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Puleo JM, Acosta EM, Crowley SG, DiCaprio MR. Nineteen-Year-Old Woman with Symptomatic Intramuscular Thigh Hemangioma-Radiographic Changes and Management: A Case Report. JBJS Case Connect 2024; 14:01709767-202406000-00049. [PMID: 38848412 DOI: 10.2106/jbjs.cc.24.00060] [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: 06/09/2024]
Abstract
CASE We report a case of an intramuscular thigh hemangioma in a 19-year-old woman with a several year history of atraumatic thigh pain. Radiographs obtained by her primary care physician demonstrated periosteal bone reaction, prompting referral to Orthopaedic Oncology department. The patient had successful symptomatic management with propranolol. CONCLUSION The case highlights the diagnosis and potential treatments. In a stepwise approach to care for symptomatic benign vascular lesions, propranolol has been a proven therapeutic option and may be a useful first-line therapy for symptomatic hemangiomas.
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Affiliation(s)
- James M Puleo
- Department of Orthopaedic Surgery, Albany Medical Center, Albany, New York
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2
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Pavanello M, Piro L, Roggero A, Rossi A, Piatelli G, Vercellino N. A case report of hemorrhagic presentation of diffuse neonatal hemangiomatosis (DNH) associated to obstructive hydrocephalus: Medical and neurosurgical considerations. Childs Nerv Syst 2024; 40:953-956. [PMID: 37978053 PMCID: PMC10891253 DOI: 10.1007/s00381-023-06226-2] [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: 10/09/2023] [Accepted: 11/12/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Diffuse neonatal hemangiomatosis (DNH) is a rare disorder typically recognized at birth or during the neonatal period. DNH involves three or more organ systems, including the central nervous system (CNS). In these cases, serious complications such as hemorrhages and obstructive hydrocephalus can develop. CASE REPORT We present a case of DNH with intracranial hypertension and CNS hemorrhagic lesions on the mesencephalic aqueduct, resulting in triventricular hydrocephalus, treated with endoscopic ventriculocisternostomy (ETV) and medical therapy. DISCUSSION DNH is a rare condition that can involve the CNS with serious complications. From a review of the literature, we highlighted only two cases of DNH with brain involvement treated surgically. We report the successful outcome of ETV, along with surgical considerations, imaging findings, and the complete resolution of cerebral and skin lesions following medical therapy. CONCLUSIONS Medical therapy is not standardized and must be individualized. In patients who develop severe neurological symptoms such as obstructive hydrocephalus, surgery may be considered to avoid neurological sequelae.
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Affiliation(s)
- Marco Pavanello
- Department of Neurosurgery, IRCCS Istituto Giannina Gaslini, Via G.Gaslini, Genoa, Italy
| | - Liliana Piro
- Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147, Genoa, Italy.
- University od Genoa, DINOGMI, Genoa, Italy.
| | - Arianna Roggero
- Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147, Genoa, Italy
- University od Genoa, DINOGMI, Genoa, Italy
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Via G.Gaslini, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Gianluca Piatelli
- Department of Neurosurgery, IRCCS Istituto Giannina Gaslini, Via G.Gaslini, Genoa, Italy
| | - Nadia Vercellino
- Cardiovascular Department, IRCCS Istituto Giannina Gaslini, Via G.Gaslini, Genoa, Italy
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Zou Y, Wu Z, Jin P, Fu R, Cheng J, Bai H, Huang M, Huang X, Yuan H. Historical and contemporary management of infantile hemangiomas: a single-center experience. Front Pharmacol 2024; 15:1280948. [PMID: 38370473 PMCID: PMC10869534 DOI: 10.3389/fphar.2024.1280948] [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: 08/21/2023] [Accepted: 01/22/2024] [Indexed: 02/20/2024] Open
Abstract
Objective: This study explores the 22-year evolution of Infantile Hemangiomas (IHs) treatment strategies at a single-center hospital, aiming to establish an individualized IHs management protocol. Methods: Retrospective review of IHs infants 2000-2022 at the Department of Plastic Surgery, Jiangxi Provincial Children's Hospital. Results: In our study of 27,513 IHs cases, 72.2% were female, with the median age at first hospital visit being 25 days. The majority of cases had localized and superficial lesions primarily on the head, face, and neck (67.5%). Ulceration rates fell from 21.1% to 12.6% with the introduction of propranolol. Management strategies have shifted over time, with the proportion of cases undergoing expectant management dropping from 32.9% to 12.4%. Since 2008, 26.1% of patients were treated with oral propranolol, largely replacing corticosteroids. Topical β-blockers have been used in 12.1% of cases, leading to a reduction in local injection therapy from 20.8% to 13.2%. Laser therapy, introduced in 2016, has been used in 13.8% of cases, while surgical excision has dropped from 25.0% to 8.5% due to alternative treatment options. Combination therapy was used in 8.8% of cases post-2015, indicating a rising trend. Drawing from the evolution of IHs management strategies, an individualized protocol for the management of IHs was successfully established. Conclusion: Treatment for IHs has evolved over recent decades, with less invasive medical interventions increasingly replacing more invasive methods. Furthermore, a personalized treatment protocol established in this study could boost the cure rate of IHs while minimizing potential side effects and complications.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Hua Yuan
- Department of Plastic Surgery, Jiangxi Provincial Children’s Hospital, Nanchang, China
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Rešić A, Benco Kordić N, Obuljen J, Bašković M. Importance of Determining Vascular Endothelial Growth Factor Serum Levels in Children with Infantile Hemangioma. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1914. [PMID: 38003963 PMCID: PMC10673278 DOI: 10.3390/medicina59111914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/10/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: A potential role of vascular endothelial growth factor (VEGF) in the pathophysiology of infantile hemangiomas (IH) is thought to be plausible. The primary objective of this study was to investigate the importance of determining VEGF serum levels at various stages of IH growth in children. Materials and Methods: A nested case-control study was conducted. For the purposes of the researched target group, samples of fifty (N = 50) children with IH without associated diseases at different stages of hemangioma growth (proliferative and involutional stages) were used. The control group consisted of one hundred (N = 100) healthy children comparable in terms of age and sex, in whom the existence of IH and vascular malformations was ruled out via clinical examination. An immunoassay (ELISA) was used to determine VEGF serum levels in hemangioma growth's proliferation and involution phases. Results: A comparison of serum levels of VEGF in the phases of proliferation and involution in the group of patients with IH did not show a statistically significant difference (p = 0.171). The control group had significantly higher serum VEGF levels than the patient group in both the proliferation phase (p = 0.009) and the involution phase (p = 0.019). In the proliferation phase, a multivariate regression model explained 15% of the variance in the dependent variable, without significant predictor variables, while in the involution phase, it explained 21% of the variance in the dependent variable, and the history of invasive prenatal procedures stood out as a significant predictor variable positively associated with serum VEGF levels (beta coefficient = 0.33; p = 0.043). Conclusions: Although IH is thought to be the result of the dysregulation of angiogenesis and vasculogenesis under the influence of angiogenic factors, especially VEGF, this study did not demonstrate that VEGF serum levels in the proliferation phase of hemangioma growth were higher than those in the involution phase, or in relation to the control group.
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Affiliation(s)
- Arnes Rešić
- Department of Pediatrics, Children’s Hospital Zagreb, Ulica Vjekoslava Klaića 16, 10 000 Zagreb, Croatia
- University Department of Health Studies, University of Split, Ruđera Boškovića 35, 21 000 Split, Croatia
| | - Nikolina Benco Kordić
- Department of Pediatrics, Children’s Hospital Zagreb, Ulica Vjekoslava Klaića 16, 10 000 Zagreb, Croatia
| | - Jasna Obuljen
- Department of Medical Biochemistry and Hematology, Children’s Hospital Zagreb, Ulica Vjekoslava Klaića 16, 10 000 Zagreb, Croatia
| | - Marko Bašković
- Department of Pediatric Surgery, Children’s Hospital Zagreb, Ulica Vjekoslava Klaića 16, 10 000 Zagreb, Croatia
- Scientific Centre of Excellence for Reproductive and Regenerative Medicine, School of Medicine, University of Zagreb, Šalata 3, 10 000 Zagreb, Croatia
- School of Medicine, University of Zagreb, Šalata 3, 10 000 Zagreb, Croatia
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Diaz-Perez JA, Kerr DA. Benign and low-grade superficial endothelial cell neoplasms in the molecular era. Semin Diagn Pathol 2023:S0740-2570(23)00041-2. [PMID: 37149395 DOI: 10.1053/j.semdp.2023.04.015] [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: 03/29/2023] [Accepted: 04/24/2023] [Indexed: 05/08/2023]
Abstract
Vascular tumors are the most common mesenchymal neoplasms of the skin and subcutis, and they encompass a heterogeneous group with diverse clinical, histological, and molecular features, as well as biological behavior. Over the past two decades, molecular studies have enabled the identification of pathogenic recurrent genetic alterations that can be used as additional data points to support the correct classification of these lesions. The purpose of this review is to summarize the available data related to superficially located benign and low-grade vascular neoplasms and to highlight recent molecular advances with the role of surrogate immunohistochemistry to target pathogenic proteins as diagnostic biomarkers.
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Affiliation(s)
- Julio A Diaz-Perez
- Departments of Dermatology and Pathology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Darcy A Kerr
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
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Benign Neonatal Hemangiomatosis. Adv Neonatal Care 2022; 22:408-412. [PMID: 35749711 DOI: 10.1097/anc.0000000000000982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Benign neonatal hemangiomatosis (BNH) is a rare, self-limiting subtype of infantile hemangiomas (IHs), in which infants with multiple cutaneous hemangiomas lack visceral involvement. Other subtypes of IHs exist that may mimic BNH and can be life-threatening depending on hemangioma location and size. CLINICAL FINDINGS At birth, a 29 5 / 7 -week preterm female presented with several pinhead-sized pink papules distributed throughout her body. At 10 days of age, the patient had 12 enlarged domed-shaped red papules in a generalized distribution throughout her body. Over several weeks, the number and size of the domed-shaped red papules continued to increase to a total of 26 located on the head, chest, abdomen, back, legs and arms. They were of firm consistency with both smooth and lobulated surfaces. PRIMARY DIAGNOSIS A diagnosis of BNH was made after extensive workup did not reveal any extracutaneous hemangiomas. INTERVENTIONS Due to the lack of extracutaneous involvement and low-risk location/size of hemangiomas in our patient, no interventions were pursued and an observation-only approach was implemented. OUTCOMES The patient remained stable while followed up over 8 months, with the size of the hemangiomas only increasing slightly in proportion to the patient's natural body growth. PRACTICE RECOMMENDATIONS Given the life-threatening nature of certain hemangioma subtypes, it is important to implement a proper workup and subtype diagnosis as early as possible in any infant with multiple hemangiomas.
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Zwicker K, Powell J, Cummings C. Les anomalies vasculaires pendant l'enfance : quand traiter les patients et quand les diriger vers une ressource spécialisée. Paediatr Child Health 2022; 27:315-319. [PMID: 36016597 PMCID: PMC9394638 DOI: 10.1093/pch/pxac056] [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: 07/11/2019] [Accepted: 11/05/2021] [Indexed: 11/13/2022] Open
Abstract
Les anomalies vasculaires sont des affections hétérogènes qui touchent les vaisseaux sanguins ou lymphatiques. Les enfants atteints peuvent éprouver de la douleur ou une perte fonctionnelle, présenter une infection ou une coagulopathie ou être confrontés à des difficultés psychologiques. Le diagnostic et la prise en charge exigent souvent une approche interdisciplinaire. Sept cliniques d'anomalies vasculaires au Canada offrent des soins interdisciplinaires. Le présent point de pratique propose une approche thérapeutique des anomalies vasculaires pédiatriques les plus fréquentes (hémangiomes). On y passe en revue les indications de diriger les patients vers une clinique spécialisée, en s'attardant sur les anomalies vasculaires complexes, et notamment les hémangiomes infantiles, qui peuvent provoquer des complications.
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Affiliation(s)
- Kelley Zwicker
- Société canadienne de pédiatrie, comité de pédiatrie communautaire, Ottawa (Ontario)Canada
| | - Julie Powell
- Société canadienne de pédiatrie, comité de pédiatrie communautaire, Ottawa (Ontario)Canada
| | - Carl Cummings
- Société canadienne de pédiatrie, comité de pédiatrie communautaire, Ottawa (Ontario)Canada
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8
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Zwicker K, Powell J, Cummings C. Vascular anomalies in childhood: When to treat and when to refer. Paediatr Child Health 2022; 27:310-314. [PMID: 36016596 PMCID: PMC9394637 DOI: 10.1093/pch/pxac057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/05/2021] [Indexed: 12/28/2022] Open
Abstract
Vascular anomalies are heterogeneous conditions that affect blood and/or lymphatic vessels. Affected children may experience pain, functional loss, infection, coagulopathies, and psychological challenges. Diagnosis and management often warrant an interdisciplinary approach. There are seven vascular anomalies clinics in Canada that offer interdisciplinary care. This practice point outlines a treatment approach for the most common paediatric vascular anomaly (hemangioma). It reviews indications for referral to a specialized clinic, with focus on complex vascular anomalies, specifically infantile hemangioma, which can pose complications.
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Affiliation(s)
- Kelley Zwicker
- Canadian Paediatric Society, Community Paediatrics Committee, Ottawa, Ontario, Canada
| | - Julie Powell
- Canadian Paediatric Society, Community Paediatrics Committee, Ottawa, Ontario, Canada
| | - Carl Cummings
- Canadian Paediatric Society, Community Paediatrics Committee, Ottawa, Ontario, Canada
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Macca L, Altavilla D, Di Bartolomeo L, Irrera N, Borgia F, Li Pomi F, Vaccaro F, Squadrito V, Squadrito F, Vaccaro M. Update on Treatment of Infantile Hemangiomas: What’s New in the Last Five Years? Front Pharmacol 2022; 13:879602. [PMID: 35721150 PMCID: PMC9204338 DOI: 10.3389/fphar.2022.879602] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 05/05/2022] [Indexed: 01/04/2023] Open
Abstract
Among benign vascular tumors of infancy, hemangiomas are the commonest, affecting approximately 5–10% of one-year-old children. They are derived from a benign proliferation of vascular endothelial cells (VECs) in the mesoderm and may arise anywhere on the body around 1–2 weeks after birth. Infantile hemangiomas (IHs) are characterized by an early proliferative phase in the first year followed by a spontaneous progressive regression within the following 5 years or longer. IH prevalence is estimated to be 5%–10% in one-year-old children and commonly affects female, Caucasian and low-birth weight infants. Although most of them spontaneously regress, approximately 10% requires treatment to prevent complications due to the site of occurrence such as bleeding, ulceration, cosmetically disfigurement, functional impairment, or life-threatening complications. For over 30 years, steroids have represented the first-line treatment for IHs, but recently topical or systemic β-blockers are increasingly being used and recognized as effective and safe. A search for “Cutaneous infantile hemangioma” [All Fields] AND “Treatment” [All Fields] was performed by using PubMed and EMBASE databases. Treatment of IHs with labeled drugs, such as oral propranolol, but also with off-label drugs, such as topical β-blockers, including topical timolol and carteolol, steroids, itraconazole or sirolimus, with a focus on formulations types and adverse events were described in our review. We also discussed the benefits of pulsed dye laser and the treatment of IHs with involvement of central nervous system, namely the PHACE and LUMBAR syndrome.
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Affiliation(s)
- Laura Macca
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | - Domenica Altavilla
- Department of Clinical and Experimental Medicine, Pharmacology, University of Messina, Messina, Italy
| | - Luca Di Bartolomeo
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
- *Correspondence: Luca Di Bartolomeo,
| | - Natasha Irrera
- Department of Clinical and Experimental Medicine, Pharmacology, University of Messina, Messina, Italy
| | - Francesco Borgia
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | - Federica Li Pomi
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | - Federico Vaccaro
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Violetta Squadrito
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi, Pediatry”, University of Messina, Messina, Italy
| | - Francesco Squadrito
- Department of Clinical and Experimental Medicine, Pharmacology, University of Messina, Messina, Italy
| | - Mario Vaccaro
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
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Kim D, Choi JY, Hong KT, Kang HJ, Kim IH, Lee JH. Long-term outcomes of low-dose radiotherapy in Kasabach-Merritt syndrome. Radiat Oncol J 2022; 40:45-52. [PMID: 35368200 PMCID: PMC8984127 DOI: 10.3857/roj.2021.00983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/27/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose Reports on results of radiation therapy (RT) for Kasabach-Merritt syndrome (KMS) are limited. We performed a retrospective study to evaluate the response rates and late complications and to determine the adequate RT dose for patients with KMS patients. Materials and Methods We studied 11 patients who received RT between October 1988 and September 2008 for KMS refractory to pharmacologic therapy. All patients had external hemangiomas and received the diagnosis of KMS within 12 months of birth. All 11 patients received steroids as the first-line therapy; eight patients additionally received interferon-α therapy, and one patient underwent surgery. Nine patients underwent single-course RT with a total dose of 4.5–8 Gy (1.5–2 Gy/fraction). Two patients received multiple courses of RT, with a cumulative total dose of 12 Gy (2 Gy/fraction) and 18 Gy (1.5 Gy/fraction), respectively. Results The median follow-up period was 156 months (interquartile range [IQR], 75 to 226 months). The median total dose of RT was 6 Gy, and all patients maintained complete remission until the last follow-up. An additional course of RT was performed for refractory cases or cases of local relapse after initial RT. Rapid platelet count increase after RT was seen in most patients, which returned to normalcy in a median of 20 days (IQR, 5 to 178 days). However, seven patients experienced radiation-related long-term complications. Conclusion Low-dose RT is effective and yields rapid response in patients with KMS. However, given growth-related late complications, RT should be carefully considered.
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Affiliation(s)
- Dowook Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Yoon Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Taek Hong
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hyoung Jin Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Il Han Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Ho Lee
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
- Correspondence: Joo Ho Lee Department of Radiation Oncology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-2072-2819 Fax: +82-2-765-3317 E-mail:
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11
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Fu C, Yang K, Zou Y, Huo R. Identification of Key microRNAs and Genes in Infantile Hemangiomas. Front Genet 2022; 13:766561. [PMID: 35360837 PMCID: PMC8963821 DOI: 10.3389/fgene.2022.766561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 02/21/2022] [Indexed: 11/29/2022] Open
Abstract
Infantile hemangiomas (IHs) are the most frequent vascular tumors that occur during infancy. Microribonucleic acids (miRNAs) have been demonstrated as critical regulators of gene expression in various diseases. However, the function of miRNAs in IH still remains largely unknown. In the present study, we performed a miRNA microarray analysis of IH and identified 68 differentially expressed miRNAs (DEMs). In addition, miRNA-gene networks and protein-protein interactions were constructed, and the hub miRNAs and genes of IH were screened out. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis were used for biological analysis of DEMs and differentially expressed genes (DEGs). The pathway enrichment analysis of DEMs revealed several tumor-related pathways, including proteoglycans in cancer, signaling pathway regulating pluripotency of stem cells and TGF-beta signaling pathway. DEGs were mainly enriched in biological processes, including intracellular signal transduction, cell adhesion, and cell death. KEGG pathway analysis indicated that DEGs were enriched in tumorigenesis- and angiogenesis-related pathways such as proteoglycans in cancer, MAPK signaling pathway and Rap1 signaling pathway. Collectively, this study first established a comprehensive miRNA-gene network in IH, which should provide novel insights into IH pathogenesis and be beneficial to the understanding of neovascularization-related disorders.
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Affiliation(s)
- Cong Fu
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
| | - Kun Yang
- Department of Medicine, Shandong University, Jinan, China
| | - Yuqing Zou
- Department of Medicine, Shandong University, Jinan, China
| | - Ran Huo
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
- Department of Medicine, Shandong University, Jinan, China
- *Correspondence: Ran Huo,
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12
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Gavelya EY, Roginsky VV, Nadtochy AG, Kotlukova NP, Mustafina FN, Bychkova IY. [Complex treatment of children with vascular head and neck malformations]. STOMATOLOGII︠A︡ 2021; 100:30-37. [PMID: 34752031 DOI: 10.17116/stomat202110005130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM The article analyzes the results of treatment of children affected with lesions of blood vessels of the head and neck. The research is aimed at developing and implementing minimally invasive techniques to treat such children. MATERIAL AND METHODS The study group comprised 4416 patients with hyperplasia of blood vessels (the so-called infantile and congenital hemangiomas) and 397 patients with blood vessel malformations, examined and treated from 1991 to 2020. RESULTS The paper summarizes developed indications and the results of implementation of effective minimally invasive methods for the treatment of children with vascular lesions: radiofrequency thermal ablation and pulsed dye laser treatment of children with severe forms of arterio-venous malformation in their maxillofacial area and. The treatment is currently the golden standard that provides stable aesthetic results. CONCLUSION The most optimal and preferred methods of vascular lesions treatment proved to be minimally invasive techniques that include: radiofrequency thermal ablation, interstitial laser coagulation, pulse phototherapy, sclerotherapy and systemic treatment of beta-blockers.
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Affiliation(s)
- E Y Gavelya
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - V V Roginsky
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - A G Nadtochy
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - N P Kotlukova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - F N Mustafina
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - I Y Bychkova
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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13
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Liu C, Zhao Z, Guo S, Zhang L, Fan X, Zheng J. Exosomal miR-27a-3p derived from tumor-associated macrophage suppresses propranolol sensitivity in infantile hemangioma. Cell Immunol 2021; 370:104442. [PMID: 34634611 DOI: 10.1016/j.cellimm.2021.104442] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 09/18/2021] [Accepted: 09/20/2021] [Indexed: 12/14/2022]
Abstract
Propranolol is the first-line drug for infantile hemangioma (IH) therapy, whereas propranolol resistance is clinically observed. Tumor-associated macrophages (TAMs)-derived exosomes may deliver biological molecules to promote tumor progression. Here, we aimed to investigate the relationship between TAMs-derived exosomal miR-27a-3p and propranolol sensitivity in IH. Human peripheral blood monocytes (PBMCs) were cultured with macrophage colony-stimulating factor (M-CSF) for 7 days to get unactivated macrophages (Un-Mac), which were further treated with IL-4 and IL-13 to induce M2 polarized macrophages. Exosomes were isolated from the conditioned medium of M2 macrophage, followed by identification. Cell co-culture and/or transfection were performed to explore whether M2 polarized macrophage-derived exosomes (M2-exos) could mediate the crosstalk between TAMs-derived miR-27a-3p and hemangioma stem cells (HemSCs). In addition, nude mice were subcutaneously transplanted with HemSCs pretreated with or without M2-Exos to examine the effects of M2-Exos on IH in vivo. M2 polarized macrophages inhibited propranolol sensitivity of HemSCs, as shown by the increased cell viability and decreased apoptosis. miR-27a-3p was upregulated in M2 polarized macrophages and M2-Exos. Moreover, M2-exos delivered miR-27a-3p from macrophages to HemSCs and subsequently reduced propranolol sensitivity. Luciferase reporter and biotin-RNA pulldown assay proved that dickkopf-related protein 2 (DKK2) was the direct target of miR-27a-3p. These results demonstrate that M2-exos could deliver miR-27a-3p from macrophages to HemSCs to reduce the sensitivity of HemSCs to propranolol by down-regulating DKK2 expression, and exosomal miR-27a-3p and DKK2 in HemSCs could be considered as treatment targets.
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Affiliation(s)
- Chao Liu
- Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China
| | - Zeliang Zhao
- Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Shikai Guo
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China
| | - Ling Zhang
- Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Xindong Fan
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Jiawei Zheng
- Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.
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14
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Raufi N, Nemat A. Infantile Hemangioma Treated with Oral Propranolol: Case Presentation. Clin Cosmet Investig Dermatol 2021; 14:1053-1055. [PMID: 34471369 PMCID: PMC8403557 DOI: 10.2147/ccid.s326794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 08/16/2021] [Indexed: 12/05/2022]
Abstract
Infantile hemangiomas (IHs) are the most common vascular tumors in childhood. We report the use of propranolol to treat the growth phase of IHs. Propranolol was given to a 6-month-old infant who presented with a 4-cm sharply demarcated hemangioma on his left gluteal region. After relevant evaluation, propranolol was prescribed with a starting dose of 1 mg/kg/day, given in 3 divided doses. Vital signs were monitored during the first 6 hours of treatment. In the absence of side effects, treatment was continued at home with 2 mg/kg/day for six months, and the child was reevaluated after 7 days of treatment and then monthly. After one month, effects on color and growth were noted. Complete healing occurred in less than 6 months. Side effects and relapse were not reported. Propranolol administered orally at 2 mg/kg/day was successful, leading to near resolution of the patient’s hemangioma.
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Affiliation(s)
- Nahid Raufi
- Department of Dermatology, Maiwand Hospital, Kabul University of Medical Sciences, Kabul, Afghanistan.,Department of Dermatology, Guangdong Provincial Dermatology Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Arash Nemat
- Department of Microbiology, Kabul University of Medical Sciences, Kabul, Afghanistan.,Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China
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15
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Cura‐Esquivel I, Velasquez‐Palacios C, Núñez‐Ku M. Gastrointestinal infantile hemangioma: A rare cause of digestive tract bleeding in children to consider. Clin Case Rep 2021; 9:e04722. [PMID: 34504695 PMCID: PMC8418681 DOI: 10.1002/ccr3.4722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/14/2021] [Accepted: 07/24/2021] [Indexed: 11/09/2022] Open
Abstract
Intestinal hemangiomas are an infrequent cause of gastrointestinal bleeding and chronic anemia in infants, which diagnosis depends on high suspicion. Propranolol has been described as an effective treatment.
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Affiliation(s)
- Idalia Cura‐Esquivel
- Pediatric Department of the University Hospital “Dr. José Eleuterio González”MonterreyMéxico
| | | | - Madeline Núñez‐Ku
- Pediatric Department of the University Hospital “Dr. José Eleuterio González”MonterreyMéxico
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16
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Abstract
BACKGROUND Hypoxia may play a role in the pathogenesis of infantile hemangioma. Cysteine-rich angiogenic inducer 61 (Cyr61), or CCN1, can be induced under hypoxic conditions in several types of cells. However, whether CCN1 has any impact on infantile hemangioma remains unknown. This study aims to explore the expression of CCN1 in infantile hemangioma and to investigate the effect of hypoxia on CCN1 and vascular endothelial growth factor-A (VEGF-A) production. METHODS Hemangioma-derived endothelial cells and hemangioma-derived stem cells were isolated from surgical specimens of proliferative infantile hemangioma. RNA extracted from infantile hemangioma tissue, hemangioma-derived endothelial cells, and hemangioma-derived stem cells was used to analyze gene expression by real-time polymerase chain reaction. The effects of CCN1 blockade were examined in hemangioma-derived stem cells. Immunostaining, immunoblotting, and enzyme-linked immunosorbent assays were used to assess protein expression. RESULTS By double-label immunofluorescence staining, the authors first identified that CCN1 was abundant in proliferative infantile hemangioma lesions and colocalized well with immature microvessels. The authors found that the mRNA level of CCN1 in proliferative infantile hemangioma was significantly higher than in healthy controls, as was involuting infantile hemangioma. Treatment with the hypoxia inducer cobalt chloride dramatically increased CCN1 production in hemangioma-derived endothelial cells in a time-dependent manner. Furthermore, blocking or knockdown of CCN1 expression reduced the expression of VEGF-A in hemangioma-derived stem cells. Lastly, the signaling pathway study showed that CCN1 up-regulation of VEGF-A synthesis in hemangioma-derived stem cells depends on nuclear factor-κB and JNK activation. CONCLUSIONS These findings provide new evidence that CCN1 participates in the crosstalk between hemangioma-derived endothelial cells and hemangioma-derived stem cells through promoting VEGF-A expression in the hypoxic environment of infantile hemangioma angiogenesis and vasculogenesis. Targeting of CCN1 might be a novel therapeutic strategy for infantile hemangioma.
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17
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Huang Y, Ran X, Xu X, Pradhan S, Sun J, Tang H, Ran Y. Itraconazole Oral Solution for a Case of Infantile Hemangioma: Monitoring the Efficacy by Dermoscopy and MRI. Dermatol Ther (Heidelb) 2021; 11:1861-1866. [PMID: 34302597 PMCID: PMC8484420 DOI: 10.1007/s13555-021-00579-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/03/2021] [Indexed: 02/05/2023] Open
Abstract
Infantile hemangioma is a common and challenging benign vascular tumor. Although involution is spontaneous, approximately 10% of infantile hemangioma of large size or in specific locations may cause ulceration, severe cosmetic and functional problems that may require intervention. Treatment options include oral propranolol, topical timolol, and oral corticosteroids. However, the clinical response is not always satisfactory. We report the case of a 4-month-old boy who presented with an irregular erythematous plaque on his left shoulder 3 days after birth. Infantile hemangioma was diagnosed. Topical application of 0.5 ml of 0.5% timolol maleate eye drops for half an hour each time three times a day was initiated. After nearly 3 months of follow-up, the size of the lesion gradually increased. Finally, after 115 days of treatment with itraconazole oral solution (the total dose was about 4025 mg), the refractory infantile hemangioma was successfully treated. Hepatic and renal function remained normal with only mild diarrhea during the course of oral medication. Treatment compliance of oral itraconazole in infants has been reported to be good. Dermoscopy and magnetic resonance imaging (MRI) played a crucial role in in vivo observation of the hemangioma changes with vascular regression during the treatment process.
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Affiliation(s)
- Ying Huang
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Ran
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoxi Xu
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, China
| | - Sushmita Pradhan
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiayu Sun
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hehan Tang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuping Ran
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, China
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18
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Jurcă MC, Ivaşcu ME, Jurcă AA, Kozma K, Magyar I, Şandor MI, Jurcă AD, Zaha DC, Albu CC, Pantiş C, Bembea M, Petcheşi CD. Genetics of congenital solid tumors. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 61:1039-1049. [PMID: 34171053 PMCID: PMC8343493 DOI: 10.47162/rjme.61.4.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
When we discuss the genetics of tumors, we cannot fail to remember that in the second decade of the twentieth century, more precisely in 1914, Theodore Boveri defined for the first time the chromosomal bases of cancer. In the last 30 years, progresses in genetics have only confirmed Boveri's remarkable predictions made more than 80 years ago. Before the cloning of the retinoblastoma 1 (RB1) gene, the existence of a genetic component in most, if not all, solid childhood tumors were well known. The existence of familial tumor aggregations has been found much more frequently than researchers expected to find at random. Sometimes, the demonstration of this family predisposition was very difficult, because the survival of children diagnosed as having a certain tumor, up to an age at which reproduction and procreation is possible, was very rare. In recent years, advances in the diagnosis and treatment of these diseases have made it possible for these children to survive until the age when they were able to start their own families, including the ability to procreate. Four distinct groups of so-called cancer genes have been identified: oncogenes, which promote tumor cell proliferation; tumor suppressor genes, which inhibit this growth/proliferation; anti-mutational genes, with a role in deoxyribonucleic acid (DNA) stability; and micro-ribonucleic acid (miRNA) genes, with a role in the posttranscriptional process.
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Affiliation(s)
- Maria Claudia Jurcă
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Romania; ,
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19
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Dai Y, Zheng H, Liu Z, Wang Y, Hu W. The flavonoid luteolin suppresses infantile hemangioma by targeting FZD6 in the Wnt pathway. Invest New Drugs 2021; 39:775-784. [PMID: 33411210 DOI: 10.1007/s10637-020-01052-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/06/2020] [Indexed: 10/22/2022]
Abstract
Infantile hemangioma is the most common vascular tumor of childhood. It is characterized by clinical expansion of endothelial cells and promoted by angiogenic factors. Luteolin is a flavonoid compound that carries anti-cancer and anti-angiogenesis properties. The study aimed to investigate the effect of luteolin in treating infantile hemangioma. We first tested the effect of luteolin on cell proliferative potential and VEGFA expression in hemangioma-derived stem cells (HemSCs). We then examined the efficacy of systemic application of luteolin in a murine hemangioma model. We then identified the downstream factor regulated by luteolin in HemSCs and validated its causative relationship with knock-down method in both in vitro and in vivo models. We also investigated the protein expression change of this targeting factor in proliferating hemangiomas. Luteolin inhibited HemSC growth and suppressed VEGF-A expression in a dose-dependent manner. Luteolin inhibited microvessel formation and de novo vasculogenesis in the murine model. FZD6 was induced by luteolin and exerted the anti-angiogenesis effect in our tumor models. Lastly, FZD6 level was repressed in the clinical tissues of human proliferating hemangiomas. Luteolin is a promising new agent to treat infantile hemangioma. Targeting the Wnt pathway may represent a potential therapeutic strategic to inhibit angiogenesis in proliferating hemangiomas.
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MESH Headings
- Animals
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents/therapeutic use
- Cell Proliferation/drug effects
- Cells, Cultured
- Fibroblasts/drug effects
- Frizzled Receptors/antagonists & inhibitors
- Frizzled Receptors/genetics
- Frizzled Receptors/metabolism
- Hemangioma/drug therapy
- Hemangioma/genetics
- Hemangioma/metabolism
- Hemangioma/pathology
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/drug therapy
- Infant, Newborn, Diseases/genetics
- Infant, Newborn, Diseases/metabolism
- Infant, Newborn, Diseases/pathology
- Luteolin/pharmacology
- Luteolin/therapeutic use
- Male
- Mesenchymal Stem Cells/drug effects
- Mesenchymal Stem Cells/metabolism
- Mice, Nude
- Microvessels/drug effects
- Neoplastic Stem Cells/drug effects
- Neoplastic Stem Cells/metabolism
- Neovascularization, Pathologic/drug therapy
- Neovascularization, Pathologic/genetics
- Neovascularization, Pathologic/metabolism
- Neovascularization, Pathologic/pathology
- Vascular Endothelial Growth Factor A/genetics
- Vascular Endothelial Growth Factor A/metabolism
- Wnt Signaling Pathway/drug effects
- Mice
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Affiliation(s)
- Yujian Dai
- Department of Pediatric Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, No. 248-252 Dong Road, Quanzhou, 362000, Fujian, China
| | - Huiming Zheng
- Department of Pediatric Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, No. 248-252 Dong Road, Quanzhou, 362000, Fujian, China.
| | - Zhen Liu
- Department of Pediatric Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, No. 248-252 Dong Road, Quanzhou, 362000, Fujian, China
| | - Yingjun Wang
- Department of Pediatric Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, No. 248-252 Dong Road, Quanzhou, 362000, Fujian, China
| | - Weize Hu
- Department of Pediatric Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, No. 248-252 Dong Road, Quanzhou, 362000, Fujian, China
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20
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Rikhotso RE, Alharbi AA. Management of Refractory Mandibular Kaposiform Hemangioendothelioma with Sirolimus: A Case Report and Review of the Literature. J Oral Maxillofac Surg 2021; 79:2086.e1-2086.e8. [PMID: 34153244 DOI: 10.1016/j.joms.2021.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
Kaposiform hemangioendothelioma (KHE) is a rare vascular neoplasm of intermediate malignancy that generally occurs in infancy and early childhood. Typically, the lesion arises from superficial or deep soft tissues of the extremities, trunk and retroperitoneum. The paucity of reported cases of head and neck KHEs is evidence of the rarity of the disease in this region. We report on the presentation and treatment of KHE in an 11-month-old boy who presented with a mandibular lesion. We include a brief discussion about the differential diagnosis of KHE. Management involved preoperative interventional radiology, surgical excision and chemotherapeutic treatment with Sirolimus. The lesion resolved without evidence of relapse 12 months later.
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Affiliation(s)
- Risimati Ephraim Rikhotso
- Department Head, Department of Maxillofacial and Oral Surgery, Wits School of Oral Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Abdulaziz Abdullah Alharbi
- Consultant, Department of Maxillofacial and Oral Surgery, Faculty of Dentistry, Taif University, Alhawiah, Saudi Arabia
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21
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Abstract
Vascular tumors are a part of the vascular anomalies spectrum. Vascular malformations are congenital vascular lesions, originating from a mesenchymal stem cell defect and distinguished from vascular tumors by their low cell turnover and lack of invasiveness. They tend to grow in proportion to the child. Vascular tumors are proliferative and range from benign proliferation to malignant tumors. The appropriate differential diagnosis is imperative. Infantile hemangioma can be diagnosed clinically and rarely requires therapy; more rare tumors are difficult to diagnose and treat. This review provides an overview of vascular tumors seen in the neonatal period and summarizes treatment options.
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Affiliation(s)
- Michael Briones
- Pediatric Hematology and Oncology, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Atlanta, GA, USA.
| | - Denise Adams
- Complex Vascular Anomalies Frontier Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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22
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Hartmann F, Lockmann A, Himpel O, Kühnle I, Hensen J, Schön MP, Thoms K. Orale Propranolol‐ und Neodym:YAG‐Farbstofflaser‐Kombinationstherapie infantiler Hämangiome: eine retrospektive Analyse von 30 Kindern mit 48 Hämangiomen. J Dtsch Dermatol Ges 2020; 18:984-994. [DOI: 10.1111/ddg.14184_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/27/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Franziska Hartmann
- Klinik für Dermatologie Venerologie und Allergologie Universitätsmedizin Göttingen
| | - Anike Lockmann
- Klinik für Dermatologie Venerologie und Allergologie Universitätsmedizin Göttingen
| | - Okko Himpel
- Klinik für Kinder‐ und Jugendmedizin Universitätsmedizin Göttingen
| | - Ingrid Kühnle
- Klinik für Kinder‐ und Jugendmedizin Universitätsmedizin Göttingen
| | - Janina Hensen
- Klinik für Dermatologie Venerologie und Allergologie Universitätsmedizin Göttingen
| | - Michael P. Schön
- Klinik für Dermatologie Venerologie und Allergologie Universitätsmedizin Göttingen
| | - Kai‐Martin Thoms
- Klinik für Dermatologie Venerologie und Allergologie Universitätsmedizin Göttingen
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23
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Hartmann F, Lockmann A, Himpel O, Kühnle I, Hensen J, Schön MP, Thoms KM. Combination therapy of oral propranolol and combined Nd:YAG/pulsed dye laser therapy in infantile hemangiomas: a retrospective analysis of 48 treated hemangiomas in 30 children. J Dtsch Dermatol Ges 2020; 18:984-993. [PMID: 32856787 DOI: 10.1111/ddg.14184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/27/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS Infantile hemangiomas can be successfully treated by both systemic propranolol and neodymium:YAG (Nd:YAG)-dye laser combination therapy. In this retrospective study, the efficacy and safety of sequential and parallel therapy of complicated hemangiomas treated with both methods were evaluated. PATIENTS AND METHODS 30 children with 48 complicated hemangiomas were treated with propranolol and Nd:YAG-dye laser combination therapy. Using photo comparison, the percentage remission rate was evaluated by three investigators on a four-step scale (I: 0-25 %, II: 26-50 %, III: 51-75 % and IV: 76-100 %). RESULTS Eleven children received propranolol and laser therapy in parallel (A), twelve children received laser therapy after propranolol (B) and seven children received propranolol after laser therapy (C). Due to emigration abroad, one child was lost to follow-up. A strong improvement (IV) was observed in 23/29 (79.3 %) of all treated children (A: 90.9 %, B 75 %, C 66.7 %). The mean duration of propranolol therapy in all children was 8.6 months (A: 8.9 months, B: 8.2 months, C: 8.9 months). On average, 2.33 laser treatments were performed per hemangioma (A: 1.95, B: 3.2, C: 1.91). Serious side effects caused by propranolol and laser therapy were not observed. CONCLUSIONS Propranolol and Nd:YAG-dye laser combination therapy can be used sequentially or in parallel safely and effectively. They complement each other in a meaningful manner.
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Affiliation(s)
- Franziska Hartmann
- Department of Dermatology, Venereology and Allergology, University Medical Center Goettingen
| | - Anike Lockmann
- Department of Dermatology, Venereology and Allergology, University Medical Center Goettingen
| | - Okko Himpel
- Department of Pediatrics and Adolescent Medicine, University Medical Center Goettingen
| | - Ingrid Kühnle
- Department of Pediatrics and Adolescent Medicine, University Medical Center Goettingen
| | - Janina Hensen
- Department of Dermatology, Venereology and Allergology, University Medical Center Goettingen
| | - Michael P Schön
- Department of Dermatology, Venereology and Allergology, University Medical Center Goettingen
| | - Kai-Martin Thoms
- Department of Dermatology, Venereology and Allergology, University Medical Center Goettingen
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24
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Kaur R, Tchanque-Fossuo C, West K, Hadian Y, Gallegos A, Yoon D, Ismailyan L, Schaefer S, Dahle SE, Isseroff RR. Beta-adrenergic antagonist for the healing of chronic diabetic foot ulcers: study protocol for a prospective, randomized, double-blinded, controlled and parallel-group study. Trials 2020; 21:496. [PMID: 32513257 PMCID: PMC7278171 DOI: 10.1186/s13063-020-04413-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 05/14/2020] [Indexed: 12/26/2022] Open
Abstract
Background Diabetic foot ulcers (DFUs) are the most common cause of leg amputations and their management is extremely challenging. Despite many advances and expensive therapies, there has been little success in improving outcomes of DFUs. In prior work our laboratory has examined the effects of beta-adrenergic antagonists (βAAs) on skin and skin-derived cells. We have shown that βAAs enhance the rate of keratinocyte migration, promote angiogenesis, and hasten wound healing in scratch wounds in vitro, in animal wound models, and in anecdotally reported cases of chronic wounds that healed successfully after topical application of the βAA timolol. Thus, we propose to test timolol directly on DFUs to determine if it improves healing above the current standard of care (SOC). This study will examine the efficacy and safety of topically applied beta-antagonist Timoptic-XE® (timolol maleate ophthalmic gel forming solution) in subjects with DFUs. Methods/design This is a phase two, randomized, double-blinded, controlled, and parallel-group clinical trial with two treatment arms, SOC plus topical Timoptic-XE® and SOC plus a non-biologically active gel (hydrogel, as placebo drug). Study subjects with a DFU will be selected from the Veterans Affairs Northern California Health Care System (VANCHCS). Study duration is up to 31 weeks, with three phases (screening phase for two weeks, active phase for up to 12 weeks, with an additional second consecutive confirmatory visit after 2 weeks, and follow-up phase comprising monthly visits for 4 months). Subjects will apply daily either the topical study drug or the placebo on the foot ulcer for 12 weeks or until healed, whichever comes first. Measurements of wound size and other data will be collected at baseline, followed by weekly visits for 12 weeks, and then a monthly follow-up period. Discussion This is a clinical translation study, moving the investigators’ pre-clinical laboratory research into a translational study in which we will analyze clinical outcomes to assess for safety and estimate the efficacy of a topical beta-antagonist in healing of DFUs. The results from this trial may establish new treatment paradigms and safety profile for DFU treatment. Trial registration ClinicalTrials.gov, NCT03282981. Registered on June 14th, 2018.
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Affiliation(s)
- Ramanjot Kaur
- Dermatology Service, VA Northern California Health Care System, Mather, CA, USA.,Department of Dermatology, UC Davis Medical Center, Sacramento, CA, USA
| | - Catherine Tchanque-Fossuo
- Dermatology Service, VA Northern California Health Care System, Mather, CA, USA.,Department of Dermatology, UC Davis Medical Center, Sacramento, CA, USA
| | - Kaitlyn West
- Dermatology Service, VA Northern California Health Care System, Mather, CA, USA.,Podiatry Service, VA Northern California Health Care System, Mather, CA, USA
| | - Yasmin Hadian
- Dermatology Service, VA Northern California Health Care System, Mather, CA, USA.,Department of Dermatology, UC Davis Medical Center, Sacramento, CA, USA
| | - Anthony Gallegos
- Department of Dermatology, UC Davis Medical Center, Sacramento, CA, USA
| | - Daniel Yoon
- Dermatology Service, VA Northern California Health Care System, Mather, CA, USA.,Department of Dermatology, UC Davis Medical Center, Sacramento, CA, USA
| | - Ligia Ismailyan
- Dermatology Service, VA Northern California Health Care System, Mather, CA, USA
| | - Saul Schaefer
- Department of Internal Medicine, UC Davis Medical Center, Sacramento, CA, USA
| | - Sara E Dahle
- Department of Dermatology, UC Davis Medical Center, Sacramento, CA, USA. .,Podiatry Service, VA Northern California Health Care System, Mather, CA, USA.
| | - R Rivkah Isseroff
- Dermatology Service, VA Northern California Health Care System, Mather, CA, USA. .,Department of Dermatology, UC Davis Medical Center, Sacramento, CA, USA.
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25
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Cutaneous vascular lesions in the pediatric population: a review of laser surgery applications and lesion-specific device parameters. Lasers Med Sci 2020; 35:1681-1687. [PMID: 32514864 DOI: 10.1007/s10103-020-03058-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 06/01/2020] [Indexed: 12/11/2022]
Abstract
Laser surgery is becoming an increasingly efficacious and customizable treatment modality for the management of pediatric vascular lesions. Proper use requires a thorough understanding of the scientific principles of laser surgery and knowledge of the various lasers available. Moreover, each laser has a multitude of settings that can be employed to properly target the lesion at hand. Each patient will present with unique challenges and variations in the presentation of their vascular lesion. This requires understanding of the most effective laser to use for each lesion and the factors that may alter the desired device settings. Using key search terms, a literature search was conducted on laser surgery for pediatric vascular lesions using PubMed/MEDLINE and Embase for articles published in English or French. Ultimately, 52 articles met our search criteria. The laser indications, limitations, and settings utilized for each type of vascular lesion were compiled for the purposes of this summative review. Laser surgery is an effective and appropriate option for the treatment of certain pediatric vascular lesions. Knowledge of optimal device parameters in every setting is essential to good clinical practice.
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26
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Léauté-Labrèze C, Baselga Torres E, Weibel L, Boon LM, El Hachem M, van der Vleuten C, Roessler J, Troilius Rubin A. The Infantile Hemangioma Referral Score: A Validated Tool for Physicians. Pediatrics 2020; 145:peds.2019-1628. [PMID: 32161112 DOI: 10.1542/peds.2019-1628] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Infantile hemangiomas (IHs) are common; some cases require timely referral and treatment to prevent complications. We developed and validated a reliable instrument for timely and adequate referral of patients with IH to experts by nonexpert primary physicians. METHODS In this multicenter, cross-sectional, observational study, we used a 3-stage process: (1) development of the Infantile Hemangioma Referral Score (IHReS) tool by IH experts who selected a representative set of 42 IH cases comprising images and a short clinical history, (2) definition of the gold standard for the 42 cases by a second independent committee of IH experts, and (3) IHReS validation by nonexpert primary physicians using the 42 gold standard cases. RESULTS A total of 60 primary physicians from 7 different countries evaluated the 42 gold standard cases (without reference to the IHReS tool); 45 primary physicians evaluated these cases using the IHReS questionnaire, and 44 completed retesting using the instrument. IHReS had a sensitivity of 96.9% (95% confidence interval 96.1%-97.8%) and a specificity of 55.0% (95% confidence interval 51.0%-59.0%). The positive predictive value and negative predictive value were 40.5% and 98.3%, respectively. Validation by experts and primary physicians revealed substantial agreement for interrater reliability and intrarater repeatability. CONCLUSIONS IHReS, a 2-part algorithm with a total of 12 questions, is an easy-to-use tool for primary physicians for the purpose of facilitating correct and timely referral of patients with IH. IHReS may help practitioners in their decision to refer patients to expert centers.
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Affiliation(s)
| | - Eulalia Baselga Torres
- Department of Dermatology, Universitat Autònoma de Barcelona and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Lisa Weibel
- Department of Pediatric Dermatology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Laurence M Boon
- Center for Vascular Anomalies, Division of Plastic Surgery, Cliniques Universitaires St Luc, Brussels, Belgium
| | - Maya El Hachem
- Pediatric Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Catharina van der Vleuten
- Expertise Center for Hemangioma and Vascular Malformations, Department of Dermatology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jochen Roessler
- Center of Pediatrics and Adolescent Medicine, Medical Center-University Freiburg, Freiburg, Germany; and
| | - Agneta Troilius Rubin
- Centre for Laser and Vascular Anomalies, Department of Dermatology, Skåne University Hospital, Malmö, Sweden
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Helal AA, Daboos MA. Five years’ experience of combined intralesional therapy in infantile hemangioma. ANNALS OF PEDIATRIC SURGERY 2019. [DOI: 10.1186/s43159-019-0008-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Abstract
Background
Infantile hemangiomas (IHs) are common vascular tumors. Although it involutes spontaneously, outcomes are unpredictable. Intralesional therapy is one of its treatment modality. We present our experience with combined intralesional therapy for IHs over a 5-year duration. A total of 427 patients were treated and followed at Al-Azhar University Hospitals during the study period of 5 years. All patients were treated by intralesional therapy in the form of combined injection of triamcinolone and bleomycin. All patients were followed for the response. Response to the treatment was graded as marked, partial, and poor improvement.
Results
IHs were noticed within the first month of life in 90.2% of patients. The commonest site of involvement was head and neck in 90% of patients. The commonest clinical presentation was swelling with discoloration. Mean age was 7.43 ± 6.04 months and mean IHs size was 15.54 ± 11.13 cm2. The response to the treatment was highest for patients below 1 year of age. The reported complications were ulceration, scarring, and subcutaneous atrophy in some cases.
Conclusion
Combined intralesional therapy in IHs showed good efficacy in most patients. It is a reliable and safe treatment modality with clear curative effects and minimal complications. If IHs treatment is indicated, combined intralesional therapy should be considered as an alternative effective treatment modality.
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Superficial Genital Infantile Hemangiomas. SERBIAN JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2019. [DOI: 10.2478/sjdv-2019-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction. Superficial infantile hemangiomas (IH) are rarely localized in the genital region.
Case Report. We present 8 infants with IHs in the genital region (3 boys and 5 girls). Our patients had only superficial IHs, their internal organs were not affected and there were no associated anomalies. In the boys, IHs were localized on the scrotum and the foreskin in 2 cases and 1 case, respectively. In the girls, IHs were on the labia majora and near the vaginal introitus. None of the IHs showed any IH-related complications. No therapy for IHs was administered in any of the presented infants, either because IHs were small and non-aggressive, or because their parents rejected the proposed therapy.
Conclusion. Genital IHs have increased tendency for ulceration, so thorough examination and follow-up are of outmost importance. If therapy is indicated, oral propranolol is the treatment of choice for genital IHs.
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Zhao J, Huang AH, Rainer BM, Kryatova MS, Eghrari AO, Wang J, Puttgen KB, Cohen BA. Periocular infantile hemangiomas: Characteristics, ocular sequelae, and outcomes. Pediatr Dermatol 2019; 36:830-834. [PMID: 31448460 DOI: 10.1111/pde.13925] [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: 11/27/2022]
Abstract
OBJECTIVES To identify clinical factors associated with complications of periocular infantile hemangioma (IH) and monitor improvement in complication rates post-treatment. METHODS Retrospective cohort study. Eighty-nine patients diagnosed with periocular IH at a pediatric dermatology clinic of a tertiary care center between 2001 and 2013 were included with parental approval. Parents were interviewed by telephone between July and September of 2015, then again in January 2018 to inquire about ophthalmologic follow-up. Electronic medical records were reviewed from January 2001 through January 2018. RESULTS Sixty percent of patients demonstrated ocular sequelae, including astigmatism (33%), visual axis obstruction (29%), nasolacrimal duct obstruction (7%), ptosis (4%), amblyopia (3%), and strabismus (1%). Compared with superficial IH, deep and mixed IH had higher odds, 3.4 (P = 0.025) and 3.8 (P = 0.034), respectively, of developing ocular sequelae. All patients with astigmatism prior to involution of IH received systemic therapy, with a significant post-treatment decrease in the proportion of patients with astigmatism (40% to 18%, P = 0.027). Three-quarters of patients experienced complete IH involution by time of enrollment in kindergarten. Fifty-one (57.3%) patients received formal ophthalmologic evaluation confirmed through chart review or phone interview, with average follow-up duration of 51.2 months (range: 1.9, 99.3). CONCLUSION Deep and mixed IH were more likely to demonstrate ocular complications than superficial IH. Rate of astigmatism decreased with systemic therapy. Our study suggests that patients with periocular IH have a lower rate of amblyopia now compared with the prepropranolol era and emphasizes the importance of early treatment of periocular IH to prevent permanent visual sequelae.
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Affiliation(s)
- Jiawei Zhao
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amy H Huang
- Division of Pediatric Dermatology, Departments of Pediatrics and Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Barbara M Rainer
- Division of Pediatric Dermatology, Departments of Pediatrics and Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Maria S Kryatova
- Division of Pediatric Dermatology, Departments of Pediatrics and Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Allen O Eghrari
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jiangxia Wang
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Biostatistics, Johns Hopkins University School of Public Health, Baltimore, Maryland
| | - Katherine B Puttgen
- Division of Pediatric Dermatology, Departments of Pediatrics and Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bernard A Cohen
- Division of Pediatric Dermatology, Departments of Pediatrics and Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Kolbe AB, Merrow AC, Eckel LJ, Kalina P, Ruano R. Congenital hemangioma of the face-Value of fetal MRI with prenatal ultrasound. Radiol Case Rep 2019; 14:1443-1446. [PMID: 31695833 PMCID: PMC6823738 DOI: 10.1016/j.radcr.2019.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/09/2019] [Accepted: 09/09/2019] [Indexed: 11/17/2022] Open
Abstract
We report the presentation, workup, and pre/perinatal management of a fetus with a large congenital hemangioma of the face. Hemangiomas are benign vascular neoplasms frequently encountered in neonates and infants. The less common congenital variant develops in utero and can present on prenatal ultrasound with diagnostic uncertainty as well as clinical implications for delivery. The differential diagnosis for these solid vascular masses when located in the head and neck includes myofibroma, kaposiform hemangioendothelioma, teratoma, and encephalocele. Potential clinical issues relate to size and location of the mass and include airway obstruction, disruption in development or compression of the globe, invasion into the cranial vault, bleeding and ulceration, and high output heart failure. Prenatal ultrasound and MRI play an important role in the diagnosis of congenital hemangiomas and planning for delivery and immediate postnatal cares.
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Affiliation(s)
- Amy B. Kolbe
- Division of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Arnold C. Merrow
- Division of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
- University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA
| | - Laurence J. Eckel
- Division of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Peter Kalina
- Division of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Rodrigo Ruano
- Division of Obstetrics and Gynecology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
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Lou L, Chen G, Zhong B, Liu F. Lycium barbarum polysaccharide induced apoptosis and inhibited proliferation in infantile hemangioma endothelial cells via down-regulation of PI3K/AKT signaling pathway. Biosci Rep 2019; 39:BSR20191182. [PMID: 31383785 PMCID: PMC6702356 DOI: 10.1042/bsr20191182] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/22/2019] [Accepted: 07/31/2019] [Indexed: 02/05/2023] Open
Abstract
Lycium barbarum polysaccharide (LBP) has a variety of pharmacological and biological activities such as anti-inflammatory, antioxidation, anti-apoptosis, immune regulation and other pharmacological effects; however, the effect of LBP on infantile hemangioma (IH) was less reported. Primary human hemangioma endothelial cells (HemECs) were isolated from fresh surgical specimens of patients. HemECs was treated with LBP and the changes in proliferative and apoptotic signaling pathways were investigated by performing cell counting kit-8, cloning formation experiment, in vitro angiogenesis experiment, flow cytometry, Western blot, immunofluorescence, HE stain and real-time quantitative polymerase chain reaction. We found that LBP potently inhibited the proliferation of HemECs and achieved a low-micromolar IC50 (45 and 40 μg/ml, the half maximal inhibitory concentration) value and less angiogenesis, however, the IC50 had no effect on human umbilical vein endothelial cells (HUVECs) viability. LBP treatment induced apoptosis in HemECs, which was supported by positive Annexin-V-FITC staining, the activation of cleaved caspase-3 and Bcl-2-associated X protein (Bax) and the inhibition of B-cell lymphoma/leukemia-2 (Bcl-2). Moreover, the result demonstrated that LBP suppressed the expressions of proliferating cell nuclear antigen (PCNA), Ki67, vascular endothelial growth factor (VEGF), VEGFR2 and phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt) signal pathway. PI3K-specific agonist (IGF-1) had promotive effects on HemECs proliferation, which was reversed by LBP. Our study suggests that the effectiveness of LBP in IHs may be associated with its potent anti-proliferative and apoptotic activities in HemECs. Thus, our findings may provide an effective medicine for IHs treatment.
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Affiliation(s)
- Lin Lou
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University China, No. 37 Guo Xue Alley, Chengdu City 610041, Sichuan Province, China
| | - Guo Chen
- Department of Otorhinolaryngology Head and Neck Surgery, The People's Hospital of Jianyang City, No. 180, Hospital Road, Jianyang City 641400, Sichuan Province, China
| | - Bing Zhong
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University China, No. 37 Guo Xue Alley, Chengdu City 610041, Sichuan Province, China
| | - Feng Liu
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University China, No. 37 Guo Xue Alley, Chengdu City 610041, Sichuan Province, China
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Amaral V, Tong J, Chow KC, Sales Marques J. Visual Diagnosis: Large Mass with Ulceration over the Right Shoulder. Pediatr Rev 2019; 40:e28-e31. [PMID: 31371642 DOI: 10.1542/pir.2017-0073] [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: 11/24/2022]
Affiliation(s)
- Vanessa Amaral
- Paediatrics Department, Centro Hospitalar Conde São Januário, Macau, China
| | - Joyce Tong
- Paediatrics Department, Centro Hospitalar Conde São Januário, Macau, China
| | - Kam Ching Chow
- Paediatrics Department, Centro Hospitalar Conde São Januário, Macau, China
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Chai Y, Zhou Z, Song J, Lv R, Xu G, Bi J, Li X, Li Z, Huo R. Safety of intralesional injection of lauromacrogol combined with triamcinolone for infantile hemangiomas. J Dermatol 2019; 46:770-776. [PMID: 31270853 DOI: 10.1111/1346-8138.14992] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 05/23/2019] [Indexed: 02/06/2023]
Abstract
The efficacy of lauromacrogol injection therapy and intralesional triamcinolone for infantile hemangiomas (IH) has been well documented recently, but with an increase in serious or rare adverse reactions. The aim of this study is to investigate the safety concerns regarding intralesional injection of lauromacrogol combined with triamcinolone for IH and to study its effect on infant growth and development. A total of 1039 IH patients who were subjected to intralesional injection of lauromacrogol combined with triamcinolone in the Plastic Surgery Department of Shandong Provincial Hospital between 1 January 2015 and 31 May 2018 were enrolled in this study. When the dose of lauromacrogol and triamcinolone was less than 3.5 and 2.0 mg/kg respectively, no serious side-effects were observed. The adverse event rate reported was 7.7%. Among the 405 patients not subjected to propranolol before the last injection, the study included three modes of treatment response: regression (82.7%), stabilization (13.8%) and failure (3.5%). By comparing height and weight to the reference standards and also by comparisons between the same-sex groups, our results confirmed that there was no significant effect on children's height and weight, regardless of whether the injection therapy was combined with oral propranolol at the appropriate dose and with more than 4-week intervals. Intralesional injection of lauromacrogol combined with triamcinolone in the treatment of IH was highly safe and effective.
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Affiliation(s)
- Yimeng Chai
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Zifu Zhou
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Jiayin Song
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Renrong Lv
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Guangqi Xu
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Jianhai Bi
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Xueqing Li
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Zhiyu Li
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Ran Huo
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
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Guo X, Dong C, Liu Q, Zhu X, Zuo S, Zhang H. The sustained and targeted treatment of hemangiomas by propranolol-loaded CD133 aptamers conjugated liposomes-in-microspheres. Biomed Pharmacother 2019; 114:108823. [PMID: 30965238 DOI: 10.1016/j.biopha.2019.108823] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/24/2019] [Accepted: 03/26/2019] [Indexed: 01/07/2023] Open
Abstract
We previously developed propranolol-encapsulated liposomes-in-microspheres (PLIM) to realize the sustained propranolol release for the treatment of hemangiomas. However, the liposomes released from the microspheres still lacked specificity for CD133-positive hemangioma-derived stem cells (HemSCs) which are considered to be the seeds of hemangiomas. Therefore, we hereby encapsulated propranolol-loaded CD133 aptamers conjugated liposomes in poly(lactic-co-glycolic acid (PLGA) microspheres to develop propranolol-loaded CD133 aptamers conjugated liposomes-in-microspheres (PCLIM), to realize the aim of the sustained and targeted therapy of hemangiomas. The evaluation of the release of propranolol from PCLIM was carried out, and the cytotoxic effect and angiogenic growth factor expression inhibitory ability of PCLIM were performed in HemSCs. The in vivo hemangioma inhibitory ability of PCLIM was also investigated in nude mice with subcutaneous human hemangiomas. PCLIM possessed a desired size of 29.2 μm, drug encapsulation efficiency (25.3%), and a prolonged drug release for 40 days. Importantly, PCLIM could inhibit HemSCs proliferation and the protein expression of basic fibroblast growth factor (bFGF) and vascular endothelial growth factor-A (VEGF) in HemSCs to a greater extent compared with PLIM. In nude mice bearing hemangioma xenograft, PCLIM showed the best therapeutic efficacy towards hemangiomas, as reflected by remarkably decreased hemangioma volume, weight and microvessel density (MVD). Thus, our results demonstrated that PCLIM realized the sustained and targeted treatment of hemangiomas, resulting in remarkable inhibition of hemangiomas.
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Affiliation(s)
- Xiaonan Guo
- Department of Hemangioma & Vascular Malformation, The People's Hospital of Zhengzhou University, 7 Weiwu Road, Jinshui District, Zhengzhou 450003, China.
| | - Changxian Dong
- Department of Hemangioma & Vascular Malformation, The People's Hospital of Zhengzhou University, 7 Weiwu Road, Jinshui District, Zhengzhou 450003, China.
| | - Qiuyu Liu
- Department of Pathology, The People's Hospital of Zhengzhou University, 7 Weiwu Road, Jinshui District, Zhengzhou 450003, China
| | - Xiaoshuang Zhu
- Department of Hemangioma & Vascular Malformation, The People's Hospital of Zhengzhou University, 7 Weiwu Road, Jinshui District, Zhengzhou 450003, China
| | - Song Zuo
- Department of Hemangioma & Vascular Malformation, The People's Hospital of Zhengzhou University, 7 Weiwu Road, Jinshui District, Zhengzhou 450003, China
| | - Hongyu Zhang
- Department of Hemangioma & Vascular Malformation, The People's Hospital of Zhengzhou University, 7 Weiwu Road, Jinshui District, Zhengzhou 450003, China
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Xiao L, Liu D, Zuo S, Zhu X, Wang Y, Dong C. Urea-modulated UT-B urea transporter internalization is clathrin- and caveolae-dependent in infantile hemangioma-derived vascular endothelial cells. J Cell Biochem 2019; 120:5128-5136. [PMID: 30367514 DOI: 10.1002/jcb.27789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/10/2018] [Indexed: 11/10/2022]
Abstract
The aim of this study was to investigate the manner of urea-modulated UT-B urea transporter (UT) internalization in infantile hemangioma-derived vascular endothelial cells (HemECs). The immunohistochemistry assay was performed to identify infancy hemangioma-derived endothelial cell line (XPTS-1) cells. Cell toxicity was detected with the 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide (MTT) assay. Quantitative real-time polymerase chain reaction and Western blot analysis were measured to analyze the expression of UT-B. UT-B internalization was observed by confocal microscopy. The clathrin inhibitor chlorpromazine (CPZ) and caveolin endocytic disrupter methyl-β-cyclodextrin (MβCD) were used in XPTS-1 cells transfected with UT-B-GFP to repress endocytosis. Urea-promoted UT-B expression in a concentration-dependent manner in an infantile XPTS-1 cell line. CPZ and MβCD significantly inhibited UT-B protein internalization. The pretreatment of UT-B-GFP cells with adaptor protein2 (AP2)-μ2-siRNA and caveolin-siRNA significantly inhibited UT-B protein internalization. Our findings suggested that urea-mediated UT-B UT internalization is clathrin and caveolae dependent in infantile HemECs.
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Affiliation(s)
- Li Xiao
- Department of Hemangioma, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Dakan Liu
- Department of Hemangioma, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Song Zuo
- Department of Hemangioma, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Xiaoshuang Zhu
- Department of Hemangioma, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Yanlin Wang
- Department of Hemangioma, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Changxian Dong
- Department of Hemangioma, Henan Provincial People's Hospital, Zhengzhou, Henan, China
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Ainipully AM, Narayanan SK, Vazhiyodan AP, Somnath P. Oral Propranolol in Infantile Hemangiomas: Analysis of Factors that Affect the Outcome. J Indian Assoc Pediatr Surg 2019; 24:170-175. [PMID: 31258264 PMCID: PMC6568152 DOI: 10.4103/jiaps.jiaps_12_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Aim The primary treatment for the subset of infantile hemangiomas (IHs) which develops complication is pharmacological intervention, and propranolol has become a popular choice. Here, we evaluated the efficacy and safety of propranolol in a clinical cohort of IHs and analyzed clinical characteristics associated with a good outcome. Materials and Methods We retrospectively reviewed a total of 52 IHs patients, between ages 1 and 48 months (median age: 7.5 months), who were treated with oral propranolol, with dose ranging from 2 to 3 mg/kg/day. Efficacy was evaluated using mean percentage reduction, visual analog scale (VAS), and parental satisfaction levels at week 2 and months 1, 2, 6, and 12. The adverse effects were noted and responses after 6 months were graded. Statistical analyses of the outcome were also performed for the responses with regard to age at propranolol initiation, site of lesion, and mean duration of treatment. Results A therapeutic response with at least 50% mean percentage reduction in size was noted in 84.6% at the end of 6 months. VAS score and parental satisfaction levels correlated well with mean percentage reduction (63.7 ± 15.6) at 6 months. Patients aged <6 months and those with cephalic lesions exhibited a greater therapeutic response rate with shorter overall mean duration of the treatment. Conclusions Oral propranolol at 2-3 mg/kg/day dosing has shown to be effective and safe for IHs in pediatric age group. Intervention in the early proliferative phase, with especially, the cephalic lesions result in better resolution rates with shorter duration of overall treatment.
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Affiliation(s)
- Arun Mohanan Ainipully
- Department of Pediatric Surgery, IMCH, Government Medical College, Kozhikode, Kerala, India
| | - Sarath Kumar Narayanan
- Department of Pediatric Surgery, IMCH, Government Medical College, Kozhikode, Kerala, India
| | - Arun Preeth Vazhiyodan
- Department of Pediatric Surgery, IMCH, Government Medical College, Kozhikode, Kerala, India
| | - Prathap Somnath
- Department of Pediatric Surgery, IMCH, Government Medical College, Kozhikode, Kerala, India
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Abstract
Infantile hemangioma can grow dramatically or typically locate on the face, which may lead to functional impairment, cosmetically disfiguring and exhibiting complications such as ulceration, bleeding, or infection. Early intervention is necessary. In this study, the authors chose individual treatment for different patients. From January 2012 to December 2016, 185 patients with hemangioma were enrolled into this study. Lesion area ranged from 0.5 cm × 0.5 cm to 9 cm × 12 cm. The initial treatment age ranged from 1 to 7 months with an average age of 3.9 months. Thirty-five children achieved the treatment of Intralesional Compound Betamethasone, 134 children achieved the treatment of oral propranolol, and 16 children achieved the treatment of topical carteolol. In the follow-up, the treatment could be repeated or switched to oral propranolol if the tumor tended to grow again. At the end of follow-up, 89% of the patients' tumors shrinked or involuted completely, 5 patients switched to oral propranolol. The adverse effects included soft tissue atrophy, moon face, diarrhea, heart rate reduction, and liver enzyme abnormalities. All of the patients recovered in a short period. Early treatment for hemangioma can achieve good results and avoid functional impairment. For different patients, the authors suggest individualized treatment according to the tumors' size and location.
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Krick J, Riehle K, Chapman T, Chabra S. Recurrent bloody stools associated with visceral infantile haemangioma in a preterm twin girl. BMJ Case Rep 2018; 11:11/1/bcr-2018-226564. [PMID: 30567166 DOI: 10.1136/bcr-2018-226564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A premature twin infant girl was transferred to a level IV neonatal intensive care unit for recurrent bloody stools, anaemia and discomfort with feeds; without radiographic evidence of necrotising enterocolitis. Additional imaging after transfer revealed a large retroperitoneal mass in the region of the pancreas compressing the inferior vena cava and abdominal aorta, raising suspicion for neuroblastoma. Abdominal exploration and biopsy unexpectedly revealed that the lesion was an infantile capillary haemangioma involving the small bowel, omentum, mesentery and pancreas. The infant was subsequently treated with propranolol, with a decrease in the size of the lesion over the first year of her life and a drastic improvement in feeding tolerance. While cutaneous infantile haemangiomas are common, visceral infantile haemangiomas are less so and may present a significant diagnostic challenge for clinicians. This interesting case demonstrates that such lesions should be considered in the differential diagnosis for unexplained gastrointestinal bleeding or abdominal symptoms in newborns.
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Affiliation(s)
- Jeanne Krick
- Neonatology, University of Washington, Seattle, Washington, USA
| | - Kimberly Riehle
- Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, Washington, USA
| | - Teresa Chapman
- Radiology, University of Washington, Seattle, Washington, USA
| | - Shilpi Chabra
- Neonatology, University of Washington, Seattle, Washington, USA
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Goemann IM, Marczyk VR, Romitti M, Wajner SM, Maia AL. Current concepts and challenges to unravel the role of iodothyronine deiodinases in human neoplasias. Endocr Relat Cancer 2018; 25:R625-R645. [PMID: 30400023 DOI: 10.1530/erc-18-0097] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/10/2018] [Indexed: 12/20/2022]
Abstract
Thyroid hormones (THs) are essential for the regulation of several metabolic processes and the energy consumption of the organism. Their action is exerted primarily through interaction with nuclear receptors controlling the transcription of thyroid hormone-responsive genes. Proper regulation of TH levels in different tissues is extremely important for the equilibrium between normal cellular proliferation and differentiation. The iodothyronine deiodinases types 1, 2 and 3 are key enzymes that perform activation and inactivation of THs, thus controlling TH homeostasis in a cell-specific manner. As THs seem to exert their effects in all hallmarks of the neoplastic process, dysregulation of deiodinases in the tumoral context can be critical to the neoplastic development. Here, we aim at reviewing the deiodinases expression in different neoplasias and exploit the mechanisms by which they play an essential role in human carcinogenesis. TH modulation by deiodinases and other classical pathways may represent important targets with the potential to oppose the neoplastic process.
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Affiliation(s)
- Iuri Martin Goemann
- Thyroid Unit, Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Vicente Rodrigues Marczyk
- Thyroid Unit, Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Mirian Romitti
- Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire, Université Libre de Bruxelles, Brussels, Belgium
| | - Simone Magagnin Wajner
- Thyroid Unit, Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Ana Luiza Maia
- Thyroid Unit, Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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41
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Kaya H, Gokce IK, Gungor S, Turgut H, Ozdemir R. A Newborn with Gastric Hemangioma Treated Using Propranolol. Pediatr Gastroenterol Hepatol Nutr 2018; 21:341-346. [PMID: 30345249 PMCID: PMC6182481 DOI: 10.5223/pghn.2018.21.4.341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 12/21/2017] [Accepted: 12/29/2017] [Indexed: 12/22/2022] Open
Abstract
Gastric hemangiomas are rare benign vascular tumors that can cause severe gastrointestinal system bleeding. We presented the case of a neonate with fresh bleeding and melena from the orogastric tube and detected gastric hemangioma in esophagogastroduodenoscopic examination. Propranolol is widely used in treatment of cutaneous hemangiomas and non-gastric gastrointestinal system hemangiomas. However, the surgical approach is preferred for treating gastric hemangiomas, and there are few reports of gastric hemangiomas associated with non-surgical treatment. Gastric hemorrhage decreased with antacid and somatostatin treatment. Propranolol treatment was initiated before the surgery decision. After three weeks of treatment, we observed regression in the hemangioma with endoscopic evaluation. During the course of treatment, the patient's gastrointestinal system bleeding did not recur, and there were no side effects associated with propranolol.
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Affiliation(s)
- Huseyin Kaya
- Division of Neonatology, Department of Pediatrics, Turgut Ozal Medical Center, Inonu University School of Medicine, Malatya, Turkey
| | - Ismail Kursad Gokce
- Division of Neonatology, Department of Pediatrics, Turgut Ozal Medical Center, Inonu University School of Medicine, Malatya, Turkey
| | - Sukru Gungor
- Division of Pediatric Gastroenterology, Department of Pediatrics, Turgut Ozal Medical Center, Inonu University School of Medicine, Malatya, Turkey
| | - Hatice Turgut
- Division of Neonatology, Department of Pediatrics, Turgut Ozal Medical Center, Inonu University School of Medicine, Malatya, Turkey
| | - Ramazan Ozdemir
- Division of Neonatology, Department of Pediatrics, Turgut Ozal Medical Center, Inonu University School of Medicine, Malatya, Turkey
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42
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Wagner MJ, Cranmer LD, Loggers ET, Pollack SM. Propranolol for the treatment of vascular sarcomas. J Exp Pharmacol 2018; 10:51-58. [PMID: 30233257 PMCID: PMC6130307 DOI: 10.2147/jep.s146211] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Vascular sarcomas are abnormal proliferations of endothelial cells. They range from benign hemangioma to aggressive angiosarcoma, and are characterized by dysregulated angiogenic signaling. Propranolol is a β-adrenergic receptor inhibitor that has demonstrated clinical efficacy in benign infantile hemangioma, and is now being used experimentally for more aggressive vascular sarcomas and other cancers. In this review, we discuss the use of propranolol in targeting these receptors in vascular tumors and other cancers.
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Affiliation(s)
- Michael J Wagner
- Division of Medical Oncology, .,Clinical Research Division University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA, USA,
| | - Lee D Cranmer
- Division of Medical Oncology, .,Clinical Research Division University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA, USA,
| | - Elizabeth T Loggers
- Division of Medical Oncology, .,Clinical Research Division University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA, USA,
| | - Seth M Pollack
- Division of Medical Oncology, .,Clinical Research Division University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA, USA,
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43
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Key Words
- CTA, computed tomography angiography
- IH, infantile hemangiomas
- LUMBAR, lower body hemangioma and other cutaneous defects, urogenital anomalies, ulceration, myelopathy, bony deformities, anorectal malformations, arterial anomalies, and renal anomalies ()
- MRA, magnetic resonance angiogram
- MRI, magnetic resonance imaging
- PELVIS, perineal hemangioma, external genitalia malformations, lipomyelomeningocele, vesicorenal abnormalities, imperforate anus, skin tag
- PHACE, posterior fossa, hemangioma, arterial abnormalities, cardiac abnormalities, eye abnormalities, sternal cleft
- connective tissue
- extracutaneous involvement
- infantile hemangioma
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Esposito F, Di Serafino M, Severino R, Vafina Z, Ferrara D, Zeccolini M. Mesenteric infantile hemangioma: diagnostic work-up. Quant Imaging Med Surg 2018; 8:252-256. [PMID: 29675365 DOI: 10.21037/qims.2017.09.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A very rare localization of infantile hemangioma (IH) is mesentery. It may manifest with intra-luminal or intra-peritoneal bleeding. Here there is the case of a 45-day-old infant, presenting with anemia and poor growth, subsequently referred to an uncommon hemangioma of the mesentery. As well as for most of IH, conservative treatment with only propranolol resulted in the disappearance of the lesion. Here we analyze ultrasound and magnetic resonance (MR) features of this uncommon lesion, trying to underline main characteristics at imaging in order to monitor the response to therapy.
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Affiliation(s)
| | - Marco Di Serafino
- Department of Emergency Radiology, San Carlo Hospital, Potenza, Italy
| | - Rosa Severino
- Radiology Department, "Federico II" University Hospital, Napoli, Italy
| | - Zukhra Vafina
- Radiology Department, "Federico II" University Hospital, Napoli, Italy
| | - Dolores Ferrara
- Radiology Department, "Federico II" University Hospital, Napoli, Italy
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Ford JR, Gonzalez-Barlatay J, Valenzuela AA. Early orbital infantile hemangioma that emphasizes the importance of glucose-transporter-1 (GLUT-1). CANADIAN JOURNAL OF OPHTHALMOLOGY 2018; 53:e58-e60. [PMID: 29631842 DOI: 10.1016/j.jcjo.2017.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 06/24/2017] [Accepted: 07/04/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Joshua R Ford
- Tulane University Department of Ophthalmology, New Orleans, LA
| | - Joaquín Gonzalez-Barlatay
- Tulane University Department of Ophthalmology, New Orleans, LA; Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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46
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Li H, Teng Y, Xu X, Liu J. Enhanced rapamycin delivery to hemangiomas by lipid polymer nanoparticles coupled with anti-VEGFR antibody. Int J Mol Med 2018; 41:3586-3596. [PMID: 29512710 DOI: 10.3892/ijmm.2018.3518] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 01/12/2018] [Indexed: 11/06/2022] Open
Abstract
The most common tumors in children are infantile hemangiomas which could cause morbidity and severe complications. The development of novel alternative drugs to treat infantile hemangiomas is necessary, since Hemangeol is the only US Food and Drug Administration-approved drug for infantile hemangiomas. However, Hemangeol has several disadvantages, including a high frequency of administration and adverse effects. Rapamycin is a well‑established antiangiogenic drug, and we have previously developed rapamycin lipid polymer nanoparticles (R‑PLNPs) as a local sustained‑release drug delivery system to achieve controlled rapamycin release and to decrease the frequency of administration and side effects of rapamycin. To improve the targeting of R‑PLNPs to infantile hemangiomas in the present study, R‑PLNPs were modified to include an antibody against vascular endothelial growth factor receptor (VEGF). The characteristics, and the anti‑hemangioma activity of the resulting R‑PLNPs coupled with the anti‑VEGFR2 antibody (named R‑PLNPs‑V) were examined in vitro and in vivo. R‑PLNPs‑V possessed a small size (115 nm) and sustained drug release for 6 days. The anti‑VEGFR2 antibody promoted the targeting and cytotoxic effect of R‑PLNPs‑V to human hemangioma endothelial cells and human umbilical vein endothelial cells. Using a subcutaneous infantile hemangioma xenograft in mice, the in vivo therapeutic effect (evaluated with hemangioma weight, volume, and microvessel density) of R‑PLNPs‑V was demonstrated to be superior compared with rapamycin alone and other non‑targeted nanoparticles, without any total body weight loss. In summary, R‑PLNPs‑V could facilitate targeted delivery and sustained release of rapamycin to infantile hemangiomas, and thus may represent a promising candidate treatment for infantile hemangiomas.
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Affiliation(s)
- Haitao Li
- Department of Vascular Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Yunfei Teng
- Department of Vascular Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Xia Xu
- Department of Pathology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Jianyong Liu
- Department of Vascular Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
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Rocco R, Alegre N, Pozner R, Wainstok R, Gazzaniga S. Selective hemangioma cell dysfunction and apoptosis triggered by in vitro treatment with imiquimod. Toxicol Lett 2018; 288:82-88. [PMID: 29410238 DOI: 10.1016/j.toxlet.2018.01.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 11/16/2017] [Accepted: 01/19/2018] [Indexed: 02/02/2023]
Abstract
Infantile hemangiomas are the most common benign tumors of infancy, characterized by unregulated angiogenesis and endothelial cells with high mitotic rate. Although spontaneous regression occurs, sometimes treatment is required and alternatives to corticosteroids should be considered to reduce side effects. Imiquimod is an imidazoquinoline, approved for some skin pathologies other than hemangioma. It is proposed that the effectiveness of imiquimod comes from the activation of immune cells at tumor microenvironment. However, the possibility to selectively kill different cell types and to directly impede angiogenesis has been scarcely explored in vitro for endothelial cells. In this work we showed a dramatic cytotoxicity on hemangioma cell, with a significant lower IC50 value in hemangioma compared to normal endothelial cells and melanoma (employed as a non-endothelial tumor cell line). Nuclear morphometric and flow-cytometry assays revealed imiquimod-induced apoptosis on hemangioma and melanoma cells but a small percentage of senescence on normal endothelial cells. At sub-lethal conditions, cell migration, a key step in angiogenesis turned out to be inhibited in a tumor-selective manner along with actin cytoskeleton disorganization on hemangioma cells. Altogether, these findings pointed out the selective cytotoxic effects of imiquimod on transformed endothelial cells, evidencing the potential for imiquimod to be a therapeutic alternative to reduce extensive superficial hemangioma lesions.
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Affiliation(s)
- Rodrigo Rocco
- Laboratorio de Biología Tumoral, Dpto. de Química Biológica IQUIBICEN-CONICET, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Nadia Alegre
- Laboratorio de Biología Tumoral, Dpto. de Química Biológica IQUIBICEN-CONICET, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Roberto Pozner
- Institute of Experimental Medicine (IMEX) -CONICET, National Academy of Medicine, Buenos Aires, Argentina
| | - Rosa Wainstok
- Laboratorio de Biología Tumoral, Dpto. de Química Biológica IQUIBICEN-CONICET, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Silvina Gazzaniga
- Laboratorio de Biología Tumoral, Dpto. de Química Biológica IQUIBICEN-CONICET, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina.
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48
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Lee JH, Jo SH, Yang JW. Treatment of Periorbital Infantile Capillary Hemangioma with Propranolol. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.5.397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jung Hoo Lee
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
- T2B Infrastructure Center for Ocular Disease, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Seung Hwan Jo
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
- T2B Infrastructure Center for Ocular Disease, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jae Wook Yang
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
- T2B Infrastructure Center for Ocular Disease, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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49
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Li Q, Li J, Chen L, Gao Y, Li J. Endogenous peptides profiles of human infantile hemangioma tissue and their clinical significance for treatment. J Cell Biochem 2017; 119:4636-4643. [PMID: 29266350 DOI: 10.1002/jcb.26632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/19/2017] [Indexed: 12/30/2022]
Abstract
Endogenous peptides play crucial roles in various biological processes. Their effects on the pathogenesis of human infantile hemangioma remains poorly understood. In this study, we construct a comparative peptidomic profiling between human infantile hemangioma tissue and matched normal skin using liquid chromatography-tandem mass spectrometry. A total of 192 peptides were significantly differentially expressed in human infantile hemangioma tissue, with 182 upregulated, and 10 downregulated peptides between infantile hemangioma tissue and matched normal skin. Performing bioinformatics analysis (Gene ontology and Kyoto Encyclopedia of Genes and Genomes pathway analysis), we found that precursor proteins of these differentially expressed peptides correlate with metabolic process, biological regulation, binding, catalytic activity, and pathways in cancer occurring during pathological changes of infantile hemangioma. Furthermore, 89 differentially expressed peptides shared homology with antimicrobial peptides and 13 matched known immunomodulatory peptides based on prediction database. In conclusion, our results reveal significantly altered expression profiles of peptides in human infantile hemangioma tissue. These peptides may participate in the etiology of infantile hemangioma and provide beneficial scheme for clinical treatments.
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Affiliation(s)
- Qian Li
- Department of Plastic & Cosmetic Surgery, Maternal and Child Health Medical Institute, The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Jingyun Li
- Department of Plastic & Cosmetic Surgery, Maternal and Child Health Medical Institute, The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Ling Chen
- Department of Plastic & Cosmetic Surgery, Maternal and Child Health Medical Institute, The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Yanli Gao
- Department of Plastic & Cosmetic Surgery, Maternal and Child Health Medical Institute, The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Jun Li
- Department of Plastic & Cosmetic Surgery, Maternal and Child Health Medical Institute, The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
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50
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Peng SH, Yang KY, Chen SY, Ji Y. [Research progresses in the pathogenesis, diagnosis and treatment of infantile hemangioma with PHACE syndrome]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2017; 19:1291-1296. [PMID: 29237532 PMCID: PMC7389804 DOI: 10.7499/j.issn.1008-8830.2017.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 10/27/2017] [Indexed: 06/07/2023]
Abstract
Infant hemangioma, the most common benign tumor in children, is characterized by rapid proliferation, followed by slower spontaneous involution. However, some patients with facial segmental hemangioma are associated with PHACE syndrome. PHACE syndrome is characterized by vascular nerve and vascular cutaneous lesions of multiple systemic systems, often resulting in structural and functional impairments. Recent studies have demonstrated that the possible pathogeneses of PHACE syndrome mainly include hypoxia, abnormality of mesodermal vascular endothelial cells, genetic abnormality, and abnormality of interstitial mesenchymal stem cells. The current medications for hemangioma with PHACE syndrome include beta blockers, glucocorticoids, and mTOR inhibitors. This review article mainly describes the pathogenesis, diagnoses and treatments of PHACE syndrome, in order to provide directions for diagnosis and treatment of this disorder.
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Affiliation(s)
- Su-Hua Peng
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, China.
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