Oregon Health & Science University, Portland, OR
| | - Alison Small
- Departments of Dermatology and Pediatrics, Oregon Health & Science University, Portland, OR
| | - Wenelia Baghoomian
- Departments of Dermatology and Pediatrics, Oregon Health & Science University, Portland, OR
| | - Albert C Yan
- Department of Pediatrics and Dermatology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - James R Treat
- Department of Pediatrics and Dermatology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Griffin Stockton Hogrogian
- Department of Pediatrics and Dermatology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Charles Huang
- Department of Pediatrics and Dermatology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Anita Haggstrom
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN
| | - Mary List
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN
| | - Catherine C McCuaig
- Division of Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, Quebec, Canada
| | - Victoria Barrio
- Department of Dermatology, Rady Children's Hospital, University of California San Diego, San Diego, CA
| | - Anthony J Mancini
- Department of Dermatology, Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Leslie P Lawley
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA
| | | | - Kimberly A Horii
- Division of Dermatology, Children's Mercy Hospital and Clinics, Kansas City, MO
| | - Brandon Newell
- Division of Dermatology, Children's Mercy Hospital and Clinics, Kansas City, MO
| | - Amy Nopper
- Division of Dermatology, Children's Mercy Hospital and Clinics, Kansas City, MO
| | - Maria C Garzon
- Department of Dermatology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Margaret E Scollan
- Department of Dermatology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Erin F Mathes
- Department of Dermatology, University of California San Francisco, San Francisco, CA.
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4
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Mologousis MA, Balkin DM, Smith ER, Lidov HGW, Li AM, Yang E, Liang MG. Non-vascular intracranial lesions in three children with PHACE association. Pediatr Dermatol 2024; 41:284-288. [PMID: 37723596 DOI: 10.1111/pde.15423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/20/2023] [Indexed: 09/20/2023]
Abstract
PHACE (posterior fossa malformations, hemangiomas, arterial anomalies, cardiac anomalies, eye anomalies) association has many recognized clinical features. A link between PHACE and non-vascular intracranial lesions has not been well-described. We report three pediatric patients with PHACE and non-vascular intracranial lesions.
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Affiliation(s)
- Mia A Mologousis
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Department of Dermatology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Daniel M Balkin
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Edward R Smith
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Hart G W Lidov
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Pathology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Alice M Li
- Department of Pathology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Edward Yang
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Marilyn G Liang
- Department of Dermatology, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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5
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Vidaurri de la Cruz H, Valderrama FV, Chambergo RB. Dermatologic Review in Pediatric Vascular Lesions. Oral Maxillofac Surg Clin North Am 2024; 36:49-60. [PMID: 37845106 DOI: 10.1016/j.coms.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
Vascular anomalies (VAs) can be present in any organ; however, the skin being the largest one, it is there where many of them are evident; some are visible at birth, others develop throughout life. Pediatric dermatologists are specially trained to distinguish VAs from their mimickers, which require different treatments and may harbor distinct prognoses. We resume the diagnostic and therapeutic tasks of pediatric dermatologist at our vascular anomaly clinics, as well as the differential diagnoses of mimickers of VAs.
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Affiliation(s)
- Helena Vidaurri de la Cruz
- Department of Pediatrics, Hospital General de México Dr. Eduardo Liceaga, O.D. Health Ministry, Mexico City, Mexico; National Autonomous University of Mexico; Society for Pediatric Dermatology, Latin American Society of Pediatric Dermatology, European Academy of Dermatology and Venereology, International Society of Pediatric Dermatology, Mexican Academy of Pediatrics, Mexican Academy of Dermatology.
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6
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Sandru F, Turenschi A, Constantin AT, Dinulescu A, Radu AM, Rosca I. Infantile Hemangioma: A Cross-Sectional Observational Study. Life (Basel) 2023; 13:1868. [PMID: 37763272 PMCID: PMC10532986 DOI: 10.3390/life13091868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/31/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: With an incidence of 4-10%, infantile hemangiomas (IH) are the most encountered benign tumors in infancy. Low birth weight (LBW), prematurity, female sex, multiple gestations, and family history of IH are some of the statistically proven risk factors for developing IH. The aim of our study was to evaluate the prevalence of IH in our clinic and its connection to maternal and perinatal factors. (2) Methods: We conducted a cross-sectional study, over three years (2020-2022), at the Clinical Hospital of Obstetrics and Gynecology, "Prof. Dr. P. Sârbu", in Bucharest, Romania. (3) Results: During this period, 12,206 newborns were born and we identified 14 infants with infantile hemangioma. In our study, the prevalence of infantile hemangioma was 0.11%. The prevalence of IH in pregnancies obtained through in vitro fertilization was 1%, in twin pregnancies it was 2.27%, and in those with placenta previa, it was 4.16%. (4) Conclusions: Our findings provide a solid image of the prevalence of IH in our country and underline that the development of IH is strongly connected to maternal and perinatal variables, such as: preterm newborns, in vitro fertilization, high blood pressure, anemia, hypothyroidism, placenta previa, and twin pregnancy.
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Affiliation(s)
- Florica Sandru
- Dermatology Department, “Elias” University Emergency Hospital, 011461 Bucharest, Romania;
- Department of Dermatovenerology, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania
| | | | - Andreea Teodora Constantin
- Pediatrics Department, National Institute for Mother and Child Health “Alessandrescu-Rusescu”, 20382 Bucharest, Romania;
- Department of Pediatrics, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania
| | - Alexandru Dinulescu
- Department of Pediatrics, Grigore Alexandrescu Emergency Hospital for Children, 011743 Bucharest, Romania;
| | - Andreea-Maria Radu
- Dermatology Department, “Elias” University Emergency Hospital, 011461 Bucharest, Romania;
| | - Ioana Rosca
- Department of Neonatology, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania;
- Neonatology Department, Clinical Hospital of Obstetrics and Gynecology “Prof. Dr. P. Sârbu”, 060251 Bucharest, Romania
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7
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Chiramel M, Katakam B, Gulati R, Gupta M, Munisamy M, S. Ranugha PS, Seetharam KA. IADVL SIG pediatric dermatology (academy) recommendations on Hemangioma of Infancy (HOI). Indian Dermatol Online J 2023; 14:172-186. [PMID: 37089858 PMCID: PMC10115319 DOI: 10.4103/idoj.idoj_52_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 12/09/2022] [Accepted: 12/13/2022] [Indexed: 03/12/2023] Open
Abstract
Hemangioma of infancy (HOI) is a benign vascular proliferation. Though resolution is the norm, potential complications make an accurate diagnosis and early management of importance. The Indian association of dermatologists, venereologists and leprologists (IADVL) special interest group (SIG) paediatric dermatology in association with IADVL academy did an extensive analysis of the literature on the clinical features, diagnosis, and management of HOI published between 2010 and 2021. Online meetings were conducted from February 2021 to March 2022 to reach a consensus on these recommendations which are made from an Indian perspective.
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8
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Modiri O, Malick MSS, Scollan ME, Duron V, Morel K, Middlesworth W, Garzon MC. Hybrid lung lesions in children with segmental infantile hemangiomas, a new association? Pediatr Dermatol 2023; 40:144-147. [PMID: 36059216 DOI: 10.1111/pde.15123] [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: 05/05/2022] [Accepted: 08/07/2022] [Indexed: 01/25/2023]
Abstract
Infantile hemangiomas (IHs) are the most common tumors of infancy and, in rare instances, can present in the setting of congenital structural anomalies or as part of syndromic disorders. In this study, we present three cases of children with segmental IHs born with concurrent pulmonary anomalies: congenital pulmonary airway malformations and bronchopulmonary sequestration. To date, no known association between these entities and hemangiomas has been described.
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Affiliation(s)
- Omeed Modiri
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | | | - Margaret E Scollan
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Vincent Duron
- Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Kimberly Morel
- Department of Dermatology, Columbia University Medical Center, New York, New York, USA.,Department of Pediatrics, Columbia University Medical Center, New York, New York, USA
| | - William Middlesworth
- Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Maria C Garzon
- Department of Dermatology, Columbia University Medical Center, New York, New York, USA.,Department of Pediatrics, Columbia University Medical Center, New York, New York, USA
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9
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Davenport R, Su JC, Nathalie J, Richmond CM, Yang Tan T, Robertson SJ. Clinical overlap of PHACE and LUMBAR syndromes. Pediatr Dermatol 2022; 39:752-756. [PMID: 35896169 DOI: 10.1111/pde.15031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 04/26/2022] [Indexed: 11/28/2022]
Abstract
Segmental infantile hemangiomas affecting the upper body are associated with PHACE(S) (Posterior fossa anomalies, Hemangioma, Arterial anomalies, Cardiac anomalies, Eye anomalies, and Sternal defects) syndrome, whereas segmental infantile hemangiomas affecting the lower body are the cutaneous hallmark of LUMBAR (Lower body hemangioma and other skin defects, Urogenital anomalies and Ulceration, Myelopathy, Bony deformities, Anorectal malformations and Arterial anomalies, and Renal anomalies) syndrome. We present two individuals with concurrent features of both PHACE and LUMBAR syndromes demonstrating an overlap phenotype. The overlapping features seen in our patients suggest that these syndromes occur on the same phenotypic spectrum and derive from a common embryonic pathophysiology.
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Affiliation(s)
- Rachael Davenport
- Department of Dermatology, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - John C Su
- Department of Dermatology, The Royal Children's Hospital, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of Dermatology, Monash University, Eastern Health, Melbourne, Victoria, Australia
| | - Janice Nathalie
- Department of Dermatology, The Royal Children's Hospital, Parkville, Victoria, Australia.,Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
| | - Christopher M Richmond
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Tiong Yang Tan
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Susan J Robertson
- Department of Dermatology, The Royal Children's Hospital, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia
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10
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Hemangioma Genetics and Associated Syndromes. Dermatol Clin 2022; 40:393-400. [DOI: 10.1016/j.det.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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11
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Mayer JLR, Intzes S, Oza VS, Blei F. How we approach hemangiomas in infants. Pediatr Blood Cancer 2022; 69 Suppl 3:e29077. [PMID: 34151510 DOI: 10.1002/pbc.29077] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/09/2021] [Indexed: 12/28/2022]
Abstract
Pediatric oncologists are increasingly involved in the management of benign vascular tumors and their associated life-threatening complications. Hemangiomas are the most common referring diagnosis to multidisciplinary vascular anomalies clinics. However, as contemporary research has revealed, hemangiomas are not a single, easily defined entity but rather a diverse set of related vascular tumors, each having a unique natural history, growth pattern, and response to therapy. This manuscript seeks to illustrate how we evaluate and manage these complex tumors, their complications, and associated syndromes, while remaining ever vigilant for malignant hemangioma mimickers such as soft tissue sarcomas and congenital leukemia.
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Affiliation(s)
- Jennifer L R Mayer
- Vascular Anomalies and Birthmarks Program, Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Stefanos Intzes
- Pediatric Hematology/Oncology, Providence Sacred Heart Children's Hospital, Spokane, Washington, USA
| | - Vikash S Oza
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA
| | - Francine Blei
- Hemangioma and Vascular/Lymphatic Malformations Program, New York University Langone Health, New York, New York, USA
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12
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Infantile hemangioma. Part 1: Epidemiology, pathogenesis, clinical presentation and assessment. J Am Acad Dermatol 2021; 85:1379-1392. [PMID: 34419524 DOI: 10.1016/j.jaad.2021.08.019] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/25/2021] [Accepted: 08/03/2021] [Indexed: 02/08/2023]
Abstract
Infantile hemangioma (IH) is the most common pediatric vascular tumor. Its pathogenesis is poorly understood but thought to represent an aberrant response of pluripotent stem cells to stimuli such as hypoxia and the renin-angiotensin-system. IH usually appears during the first few weeks of life and follows a characteristic natural trajectory of proliferation and involution. Their clinical appearance depends on their depth and distribution. Classification comprises superficial, mixed and deep IH as well as IH with minimal or arrested growth. Multifocal IHs are more likely to be associated with infantile hepatic hemangioma, and although the need for screening based on a specific number of IH has been recently debated, 5 remains the most widely acceptable cut off point. Large facial or lumbar IH warrants investigation for PHACE and LUMBAR syndrome, respectively. Complications of IH include ulceration, obstruction or functional impairment, hypothyroidism, and cosmetic sequelae. Differential diagnoses mostly consist of other vascular tumors and vascular malformations, though IH may sometimes mimic non-vascular tumors or developmental anomalies. Diagnosis is usually clinical and biopsy rarely indicated. High-frequency ultrasonography may help with the differential diagnosis, particularly with subcutaneous lesions. Referral to other specialists may be required in specific cases.
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Zargari O, Asadi M, Azimi SZ, Mesbah A. Rhabdomyomatous mesenchymal hamartoma presenting as telangiectasia in a 57-year-old man. J Cutan Pathol 2021; 48:1182-1184. [PMID: 33964023 DOI: 10.1111/cup.14044] [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: 02/04/2021] [Revised: 04/25/2021] [Accepted: 05/05/2021] [Indexed: 11/30/2022]
Abstract
Rhabdomyomatous mesenchymal hamartoma (RMH) is a rare congenital malformation of the dermis and subcutaneous tissue. Usually, RMH occurs in the midline of the face and neck region. We described a case of RMH presenting as telangiectasia in a 57-year-old man with a history of pityriasis lichenoides chronicus. Histopathological examination revealed a subepidermal haphazard proliferation of striated muscular tissue perpendicular to the epidermis. These bundles of striated muscular tissue were admixed with adnexal structures. The diagnosis was consistent with RMH. RMH is more common in the neonatal period or in young children, but we should consider it as part of a differential diagnosis in older adults as well.
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Affiliation(s)
- Omid Zargari
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Seyyede Zeinab Azimi
- Center for Research & Training in Skin Diseases & Leprosy, Tehran University of Medical Sciences, Tehran, Iran
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14
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Berklite L, Ozolek J, Wang L, Santoro L, Donofrio V, Stracuzzi A, John I, Alaggio R. Pediatric Benign Tumors With a Skeletal Muscle Component: Myogenin Expression, Diagnostic Pitfalls, and New Molecular Insights. Pediatr Dev Pathol 2021; 24:213-226. [PMID: 33683985 DOI: 10.1177/1093526621998932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Benign tumors with skeletal muscle differentiation are rare and their characterization in the literature is limited. We present a series of twelve pediatric benign tumors with rhabdomyomatous differentiation including seven rhabdomyomatous mesenchymal hamartomas, four fetal rhabdomyomas, and one benign triton tumor, analyzing myogenic markers as well as clinicopathologic and molecular features. A review of the literature was also performed with an emphasis on myogenic marker expression and correlation with molecular features. METHODS AND RESULTS Cases obtained from three tertiary pediatric hospitals were retrospectively reviewed. Eleven of twelve cases expressed myogenin in rare to greater than 15% of cells. Five of nine cases had rare to 70-80% of cells positive for MyoD1. One fetal rhabdomyoma demonstrated homozygous deletions in ZEB2. The benign triton tumor harbored a CTNNB1 mutation. Review of the literature identified 160 pediatric benign tumors with skeletal muscle differentiation of which 9 reported myogenin positivity. CONCLUSIONS Myogenin and MyoD1 may be variably expressed in benign lesions with skeletal muscle differentiation. Recognition of key morphologic features remains critical to diagnose these lesions and, in rhabdomyoma, to exclude malignancy. Our series expands the knowledge of the relationship between rhabdomyoma and rhabdomyosarcoma (RMS) by identifying a shared molecular alteration in ZEB2.
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Affiliation(s)
- Lara Berklite
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John Ozolek
- Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University, 64 Medical Center Drive, Morgantown, West Virginia
| | - Larry Wang
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California
| | - Luisa Santoro
- Department of Pathology, Azienda Ospedaliera di Padova, Padova, Italy
| | - Vittoria Donofrio
- Department of Pathology, Ospedale Pediatrico Pausilipon, Napoli, Italy
| | | | - Ivy John
- Department of Pathology, University of Pittsburgh Medical Center Shadyside Hospital, Pittsburgh, Pennsylvania
| | - Rita Alaggio
- Department of Pathology, Ospedale Pediatrico Bambino Gesú, Rome, Italy
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15
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Leuzzi M, Sechi A, Filippi F, Di Altobrando A, Gurioli C, Neri I. Infantile hemangioma with minimal or arrested growth and isolated spinal dysraphism: A new or underrecognized entity? Indian J Dermatol 2021; 66:559-561. [PMID: 35068518 PMCID: PMC8751710 DOI: 10.4103/ijd.ijd_267_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Zarbo A, Luk KM, Shwayder TA, Friedman BJ. Congenital midline nodules on the chin and sternum. Pediatr Dermatol 2020; 37:1145-1146. [PMID: 33283934 DOI: 10.1111/pde.14261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Allison Zarbo
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA.,Division of Pediatric Dermatology, Henry Ford Health System, Detroit, Michigan, USA
| | - Kevin M Luk
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA
| | - Tor A Shwayder
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA.,Division of Pediatric Dermatology, Henry Ford Health System, Detroit, Michigan, USA
| | - Ben J Friedman
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA.,Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, Michigan, USA
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