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Bakker AC, Fishman SJ, Liang MG, Al-Ibraheemi A, Kozakewich HP, Mulliken JB, Slack JC. Immunohistochemical Expression of Lymphatic Endothelial Markers in Blue Rubber Bleb Nevus Syndrome. Pediatr Dev Pathol 2024:10935266241228930. [PMID: 38512910 DOI: 10.1177/10935266241228930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Blue rubber bleb nevus syndrome (BRBNS) is an uncommon vascular anomaly characterized by multifocal cutaneous, visceral, and other soft tissue or solid organ venous malformations. We observed that BRBNS lesions express immunohistochemical markers of lymphatic differentiation. METHODS BRBNS histopathologic specimens assessed at our institution during the past 27 years were reviewed. Slides from 19 BRBNS lesions were selected from 14 patients (9 cutaneous, 9 gastrointestinal, and 1 hepatic). We recorded the involved anatomical compartments and presence/absence of thrombi or vascular smooth muscle. Immunohistochemical endothelial expression of PROX1 (nuclear) and D2-40 (membranous/cytoplasmic) was evaluated semi-quantitatively. RESULTS Endothelial PROX1 immunopositivity was noted in all specimens; the majority (89.5%) demonstrated staining in more than 10% of cells. D2-40 immunopositivity was present in one-third (33%) of cutaneous lesions and only 1 gastrointestinal lesion. CONCLUSION Endothelial cells in BRBNS almost always express 1 or more immunohistochemical markers of lymphatic differentiation.
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Affiliation(s)
- Andrea C Bakker
- Departments of Pathology, Boston Children's Hospital, Boston, MA, USA
| | - Steven J Fishman
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Marilyn G Liang
- Department of Dermatology, Boston Children's Hospital, Boston, MA, USA
| | | | | | - John B Mulliken
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Jonathan C Slack
- Departments of Pathology, Boston Children's Hospital, Boston, MA, USA
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2
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Kozai L, Nishimura Y. Clinical characteristics of blue rubber bleb nevus syndrome in adults: systematic scoping review. Scand J Gastroenterol 2023; 58:1108-1114. [PMID: 37211745 DOI: 10.1080/00365521.2023.2214263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/02/2023] [Accepted: 05/10/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Blue rubber bleb nevus syndrome (BRBNS) is a rare systemic vascular anomaly mainly affecting the skin, central nervous system and gastrointestinal tracts. Its clinical presentation and characteristics in adult patients are unclear. AIM To clarify the characteristics of BRBNS in adult patients with a focus on gastrointestinal symptoms. METHODS Following the PRISMA Extension for Scoping Reviews, we searched MEDLINE and EMBASE for all peer-reviewed articles using keywords including 'Blue rubber bleb nevus syndrome' from their inception to 28 December 2021. RESULTS Ninety-nine articles, including 3 observational studies and 101 cases from case reports and series, were included. Observational studies were consistently with small sample sizes, and there was only one prospective study to show the effectiveness of sirolimus in BRBNS. Common clinical presentations included anemia (50.5%) and melena (26.5%). While skin findings were known to be representative of BRBNS, only 57.4% had known vascular malformation. The diagnosis was primarily made clinically, with only 1% being diagnosed with BRBNS through genetic sequencing. Distribution of BRBNS-related lesions were variable, but predominantly oral (55.9%), followed by small bowel (49.5%), colorectal (35.6%) and stomach (26.7%) vascular malformations. CONCLUSION While it has been underrecognized, adult BRBNS could be a culprit for refractory microcytic anemia or occult gastrointestinal bleeding. Further studies are critical to establish a uniform understanding of diagnosis and treatment for those with adult BRBNS. The utility of genetic testing in adult BRBNS diagnosis and the patient characteristics that may benefit from sirolimus, a potentially curative agent, remain to be clarified.
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Affiliation(s)
- Landon Kozai
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Yoshito Nishimura
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
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3
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Lu VM, Luiselli GA, Parker T, Klinger NV, Sadegh C, See AP. Surgical considerations for spinal epidural hematoma evacuation in the setting of blue rubber bleb nevus syndrome in a child. Childs Nerv Syst 2023; 39:1691-1694. [PMID: 36862185 DOI: 10.1007/s00381-023-05843-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/09/2023] [Indexed: 03/03/2023]
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare condition that presents with venous malformation blebs throughout the body, most commonly on the skin and gastrointestinal tract. There have only been a limited number of reports of benign BRBNS lesions involving the spine in children, which were detected after chronic symptomatology. We herein present a unique case of a ruptured BRBNS venous malformation into the epidural space of the lumbar spine in a child presenting with acute neurologic deficit and discuss the relevant surgical considerations for operating in the setting of BRBNS.
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Affiliation(s)
- Victor M Lu
- Department of Neurosurgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
- Department of Neurological Surgery, University of Miami Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL, 33136, USA.
| | - Gabrielle A Luiselli
- Department of Neurosurgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
- Department of Neurological Surgery, Brigham and Women's Hospitaland , Harvard Medical School, Boston, MA, USA
| | - Tariq Parker
- Department of Neurosurgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
- Department of Neurosurgery, Massachusetts General Hospitaland, Harvard Medical School, MA, Boston, USA
| | - Neil V Klinger
- Department of Neurosurgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Cameron Sadegh
- Department of Neurosurgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Alfred P See
- Department of Neurosurgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
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Ma JX, Xia YC, Zou LP, Lin HJ, Chang X, Liu LY, Toledo JRA. Sirolimus as a promising drug therapy for blue rubber bleb nevus syndrome: Two-case report. SAGE Open Med Case Rep 2022; 10:2050313X221097755. [PMID: 35573101 PMCID: PMC9102151 DOI: 10.1177/2050313x221097755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 04/13/2022] [Indexed: 11/24/2022] Open
Abstract
Blue rubber bleb nevus syndrome is a very rare systemic vascular malformation frequently affecting the skin and the gastrointestinal tract. The pathogenesis of the disease is still unclear, and the standard treatment does not exist. This study reports two blue rubber bleb nevus syndrome cases, of which the second patient received the TEK gene mutations detection and got a low-dose sirolimus therapy, compared with the first patient who was not treated with sirolimus. The report shows some positive findings of TEK gene mutations and the efficacy of sirolimus treatment. We postulate that the TEK gene mutations play an important role in the pathogenesis. The mutations of different locations of the TEK gene cause a wide range of activating TIE2 mutations, which could stimulate the mammalian target of rapamycin signaling pathways to mediate angiogenesis, resulting in different clinical phenotypes of cutaneomucosal venous malformations. Sirolimus could effectively block the upstream and downstream factors of mammalian target of rapamycin signaling pathways to achieve the antiangiogenic effect. The initial dose of sirolimus can be 0.05–0.1 mg/kg/d for a trough level of 5–15 μg/L in the treatment of blue rubber bleb nevus syndrome. However, a lower-dose sirolimus is also effective while minimizing the side effects.
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Affiliation(s)
- Jian-Xun Ma
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - You-Chen Xia
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Li-Ping Zou
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China
| | - Heng-Ju Lin
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Xu Chang
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Li-Ying Liu
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, China
| | - Joy Roechelle A Toledo
- Department of Obstetrics and Gynecology, St. Joseph Mercy Hospital and Mercy Women's Center, Pontiac, MI, USA
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Wang M, Wang H, Huang XL, Chang GQ. Endovascular treatment of an inferior vena cava aneurysm in a patient with blue rubber bleb nevus syndrome. J Vasc Surg Cases Innov Tech 2021; 7:634-635. [PMID: 34693092 PMCID: PMC8515160 DOI: 10.1016/j.jvscit.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/10/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Mian Wang
- Department of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hui Wang
- Department of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xue-Ling Huang
- Department of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Guang-Qi Chang
- Department of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Dooghaie Moghadam A, Bagheri M, Eslami P, Farokhi E, Nezami Asl A, Khavaran K, Iravani S, Saeedi S, Mehrvar A, Dooghaie-Moghadam M. Blue Rubber Bleb Nevus Syndrome because of 12 Years of Iron Deficiency Anemia in a Patient by Double Balloon Enteroscopy; A Case Report and Review of Literature. Middle East J Dig Dis 2021; 13:153-159. [PMID: 34712454 PMCID: PMC8531930 DOI: 10.34172/mejdd.2021.219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 03/03/2021] [Indexed: 01/10/2023] Open
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare disorder comprised of venous malformation mostly involving the skin and gastrointestinal (GI) tract but can also involve other visceral organs. The most predominant site of GI tract involvement is the small bowel. In patients with GI lesions, treatment depends on the severity of bleeding, and extent of involvement. Conservative therapy with iron supplementation and blood transfusion is appropriate in cases with mild bleeding but in severe cases endoscopic and surgical interventions would be beneficial. Also, medical therapy with sirolimus significantly reduces bleeding. A 20-year-old woman was referred to our hospital after transfusion of six units of packed cell because of several episodes of lower GI bleeding within the past three months in the form of melena and a single episode of hematochezia. Her last hemoglobin level before admission was 10mg/dl. She underwent various unsuccessful investigations since she was eight years old to find the origin of refractory iron deficiency anemia. In upper endoscopy, five bleeding polypoid lesions were discovered in the jejunum. Lesions were excised by snare polypectomy. Over a six-month follow-up period, no signs of lower GI bleeding were noted and the patient had a normal hemoglobin level.
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Affiliation(s)
- Arash Dooghaie Moghadam
- Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Bagheri
- Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pegah Eslami
- Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ermia Farokhi
- Liver Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Nezami Asl
- Gastroenterology and Hepatobiliary Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Karim Khavaran
- Gastroenterology and Hepatobiliary Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Shahrokh Iravani
- Research Center for Cancer Screening and Epidemiology, AJA University of Medical Sciences, Tehran, Iran.,Gastroenterology and Hepatobiliary Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Sandra Saeedi
- Gastroenterology and Hepatobiliary Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Azim Mehrvar
- Research Center for Cancer Screening and Epidemiology, AJA University of Medical Sciences, Tehran, Iran
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7
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AlNooh BM, AlQadri NG, Alghubayn M, AlAjlan SM. Sirolimus in the Management of Blue Rubber Bleb Nevus Syndrome: A Case Report and Review of the Literature. Case Rep Dermatol 2021; 13:417-421. [PMID: 34594200 PMCID: PMC8436651 DOI: 10.1159/000511535] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/08/2020] [Indexed: 01/10/2023] Open
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare multifocal venous malformation (VM) that may affect any tissue or organ but mainly affects the skin, subcutaneous tissue and gastrointestinal (GI) tract. Patients present with serious anemia, treated with lifelong iron supplements and frequent blood transfusion secondary to chronic GI bleeding. Variable therapeutic modalities were used in the management of BRBNS; sirolimus (SRL), a mammalian target of rapamycin (mTOR) inhibitor, is found to be a promising therapy for vascular anomalies.
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Affiliation(s)
- Bayan Musaed AlNooh
- Department of Dermatology, King Saud University and King Khalid University Hospital, Riyadh, Saudi Arabia
| | | | - Muhtadi Alghubayn
- Department of Medicine, King Saud Medical City, Riyadh, Saudi Arabia
| | - Saad Mohammed AlAjlan
- Department of Dermatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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8
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Yang SS, Yang M, Yue XJ, Tou JF. Sirolimus treatment for neonate with blue rubber bleb nevus syndrome: A case report. World J Clin Cases 2021; 9:6929-6934. [PMID: 34447844 PMCID: PMC8362515 DOI: 10.12998/wjcc.v9.i23.6929] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/08/2021] [Accepted: 06/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Blue rubber bleb naevus syndrome (BRBNS) is a rare disease that usually presents with multiple venous malformations in the skin and gastrointestinal tract. Lesions located in the gastrointestinal tract always result in chronic gastrointestinal bleeding and severe anemia. The successful management of BRBNS with sirolimus had been reported in many institutions, due to its impact on signaling pathways of angiogenesis. However, the experience in treatment of neonates with BRBNS was limited.
CASE SUMMARY A 38-day-old premature female infant born with multiple skin lesions, presented to our center complaining of severe anemia and hematochezia. Laboratory examination demonstrated that hemoglobin was 5.3 g/dL and contrast-enhanced abdominal computed tomography showed multiple low-density space-occupying lesions in the right lobe of the liver. She was diagnosed as having BRBNS based on typical clinical and examination findings. The patient was treated by transfusions twice and hemostatic drugs but symptoms of anemia were difficult to alleviate. A review of BRBNS case reports found that patients had been successfully treated with sirolimus. Then the patient was treated with sirolimus at an average dose of 0.95 mg/m2/d with a target drug level of 10-15 ng/mL. During 28 mo of treatment, the lesion was reduced, hemoglobin returned to normal, and there were no adverse drug reactions.
CONCLUSION This case highlights the dosing regimen and plasma concentration in neonates, for the current common empiric dose is high.
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Affiliation(s)
- Si-Si Yang
- Department of Neonatal Surgery, The Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Ming Yang
- Department of Burn and Plastic Surgery, The Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Xiao-Jie Yue
- Department of Burn and Plastic Surgery, The Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Jin-Fa Tou
- Department of Neonatal Surgery, The Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
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De Loecker K, Labarque V, Seynaeve H, Casteels I. Subconjunctival Hemorrhage in a Child with the Blue Rubber Bleb Nevus Syndrome on Treatment with Oral Propranolol. Case Rep Ophthalmol 2021; 12:451-456. [PMID: 34177541 PMCID: PMC8215979 DOI: 10.1159/000513504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/01/2020] [Indexed: 11/19/2022] Open
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare syndrome characterized by venous malformations of mostly skin and gastrointestinal tract. Patients present with multiple venous malformations in various organs including liver, spleen, heart, eye, and central nervous system. Few ophthalmological cases have been published in literature and at present, there are no clear guidelines on the treatment of eye hemorrhages associated with the BRBNS. We report a 3-year-old boy with the BRBNS who developed a spontaneous progressive enlarging subconjunctival hemorrhage in the left eye despite being treated with oral propranolol. The subconjunctival hemorrhage was caused by an underlying conjunctival vascular malformation. With topical treatment with timolol maleate 0.5% once a day in the affected eye, the lesion regressed completely after 4 months. This child represents the first case of the BRBNS associated with a subconjunctival progressive bleeding necessitating topical treatment despite oral propranolol effectively controlling the cutaneous lesions. We recommend ophthalmic screening of patients with BRBNS in early childhood. For patients with BRBNS-related subconjunctival vascular lesions with subsequent hemorrhage, treatment with a topical β-blocker may be an efficient and harmless treatment option.
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Affiliation(s)
- Karen De Loecker
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | - Veerle Labarque
- Department Pediatric Hematology, University Hospitals Leuven, Leuven, Belgium
| | - Hilde Seynaeve
- Department of Ophthalmology, AZ Delta, Roeselare, Belgium
| | - Ingele Casteels
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
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Lasso Andrade FA, Cadena Arteaga JA, Echeverry Morillo VL, Fajardo Arteaga ÁM, Jurado Pantoja JA, Lasso Anacona MZZ, Nieto Lozano PA, Possos Obando DS, Palacios Rodríguez MA, Ortiz Cárdenas MA, Ortega Díaz HA, Ramírez Anacona DY, Zarmienta RZ. Blue rubber bleb nevus syndrome: Presentation of a case and review of the literature. Radiol Case Rep 2021; 16:2003-2006. [PMID: 34158881 PMCID: PMC8203586 DOI: 10.1016/j.radcr.2021.04.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 01/10/2023] Open
Abstract
Blue Rubber Bleb Nevus Syndrome, is a rare condition characterized by skin lesions caused by vascular malformations most frequently associated with lesions of the gastrointestinal tract, although rare, it can present with lesions in the central nervous system, thyroid, liver, spleen and lungs; common symptoms are: digestive tract bleeding and iron deficiency anemia. The main manifestation are skin lesions that are characterized by being button-like, with a bluish tint, covered by skin, called blue nevus with a rubbery consistency due to its rubber-like consistency. We present a case of Blue Rubber Bleb Nevus Syndrome with involvement in the central nervous and gastrointestinal systems.
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Affiliation(s)
- Fabricio Andres Lasso Andrade
- MD. Universidad del Cauca, Especialista Epidemiología. Universidad Autónoma de Bucaramanga, Residente Anestesiología y Reanimación, Universidad Nacional de Colombia Bogotá D.C., Correo electrónico: . Bogotá D.C, Colombia
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Marakhouski K, Sharafanovich E, Kolbik U, Sautin A, Nikalayeva K, Pataleta A, Sanfirau K, Svirsky A. Endoscopic treatment of blue rubber bleb nevus syndrome in a 4-year-old girl with long-term follow-up: A case report. World J Gastrointest Endosc 2021; 13:90-96. [PMID: 33763189 PMCID: PMC7958468 DOI: 10.4253/wjge.v13.i3.90] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/01/2021] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Blue rubber bleb nevus syndrome (BRBNS) is a rare vascular disease, difficult to diagnose and choose a treatment method, especially in young children. There are several limiting factors to the use of enteroscopy for diagnostics and treatment in pediatric patients, in general. The literature on BRBNS cases is limited and presents various therapeutic approaches.
CASE SUMMARY We present here a case of BRBNS involving a 4-year-old female, whose intestinal venous lesions were successfully treated by endoscopic sclerotherapy and aethoxysklerol foam. Skin lesions, typical for BRBNS, appeared on the 8th d of the child’s life and their number increased over the next several months. The child also experienced episodes of critical decrease in hemoglobin level (by as much as 52 g/L) for several years, requiring iron supplementation and several blood transfusions. Video capsule endoscopy revealed numerous vascular formations in the small bowel. The combined findings of gastrointestinal venous formations and skin lesions prompted BRBNS diagnosis. Single-balloon enteroscopy was used to perform sclerotherapy, with aethoxysklerol foam. A positive effect was observed within 19 mo of follow-up. We continue to monitor the patient’s hemoglobin level, every 2 wk, and it has remained satisfactory (> 120 g/L).
CONCLUSION Endoscopic sclerotherapy can be effective in the clinical management of gastrointestinal manifestations of BRBNS in young children.
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Affiliation(s)
- Kirill Marakhouski
- Diagnostic Division, Republican Scientific and Practical Center of Pediatric Surgery, Minsk 220113, Belarus
| | - Elena Sharafanovich
- Department of Elective Surgery, Republican Scientific and Practical Center of Pediatric Surgery, Minsk 220113, Belarus
| | - Uladzislau Kolbik
- Department of Elective Surgery, Republican Scientific and Practical Center of Pediatric Surgery, Minsk 220113, Belarus
| | - Aleh Sautin
- Diagnostic Division, Republican Scientific and Practical Center of Pediatric Surgery, Minsk 220113, Belarus
| | - Katsiaryna Nikalayeva
- Department of Pediatric Surgery, Republican Scientific and Practical Center of Pediatric Surgery, Minsk 220013, Belarus
| | - Aleh Pataleta
- Diagnostic Division, Republican Scientific and Practical Center of Pediatric Surgery, Minsk 220113, Belarus
| | - Kiryl Sanfirau
- Diagnostic Division, Republican Scientific and Practical Center of Pediatric Surgery, Minsk 220113, Belarus
| | - Aliaksandr Svirsky
- Department of Pediatric Surgery, Republican Scientific and Practical Center of Pediatric Surgery, Minsk 220013, Belarus
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12
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Zenjari L, Hali F, Elfatoiki FZ, Dahbi Skalli H, Chiheb S. [Diffuse angiomatous lesions]. Rev Med Interne 2021; 42:740-1. [PMID: 33663871 DOI: 10.1016/j.revmed.2021.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/10/2021] [Accepted: 02/14/2021] [Indexed: 11/20/2022]
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Dryden SC, Eder AE, Meador AG, Fleming JC, Fowler BT. Blue rubber bleb nevus syndrome of the orbit and gastrointestinal tract. Orbit 2020; 39:456-457. [PMID: 31718361 DOI: 10.1080/01676830.2019.1687737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 10/27/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Stephen C Dryden
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center , Memphis, Tennessee, USA
| | - Adrianna E Eder
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center , Memphis, Tennessee, USA
| | - Andrew G Meador
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center , Memphis, Tennessee, USA
| | - James C Fleming
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center , Memphis, Tennessee, USA
| | - Brian T Fowler
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center , Memphis, Tennessee, USA
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Yin J, Qin Z, Wu K, Zhu Y, Hu L, Kong X. Rare Germline GLMN Variants Identified from Blue Rubber Bleb Nevus Syndrome Might Impact mTOR Signaling. Comb Chem High Throughput Screen 2020; 22:675-682. [PMID: 31793416 DOI: 10.2174/1386207322666191203110042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/18/2019] [Accepted: 07/26/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Blue rubber bleb nevus syndrome (BRBN) or Bean syndrome is a rare Venous Malformation (VM)-associated disorder, which mostly affects the skin and gastrointestinal tract in early childhood. Somatic mutations in TEK have been identified from BRBN patients; however, the etiology of TEK mutation-negative patients of BRBN need further investigation. METHODS Two unrelated sporadic BRBNs and one sporadic VM were firstly screened for any rare nonsilent mutation in TEK by Sanger sequencing and subsequently applied to whole-exome sequencing to identify underlying disease causative variants. Overexpression assay and immunoblotting were used to evaluate the functional effect of the candidate disease causative variants. RESULTS In the VM case, we identified the known causative somatic mutation in the TEK gene c.2740C>T (p.Leu914Phe). In the BRBN patients, we identified two rare germline variants in GLMN gene c.761C>G (p.Pro254Arg) and c.1630G>T(p.Glu544*). The GLMN-P254R-expressing and GLMN-E544X-expressing HUVECs exhibited increased phosphorylation of mTOR-Ser-2448 in comparison with GLMN-WTexpressing HUVECs in vitro. CONCLUSION Our results demonstrated that rare germline variants in GLMN might contribute to the pathogenesis of BRBN. Moreover, abnormal mTOR signaling might be the pathogenesis mechanism underlying the dysfunction of GLMN protein.
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Affiliation(s)
- Jie Yin
- State Key Laboratory for Medical Genetics, Institute of Health Sciences, Shanghai Jiao Tong University School of Medicine (SITUSM) and Shanghai Institutes for Biological Sciences (SIBS), Chinese Academy of Sciences (CAS), Shanghai 200031, China
| | | | - Kai Wu
- State Key Laboratory for Medical Genetics, Institute of Health Sciences, Shanghai Jiao Tong University School of Medicine (SITUSM) and Shanghai Institutes for Biological Sciences (SIBS), Chinese Academy of Sciences (CAS), Shanghai 200031, China
| | - Yufei Zhu
- State Key Laboratory for Medical Genetics, Institute of Health Sciences, Shanghai Jiao Tong University School of Medicine (SITUSM) and Shanghai Institutes for Biological Sciences (SIBS), Chinese Academy of Sciences (CAS), Shanghai 200031, China
| | - Landian Hu
- State Key Laboratory for Medical Genetics, Institute of Health Sciences, Shanghai Jiao Tong University School of Medicine (SITUSM) and Shanghai Institutes for Biological Sciences (SIBS), Chinese Academy of Sciences (CAS), Shanghai 200031, China
| | - Xiangyin Kong
- State Key Laboratory for Medical Genetics, Institute of Health Sciences, Shanghai Jiao Tong University School of Medicine (SITUSM) and Shanghai Institutes for Biological Sciences (SIBS), Chinese Academy of Sciences (CAS), Shanghai 200031, China
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Mat Johar F, Wan Sulaiman WA, Mat Saad AZ, Basiron N, Sahid NA. Blue rubber bleb nevus syndrome in a Malay girl: A case report and literature review. Int J Surg Case Rep 2020; 72:202-206. [PMID: 32544829 PMCID: PMC7298517 DOI: 10.1016/j.ijscr.2020.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 02/07/2023] Open
Abstract
BRBNS also known as Bean’s Syndrome are atypical type of vascular malformation which uncommon. The key features of this syndrome is characterized by multiple cutaneous, soft tissue and gastrointestinal tract venous malformation. Current treatment modality for this rare disease is based on the severity of the organ involvement. It may involve minimaly invasive technique or extensive surgical resection.
Introduction Blue Rubber Bleb Nevus Syndrome (BRBNS) also known as Bean’s Syndrome is an atypical type of vascular malformation. To date, around 200 cases have been reported world-wide. In view of its low incidence rate, clinicians might misdiagnose and under treat. The key features of this syndrome are characterized by multiple cutaneous, soft tissue and gastrointestinal tract venous malformations. Presentation of case We report the first case of Blue Rubber Bleb Nevus Syndrome in Malaysia, a 23 years old Malay girl who suffers from multiple cutaneous venous malformation and gastrointestinal bleeding episodes. Discussion The typical morbidity for this syndrome is symptomatic anemia due to secondary iron deficiency due to the gastrointestinal venous malformation bleeding. In managing the gastrointestinal bleeding, it mainly depends on the severity of gastrointestinal bleeding, some may resolve spontaneously, while the others may be needing blood transfusion, and some may require GIT resections. As for cutaneous lesions, normally it is innocuous depending on the region and size. Large or problematic cutaneous venous malformation might benefit from sclerotherapy or excision. Conclusion Multidisciplinary approach is crucial in managing BRBNS case due to its complexity and the spectrum of multiple organ involvement to ensure the best outcome to the patient.
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Affiliation(s)
- Fatimah Mat Johar
- Reconstructive Sciences Unit, School of Medical Science, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia; Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Wan Azman Wan Sulaiman
- Reconstructive Sciences Unit, School of Medical Science, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia; Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Arman Zaharil Mat Saad
- Reconstructive Sciences Unit, School of Medical Science, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia; Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Normala Basiron
- Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, 23, Jalan Pahang, 50586 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Nik Amin Sahid
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Sabah, Malaysia.
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Xu Y, Wu Y, Dai Z, Xia F, Xu F. A combination of single-balloon enteroscopy-assisted laparoscopy and endoscopic mucosal resection for treating gastrointestinal venous malformations in blue rubber bleb nevus syndrome: a case report. BMC Gastroenterol 2020; 20:182. [PMID: 32522148 PMCID: PMC7285593 DOI: 10.1186/s12876-020-01328-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 06/01/2020] [Indexed: 01/10/2023] Open
Abstract
Background Blue rubber bleb nevus syndrome (BRBNS) is a rare congenital disease characterized by multifocal venous malformations. It remains a considerable challenge in treating the gastrointestinal (GI) venous malformations due to multiple lesions throughout the GI tract, and the likelihood of recurrence. We report a case study of BRBNS in the GI tract, in which GI venous malformations and related GI bleeding were successfully treated with a combination of multiple endoscopic procedures. Case presentation A 17-year-old man was admitted to our hospital for dizziness and hypodynamia. The symptoms persisted for nearly 1 year. The laboratory tests revealed iron-deficiency anemia with abnormally low hemoglobin (Hb), and a strong positive fecal occult blood test. A total of four hemangiomas were detected: one in the stomach, one in the descending colon, and two in the small intestines with a high risk of hemorrhage. Under gastroendoscopy, enteroscopy, and video capsule endoscopy (VCE) throughout the GI tract, the patient underwent surgical treatment. Endoscopic mucosal resection was initially performed in the stomach and colon, and the lesions in the small intestine were resected with laparoscopy auxiliaried by single-balloon enteroscopy (SBE), during which SBE assisted in identifying the lesions. The patient well-tolerated the procedures, and had a favorable prognosis. Conclusion The combination of single-balloon enteroscopy-assisted laparoscopy and endoscopic mucosal resection was effective for the present case, which could be considered for patients with similar clinical conditions.
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Affiliation(s)
- Yuemei Xu
- Department of Gastroenterology, Yinzhou Hospital affiliated to Medical School of Ningbo University, 251 Baizhang Rd. Ningbo, Zhejiang, 315040, China
| | - Yingjie Wu
- Department of Gastroenterology, Yinzhou Hospital affiliated to Medical School of Ningbo University, 251 Baizhang Rd. Ningbo, Zhejiang, 315040, China
| | - Zhenzhen Dai
- Department of Gastroenterology, Yinzhou Hospital affiliated to Medical School of Ningbo University, 251 Baizhang Rd. Ningbo, Zhejiang, 315040, China
| | - Feizhen Xia
- Department of Gastroenterology, Yinzhou Hospital affiliated to Medical School of Ningbo University, 251 Baizhang Rd. Ningbo, Zhejiang, 315040, China
| | - Feng Xu
- Department of Gastroenterology, Yinzhou Hospital affiliated to Medical School of Ningbo University, 251 Baizhang Rd. Ningbo, Zhejiang, 315040, China.
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Fragiotta S, Sepe M, Perdicchi A, Scuderi L, Trani M, Scuderi G. Postural changes revealing orbital venous malformation using ultrasound in blue rubber bleb nevus syndrome. Orbit 2019; 39:293-297. [PMID: 31691617 DOI: 10.1080/01676830.2019.1688357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A 62-year-old white woman presented with a diagnosis of blue rubber bleb nevus syndrome (BRBNS). The right eye appeared enophthalmic, yet the patient complained of episodes of right proptosis on bending forward. The remainder of the examination was unremarkable. Orbital ultrasound (US) in an upright posture revealed a single low reflectivity cavity (4.27 mm x 2.82 mm) of uncertain interpretation. In a forward-leaning posture the lesion increased in size (maximum thickness of 13.72 mm), demonstrating multiple low reflectivity spaces with highly reflective septae. This case first reports the use of US with postural changes to assess the presence of orbital venous malformation in BRBNS. The expansile nature upon postural changes supports the venous origin of the orbital lesion.
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Affiliation(s)
- Serena Fragiotta
- NESMOS Department, Ophthalmology Unit, S. Andrea Hospital, University of Rome "La Sapienza" , Rome, Italy
| | - Massimiliano Sepe
- Ophthalmology Department, Santa Maria Goretti Hospital , Latina (LT), Italy
| | - Andrea Perdicchi
- NESMOS Department, Ophthalmology Unit, S. Andrea Hospital, University of Rome "La Sapienza" , Rome, Italy
| | - Luca Scuderi
- Ophthalmology Unit, Azienda Ospedaliera Universitaria Policlinico Umberto I, University of Rome "Sapienza" , Rome, Italy
| | - Maria Trani
- Ophthalmology Department, Santa Maria Goretti Hospital , Latina (LT), Italy
| | - Gianluca Scuderi
- NESMOS Department, Ophthalmology Unit, S. Andrea Hospital, University of Rome "La Sapienza" , Rome, Italy
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Pan Y, Zhang L, Duan M, Yang H, Zhao D, Li W. Blue Rubber Bleb Nevus Syndrome: A Possible Cause for Growth Retardation and Pubertal Delay. Med Princ Pract 2019; 28:294-296. [PMID: 30537707 PMCID: PMC6597915 DOI: 10.1159/000496105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 12/10/2018] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE The aim of this paper was to describe a rare case of blue rubber bleb nevus (BRBNS) with growth retardation and pubertal delay. CLINICAL PRESENTATION AND INTERVENTION A 16-year-old boy with severe iron deficiency anemia was diagnosed with BRBNS, showing growth retardation and pubertal delay simultaneously. The patient was treated conservatively with intravenous iron therapy, and his puberty advanced gradually. CONCLUSION Given that growth retardation and pubertal delay are rare in BRBNS patients, this case reminds us to include BRBNS in the differential diagnosis of growth retardation.
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Affiliation(s)
- Yi Pan
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,
| | - Minghui Duan
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Yang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Duoduo Zhao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weifeng Li
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Ivars M, Martin-Santiago A, Baselga E, Guibaud L, López-Gutiérrez JC. Fern-shaped patch as a hallmark of blue rubber bleb nevus syndrome in neonatal venous malformations. Eur J Pediatr 2018. [PMID: 29520504 DOI: 10.1007/s00431-018-3126-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
UNLABELLED Blue rubber bleb nevus syndrome (BRBNS) is a rare congenital vascular disease associated with important morbidity and non-insignificant risk of mortality in cases of severe gastrointestinal or neurological involvement. Early diagnosis in the neonatal period can be difficult as very often skin lesions appear progressively during childhood having no correlation with gastrointestinal lesion development. The appearance of one large venous malformation (VM) in the neonatal period has suggested a characteristic finding of this syndrome. The objective of the study was to identify a specific clinical sign in the congenital venous malformations (VMs) of the BRBNS to distinguish them from the conventional VMs. Clinical histories of all patients diagnosed with BRBNS were reviewed, including those who presented a large VM at birth. Clinical characteristics of congenital VM associated with BRBNS were recorded. Five patients with BRBNS were found to have a large VM since birth. All of them presented a fern-shaped patch over the surface of the VM. CONCLUSION The finding of this macroscopic sign in the evaluation of the newborn with a VM could be considered as a guiding syndromic herald which should raise suspicion for BRBNS and allow for more accurate evaluation and surveillance for complications. What is Known: • BRBNS is a rare vascular disease associated with important morbidity and non-insignificant risk of mortality in cases of severe gastrointestinal or neurological involvement. • Early diagnosis in the neonatal period can be difficult as very often skin lesions appear progressively during childhood having no correlation with gastrointestinal lesion development. What is New: • Recognition of a fern-shaped patch in neonates with a VM should raise suspicion for BRBNS and allow for more accurate evaluation and surveillance for complications.
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Affiliation(s)
- Marta Ivars
- Department of Dermatology, University Clinic of Navarra (Madrid), Marquesado de Santa Marta street, 3., 28022, Madrid, Spain.
| | | | - Eulalia Baselga
- Department of Dermatology, University Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Laurent Guibaud
- Department of Radiology, Femme-Mère-Enfant Hospital, Lyon, Spain
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20
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Aravindan U, Ganesan R, Thamarai Kannan M. Surgery for Blue Rubber Bleb Nevus Syndrome-a Case Report. Indian J Surg 2018; 80:272-274. [PMID: 29973759 DOI: 10.1007/s12262-017-1715-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 12/08/2017] [Indexed: 01/10/2023] Open
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare disease characterised by multiple venous malformations and haemangioma in the skin and visceral organs. The lesion often involves the cutaneous and gastrointestinal tract. Most common visceral organ affected is the GIT. Most predominant region involved in the GIT is small bowel. However, vascular lesions can occur anywhere from oral mucosa to anal canal. GIT bleed is relatively slow, resulting in minor, chronic and occult blood loss. The syndrome in the GIT may also present with severe complications such as rupture, volvulus, intussusceptions and even death. Cutaneous malformations are usually asymptomatic and do not require treatment. The treatment of GIT lesions is determined by the extent of intestinal involvement and severity of the disease. Most patients respond to supportive therapy such as iron supplementation and blood transfusion. Surgical resection, endoscopic sclerosis and laser photocoagulation have been proposed for more significant haemorrhage and severe complications. Here, we present a case of BRBNS in a 13-year-old girl involving the GIT especially the large bowel, presenting with the complaints of bleeding per rectum and iron deficiency anaemia. Initially, endoscopic sclerotherapy was performed, but to no response. Hence, proceeded with surgical resection.
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Affiliation(s)
| | - R Ganesan
- Department of MGE, TMCH, Thanjavur, India
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21
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Salloum R, Fox CE, Alvarez-Allende CR, Hammill AM, Dasgupta R, Dickie BH, Mobberley-Schuman P, Wentzel MS, Chute C, Kaul A, Patel M, Merrow AC, Gupta A, Whitworth JR, Adams DM. Response of Blue Rubber Bleb Nevus Syndrome to Sirolimus Treatment. Pediatr Blood Cancer 2016; 63:1911-4. [PMID: 27273326 DOI: 10.1002/pbc.26049] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 04/13/2016] [Accepted: 04/14/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Blue rubber bleb nevus syndrome (BRBNS) is a rare multifocal venous malformation syndrome involving predominantly the skin and gastrointestinal tract. Traditional treatment modalities include corticosteroids, interferon-α, sclerotherapy, and aggressive surgical resection. Sirolimus has been used in several single case reports. PROCEDURE We performed a single-institution retrospective review of four children with BRBNS, who received sirolimus as part of their treatment regimens. A diagnosis of BRBNS was based on clinical, radiologic, and pathologic criteria. RESULTS Median age was 6.5 years (range: 2-16 years). Pathologic evaluations revealed a combined malformation with venous and lymphatic components. The novel finding of a lymphatic component was confirmed with PROX-1 immunostaining. Patients received oral sirolimus with target drug levels between 10 and 13 ng/ml. Responses to treatment were defined as stabilization/decrease in size of lesions; resolution of transfusion requirements; reduction in pain, and improvement in quality of life (QOL). Median time to response was 1.5 months (SD ± 0.96 month, range: 1-3 months). Median follow-up was 21 months (range: 18-26 months). Lesion size and characteristics improved in all patients. All patients reported decrease in pain and improvement in QOL. All three patients requiring transfusions became transfusion-independent. One patient had resolution of coagulopathy. Adverse effects of sirolimus consisted of mucositis in three patients and neutropenia in one patient. CONCLUSIONS Sirolimus is safe and efficient for the treatment of BRBNS. Further prospective studies are needed to evaluate the long-term effectiveness of this drug. This is the first report that identifies a lymphatic component as part of BRBNS.
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Affiliation(s)
- Ralph Salloum
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Courtney E Fox
- Hemangioma and Vascular Malformation Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Adrienne M Hammill
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Hemangioma and Vascular Malformation Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Belinda H Dickie
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Mary Sue Wentzel
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Carol Chute
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Hemangioma and Vascular Malformation Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ajay Kaul
- Division of Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Manish Patel
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Arnold C Merrow
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Anita Gupta
- Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - John R Whitworth
- Division of Gastroenterology, Le Bonheur Children's Hospital, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Denise M Adams
- Vascular Anomalies Center, Boston Children's Hospital, Boston, Massachusetts
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22
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Sancheti K, Podder I, Das A, Choudhury S, Chandra S, Gharami RC. Unilateral, Linear Blue Rubber Bleb Nevus Syndrome (Bean's syndrome): An Unfamiliar Presentation: First Case from India. Indian J Dermatol 2015; 60:616-9. [PMID: 26677281 PMCID: PMC4681206 DOI: 10.4103/0019-5154.159644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Blue rubber bleb nevus syndrome (BRBNS) also called Bean's syndrome is a rare disorder characterized by multiple cutaneous venous malformations in association with visceral lesions, most commonly affecting the gastrointestinal tract. We report here, a 21-year-old woman patient, who presented with unilateral, blaschkoid distribution of cutaneous venous malformations along with blue rubber bleb nevus and recurrent episodes of hematochezia due to vascular lesions in the sigmoid colon; likely to be a case of BRBNS. The unusual unilateral, blaschkoid distribution of BRBNS prompted this present report.
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Affiliation(s)
- Karan Sancheti
- Department of Dermatology, Medical College and Hospital, Kolkata, West Bengal, India
| | - Indrashis Podder
- Department of Dermatology, Medical College and Hospital, Kolkata, West Bengal, India
| | - Anupam Das
- Department of Dermatology, Medical College and Hospital, Kolkata, West Bengal, India
| | - Sourav Choudhury
- Department of General Surgery, Medical College and Hospital, Kolkata, West Bengal, India
| | - Somodyuti Chandra
- Department of Dermatology, Medical College and Hospital, Kolkata, West Bengal, India
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23
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Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare syndrome characterized by multiple vascular malformations of varying size and appearance that present predominantly on the skin and within the gastrointestinal tract and, less often, in other internal organs. Gastrointestinal lesions of BRBNS can cause acute or chronic bleeding, and the treatment is challenging. In this case, we reported a successful treatment of vascular malformations in all segments of gastrointestinal tract, including the small intestine, by endoscopic sclerotherapy, in a 10-year-old boy with BRBNS.
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Affiliation(s)
- Shoubin Ning
- Shoubin Ning, Department of Gastroenterology, General Hospital of Air Force, PLA, Beijing, China
| | - Yafei Zhang
- Yafei Zhang, Department of Gastroenterology, General Hospital of Air Force, PLA, Beijing, China
| | - Zhanfei Zu
- Zhanfei Zu, Department of Gastroenterology, General Hospital of Air Force, PLA, Beijing, China
| | - Xuyan Mao
- Xuyan Mao, Department of Gastroenterology, General Hospital of Air Force, PLA, Beijing, China
| | - Gaoping Mao
- Gaoping Mao, Department of Gastroenterology, General Hospital of Air Force, PLA, Beijing, China
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24
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Takasumi M, Hikichi T, Takagi T, Sato M, Suzuki R, Watanabe K, Nakamura J, Sugimoto M, Waragai Y, Kikuchi H, Konno N, Watanabe H, Obara K, Ohira H. Endoscopic therapy for esophageal hematoma with blue rubber bleb nevus syndrome. World J Gastrointest Endosc 2014; 6:630-634. [PMID: 25512774 PMCID: PMC4265962 DOI: 10.4253/wjge.v6.i12.630] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 10/08/2014] [Accepted: 10/29/2014] [Indexed: 02/05/2023] Open
Abstract
A 57-year-old woman previously diagnosed with blue rubber bleb nevus syndrome (BRBNS) reported hematemesis. BRBNS is a rare vascular anomaly syndrome consisting of multifocal hemangiomas of the skin and gastrointestinal (GI) tract but her GI tract had never been examined. An upper gastrointestinal endoscopy revealed a large bleeding esophageal hematoma positioned between the thoracic esophagus and the gastric cardia. An endoscopic injection of polidocanol was used to stop the hematoma from bleeding. The hematoma was incised using the injection needle to reduce the pressure within it. Finally, argon plasma coagulation (APC) was applied to the edge of the incision. The esophageal hematoma disappeared seven days later. Two months after the endoscopic therapy, the esophageal ulcer healed and the hemangioma did not relapse. This rare case of a large esophageal hematoma originating from a hemangioma with BRBNS was treated using a combination of endoscopic therapy with polidocanol injection, incision, and APC.
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25
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Jin XL, Wang ZH, Xiao XB, Huang LS, Zhao XY. Blue rubber bleb nevus syndrome: A case report and literature review. World J Gastroenterol 2014; 20:17254-17259. [PMID: 25493043 PMCID: PMC4258599 DOI: 10.3748/wjg.v20.i45.17254] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 04/21/2014] [Accepted: 07/25/2014] [Indexed: 02/06/2023] Open
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare disease characterized by multiple venous malformations and hemangiomas in the skin and visceral organs. The lesions often involve the cutaneous and gastrointestinal systems. Other organs can also be involved, such as the central nervous system, liver, and muscles. The most common symptoms are gastrointestinal bleeding and secondary iron deficiency anemia. The syndrome may also present with severe complications such as rupture, intestinal torsion, and intussusception, and can even cause death. Cutaneous malformations are usually asymptomatic and do not require treatment. The treatment of gastrointestinal lesions is determined by the extent of intestinal involvement and severity of the disease. Most patients respond to supportive therapy, such as iron supplementation and blood transfusion. For more significant hemorrhages or severe complications, surgical resection, endoscopic sclerosis, and laser photocoagulation have been proposed. Here we present a case of BRBNS in a 45-year-old woman involving 16 sites including the scalp, eyelid, orbit, lip, tongue, face, back, upper and lower limbs, buttocks, root of neck, clavicle area, superior mediastinum, glottis, esophagus, colon, and anus, with secondary severe anemia. In addition, we summarize the epidemiology, clinical manifestations, diagnosis, differential diagnosis and therapies of this disease by analyzing all previously reported cases to enhance the awareness of this syndrome.
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26
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Abstract
Vascular malformations affect the viscera less commonly than the head and neck, extremities, and extra-cavitary soft tissues. They present with a wide spectrum of symptoms and findings including pain, respiratory compromise, hemoptysis, chylothorax, ascites, gastrointestinal bleeding, and obstruction. Management options depend upon the subtype of malformation and anatomic extent and may include sclerotherapy, embolization, surgical extirpation, coloanal pull-through, and occasionally more innovative individualized surgical approaches.
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Affiliation(s)
- Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children׳s Medical Center, University of Cincinnati, 3333 Burnett Ave, Cincinnati, Ohio 45229.
| | - Steven J Fishman
- Department of Pediatric Surgery, Boston Children׳s Hospital, Harvard Medical School, Boston, Massachusetts
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Han EC, Kim SH, Kim HY, Jung SE, Park KW. Gastrointestinal hemangioma in childhood: a rare cause of gastrointestinal bleeding. Korean J Pediatr 2014; 57:245-9. [PMID: 25045368 PMCID: PMC4102688 DOI: 10.3345/kjp.2014.57.5.245] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 07/23/2013] [Accepted: 10/28/2013] [Indexed: 12/22/2022]
Abstract
Gastrointestinal (GI) hemangiomas are relatively rare benign vascular tumors. The choice of an appropriate diagnostic method depends on patient age, anatomic location, and presenting symptoms. However, GI hemangiomas are not a common suspected cause of GI bleeding in children because of their rarity. Based on medical history, laboratory results, and imaging study findings, the patient could be treated with either medication or surgery. Herein, we report 3 cases of GI hemangioma found in the small bowel, rectum, and GI tract (multiple hemangiomas). Better knowledge and understanding of GI hemangioma could help reduce the delayed diagnosis rate and prevent inappropriate management. Although rare, GI hemangiomas should be considered in the differential diagnosis of GI bleeding.
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Affiliation(s)
- Eon Chul Han
- Department of Pediatric Surgery, Seoul National University College of Medicine, Seoul, Korea. ; Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Soo-Hong Kim
- Department of Pediatric surgery, Pusan National University Childrens' Hospital, Yangsan, Korea
| | - Hyun-Young Kim
- Department of Pediatric Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Eun Jung
- Department of Pediatric Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kwi-Won Park
- Department of Pediatric Surgery, Seoul National University College of Medicine, Seoul, Korea
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Abstract
Blue Rubber Bleb Nevus Syndrome (BRBNS) is an uncommon congenital disorder characterized by sporadic venous malformation which mainly occurs in skin and alimentary canal. Here, we report a BRBNS patient with concomitant intestinal intussusception who diagnosed by intraoperative endoscopy and ultimately managed using surgical resection. A 19-year-old boy was referred to urgent surgery for acute melena and stomachache. He had used to be a long-term iron user for undiagnosed chronic anemia and papules. Abdominal CT on admission demonstrated the presence of intestinal intussusception. The following exploratory laparotomy and intraoperative endoscopy revealed multiple gastrointestinal hemangiomas. The postoperative course was uneventful and pathological examination certified multiple cavernous hemangiomas in the resected gastrointestines.
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Affiliation(s)
- Yuanjie Wang
- Department of Gastroenterology Surgery, Taizhou People's hospital, Taizhou, China
| | - Xiaojun Zhao
- Department of Gastroenterology Surgery, Taizhou People's hospital, Taizhou, China
| | - Xiaolan You
- Department of Gastroenterology Surgery, Taizhou People's hospital, Taizhou, China
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Zahedi MJ, Darvish Moghadam S, Seyed Mirzaei SM, Dehghani M, Shafiei pour S, Rasti A. Blue Rubber Bleb Nevus Syndrome as a rare Cause of Iron Deficiency Anemia: a Case Report and Review of Literature. Middle East J Dig Dis 2013; 5:235-9. [PMID: 24829697 PMCID: PMC3990150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 09/11/2013] [Indexed: 11/08/2022] Open
Abstract
Blue Rubber Bleb Nevus Syndrome is a rare disorder that is characterizedby multiple recurrent vascular malformations of skin and gastrointestinal tract.The affected patients may present with diverse manifestations including irondeficiency anemia. We report this syndrome in a 22-year-old man that was referred to our hospitalfor iron deficiency anemia with unknown cause and vascular malformationsin the skin and gastrointestinal tract. Because of stable hemoglobin level,we decided to treatment him by iron supplementation and close follow up. Wereport this case along with a review of literature.
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Affiliation(s)
- Mohammad Javad Zahedi
- 1Department of Internal Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | | | | | - Masood Dehghani
- 2Clinical Research Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Sara Shafiei pour
- 1Department of Internal Medicine, Kerman University of Medical Sciences, Kerman, Iran
,Corresponding Author: Sara Shafieipour, MD Clinical Research Unit, Afzalipour Hospital, Kerman, Iran Telefax: +98 341 3222270
| | - Atefe Rasti
- 2Clinical Research Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
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Lee SJ, Lee HY, Jung K, Kim SE. (99m)Tc-Labeled RBC Scan in a Patient with Blue Rubber Bleb Nevus Syndrome: A Case Report. Nucl Med Mol Imaging 2013; 47:115-8. [PMID: 24900091 DOI: 10.1007/s13139-013-0199-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Revised: 03/05/2013] [Accepted: 03/06/2013] [Indexed: 01/10/2023] Open
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare disorder characterized by cutaneous and gastrointestinal vascular malformations. We report here the case of a 13-year-old patient with BRBNS who was suffering from chronic anemia. His chief complaint was melena. Contrast-enhanced abdominal computed tomography showed multiple hemangiomas in the small bowel. (99m)Tc-labeled red blood cell (RBC) scan identified the bleeding sites in the small bowel. The patient underwent exploratory laparotomy with segmental resection and multiple wedge resection of the small bowel. The pathological results confirmed the multiple cavernous hemangiomas. This case confirms the critical role of the (99m)Tc-labeled RBC scan in localizing the bleeding sites in patients with BRBNS.
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31
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Aroor S, Varma C, Mundkur SC. Blue Rubber-Bleb Nevus Syndrome which was Associated with an Atrial Septal Defect: A Case Report. J Clin Diagn Res 2013; 6:1566-7. [PMID: 23285461 DOI: 10.7860/jcdr/2012/4197.2564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Accepted: 07/16/2012] [Indexed: 11/24/2022]
Abstract
The Blue Rubber Bleb Nevus Syndrome (BRBNS) is a rare cause of persisting gastrointestinal bleeding. We are presenting a case which was associated with an atrial septal defect.
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Grammatopoulos A, Petraki K, Katsoras G. Combined use of band ligation and detachable snares (endoloop) in a patient with blue rubber bleb nevus syndrome. Ann Gastroenterol 2013; 26:264-6. [PMID: 24714239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 03/18/2013] [Indexed: 11/17/2022] Open
Abstract
A 20-year-old woman was admitted with iron deficiency anemia and history of melena. Upper endoscopy demonstrated normal esophagus, stomach and proximal duodenum. At colonoscopy, two bluish pedunculated angiectatic polypoid lesions (1 to 2 cm in diameter) were noted due to blue rubber bleb nevus syndrome (BRBNS). The small intestine was screened for further lesions with the use of capsule endoscopy. The capsule identified four more lesions at the proximal jejunum. The small bowel lesions were smaller, 0.5 to 1cm in diameter at their bases. We performed enteroscopy to approach the jejunal lesions. All lesions were ligated in one session using the band ligation technique with multi-band ligator device. A colonoscopy was performed and detachable snares - endoloops were inserted at the colonic lesions. Three weeks following the interventions further endoscopic evaluations were performed; they revealed scars at all sites treated with either technique. No bleeding or new venous malformations were observed. In conclusion, we report a dual technique resection method on a patient with BRBNS. The choice of resection technique depended on the lesion characteristics. Both band ligation and endoloop can be safely used for polypoid BRBNS lesions at the jejunum and colon respectively.
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Choi KK, Kim JY, Kim MJ, Park H, Choi DW, Choi SH, Heo JS. Radical resection of intestinal blue rubber bleb nevus syndrome. J Korean Surg Soc 2012; 83:316-20. [PMID: 23166891 PMCID: PMC3491234 DOI: 10.4174/jkss.2012.83.5.316] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 07/09/2012] [Accepted: 07/30/2012] [Indexed: 02/06/2023]
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare systemic vascular disorder characterized by multiple venous malformations involving many organs. BRBNS can occur in various organs, but the most frequently involved organs are the skin and gastrointestinal (GI) tract. GI lesions of BRBNS can cause acute or chronic bleeding, and treatment is challenging. Herein, we report a case of GI BRBNS that was successfully treated with a combination of intraoperative endoscopy and radical resection.
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Affiliation(s)
- Kang Kook Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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34
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Zhao J, Gao SL, Liu BR, Liu ZH, Fan YJ. One case report of blue rubber bleb nevus syndrome. Shijie Huaren Xiaohua Zazhi 2011; 19:2081-2083. [DOI: 10.11569/wcjd.v19.i19.2081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare disorder characterized by distinctive cutaneous and gastrointestinal venous malformations that usually cause massive or occult gastrointestinal hemorrhage and iron deficiency anemia secondary to the bleeding episodes. Other organs may also be involved. We report a case with symptoms of chronic gastrointestinal hemorrhage. The endoscopy revealed multiple bluish polypoid venous malformations throughout the GI tract. Curative effect was obtained by removing venous malformations of the GI through endoscopic sclerotherapy, ligation and ESD.
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