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Kim YM, Lee Y, Choi Y, Choi IH, Heo SH, Choi JM, Do HS, Jang JH, Yum MS, Yoo HW, Lee BH. Clinical and genetic analyses of patients with lateralized overgrowth. BMC Med Genomics 2022; 15:206. [PMID: 36175890 PMCID: PMC9524090 DOI: 10.1186/s12920-022-01362-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/20/2022] [Indexed: 11/14/2022] Open
Abstract
Background The genetic features and treatment strategies of lateralized overgrowth have been elusive. We performed this study to analyze the genetic characteristics and treatment results of propranolol- or alpelisib-treated patients with lateralized overgrowth. Methods Fifteen patients with lateralized overgrowth were involved. Clinical characteristics and whole-body magnetic resonance imaging (WB-MRI) findings were evaluated. Targeted exome sequencing with a gene panel of affected tissue and peripheral white blood cells was performed. Propranolol was administered and treatment results were evaluated. The PIK3CA inhibitor alpelisib was prescribed via a managed access program. Results The identified mutations were PIK3CA (n = 7), KRAS (n = 2), PTEN (n = 1), MAP2K3 (n = 1), GNAQ (n = 1), TBC1D4 (n = 1), and TEK (n = 1). Propranolol was prescribed in 12 patients, and 7 experienced mild improvement of symptoms. Alpelisib was prescribed in two patients with a PIK3CA mutation, and the reduction of proliferated masses after 1 year of treatment was proved by WB-MRI. Conclusions Targeted exome sequencing identified various genetic features of lateralized overgrowth. Propranolol could be applied as an adjuvant therapy for reducing vascular symptoms, but a PIK3CA inhibitor would be the primary therapeutic strategy for PIK3CA-related overgrowth syndrome. Supplementary Information The online version contains supplementary material available at 10.1186/s12920-022-01362-1.
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Affiliation(s)
- Yoon-Myung Kim
- Department of Pediatrics, Gangneung Asan Hospital, College of Medicine, University of Ulsan, Gangneung, South Korea
| | - Yena Lee
- Department of Pediatrics, Asan Medical Center Children's Hospital, College of Medicine, University of Ulsan, Seoul, South Korea
| | - Yunha Choi
- Department of Pediatrics, Asan Medical Center Children's Hospital, College of Medicine, University of Ulsan, Seoul, South Korea
| | - In Hee Choi
- Department of Pediatrics, Asan Medical Center Children's Hospital, College of Medicine, University of Ulsan, Seoul, South Korea
| | - Sun Hee Heo
- Asan Medical Center, Asan Institute for Life Sciences, College of Medicine, University of Ulsan, Seoul, South Korea
| | - Jung Min Choi
- Asan Medical Center, Asan Institute for Life Sciences, College of Medicine, University of Ulsan, Seoul, South Korea
| | - Hyo-Sang Do
- Asan Medical Center, Asan Institute for Life Sciences, College of Medicine, University of Ulsan, Seoul, South Korea
| | - Ja-Hyun Jang
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Mi-Sun Yum
- Department of Pediatrics, Asan Medical Center Children's Hospital, College of Medicine, University of Ulsan, Seoul, South Korea
| | - Han-Wook Yoo
- Department of Pediatrics, Asan Medical Center Children's Hospital, College of Medicine, University of Ulsan, Seoul, South Korea.,Medical Genetics Center, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
| | - Beom Hee Lee
- Department of Pediatrics, Asan Medical Center Children's Hospital, College of Medicine, University of Ulsan, Seoul, South Korea. .,Medical Genetics Center, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea.
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Singh G, Gupta A, Gupta SK, Rai RK, Pandey A, Kureel SN. Oral Propranolol in the Treatment of Ulcerated Bleeding Scrotal Arteriovenous Malformation. J Indian Assoc Pediatr Surg 2020; 25:401-403. [PMID: 33487946 PMCID: PMC7815032 DOI: 10.4103/jiaps.jiaps_232_19] [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: 12/31/2019] [Revised: 02/02/2020] [Accepted: 07/07/2020] [Indexed: 02/05/2023] Open
Abstract
Arteriovenous malformations (AVMs) of the scrotum are very rare, with only 35 adult cases in the literature. An 8-year-old boy presented with an ulcerated bleeding AVM of the scrotum. The patient was resuscitated and managed conservatively initially. After the control of bleeding, oral propranolol was started. There was a decrease in the size of scrotal and penile swelling, healing of ulcer with total healing by 1 month, and no recurrence of bleeding episode. To the best of our knowledge, this was the first case of pediatric scrotal AVM treated by oral propranolol.
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Affiliation(s)
- Gurmeet Singh
- Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Archika Gupta
- Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sarvesh Kumar Gupta
- Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rahul Kumar Rai
- Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Anand Pandey
- Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - S N Kureel
- Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
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3
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Lobeek D, Bouwman FCM, Aarntzen EHJG, Molkenboer-Kuenen JDM, Flucke UE, Nguyen HL, Vikkula M, Boon LM, Klein W, Laverman P, Oyen WJG, Boerman OC, Terry SYA, Schultze Kool LJ, Rijpkema M. A Clinical Feasibility Study to Image Angiogenesis in Patients with Arteriovenous Malformations Using 68Ga-RGD PET/CT. J Nucl Med 2019; 61:270-275. [PMID: 31519800 DOI: 10.2967/jnumed.119.231167] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/08/2019] [Indexed: 11/16/2022] Open
Abstract
Arteriovenous malformations (AVMs) have an inherent capacity to form new blood vessels, resulting in excessive lesion growth, and this process is further triggered by the release of angiogenic factors. 68Ga-labeled arginine-glycine-aspartate tripeptide sequence (RGD) PET/CT imaging may provide insight into the angiogenic status and treatment response of AVMs. This clinical feasibility study was performed to demonstrate that 68Ga-RGD PET/CT imaging can be used to quantitatively assess angiogenesis in peripheral AVMs. Methods: Ten patients with a peripheral AVM (mean age, 40 y; 4 men and 6 women) and scheduled for endovascular embolization treatment were prospectively included. All patients underwent 68Ga-RGD PET/CT imaging 60 min after injection (mean dose, 207 ± 5 MBq). Uptake in the AVM, blood pool, and muscle was quantified as SUVmax and SUVpeak, and a descriptive analysis of the PET/CT images was performed. Furthermore, immunohistochemical analysis was performed on surgical biopsy sections of peripheral AVMs to investigate the expression pattern of integrin αvβ3 Results: 68Ga-RGD PET/CT imaging showed enhanced uptake in all AVM lesions (mean SUVmax, 3.0 ± 1.1; mean SUVpeak, 2.2 ± 0.9). Lesion-to-blood and lesion-to-muscle ratios were 3.5 ± 2.2 and 4.6 ± 2.8, respectively. Uptake in blood and muscle was significantly higher in AVMs than in background tissue (P = 0.0006 and P = 0.0014, respectively). Initial observations included uptake in multifocal AVM lesions and enhanced uptake in intraosseous components in those AVM cases affecting bone integrity. Immunohistochemical analysis revealed cytoplasmatic and membranous integrin αvβ3 expression in the endothelial cells of AVMs. Conclusion: This feasibility study showed increased uptake in AVMs with angiogenic activity, compared with surrounding tissue without angiogenic activity, suggesting that 68Ga-RGD PET/CT imaging can be used as a tool to quantitatively determine angiogenesis in AVMs. Further studies will be conducted to explore the potential of 68Ga-RGD PET/CT imaging for guiding current treatment decisions and for assessing response to antiangiogenic treatment.
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Affiliation(s)
- Daphne Lobeek
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frédérique C M Bouwman
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erik H J G Aarntzen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Uta E Flucke
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ha-Long Nguyen
- Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium
| | - Miikka Vikkula
- Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium.,Centre for Vascular Anomalies (part of VASCERN European Reference Network), Division of Plastic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Laurence M Boon
- Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium.,Centre for Vascular Anomalies (part of VASCERN European Reference Network), Division of Plastic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Willemijn Klein
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Centre for Vascular Anomalies (part of VASCERN European Reference Network), Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter Laverman
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wim J G Oyen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands; and
| | - Otto C Boerman
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Samantha Y A Terry
- Department of Imaging Chemistry and Biology, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Leo J Schultze Kool
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Centre for Vascular Anomalies (part of VASCERN European Reference Network), Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark Rijpkema
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Morgado M, Lobo S, Vieira E, Lobo L, Gonçalves M. Combined surgical and medical treatment of a retroperitoneal lymphatic-venous malformation presenting with significant haemorrhage. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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5
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Lu J, Anvari R, Wang J, Huang J, Pei S, Xiang Y, Huang J, Yin Z, Chen J, Nelson JS, Tan W. Propranolol as a potentially novel treatment of arteriovenous malformations. JAAD Case Rep 2018; 4:355-358. [PMID: 29693069 PMCID: PMC5911814 DOI: 10.1016/j.jdcr.2017.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Jianyun Lu
- Department of Dermatology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Radean Anvari
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California - Irvine, Irvine, California
| | - Jinwei Wang
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California - Irvine, Irvine, California.,Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jian Huang
- Department of Dermatology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Shiyao Pei
- Department of Dermatology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yaping Xiang
- Department of Dermatology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jinhua Huang
- Department of Dermatology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhaoqi Yin
- Department of Plastic Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jing Chen
- Department of Dermatology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - J Stuart Nelson
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California - Irvine, Irvine, California.,Department of Biomedical Engineering, University of California - Irvine, Irvine, California
| | - Wenbin Tan
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California - Irvine, Irvine, California
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Angiomatosis of the Orbit: Clinical, Imaging, and Histologic Findings. Ophthalmic Plast Reconstr Surg 2018; 34:e59-e61. [PMID: 29342032 DOI: 10.1097/iop.0000000000001035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Angiomatosis is a complex vascular malformation that denotes a clinically extensive hemangioma, which either involves multiple tissue planes or extensively infiltrates 1 type of tissue. It is a rare condition characterized by diffuse proliferation of blood vessels admixed with fat and fibrotic tissue. Typically, this process involves the limbs in multiple tissue planes, including dermis, subcutis, muscle, and bone. In this report, the authors present the first case of angiomatosis infiltrating the orbit, controlled effectively with a combination of systemic steroids, radiation, and beta-blocker therapy. The characteristic imaging and histologic features and management options are discussed.
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Castel P, Carmona FJ, Grego-Bessa J, Berger MF, Viale A, Anderson KV, Bague S, Scaltriti M, Antonescu CR, Baselga E, Baselga J. Somatic PIK3CA mutations as a driver of sporadic venous malformations. Sci Transl Med 2016; 8:332ra42. [PMID: 27030594 PMCID: PMC4962922 DOI: 10.1126/scitranslmed.aaf1164] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 03/02/2016] [Indexed: 12/13/2022]
Abstract
Venous malformations (VM) are vascular malformations characterized by enlarged and distorted blood vessel channels. VM grow over time and cause substantial morbidity because of disfigurement, bleeding, and pain, representing a clinical challenge in the absence of effective treatments (Nguyenet al, 2014; Uebelhoeret al, 2012). Somatic mutations may act as drivers of these lesions, as suggested by the identification of TEK mutations in a proportion of VM (Limayeet al, 2009). We report that activating PIK3CA mutations gives rise to sporadic VM in mice, which closely resemble the histology of the human disease. Furthermore, we identified mutations in PIK3CA and related genes of the PI3K (phosphatidylinositol 3-kinase)/AKT pathway in about 30% of human VM that lack TEK alterations. PIK3CA mutations promote downstream signaling and proliferation in endothelial cells and impair normal vasculogenesis in embryonic development. We successfully treated VM in mouse models using pharmacological inhibitors of PI3Kα administered either systemically or topically. This study elucidates the etiology of a proportion of VM and proposes a therapeutic approach for this disease.
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Affiliation(s)
- Pau Castel
- Human Oncology and Pathogenesis Program (HOPP), Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - F Javier Carmona
- Human Oncology and Pathogenesis Program (HOPP), Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Joaquim Grego-Bessa
- Developmental Biology Program, Sloan Kettering Institute, New York, NY 10065, USA
| | - Michael F Berger
- Human Oncology and Pathogenesis Program (HOPP), Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Agnès Viale
- Genomics Core Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Kathryn V Anderson
- Developmental Biology Program, Sloan Kettering Institute, New York, NY 10065, USA
| | - Silvia Bague
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, 167 Sant Antoni M. Claret, Barcelona 08025, Spain
| | - Maurizio Scaltriti
- Human Oncology and Pathogenesis Program (HOPP), Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Cristina R Antonescu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Eulàlia Baselga
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain
| | - José Baselga
- Human Oncology and Pathogenesis Program (HOPP), Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
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Abematsu T, Okamoto Y, Nakagawa S, Kurauchi K, Kodama Y, Nishikawa T, Tanabe T, Shinkoda Y, Mukai M, Kaji T, Kawano Y. Rectosigmoid colon venous malformation successfully treated with propranolol and celecoxib. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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