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Perez-Atayde AR, Debelenko L, Al-Ibraheemi A, Eng W, Ruiz-Gutierrez M, O'Hare M, Croteau SE, Trenor CC, Boyer D, Balkin DM, Barclay SF, Hsi Dickie B, Liang MG, Chaudry G, Alomari AI, Mulliken JB, Adams DM, Kurek KC, Fishman SJ, Kozakewich HPW. Kaposiform Lymphangiomatosis: Pathologic Aspects in 43 Patients. Am J Surg Pathol 2022; 46:963-976. [PMID: 35385405 DOI: 10.1097/pas.0000000000001898] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Kaposiform lymphangiomatosis is an uncommon generalized lymphatic anomaly with distinctive clinical, radiologic, histopathologic, and molecular findings. Herein, we document the pathology in 43 patients evaluated by the Boston Children's Hospital Vascular Anomalies Center from 1999 to 2020. The most frequent presentations were respiratory difficulty, hemostatic abnormalities, and a soft tissue mass. Imaging commonly revealed involvement of some combination of mediastinal, pulmonary, pleural, and pericardial compartments and most often included spleen and skeleton. Histopathology was characterized by dilated, redundant, and abnormally configured lymphatic channels typically accompanied by dispersed clusters of variably canalized, and often hemosiderotic, spindled lymphatic endothelial cells that were immunopositive for D2-40, PROX1, and CD31. An activating lesional NRAS variant was documented in 9 of 10 patients. The clinical course was typically aggressive, marked by hemorrhage, thrombocytopenia, diminished fibrinogen levels, and a mortality rate of 21%.
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Affiliation(s)
| | - Larisa Debelenko
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
| | | | | | - Melisa Ruiz-Gutierrez
- Division of Hematology/Oncology, Boston Children's Hospital and Dana-Farber Cancer Institute
| | | | - Stacy E Croteau
- Dana-Farber/Boston Children's Hospital Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA
| | - Cameron C Trenor
- Dana-Farber/Boston Children's Hospital Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA
| | | | | | - Sarah F Barclay
- Departments of Pathology & Laboratory Medicine
- Medical Genetics, Alberta Children's Hospital Research Institute and Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | | | - Gulraiz Chaudry
- Division of Interventional Radiology, Boston Children's Hospital and Harvard Medical School
| | - Ahmad I Alomari
- Division of Interventional Radiology, Boston Children's Hospital and Harvard Medical School
| | | | - Denise M Adams
- Division of Oncology, Department of Pediatrics, Comprehensive Vascular Anomalies Program, Children's Hospital of Philadelphia, University of Pennsylvania Medical Center, Philadelphia, PA
| | - Kyle C Kurek
- Departments of Pathology & Laboratory Medicine
- Medical Genetics, Alberta Children's Hospital Research Institute and Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Anderson T, Bourke C, Kimble R. Sigmoid colon obstruction due to Kaposiform Haemangioendothelioma. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Zhu K, Gu W, Wang L, Wang J, Tang H, Shen H, Jiang K, Shu Q. A 6-Year-Old Boy With a Mediastinal Mass. Chest 2021; 158:e317-e321. [PMID: 33280776 DOI: 10.1016/j.chest.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 06/10/2020] [Accepted: 07/04/2020] [Indexed: 11/16/2022] Open
Abstract
CASE PRESENTATION A 6-year-old boy was referred to our hospital with an anterior mediastinal mass. This was discovered by chest radiography performed when the boy was examined after being caught by an elevator door about 2 weeks earlier. The patient had been born full term without any complications during pregnancy or delivery. No clinical symptoms were observed during this presentation, and he had no history of previous infections.
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Affiliation(s)
- Kun Zhu
- Department of Pathology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Weizhong Gu
- Department of Pathology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Larry Wang
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jinhu Wang
- Department of Surgical Oncology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Hongfeng Tang
- Department of Pathology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Hongqiang Shen
- Clinical Laboratory Department, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Kewen Jiang
- Biobank Department, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Qiang Shu
- Department of Thoracic and Cardiovascular Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
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Abstract
OBJECTIVE Kaposiform hemangioendothelioma (KHE) is a unique locally aggressive vascular tumor with poor prognosis. The aim of this study is to assess the clinical and imaging features of KHE, and to compare the differences between solitary and diffusive infiltrative subtype further. METHODS The clinical and radiological findings of a cohort of 25 cases with histologically proven KHE, between June 2011 and June 2016, were reviewed retrospectively. 7 solitary and 18 diffusive infiltrative subtypes KHE were included. The differences of clinical and imaging features between these two subtypes were compared statistically by Wilcoxon rank sum test and Fisher exact test. RESULTS The median age was 4 months old. 20 cases (80%) were accompanied by Kasabach-Merritt phenomenon (KMP). Most KHE located in trunk and/or extremity. The masses showed inhomogeneous echogenicity and were rich in vascularity on ultrasound; showed isoattenuation relative to muscle on unenhanced CT, isointense (n = 15) or slightly hyperintense (n = 7) T1 weighted imaging (T1WI) signal relative to muscle, mainly heterogeneous hyperintense or slightly hyperintense with speckled hypointense (n = 17) T2WI signal (77%) relative to muscle, and notable (n = 15) and moderate (n = 3) enhancement. Feeding and draining vessels were revealed in 15 cases. Five masses with DWI showed slightly restricted diffusivity, with average apparent diffusion coefficient value of (1.28 ± 0.09) × 10-3 mm2 s-1. Necrosis and hemorrhage were also found. Compared with solitary ones, diffusive infiltrative KHE were larger, more commonly accompanied by KMP and reticular lymphedema, and more frequently located in trunk and/or extremity. CONCLUSION Five masses with DWI showed slightly restricted diffusivity. A hypervascular mass accompanied by KMP and reticular lymphedema, with speckled hypointense signal T2WI signal, especially in pediatric patients, is highly suggestive of the diagnosis of KHE. Advances in knowledge: Speckled hypointense signal T2WI signal, and notable enhancement were unique features of KHE. KHE showed slightly restricted diffusivity on DWI, commonly accompanied by KMP and reticular lymphedema.
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Affiliation(s)
- Pei-An Hu
- 1 Department of Radiology, Shanghai Institute of Medical Imaging , Shanghai , China.,2 Department of Radiology, Children's Hospital of Fudan University , Shanghai , China.,3 Department of Radiology, Fudan University Shanghai Cancer Center , Shanghai , China.,4 Department of Oncology, Shanghai Medical College, Fudan University , Shanghai , China
| | - Zheng-Rong Zhou
- 3 Department of Radiology, Fudan University Shanghai Cancer Center , Shanghai , China.,4 Department of Oncology, Shanghai Medical College, Fudan University , Shanghai , China
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Adams DM, Brandão LR, Peterman CM, Gupta A, Patel M, Fishman S, Trenor CC. Vascular anomaly cases for the pediatric hematologist oncologists-An interdisciplinary review. Pediatr Blood Cancer 2018; 65. [PMID: 28727248 DOI: 10.1002/pbc.26716] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 06/14/2017] [Accepted: 06/15/2017] [Indexed: 01/19/2023]
Abstract
Vascular anomalies (VAs) are classified as tumors or malformations depending on their clinical characteristics, pathological diagnosis, and genomic information. Diagnosis can be challenging because of the heterogeneity of clinical presentation; thus, the best diagnosis and care are provided by an interdisciplinary team of specialists. Over the past 10 years, an increasing number of pediatric hematologist/oncologists are caring for patients with VAs secondary to new medical therapy options and clinical trials. This paper focuses on complicated VA issues often seen by the pediatric hematologist/oncologist. The paper reviews clinical pearls on diagnosis, histology, radiology, and treatment options.
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Affiliation(s)
- Denise M Adams
- Vascular Anomalies Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Leonardo R Brandão
- Division of Hematology Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Caitlin M Peterman
- Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, MA.,Tufts University School of Medicine, Boston, Massachusetts
| | - Anita Gupta
- Department of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Manish Patel
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Steven Fishman
- Vascular Anomalies Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cameron C Trenor
- Vascular Anomalies Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Kai L, Wang Z, Yao W, Dong K, Xiao X. Sirolimus, a promising treatment for refractory Kaposiform hemangioendothelioma. J Cancer Res Clin Oncol 2014; 140:471-6. [DOI: 10.1007/s00432-013-1549-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 11/11/2013] [Indexed: 12/31/2022]
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