A case report of Kaposiform haemangioendothelioma; response with propranolol and steroids

Background

Kaposiform haemangioendothelioma is a rare vascular tumor and may involve skin, deep soft tissue or bone. It is a locally aggressive tumor usually seen in infants. Here we report a case of kaposiform hemagioendothelioma in a child who responded to propranolol and steroids.

Case presentation

A 3-year-old male child presented with a swelling below his right knee with characteristic violet skin lesion. There was no evidence of Kasabach–Merritt phenomenon. After no improvement with several attempts at debridement and anti-tubercular treatment; a diagnosis of Kaposiform Haemangioendothelioma was reached on the basis of overall clinical picture and histology. The child was treated with propranolol and steroids and had an excellent clinical response and a near complete resolution on imaging at 5 months.

Conclusions

These cases are often misdiagnosed and despite a delay in diagnosis have good outcomes with appropriate multimodality management. This case highlights the unique and typical characteristics of kaposiform haemangioendothelioma.

The changing face of complicated infantile hemangioma treatment

Infantile hemangiomas are the most common vascular tumors of infancy. A multidisciplinary approach including dermatologists, otolaryngologists, plastic surgeons, hematologists/oncologists and interventional/diagnostic radiologists is crucial for appropriate management of children with complicated infantile hemangiomas. Since its unforeseen discovery in 2008, propranolol has become the first-line treatment for infantile hemangiomas, eclipsing systemic corticosteroids and radiologic intervention. There are still, however, uncommon indications for more aggressive interventional management. We review the 2014-updated International Society for the Study of Vascular Anomalies (ISSVA) classification for vascular anomalies. Additionally, we suggest management algorithms for complicated lesions, including recommendations for radiologic and surgical intervention.

[Rare case of haemangioma of the pharynx]

The hemangioma is a benign tumour located mostly in the region of head and neck. It can appear at any age but especially it is diagnosed among children. The disease can be successfully treated with surgery, criotherapy, propranolol or endovascular procedures. The rare case of the 59-year-old, male patient with huge heamangioma of the pharynx was shown in this paper. The patient was mildly symptomatic - he neglected difficulty with swallowing or breathing and there was no pain. The only one complaint was experiencing a worsened hearing in the left ear. The patient was referred to the laryngologist with acute pharyngitis and with the suspicion of peritonsillar abscess. In the ENT examination apart from acute tonsillitis, the tumour of pharynx was diagnosed. Diagnostic puncture of the tumour showed blood. Ambulatory treatment with antibiotics was administered. The inflammation of pharynx was cured but the tumour remained. In the ENT department the patient underwent diagnostic process including CT of the head, angioCT of carotid arteries and consultation of vascular surgeon. The diagnosis was established and patient was referred for endovascular treatment. The outcome of the embolization of hemangioma resulted in reducing the tumour size and decreasing patient's symptoms. The epidemiology, diagnostic problems and therapy were described.