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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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2
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Ke C, Chen C, Yang M, Chen H, Ke Y, Li L. Inhibition of infantile hemangioma growth and promotion of apoptosis via VEGF/PI3K/Akt axis by 755-nm long-pulse alexandrite laser. Biomed J 2023:100675. [PMID: 37944864 DOI: 10.1016/j.bj.2023.100675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/28/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Infantile hemangioma (IH) is a common vascular tumor in female infants, which can lead to aesthetic issues and facial scarring. This study aimed to investigate the inhibitory effects and underlying mechanisms of 755 nm long-pulsed alexandrite laser on IH. METHODS Hemangioma endothelial cells (HemECs) were exposed to 755 nm long-pulsed alexandrite laser to evaluate its impact on cell proliferation and apoptosis. A patient-derived xenograft model was established to assess the inhibitory effects of laser treatment on IH in vivo. RESULTS In vitro, 755 nm long-pulsed alexandrite laser effectively suppressed the proliferation of HemECs and induced cell apoptosis. Laser treatment significantly inhibited the volume and weight of tumors, accompanied by significant downregulation of vascular endothelial growth factor A (VEGFA), vascular endothelial growth factor receptor 2 (VEGFR2), phosphatidylinositol 3-kinase (PI3K), and protein kinase B (Akt) expression levels in both hemangioma cells and tumors. Additionally, laser treatment resulted in the conversion of VEGFA165a to VEGFA165b. TUNEL staining demonstrated increased apoptosis in tumor cells after laser treatment, along with upregulation of cleaved caspase-3 and Bax, and downregulation of Bcl-2. CONCLUSION In addition to the principle of selective photothermal decomposition, modulation of the VEGF/PI3K/Akt axis may serve as a potential mechanism for IH treatment using a long pulse-width 755 nm laser. This sheds valuable light on the molecular mechanisms underlying IH pathogenesis and potential therapeutic targets while providing a theoretical basis for the safe and efficient management of proliferative IH using laser therapy.
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Affiliation(s)
- Chen Ke
- Plastic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Changhan Chen
- Department of Cosmetology, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, Zhejiang, China; Wenzhou Key Laboratory of Laser Cosmetology, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, Zhejiang, China
| | - Ming Yang
- Department of Cosmetology, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, Zhejiang, China
| | - Hao Chen
- Department of Cosmetology, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, Zhejiang, China
| | - Youhui Ke
- Department of Cosmetology, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, Zhejiang, China; Wenzhou Key Laboratory of Laser Cosmetology, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, Zhejiang, China.
| | - Liqun Li
- Plastic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Beqo BP, Gasparella P, Flucher C, Spendel S, Quehenberger F, Haxhija EQ. Indications for surgical resection of complicated infantile hemangiomas in the β-blocker's era: a single-institution experience from a retrospective cohort study. Int J Surg 2023; 109:829-840. [PMID: 36974689 PMCID: PMC10389552 DOI: 10.1097/js9.0000000000000324] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/24/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND AND OBJECTIVES This study aims to review how the introduction of propranolol as the primary treatment option for children with infantile hemangiomas (IHs) has affected the use of other treatment options at our institution and to determine the indications for surgical treatment of children with IHs in the propranolol era. PATIENTS AND METHODS The authors conducted a single-center, noncompeting, historical/retrospective cohort study to review all cases referred to the institution for IH evaluation from 2005 to 2020. The authors analyzed the complete charts of patients who received surgery from 2011 to 2020 and evaluated the reasons for each surgical intervention. Detailed descriptive statistics are provided. Logistic regression analysis and Pearson's χ2 -test were applied. RESULTS During the study period, 592 children received treatment. From 2011, oral propranolol ( n =268; 74%) and surgery ( n =95; 26%) were the only treatments of choice for complicated IH cases. A significant decrease in the frequency of surgical treatment was observed ( P =0.01). The authors identified four main indications for surgical treatment: (1) patients with ulceration and IH size appropriate for surgical resection (15%); (2) patients whose parents preferred surgical treatment (19%); (3) patients who presented late and underwent surgery before the age of three (29%); and (4) patients with sequelae after IH involution and excision after the third year of life (37%). CONCLUSIONS Despite the significant decrease in the need for surgical treatment of children with IHs since the introduction of propranolol, there are still several clear indications for treating IH cases where surgery plays a crucial role.
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Affiliation(s)
- Besiana P. Beqo
- Department of Paediatric and Adolescent Surgery
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Stephan Spendel
- Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Graz, Graz, Austria
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Identification of novel potential biomarkers in infantile hemangioma via weighted gene co-expression network analysis. BMC Pediatr 2022; 22:239. [PMID: 35501731 PMCID: PMC9063075 DOI: 10.1186/s12887-022-03306-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/20/2022] [Indexed: 11/20/2022] Open
Abstract
Background Infantile hemangioma (IH) is the most common benign tumor in children and is characterized by endothelial cells proliferation and angiogenesis. Some hub genes may play a critical role in angiogenesis. This study aimed to identify the hub genes and analyze their biological functions in IH. Methods Differentially expressed genes (DEGs) in hemangioma tissues, regardless of different stages, were identified by microarray analysis. The hub genes were selected through integrated weighted gene co-expression network analysis (WGCNA) and protein–protein interaction (PPI) network. Subsequently, detailed bioinformatics analysis of the hub genes was performed by gene set enrichment analysis (GSEA). Finally, quantitative real-time polymerase chain reaction (qRT-PCR) analysis was conducted to validate the hub genes expression in hemangioma-derived endothelial cells (HemECs) and human umbilical vein endothelial cells (HUVECs). Results In total, 1115 DEGs were identified between the hemangiomas and normal samples, including 754 upregulated genes and 361 downregulated genes. Two co-expression modules were identified by WGCNA and green module eigengenes were highly correlated with hemangioma (correlation coefficient = 0.87). Using module membership (MM) > 0.8 and gene significance (GS) > 0.8 as the cut-off criteria, 108 candidate genes were selected and put into the PPI network, and three most correlated genes (APLN, APLNR, TMEM132A) were identified as the hub genes. GSEA predicted that the hub genes would regulate endothelial cell proliferation and angiogenesis. The differential expression of these genes was validated by qRT-PCR. Conclusions This research suggested that the identified hub genes may be associated with the angiogenesis of IH. These genes may improve our understanding of the mechanism of IH and represent potential anti-angiogenesis therapeutic targets for IH.
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Li CX, Li H, Zhou YC, Gong ZC, Ling B. Application of topical betaxolol to cure superficial infantile hemangioma: A pilot study. Pediatr Int 2022; 64:e15384. [PMID: 36222187 DOI: 10.1111/ped.15384] [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: 09/22/2022] [Revised: 09/27/2022] [Accepted: 10/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Beta-blockers have gradually become an attractive option for the treatment of infantile hemangiomas. Topical application is preferred to oral administration because of their potential systemic adverse effects. The aim of this study is to investigate the effect of betaxolol in treating superficial infantile hemangioma. METHODS Seventy-four infants admitted to the First Affiliated Hospital of Xinjiang Medical University from 2018 to 2019 were observed and recorded. Variables such as color, size, tension, and thickness were recorded monthly and evaluated using visual analog scales. Multi-factor analysis of variance with repeated measurements and the non-parametric Kruskal-Wallis H test were used to compare clinical effectiveness across the different groups. RESULTS After 6 months of treatment, 33.78% (25/74) showed excellent results, 55.41% (41/74) had good responses, 8.11% (6/74) had moderate responses, and 2.70% (2/74) had poor responses. Local discomfort and systemic complications were not found. There was no significant difference in gender and location of occurrence among groups (p > 0.05), and the effect of topical application of betaxolol was optimum in the children aged 0-3 months (p = 0.002). None of three age groups had statistically significant difference in heart rate and blood pressure after accepting treatment (1 month, p = 0.618; 4 months, p = 0.138; 6 months, p = 0.757). CONCLUSIONS Our study showed that topical administration of betaxolol was effective and well tolerated for superficial infantile hemangiomas, particularly in the early proliferative stage. However, its safety and efficacy need further research.
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Affiliation(s)
- Chen-Xi Li
- Department of Oral and Maxillofacial Surgery & Oncology, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology Xinjiang Medical University, Stomatological Research Institute of Xinjiang Autonomous Region, Urumqi, China.,Laboratory for Tumor Genetics and Regenerative Medicine, Department of Oral and Maxillofacial Surgery, Department of Neurology, the Head and Neurocenter, University Hospital Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Hong Li
- Department of Oral and Maxillofacial Surgery & Oncology, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology Xinjiang Medical University, Stomatological Research Institute of Xinjiang Autonomous Region, Urumqi, China
| | - Yu-Chuan Zhou
- Department of Oral and Maxillofacial Surgery & Oncology, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology Xinjiang Medical University, Stomatological Research Institute of Xinjiang Autonomous Region, Urumqi, China
| | - Zhong-Cheng Gong
- Department of Oral and Maxillofacial Surgery & Oncology, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology Xinjiang Medical University, Stomatological Research Institute of Xinjiang Autonomous Region, Urumqi, China
| | - Bin Ling
- Department of Oral and Maxillofacial Surgery & Oncology, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology Xinjiang Medical University, Stomatological Research Institute of Xinjiang Autonomous Region, Urumqi, China
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Liu Z, Lv S, Wang S, Qu SM, Zhang GY, Lin YT, Yang L, Li FQ. Itraconazole therapy for infant hemangioma: Two case reports. World J Clin Cases 2021; 9:8579-8586. [PMID: 34754871 PMCID: PMC8554448 DOI: 10.12998/wjcc.v9.i28.8579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/05/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Infantile hemangiomas (IHs) are the most common childhood benign tumors, showing distinctive progression characteristics and outcomes. Due to the high demand for aesthetics among parents of IH babies, early intervention is critical in some cases. β-Adrenergic blockers and corticosteroids are first-line medications for IHs, while itraconazole, an antifungal medicine, has shown positive results in recent years.
CASE SUMMARY In the present study, itraconazole was applied to treat two IH cases. The therapeutic course lasted 80-90 d, during which the visible lesion faded by more than 90%. Moreover, no obvious side effects were reported, and the compliance of the baby and parents was desirable.
CONCLUSION Although these outcomes further support itraconazole as an effective therapeutic choice for IHs, large-scale clinical and basic studies are still warranted to improve further treatment.
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Affiliation(s)
- Zhe Liu
- Department of Dermatology, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Sha Lv
- Department of Dermatology, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Shuang Wang
- Department of Dermatology, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Sheng-Ming Qu
- Department of Dermatology, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Gui-Yun Zhang
- Department of Dermatology, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Yi-Tong Lin
- Department of Dermatology, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Lei Yang
- Department of Dermatology, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Fu-Qiu Li
- Department of Dermatology, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
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7
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Shen Z, Zhang D, Li G, Huang D, Qiu Y, Xie C, Zhang X, Wang X, Liu Y. Clinical Characteristics, Classification, and Management of Adult Nasopharyngolaryngeal Hemangioma. Laryngoscope 2021; 131:2724-2728. [PMID: 34160868 DOI: 10.1002/lary.29703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/03/2021] [Accepted: 06/14/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS To analyze the clinical features, classification, and treatment of adult nasopharyngolaryngeal hemangioma (ANPLH). STUDY DESIGN Retrospective study. METHODS From February 2009 to May 2020, 101 patients with ANPLH were reviewed and analyzed. RESULTS Symptoms of ANPLH were frequently displayed as abnormal pharyngeal sensation and functional defection. According to lesion location, ANPLH was divided into five categories including nasopharyngeal, oropharyngeal, hypopharyngeal, laryngeal, and mixed types. The mixed type constitutes the highest portion, and the nasopharyngeal type is the least in our cohort. Most lesions could resect through natural cavity under endoscopy. Patients with mixed lesions had a higher rate of postoperative recurrence and planned multiple surgeries. Acceptable but not severe intraoperative and postoperative complications occurred in our patient cohort. CONCLUSIONS Patients with ANPLH are always symptomatic and even functional defective, which can be classified into five categories based on lesion location. For these patients, endoscopic surgery through natural cavity is recommended to remove lesions with fewer complications and favorable clinical outcomes. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Zhe Shen
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Otolaryngology Major Disease Research, Key Laboratory of Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Diekuo Zhang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Otolaryngology Major Disease Research, Key Laboratory of Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Guo Li
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Otolaryngology Major Disease Research, Key Laboratory of Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Donghai Huang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Otolaryngology Major Disease Research, Key Laboratory of Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Yuanzheng Qiu
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Otolaryngology Major Disease Research, Key Laboratory of Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Changning Xie
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Otolaryngology Major Disease Research, Key Laboratory of Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Xin Zhang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Otolaryngology Major Disease Research, Key Laboratory of Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Xingwei Wang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Otolaryngology Major Disease Research, Key Laboratory of Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Yong Liu
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Otolaryngology Major Disease Research, Key Laboratory of Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Xiangya Hospital, Central South University, Changsha, People's Republic of China
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Leung AKC, Lam JM, Leong KF, Hon KL. Infantile Hemangioma: An Updated Review. Curr Pediatr Rev 2021; 17:55-69. [PMID: 32384034 DOI: 10.2174/1573396316666200508100038] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/20/2020] [Accepted: 03/20/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Infantile hemangiomas are the most common vascular tumors of infancy, affecting up to 12% of infants by the first year of life. OBJECTIVE To familiarize physicians with the natural history, clinical manifestations, diagnosis, and management of infantile hemangiomas. METHODS A Pubmed search was conducted in November 2019 in Clinical Queries using the key term "infantile hemangioma". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews published within the past 20 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. RESULTS The majority of infantile hemangiomas are not present at birth. They often appear in the first few weeks of life as areas of pallor, followed by telangiectatic or faint red patches. Then, they grow rapidly in the first 3 to 6 months of life. Superficial lesions are bright red, protuberant, bosselated, or with a smooth surface, and sharply demarcated. Deep lesions are bluish and dome-shaped. Infantile hemangiomas continue to grow until 9 to 12 months of age, at which time the growth rate slows down to parallel the growth of the child. Involution typically begins by the time the child is a year old. Approximately 50% of infantile hemangiomas will show complete involution by the time a child reaches age 5; 70% will have disappeared by age 7; and 95% will have regressed by 10 to 12 years of age. The majority of infantile hemangiomas require no treatment. Treatment options include oral propranolol, topical timolol, and oral corticosteroids. Indications for active intervention include hemorrhage unresponsive to treatment, impending ulceration in areas where serious complications might ensue, interference with vital structures, life- or function-threatening complications, and significant disfigurement. CONCLUSION Treatment should be individualized, depending upon the size, rate of growth, morphology, number, and location of the lesion (s), existing or potential complications, benefits and adverse events associated with the treatment, age of the patient, level of parental concern, and the physician's comfort level with the various treatment options. Currently, oral propranolol is the treatment of choice for high-risk and complicated infantile hemangiomas. Topical timolol may be considered for superficial infantile hemangiomas that need to be treated and for complicated infantile hemangiomas in patients at risk for severe adverse events from oral administration of propranolol.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kin F Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam L Hon
- Department of Paediatrics, The Chinese University of Hong Kong, and Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong
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Qiao J, Lin J, Zhang D, Li J, Chen C, Yu H, Li X, Fang B. Efficacy of Combined Topical Timolol and Oral Propranolol for Treating Infantile Hemangioma: A Meta-Analysis of Randomized Controlled Trials. Front Pharmacol 2020; 11:554847. [PMID: 33132908 PMCID: PMC7578425 DOI: 10.3389/fphar.2020.554847] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/31/2020] [Indexed: 11/21/2022] Open
Abstract
Background Oral propranolol has become the first-line treatment for infantile hemangioma (IH). However, combined therapy with topical timolol and oral propranolol has been proposed as a more effective IH treatment strategy. We aimed to compare the safety and efficacy of topical timolol, oral propranolol, and their combination for treating IH in a meta-analysis. Methods Relevant randomized controlled trials (RCTs) were obtained after searching the PubMed, Embase, Cochrane’s Library, China National Knowledge Infrastructure, and WanFang databases. A random-effect model was used to pool the results. Results Eight RCTs with 759 patients with IH were included in this meta-analysis. Treatment with topical timolol alone showed a similar response rate compared to oral propranolol (risk ratio [RR] = 0.97, p = 0.63), but resulted in fewer adverse events (RR = 0.36, p = 0.002). Combined treatment with topical timolol and oral propranolol showed a favorable response rate compared to treatment with oral propranolol (RR = 1.14, p = 0.03) or topical timolol (RR = 1.36, p = 0.01) alone. Moreover, combined treatment showed similar risks of adverse events compared to oral propranolol (RR = 0.80, p = 0.24) or topical timolol (RR = 1.31, p = 0.25) alone. Conclusions Combined treatment with topical timolol and oral propranolol may be more effective than either single treatment strategy in patients with IH. Topical timolol alone conferred similar efficacy for IH compared to oral propranolol, but with less incidence of adverse events.
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Affiliation(s)
- Junbo Qiao
- Department of Hemangioma Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junjie Lin
- Department of Hemangioma Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dexin Zhang
- Department of Hemangioma Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junhua Li
- Department of Hemangioma Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Changkuan Chen
- Department of Hemangioma Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongye Yu
- Department of Hemangioma Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaodi Li
- Department of Hemangioma Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bin Fang
- Department of Hemangioma Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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10
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Tiemann L, Hein S. Infantile Hemangioma: A Review of Current Pharmacotherapy Treatment and Practice Pearls. J Pediatr Pharmacol Ther 2020; 25:586-599. [PMID: 33041713 DOI: 10.5863/1551-6776-25.7.586] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Infantile hemangioma (IH) is the most common vascular tumor of infancy, affecting as many as 5% to 10% of all infants. The exact cause is unclear, but specific risk factors, such as low birth weight, prematurity, female sex, white race, and family history are associated with IH development. Most IHs are benign and self-resolving, but a small subset of patients with IHs are at risk of severe or life-threatening outcomes. Systemic and topical β-blockers are effective and safe for use in pediatric patients and considered first-line treatment for both complicated and uncomplicated IHs. Recently published guidelines provide a thorough review of IH and management. This article focuses on IH pharmacotherapy and provides practice pearls to support health care providers in IH medication management.
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Zhang JW, Yin SY, Zhou DK, Wen JX, Gao H, Chen L, Wang ZX. Quantitative Evaluation of Percutaneous Local Drug Perfusion Against Refractory Infantile Hemangioma via 3-D Power Doppler Angiography. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:610-619. [PMID: 31810804 DOI: 10.1016/j.ultrasmedbio.2019.11.002] [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: 11/27/2018] [Revised: 10/26/2019] [Accepted: 11/04/2019] [Indexed: 06/10/2023]
Abstract
To assess the practicality of 3-D power Doppler angiography (3-D-CPA) for local drug perfusion dosage guidance of refractory infantile hemangioma (IH) treatment, 47 cases (48 lesions) of refractory IH were selected for local bleomycin infusion (once a month). Ultrasound was performed before treatment and 1 and 2 months after the first treatment. The 3-D volume (V) change of infantile hemangiomas and the ratio of bleomycin injection to 3-D V before treatment were calculated, and statistical analysis was performed. One month after percutaneous local drug perfusion, 37 participants (77.08%) exhibited significant improvement; controlled growth was observed on six lesions (12.5%); and treatment of the remaining 5 lesions (10.42%) failed to suppress growth. The calculated tolerable and effective dose of bleomycin for refractory IH was 0.34 ± 0.03 mL/cm3; the corresponding 3-D V decreased approximately 70.27 ± 6.27%. Three-dimensional CPA can provide abundant information on internal lesions. In particular, 3-D-CPA can quantitatively assess changes in lesion volume and guide the effective and rational use of interventional drugs.
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Affiliation(s)
- Jin-Wei Zhang
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Shu-Yue Yin
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - De-Kai Zhou
- Department of Hemangioma, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jie-Xin Wen
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Hui Gao
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Lu Chen
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Zhao-Xia Wang
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China.
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12
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Calcium Signaling in Endothelial Colony Forming Cells in Health and Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1131:1013-1030. [PMID: 31646543 DOI: 10.1007/978-3-030-12457-1_40] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Endothelial colony forming cells (ECFCs) represent the only known truly endothelial precursors. ECFCs are released in peripheral circulation to restore the vascular networks dismantled by an ischemic insult or to sustain the early phases of the angiogenic switch in solid tumors. A growing number of studies demonstrated that intracellular Ca2+ signaling plays a crucial role in driving ECFC proliferation, migration, homing and neovessel formation. For instance, vascular endothelial growth factor (VEGF) triggers intracellular Ca2+ oscillations and stimulates angiogenesis in healthy ECFCs, whereas stromal derived factor-1α promotes ECFC migration through a biphasic Ca2+ signal. The Ca2+ toolkit endowed to circulating ECFCs is extremely plastic and shows striking differences depending on the physiological background of the donor. For instance, inositol-1,4,5-trisphosphate-induced Ca2+ release from the endoplasmic reticulum is downregulated in tumor-derived ECFCs, while agonists-induced store-operated Ca2+ entry is up-regulated in renal cellular carcinoma and is unaltered in breast cancer and reduced in infantile hemangioma. This remodeling of the Ca2+ toolkit prevents VEGF-induced pro-angiogenic Ca2+ oscillations in tumor-derived ECFCs. An emerging theme of research is the dysregulation of the Ca2+ toolkit in primary myelofibrosis-derived ECFCs, as this myeloproliferative disorder may depend on a driver mutation in the calreticulin gene. In this chapter, I provide a comprehensive, but succinct, description on the architecture and role of the intracellular Ca2+ signaling toolkit in ECFCs derived from umbilical cord blood and from peripheral blood of healthy donors, cancer patients and subjects affected by primary myelofibrosis.
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13
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Kaley VR, Aregullin EO, Samuel BP, Vettukattil JJ. Trends in the off-label use of β-blockers in pediatric patients. Pediatr Int 2019; 61:1071-1080. [PMID: 31571355 DOI: 10.1111/ped.14015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 06/10/2019] [Accepted: 09/24/2019] [Indexed: 11/30/2022]
Abstract
The use of US Food and Drug Administration (FDA)-approved drugs for the treatment of an unapproved indication or in an unapproved age group, or at doses or route of administration not indicated on the label is known as off-label use. Off-label use may be beneficial in circumstances when the standard-of-care treatment has failed, and/or no other FDA-approved medications are available for a particular condition. In pediatric patients, off-label use may increase the risk of adverse events as pharmacokinetic and pharmacodynamic data are limited in children. Approximately 73% of off-label drugs currently prescribed for various conditions do not have sufficient scientific evidence for safety and efficacy. For example, β-blockers are a class of drugs with FDA-approval for very few indications in pediatrics but are commonly used for various off-label indications. Interestingly, the proportion of off-label use of β-blockers in adults is at about 52% (66.2 million) of the total number of β-blockers prescribed. The frequency of off-label use of β-blockers in children is also high with limited data on the indications as well as safety and efficacy. We present trends in off-label use of β-blockers in children to discuss drug safety and efficacy and include recommendations for pediatric providers.
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Affiliation(s)
- Vishal R Kaley
- Congenital Heart Center, Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA
| | - E Oliver Aregullin
- Congenital Heart Center, Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA.,College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Bennett P Samuel
- Congenital Heart Center, Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA
| | - Joseph J Vettukattil
- Congenital Heart Center, Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA.,College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
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14
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Surgical Treatment of Infantile Hemangioma Involuted With Fatty Degeneration. Ophthalmic Plast Reconstr Surg 2019; 35:409-411. [PMID: 31283693 DOI: 10.1097/iop.0000000000001403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Zeng Z, Liu S, Cai J, Li Z, Wu H, Chen H, Huang Y. miR-501 promotes hemangioma progression by targeting HOXD10. Am J Transl Res 2019; 11:2439-2446. [PMID: 31105850 PMCID: PMC6511771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 03/13/2019] [Indexed: 06/09/2023]
Abstract
MicroRNAs (miRNAs) are often abnormally expressed in human cancers to act as either oncogenes or tumor suppressor genes. MiRNA-501 (miR-501) has been found to be abnormally expressed in certain types of cancer, but its expression and biological role in hemangioma remain to be fully elucidated. In this study, the expression of miR-501 in hemangioma cell lines was analyzed by quantitative real-time polymerase chain reaction (qRT-PCR). The TargetScan algorithm, luciferase activity reporter assay, and Western blot analysis were conducted to validate homeobox D10 (HOXD10) as a direct target of miR-501. The results revealed that miR-501 expression was upregulated in hemangioma cell lines. Downregulation of miR-501 inhibited hemangioma cell proliferation, cell cycle progression, colony formation, migration, and invasion in vitro. Bioinformatics analysis indicated that HOXD10 was a putative target of miR-501. In addition, in a luciferase reporter system, it was confirmed that HOXD10 is a direct target of miR-501. It was also demonstrated HOXD10 downregulation reversed the effects of the miR-501 inhibitor on hemangioma cell activities. These findings indicated that miR-501 targeted HOXD10 to promote hemangioma cell processes, suggesting that miR-501 has an oncogenic role in the pathogenesis of hemangioma.
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Affiliation(s)
- Zhaofan Zeng
- Department of Vascular Surgery, Hainan General HospitalHaikou 570311, P. R. China
| | - Sahua Liu
- Department of Vascular Surgery, Hainan General HospitalHaikou 570311, P. R. China
| | - Junhong Cai
- Molecular Laboratory Center, Hainan General HospitalHaikou 570311, P. R. China
| | - Zhenzhen Li
- Department of Vascular Surgery, Hainan General HospitalHaikou 570311, P. R. China
| | - Hongfei Wu
- Department of Vascular Surgery, Hainan General HospitalHaikou 570311, P. R. China
| | - Hao Chen
- Department of Vascular Surgery, Hainan General HospitalHaikou 570311, P. R. China
| | - Yanjing Huang
- Department of Medical Oncology, Hainan General HospitalHaikou 570311, P. R. China
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16
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Abstract
Infantile hemangiomas (IH) are a common benign tumor of infancy, most being uncomplicated and not requiring therapy. Some IH may require treatment; the pediatric provider must be familiar with morphology, distribution, natural history, and associations of IH. Several treatment options are available for IH: current standard of care, oral propranolol. Other therapies include wound care; topical beta-blocker therapy for small, superficial, and uncomplicated IH; treatment of IH residua. In addition to functional compromise and other complications, potential for permanent deformity and eventual psychosocial stigmatization are important when considering the need for treatment of IH in a neonate or infant.
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17
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Sun B, Dong C, Lei H, Gong Y, Li M, Zhang Y, Zhang H, Sun L. Knockdown of inhibitor of differentiation 1 suppresses proliferation and induces apoptosis by inactivating PI3K/Akt/mTOR signaling in hemangioma-derived endothelial cells. Biomed Pharmacother 2019; 111:236-243. [DOI: 10.1016/j.biopha.2018.12.072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 12/13/2018] [Accepted: 12/17/2018] [Indexed: 02/07/2023] Open
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18
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Yong F, Juan L, Jinhuan W, Haohua Y, Wei C, Jiacong M, Junhang L, Wenwei W. Urethral cavernous hemangioma: a highly misdiagnosed disease (a case report of two patients and literature review). BMC Urol 2019; 19:13. [PMID: 30704439 PMCID: PMC6357368 DOI: 10.1186/s12894-019-0441-0] [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: 08/09/2018] [Accepted: 01/21/2019] [Indexed: 12/20/2022] Open
Abstract
Background Diagnosis of urethral cavernous hemangioma (UCH) is very rare. It can be easy to misdiagnose and mistreat due to its atypical clinical manifestations and a lack of relevant knowledge. The study is to explore the diagnosis, differential diagnosis, and treatment of UCH. Case presentation The first patient was a 15-year-old male, who was admitted to the hospital for more than 1 year with repeated hematuria. UCH was diagnosed by cystoscope biopsy, and cured with local injection of pingyangmycin. The second patient was a 49-year-old male, who was admitted for repeated painless gross hematuria and intermittent urethral bleeding after penile erection for more than 20 years. The case had been misdiagnosed as seminal vesiculitis, urethritis, or prostatitis, for over 20 years, until it was diagnosed as UCH by MR examination of the penis. It was treated by injection of pingyangmycin into the hemangioma’s lumen and base. A small incision in the ventral penile area was separated from the location of the hemangioma, which was injected with pingyangmycin again. A biopsy of resected tissue further confirmed the diagnosis of UCH. Conclusions UCH is an easily misdiagnosed disease. Intermittent painless hematuria is important characteristic of UCH. Local injection of pingyangmycin is a good option for treatment of UCH. Electronic supplementary material The online version of this article (10.1186/s12894-019-0441-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fang Yong
- Department of Urology, First Affiliated Hospital of Sun Yat-sen university, Guangzhou, 510080, China
| | - Lin Juan
- Department of Pediatrics, Third Affiliated Hospital of Sun Yat-sen university, Guangzhou, 510630, China
| | - Wei Jinhuan
- Department of Urology, First Affiliated Hospital of Sun Yat-sen university, Guangzhou, 510080, China
| | - Yao Haohua
- Department of Urology, First Affiliated Hospital of Sun Yat-sen university, Guangzhou, 510080, China
| | - Chen Wei
- Department of Urology, First Affiliated Hospital of Sun Yat-sen university, Guangzhou, 510080, China
| | - Mo Jiacong
- Department of Urology, First Affiliated Hospital of Sun Yat-sen university, Guangzhou, 510080, China
| | - Luo Junhang
- Department of Urology, First Affiliated Hospital of Sun Yat-sen university, Guangzhou, 510080, China
| | - Wang Wenwei
- Department of Urology, First Affiliated Hospital of Sun Yat-sen university, Guangzhou, 510080, China.
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Choi W, Choi YB. Splenic embolization for a giant splenic hemangioma in a child: a case report. BMC Pediatr 2018; 18:354. [PMID: 30419881 PMCID: PMC6233546 DOI: 10.1186/s12887-018-1331-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 10/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Splenic hemangioma is the most common benign tumor of the spleen. However, it remains a rare medical condition in children. Although the natural course of splenic hemangioma is slow growth, treatment for large splenic hemangiomas has been recommended due to the risk of spontaneous rupture causing life-threating hemorrhage. However, the optimal treatment for splenic hemangioma in children is unclear. CASE PRESENTATION An 11-year-old girl had an enhancing mass, 61 × 54 × 65 mm in size and numerous daughter nodules throughout the entire spleen on a contrast-enhanced computed tomography scan of the abdomen and angiography. The patient was treated by complete embolization at the distal level of splenic artery, which resulted in total splenic infarction. Treatment-related complications were thrombocytosis and postembolization syndrome, including abdominal pain and, intermittent fever below 39 °C. There were no other serious complications, including bleeding. CONCLUSION Splenic embolization may be a safe and less invasive intervention for children with a large splenic hemangioma. Further studies are needed to confirm the effectiveness of our approach.
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Affiliation(s)
- Woosun Choi
- Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Young Bae Choi
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Republic of Korea.
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20
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Fei Z, Qiu M, Qi X, Dai Y, Wang S, Quan Z, Liu Y, Ou J. MicroRNA‑424 suppresses the proliferation of hemangioma‑derived endothelial cells by targeting VEGFR‑2. Mol Med Rep 2018; 18:4065-4071. [PMID: 30132564 DOI: 10.3892/mmr.2018.9409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 07/27/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Zhewei Fei
- Department of General Surgery, Xinhua Hospital (Chong Ming) Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 202150, P.R. China
| | - Mingke Qiu
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, P.R. China
| | - Xianqin Qi
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, P.R. China
| | - Yuxin Dai
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, P.R. China
| | - Shuqing Wang
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, P.R. China
| | - Zhiwei Quan
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, P.R. China
| | - Yingbin Liu
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, P.R. China
| | - Jingmin Ou
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, P.R. China
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Propranolol inhibits proliferation and invasion of hemangioma-derived endothelial cells by suppressing the DLL4/Notch1/Akt pathway. Chem Biol Interact 2018; 294:28-33. [PMID: 30130526 DOI: 10.1016/j.cbi.2018.08.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/29/2018] [Accepted: 08/17/2018] [Indexed: 11/21/2022]
Abstract
Infantile hemangioma (IH) is one of the most common benign vascular tumors of infancy. Propranolol has been recently introduced for the treatment of IH. However, the mechanism of protective effect has not been fully understood. In this study, hemangioma-derived endothelial cells (HemECs) were isolated and treated with propranolol. The cell viability was measured by MTT assay, and the cell cycle arrest was detected using flow cytometry. Cell invasion was determined using transwell assay. The expressions of matrix metalloproteinase (MMP)-2, MMP-9, Delta-like 4 (DLL4), Notch1, Akt, p-Akt, and vascular endothelial growth factor (VEGF) were detected using western blot. HemECs were incubated with recombinant human DLL4 (rhDLL4) to investigate the role of DLL4/Notch1 in the effect of propranolol. The results showed that propranolol inhibited cell viability of HemECs in a time-dependent manner. Propranolol suppressed cell proliferation of HemECs by arresting cell progression at G0/G1 phase. Propranolol inhibited the invasion ability of HemECs and reduced the expression levels of MMP-2 and MMP-9 in HemECs. Besides, propranolol treatment blocked the DLL4/Notch1 and Akt signaling and inhibited VEGF expression in HemECs. Treatment with rhDLL4 activated the Akt signaling and attenuated the effect of propranolol on HemECs. Our data indicated that propranolol inhibited the cell proliferation and invasion of HemECs. The effect was possibly involved in the DLL4/Notch1/Akt signaling pathway.
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