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Bhari N, Agarwal A, Asritha CVV, Panda M, Mahajan R. Vascular Malformations. Indian Dermatol Online J 2024; 15:415-430. [PMID: 38845674 PMCID: PMC11152494 DOI: 10.4103/idoj.idoj_633_23] [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: 08/17/2023] [Revised: 12/19/2023] [Accepted: 12/24/2023] [Indexed: 06/09/2024] Open
Abstract
Vascular malformations are intricate anomalies of the circulatory system, presenting a diverse array of clinical manifestations, and posing significant challenges in diagnosis and treatment. The pathogenesis of vascular malformations is explored through the lens of genetic and molecular mechanisms, shedding light on the pivotal role of somatic mutations and dysregulated signaling pathways. Clinical presentations of vascular malformations are widely variable, ranging from cosmetic concerns to life-threatening complications. The utility of imaging techniques, such as magnetic resonance imaging (MRI), computed tomography (CT), and angiography, are discussed in detail, emphasizing their role in precise delineation and characterization. Therapeutic strategies for vascular malformations are multifaceted, considering factors such as lesion size, location, potential complications, and patient-specific factors. Traditional interventions, including surgical excision and embolization, are appraised alongside emerging approaches like targeted molecular therapies and minimally invasive procedures. The manuscript underscores the need for an individualized treatment approach, optimizing outcomes while minimizing risks and complications. In summation, this manuscript offers a comprehensive analysis of vascular malformations, encompassing their underlying pathogenesis, clinical nuances, diagnostic methods, and therapeutic considerations. By synthesizing current knowledge and highlighting gaps in understanding, this review serves as a valuable resource for clinicians, researchers, and medical practitioners, fostering an enhanced comprehension of vascular malformations and paving the way for improved patient care and innovative research endeavors.
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Affiliation(s)
- Neetu Bhari
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Akash Agarwal
- Department of Dermatology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - C. V. V. Asritha
- Department of Dermatology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Maitreyee Panda
- Department of Dermatology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Rahul Mahajan
- Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Volpato LR, Junior F, da Silva E, Paz ALM. Extensive tongue lymphangioma followed for eight years: Case report. J Oral Maxillofac Pathol 2023; 27:S6-S9. [PMID: 37082292 PMCID: PMC10112709 DOI: 10.4103/jomfp.jomfp_511_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/15/2022] [Accepted: 05/19/2022] [Indexed: 03/15/2023] Open
Abstract
Lymphangiomas are benign hamartomatous tumours similar to lymphatic vessel neoplasms, originating from lymphatic tissue sequestration and may or may not communicate with the rest of the system. There are several treatment options for lymphangioma, such as surgery, sclerotherapy, cryotherapy, lasers, steroids and bleomycin. Although surgery is the most indicated treatment, it can result in severe sequelae and loss of function in patients. The present case shows a 5-year-old patient diagnosed with extensive tongue lymphangioma and, due to the mutilation that would be caused by its complete excision, the option was for more conservative treatments such as laser therapy and cryotherapy. After follow-up for 8 years, the patient presents with preserved functions and controlled lesion.
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Muacevic A, Adler JR, Vaidyanathan A, Ahmad Mokhtar E, Ghimire AC. Lymphangioma of the Oral and Maxillofacial Region: A Report of Three Cases. Cureus 2022; 14:e32577. [PMID: 36654537 PMCID: PMC9840748 DOI: 10.7759/cureus.32577] [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] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Lymphangiomas, or lymphatic malformations (LM), are benign malformations of the lymphatic system characterized by abnormal proliferation of lymphatic vessels. It was first described by Virchow in 1854. They occur rarely in the oral cavity and involve the tongue dorsum more often. Though complete surgical excision is the gold standard and most desirable management, certain limitations restrict this approach. Laser therapy, cryotherapy, electrocautery, sclerotherapy, and intralesional injections of steroids and Bevacizumab are other treatment options in such cases. Here, we present three cases of diverse forms of lymphatic malformations treated with two different modalities of treatment.
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Pessanha I, Bravo M, Piedade C, Lopes MF. Complex lymphatic malformations in pediatrics: a review of treatment options. Minerva Pediatr (Torino) 2022; 74:70-80. [PMID: 35283478 DOI: 10.23736/s2724-5276.20.06037-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Lymphatic malformations (LMs) are low-flow lesions resulting from abnormalities in the development of lymphatics. The management of these lesions is complex and involve the collaboration of many specialties. The purpose of this review is to summarize current knowledge regarding the different therapeutic options used in complex lymphatic malformations, analyzing their indications, efficacy and complications. EVIDENCE ACQUISITION A search was made using the algorithm: "(lymphatic abnormality OR lymphatic malformation OR lymphangioma OR cystic hygroma) AND (extensive OR giant OR complex) AND (therapeutics OR treatment) AND (child OR children)". Of the 120 articles found, 53 were included. EVIDENCE SYNTHESIS Historically, surgery was the treatment of choice for this type of lesions. However, excision was often incomplete, associated with high rates of recurrence and severe complications. The use of sclerotherapy emerged as a minimal invasive option appropriate in selected cases as a single or adjuvant therapy. Inhibitors of the mammalian target of rapamycin, such as sirolimus, now play a central role in the treatment of complex malformations resistant to sclerotherapy, recurrent after surgery or more extensive malformations that affect vital structures. Other therapeutic options as sildenafil and laser ablation are also recognized as effective in selected cases. CONCLUSIONS Looking through the literature over the last decade authors realize that surgery had gradually been replaced by less invasive options such as sirolimus with or without adjuvant sclerotherapy. In conclusion, each treatment option seems to have its own indications and characteristics, which must be considered in therapeutic decision and individualized for each patient.
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Affiliation(s)
- Inês Pessanha
- Department of Pediatric Surgery, Pediatric Hospital, University Hospital of Coimbra, Coimbra, Portugal -
| | - Mariana Bravo
- Department of Pediatric Surgery, Pediatric Hospital, University Hospital of Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Cláudia Piedade
- Department of Pediatric Surgery, Pediatric Hospital, University Hospital of Coimbra, Coimbra, Portugal
| | - Maria F Lopes
- Department of Pediatric Surgery, Pediatric Hospital, University Hospital of Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Das A, Toshniwal A, Madke B. What is new in dermatotherapy? Indian J Dermatol Venereol Leprol 2021; 87:135-143. [PMID: 33580938 DOI: 10.25259/ijdvl_342_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 07/01/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Anupam Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
| | - Anand Toshniwal
- Aesthetic Aura Skin and Hair Clinic, Hyderabad, Telangana, India
| | - Bhushan Madke
- Department of Dermatology, Jawaharlal Nehru Medical College and AVBR Hospital, Wardha, Maharashtra, India
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Khurana A, Gupta A, Ahuja A, Sardana K, Malhotra P. Lymphangioma circumscriptum treated with combination of Bleomycin sclerotherapy and Radiofrequency ablation. J COSMET LASER THER 2018; 20:326-329. [DOI: 10.1080/14764172.2018.1493510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Ananta Khurana
- Department of Dermatology and Pathology, Dr Ram Manohar Lohia Hospital and Postgraduate Institute of Medical Education and Research, New Delhi, India
| | - Aastha Gupta
- Department of Dermatology and Pathology, Dr Ram Manohar Lohia Hospital and Postgraduate Institute of Medical Education and Research, New Delhi, India
| | - Arvind Ahuja
- Department of Dermatology and Pathology, Dr Ram Manohar Lohia Hospital and Postgraduate Institute of Medical Education and Research, New Delhi, India
| | - Kabir Sardana
- Department of Dermatology and Pathology, Dr Ram Manohar Lohia Hospital and Postgraduate Institute of Medical Education and Research, New Delhi, India
| | - Purnima Malhotra
- Department of Dermatology and Pathology, Dr Ram Manohar Lohia Hospital and Postgraduate Institute of Medical Education and Research, New Delhi, India
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Tanoue N, Moedano L, Witte M, Montague M, Lukefahr A, Bernas M. Primary versus trauma-induced Gorham-Stout disease. Lymphology 2018; 51:18-27. [PMID: 30248728 PMCID: PMC7852030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Gorham-Stout disease - also known as "disappearing bone disease" is currently considered a single entity with varying clinical manifestations. We reviewed the existent literature from the earliest historic description(Jackson in 1838) and Gorham and Stout's original series of patients, multiple case reports and series since. After analyzing 212 reported cases, we identified 76 cases with details that recorded either a history of multifocal disease or an identifiable history of preceding trauma. From this review, we have defined two distinct Gorham-Stout entities - those characteristically associated with lymphangiomatosis [a form of GLA (generalized lymphangiomatosis) questionably distinguishable by bone biopsy and radiologic appearance] with multifocal distributed bone lesions, and those others, usually self-limited, first appearing after a traumatic event and always confined to a single bone or closely adjacent one. Multifocal disease is more likely to have chylothorax as a complication. These two Gorham-Stout entities differ in their demographic distribution, clinical history and manifestations, and they follow divergent clinical courses. The prognosis differs, and so should approaches to monitoring as well as acute and long-term treatment. Further research should seek to identify and define the differences in pathology and molecular mechanisms.
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Affiliation(s)
- N Tanoue
- Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona USA
| | - L Moedano
- Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona USA
| | - M Witte
- Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona USA
| | - M Montague
- Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona USA
| | - A Lukefahr
- Department of Pahtology, University of Arizona College of Medicine, Tucson, Arizona USA
| | - M Bernas
- Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona USA
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Heredea R, Cimpean AM, Cerbu S, Popoiu CM, Jitariu AA, Raica M. New Approach to Rare Pediatric Multicystic Mesenteric Lymphangioma; Would It Guide the Development of Targeted Therapy? Front Pediatr 2018; 6:223. [PMID: 30131951 PMCID: PMC6090038 DOI: 10.3389/fped.2018.00223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/19/2018] [Indexed: 11/13/2022] Open
Abstract
In children, lymphangiomas are extremely rare pathologic entities that are characterized by unusual locations. The mesenteric localization is extremely rare in children, and the clinical signs usually mimic an acute abdominal syndrome. For most of the cases, their diagnosis is established by the radiologist, and the main therapeutic option is represented by surgery for lesion removal. We hereby describe the case of a 4 year old girl admitted to the pediatric emergency department for continuous abdominal pain, more intense in the orthostatic position, associated with abdominal distension, nausea, and vomiting. These symptoms raised the clinical suspicion of acute abdominal syndrome. The patient had no previous clinically significant events. Radiologic examination suggested a mesenteric multicystic lymphangioma certified by surgical and histopathological evaluation. No specific targeted therapy is currently available; moreover, no specific criteria for recurrences have been stated. A new approach of infantile lymphangiomas following surgery, regarding the use of specific lymphatic markers panel including D2-40, Prox-1, VEGFR-3, PDGFs, and Ki67 may improve the characterization of such lesions regarding their prognosis, recurrence rate and targeted therapy implementation especially for those with a more aggressive or recurrent behavior.
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Affiliation(s)
- Rodica Heredea
- Department of Pathology, "Louis Turcanu" Children's Clinical Emergency Hospital, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Anca M Cimpean
- Department of Microscopic Morphology/Histology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.,Angiogenesis Research Center, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Simona Cerbu
- Department of Radiology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Calin M Popoiu
- Department of Pediatric Surgery, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Adriana A Jitariu
- Department of Microscopic Morphology/Histology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.,Angiogenesis Research Center, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Marius Raica
- Department of Microscopic Morphology/Histology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.,Angiogenesis Research Center, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
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