Efficacy of foam sclerotherapy with polidocanol for the management of oral venous malformations

The present aimed to examine the effectiveness of polidocanol-based foam sclerotherapy for oral venous malformations (OVMs). The present study performed a retrospective analysis of patients with OVMs who underwent sclerotherapy using polidocanol. Patients achieving the complete resolution of OVM were categorized as having a complete response (CR), those with a reduction in size from the initial diagnosis were categorized as having a partial response (PR), those with no change in size as stable disease (SD), and those with an increase in size as progressive disease (PD). A total of 16 patients, comprising 4 males and 12 females, underwent treatment with polidocanol foam therapy, covering 22 affected areas. The treatment administered resulted in CR in 6 cases and PR in 10 cases, with no instances of SD or PD. Apart from localized injection site pain or swelling, there were no severe side-effects reported, such as circulatory dynamic changes or skin necrosis. On the whole, these findings underscore the effectiveness of foam sclerotherapy with polidocanol as a viable treatment for venous malformations in the oral and maxillofacial regions.

Fluoroscopy- and Endoscopy-Guided Transoral Sclerotherapy Using Foamed Polidocanol for Oropharyngolaryngeal Venous Malformations in a Hybrid Operation Room: A Case Series

Background: Treatment of oropharyngolaryngeal venous malformations (VMs) remains challenging. This study evaluated the effectiveness and safety of fluoroscopy- and endoscopy-guided transoral sclerotherapy for oropharyngolaryngeal VMs in a hybrid operation room (OR). Methods: Patients with oropharyngolaryngeal VMs who underwent transoral sclerotherapy in a hybrid OR were enrolled. Results: Fourteen patients (six females, eight males; median age of 26 years; range, 4-71 years) were analyzed. The symptoms observed were breathing difficulties (n = 3), snoring (n = 2), sleep apnea (n = 1), and swallowing difficulties (n = 1). Lesions were extensive in the face and neck (n = 9) and limited in the oropharyngolarynx (n = 5). A permanent tracheostomy was performed on two patients, while a temporary tracheostomy was performed on five patients. The treated regions were the soft palate (n = 8), pharynx (n = 7), base of the tongue (n = 4), and epiglottis (n = 1). The median number of sclerotherapy sessions was 2.5 (range, 1-9). The median follow-up duration was 81 months (range, 6-141). Treatment outcomes were graded as excellent (n = 2), good (n = 7), or fair (n = 5). The post-treatment complication was bleeding (n = 1), resulting in an urgent tracheostomy. Conclusions: Fluoroscopy- and endoscopy-guided transoral sclerotherapy in a hybrid OR can be effective and safe for oropharyngolaryngeal VMs.

Breast Hemangiomas: Imaging Features With Histopathology Correlation

Breast hemangiomas are rare benign vascular lesions. In a previously performed review of approximately 10,000 breast surgical pathology results, roughly 0.15% (15/~10,000) were hemangiomas. Hemangiomas are more frequent in women and have a documented age distribution of 1.5 to 82 years. They are most often subcutaneous or subdermal and anterior to the anterior mammary fascia but may rarely be seen in the pectoralis muscles or chest wall. On imaging, breast hemangiomas typically present as oval or round masses, often measuring less than 2.5 cm, with circumscribed or mostly circumscribed, focally microlobulated margins, equal or high density on mammography, and variable echogenicity on US. Calcifications, including phleboliths, can be seen. Color Doppler US often shows hypovascularity or avascularity. MRI appearance can vary, although hemangiomas are generally T2 hyperintense and T1 hypointense with variable enhancement. Pathologic findings vary by subtype, which include perilobular, capillary, cavernous, and venous hemangiomas. If core biopsy pathology results are benign, without atypia, and concordant with imaging and clinical findings, surgical excision is not routinely indicated. Because of histopathologic overlap with well-differentiated or low-grade angiosarcomas, surgical excision may be necessary for definitive diagnosis. Findings that are more common with angiosarcomas include size greater than 2 cm, hypervascularity on Doppler US, irregular shape, and invasive growth pattern.

PHACE syndrome: a case report and a comprehensive review

Introduction and importance

PHACE syndrome is a rare neurocutaneous disorder characterized by large segmental hemangiomas on the face and is associated with multiple developmental defects. PHACE stands for posterior fossa malformations, hemangiomas, arterial abnormalities, cardiac defects, and eye anomalies, with the most common manifestation being hemangioma in the cervico-facial region in early childhood.

Case presentation

The authors report a case of a 15-year-female with complaints of facial hemangioma which on multisystemic imaging showed features of central nervous system (CNS) anomalies that led to the diagnosis of PHACE syndrome. The patient was started on propanolol which decreased the size of hemangioma in follow-up visits.

Clinical discussion

The hemangioma in the frontotemporal and frontonasal area of the face are associated more with CNS and cardiovascular anomalies needing a detailed multisystem approach. CNS anomalies include posterior cerebral fossa enlargement, cystic dilation of the fourth ventricle, arachnoid cyst, and cerebellar hypoplasia which were present in our case. Propanolol is considered the first-line drug for facial hemangioma with reported evidence of remarkable improvement and good tolerance. However, regular follow-up of the patient is needed to rule out any recurrence.

Conclusion

PHACE syndrome, although being a rare occurrence, must be kept as a differential diagnosis in infants and children with facial hemangioma. Imaging modalities like MRI/magnetic resonance arteriography must be used to rule out possible associations related to PHACE syndrome and focus on early treatment to prevent possible complications.

A Rare Case of Intraosseous Papillary Hemangioma of the Head and Neck

Papillary hemangioma is a novel variant of intravascular hemangioma. It is more common in adults and has a male predominance. Most tumors reported so far are solitary and cutaneous. Here we present a rare case of an intraosseous papillary hemangioma involving the frontal bone. Brain imaging in a 69-year-old man with a slowly enlarging swelling on the right frontal area following an accidental fall demonstrated a 4.5 cm × 1.7 cm × 4.2 cm mass originating from the right frontal bone, with a tiny defect on the orbital roof. A malignant process was favored, and the mass was removed. Histopathology revealed a vascular lesion showing intraosseous distribution with foci of extension into the fibrous connective tissue. There were areas of plump endothelial cells with intracytoplasmic hyaline globules arranged in papillary configuration. The lesional cells were immunoreactive with CD34. AE1/AE3, EMA, PR, D2-40, inhibin, and S100 stains were negative. Ki-67 was low. This is the first intraosseous and second noncutaneous papillary hemangioma. Clinically it differs from other cases by the presence of trauma as a preceding event. Since its prognosis is unknown such patients should be monitored for recurrence or malignant transformation.

Subcutaneous fibroblastoma resembling hemangioma: A case of benign tumor of the chest wall

Key Clinical Message

Desmoplastic fibroma presents similar to other soft tissue tumors to such an extent that even a gold standard investigation can miss.

Abstract

This is to report a mass in a 47-year-old male arising from the chest wall, which was first thought to be a hemangioma but was later diagnosed as a case of desmoplastic fibroblastoma with the help of a biopsy.

Effect of Thyrocervical Artery Embolization for Mediastinal Hemangioma with Pleural Effusion

A 72-year-old man was admitted to our hospital with a complaint of breathlessness. Computed tomography (CT) revealed a tumor with intense early enhancement and pleural effusion. Although the pleural effusion was not bloody, the tumor showed a hypervascular area on angiography. Left thyrocervical artery embolization was performed to prevent bleeding during the operation. After embolization, chest radiography revealed decreased pleural effusion. The tumor was resected and pathologically diagnosed as a mediastinal cavernous hemangioma. To our knowledge, mediastinal hemangiomas with pleural effusion are extremely rare; thus, this is the first report of reduced pleural effusion in mediastinal hemangiomas after artery embolization.

Fallopian Tube Hemangioma Discovered on Follow-up for Uterine Leiomyoma

Hemangioma in female reproductive organs, particularly in the fallopian tube (FT), is a sporadic disease. In this report, we describe a case of hidden capillary hemangioma in FT in a 39-year-old woman who suffered from uterine leiomyoma. During the preoperative stage, pelvic sonography, computed tomography, and diagnostic laparoscopy revealed a subserous leiomyomatous nodule located along the posterior wall of the uterus. Despite this, intraoperatively, a benign vascular neoplasm was diagnosed. Histologically, it is characterized by multiple thin-walled vascular spaces lined with a single layer of endothelial cells, in which single mitoses were observed. The diagnosis was then confirmed immunohistochemically by CD31 and CD34 expression in the endothelial cells lining the inner surface of the spaces and the low mitotic activity of the tumor cells. It is virtually impossible to diagnose this asymptomatic neoplasm before and during surgery, which can result in an inadequate number of surgeries. Incorrect interpretation of a benign tumor at a young age can lead to unnecessary radical surgery with a resulting loss of fertility, and an unrevealed malignant process can threaten life.

Non-vascular intracranial lesions in three children with PHACE association

PHACE (posterior fossa malformations, hemangiomas, arterial anomalies, cardiac anomalies, eye anomalies) association has many recognized clinical features. A link between PHACE and non-vascular intracranial lesions has not been well-described. We report three pediatric patients with PHACE and non-vascular intracranial lesions.

Fucoidan suppresses proliferation and epithelial-mesenchymal transition process via Wnt/β-catenin signalling in hemangioma

Hemangioma is a common benign tumour that usually occurs on the skin of the head and neck, particularly among infants. The current clinical treatment against hemangioma is surgery excision, however, application of drug is a safer and more economical therapy for children suffering from hemangioma. As a natural sulfated polysaccharide rich in brown algae, fucoidan is widely recognized for anti-tumour bioactivity and dosage safety in humans. This study aims to demonstrate the anti-tumour effect and underlying mechanism of fucoidan against hemangioma in vivo and in vitro. We investigated the effects of fucoidan by culturing hemangioma cells in vitro and treating BALB/c mice bearing with hemangioma. At first, we measured the cell proliferation and migration ability through in vitro experiments. Then, we tested the expression of epithelial-mesenchymal transition (EMT) and Wnt/β-catenin pathway-related biomarkers by western blot and qPCR. Furthermore, we applied β-catenin-specific inhibitor, XAV939, to determine whether fucoidan suppressed EMT via the Wnt/β-catenin pathway in hemangioma cells. In vivo experiments, we applied oral gavage of fucoidan to treat EOMA-bearing mice, along with evaluating the safety and efficacy of fucoidan. We found that fucoidan remarkably inhibits the proliferation and EMT ability of hemangioma cells, which is dependent on the Wnt/β-catenin pathway. These results suggest that fucoidan exhibits tumour inhibitory effect on aggressive hemangioma via regulating the Wnt/β-catenin signalling pathway both in vitro and in vivo, providing a new potent drug candidate for treating hemangioma.

Electrochemotherapy in Aggressive Hemangioma of the Spine: A Case Series and Narrative Literature Review

(1) Background: this case series and literature review aims to evaluate the efficacy and safety of electrochemotherapy in the management of aggressive spinal hemangiomas, presenting two distinct cases. (2) Methods: we present two cases of spinal aggressive hemangioma which were refractory to conventional treatments and underwent electrochemotherapy. Case 1 involves a 50-year-old female who presented with an aggressive spinal hemangioma of L1, who previously underwent various treatments including surgery, radio-chemotherapy, and arterial embolization. Case 2 describes a 16-year-old female with a T12 vertebral hemangioma, previously treated with surgery and stabilization, who faced limitations in treatment options due to her young age and the location of the hemangioma. (3) Results: in Case 1, electrochemotherapy with bleomycin was administered following the failure of previous treatments and resulted in the reduction of the lesion size and improvement in clinical symptoms. In Case 2, electrochemotherapy was chosen due to the risks associated with other treatments and was completed without any adverse events. Both cases demonstrated the potential of electrochemotherapy as a viable treatment option for spinal hemangiomas, especially in complex or recurrent cases. (4) Conclusions: electrochemotherapy with bleomycin is a promising treatment for aggressive spinal hemangiomas when conventional therapies are not feasible or have failed. Further research is needed to establish definitive protocols and long-term outcomes of electrochemotherapy in spinal hemangioma management.

Littoral cell angioma of the spleen: case report and literature review

Littoral cell angioma is an extremely rare splenic vascular tumor originating from the cells lining the splenic red pulp sinuses. Approximately 150 cases of littoral cell angioma have been reported since 1991. Its clinical manifestation is usually asymptomatic and is mostly diagnosed as an incidental finding through abdominal imaging. Herein, we present a case of littoral cell angioma in a 41-year-old woman with no previous comorbidities, which initially presented as a nonspecific splenic lesion diagnosed on imaging in the emergency room. The patient was treated through laparoscopic intervention.

Documented growth of an intracranial capillary hemangioma: A case report

Intracranial capillary hemangiomas in adults are rare, and diagnosis can be challenging. Hemangiomas, in general (and particularly in the skin), are more often noted in the pediatric population. Due to the lack of imaging undertaken in the presymptomatic phase, the literature provides few clues on the rate of growth of these unusual tumors. Therefore, we report a case of a 64-year-old man with a medical history of Lyme disease who presented with exhaustion and confusion. Imaging demonstrated an intra-axial lesion with vascularity in the posterior right temporal lobe, raising the possibility of a glioma. Imaging two years prior revealed a very small lesion in the same location. The patient underwent a craniectomy, total resection of the lesion was completed, and his symptoms of confusion resolved. Biopsy revealed a capillary hemangioma composed of small vascular channels lined by endothelial cells and pericytes without smooth muscle. Features of glioma, vascular neoplasms or neuroborreliosis (cerebral Lyme disease) were not identified. Our case documents the growth over two years of a rare intracranial capillary hemangioma in an older adult male.

A rare case report of cervical hemangioma and a comprehensive literature review of 137 cases of cervical and uterine hemangiomas

The cervix of the uterus is a rare site for cavernous hemangiomas. Cervical hemangiomas are slow-growing tumors with characteristic histological findings, including dilated vessels with increased endothelial cells. Although their pathophysiology remains unclear, hormones are believed to play an important role in the development of these vascular tumors. They may be asymptomatic due to their small size, but they can cause gynecological and obstetrical complications, including abnormal uterine bleeding and impaired fertility. Due to their small size, conservative treatment is the first line of management. Hysterectomy is considered for refractory cases or for patients who are not of childbearing age. In this study, firstly, we presented a case of a 60-year-old postmenopausal female without any gynecological-related signs or symptoms with a polypoid nodule hanging over the anterior cervical wall through its stalk. The surgical biopsy revealed no signs of neoplastic changes, with the only notable finding being a benign vascular lesion representing a cavernous hemangiomatous cervical polyp. The patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy and she is currently healthy without any further abnormal findings. Additionally, we provided a comprehensive review of 137 cases in the literature since 1883, detailing their characteristics, signs and symptoms, and pathology.

Rapid low-cost hyperspectral imaging system for quantitative assessment of infantile hemangioma

Hemangioma, the predominant benign tumor occurring in infancy, exhibits a wide range of prognoses and associated outcomes. The accurate determination of prognosis through noninvasive imaging modalities holds essential importance in enabling effective personalized treatment strategies and minimizing unnecessary surgical interventions for individual patients. The present study focuses on advancing the personalized prognosis of hemangioma by leveraging noninvasive optical sensing technologies by the development of a novel rapid hyperspectral sensor (image collection in 5 s, lateral resolution of 10 μm) that is capable of quantifying hemoglobin oxygenation and vascularization dynamics during the course of tumor evolution. We have developed a quantitative parameter for hemangioma assessment, that demonstrated agreement with the clinician's conclusion in 90% among all cases during clinical studies on six patients, who visited clinician from two to four times. The presented methodology has potential to be implemented as a supportive tool for accurate hemangioma diagnostics in clinics.

Clinical Approaches To External Auditory Canal Hemangiomas: A Systematic Review

OBJECTIVES

Hemangioma is a common soft tissue tumor that can be categorized mainly into cavernous, capillary, and venous subtypes. It usually develops in the head and neck and rarely in the external auditory canal (EAC).

METHODS

A systematic review of patients with capillary hemangioma of the EAC was performed. A computerized systematic search was conducted in PubMed, Scopus, and Web of Science to extract relevant studies for a qualitative review.

RESULTS

A total of 38 patients were included in the systematic review, and half of them were men. Hearing loss was the most common presenting feature (n = 19; 50%), followed by aural fullness (n = 15; 39.4%). Cavernous hemangioma was the predominant type (n = 22, 57.8%). Endaural and transcanal surgical approaches were the most frequent, with ten (26.3%) and nine (23.6%) cases, respectively. Most of the patients (n = 31; 81.5%) had no recurrence.

CONCLUSIONS

Hemangioma of the EAC may not be uncommon as healthcare professionals may expect. Hearing loss, aural fullness, and tinnitus are possible symptoms, but many patients remain asymptomatic. Surgical excision is the main effective management option, and complete resolution is the most prevalent outcome. Computed tomography assists in the diagnosis, but histopathological examination after resection is mandatory for the definitive diagnosis.

MicroRNA‑203a‑3p improves bleomycin and pingyangmycin sensitivity by inactivating the PI3K/AKT pathway in hemangioma

MicroRNAs (miRs) have been found to play a fundamental role in the pathology and progression of hemangioma. Of note, miR-203a-3p prevents hemangioma progression via inactivation of the PI3K/AKT pathway. Bleomycin and pingyangmycin are drugs used in sclerotherapy, but certain hemangioma patients experience drug resistance, leading to poor clinical outcomes. The present study aimed to explore the impact of miR-203a-3p on bleomycin and pingyangmycin sensitivity in hemangioma, as well as the involvement of the PI3K/AKT pathway. miR-203a-3p or negative control mimics were transfected into human hemangioma endothelial cells, which were treated with 0-20 µM bleomycin or pingyangmycin. Subsequently, 740 Y-P, a PI3K/AKT pathway agonist, was added. Cell viability, rate of apoptosis and the expression levels of proteins involved in the PI3K/AKT pathway, including phosphorylated (p)-PI3K, PI3K, p-AKT and AKT, were detected. miR-203a-3p overexpression significantly decreased the half-maximal inhibitory concentration (IC50) values of bleomycin (5.84±0.87 vs. 14.23±2.17 µM; P<0.01) and pingyangmycin (5.13±0.55 vs. 12.04±1.86 µM; P<0.01), compared with untreated cells. In addition, under bleomycin or pingyangmycin treatment, miR-203a-3p overexpression significantly reduced the proportion of EdU positive cells (both P<0.05) and B-cell leukemia/lymphoma-2 (BCL2) protein expression levels (both P<0.05), whilst increasing cell apoptosis rate (both P<0.05) and cleaved caspase 3 protein expression levels (both P<0.05) compared with untreated controls. Furthermore, miR-203a-3p overexpression significantly inhibited the phosphorylation of PI3K and AKT (both P<0.05), an effect that was significantly diminished by 740 Y-P treatment (both P<0.01). In addition, 740 Y-P significantly increased IC50 values of bleomycin (P<0.01) and pingyangmycin (P<0.001) and also significantly increased the proportion of EdU-positive cells and BCL2 protein expression levels, while decreasing the apoptosis rate and cleaved caspase 3 protein expression levels in cells treated with bleomycin or pingyangmycin (all P<0.05). Of note, 740 Y-P weakened the effect of miR-203a-3p overexpression on the aforementioned cellular characteristics. The present study demonstrated that miR-203a-3p improved the sensitivity of cells to bleomycin and pingyangmycin treatment by inhibiting PI3K/AKT signaling in hemangioma.

New Prospects on Neuroimaging in Von Hippel Lindau Disease-A Narrative Review

(1) Background: Hemangiomas in Von Hippel-Lindau (VHL) syndrome patients are typically benign but pose threats due to their vital locations involving the central nervous system and the retina. An MRI is currently recommended as the gold standard for tumors associated with VHL in the head region. This narrative review aims to comprehensively outline current standards and recent findings related to imaging of retinal and CNS hemangiomas in Von Hippel-Lindau syndrome. (2) Material and Methods: A review in adherence to PRISMA guidelines using the search string "Von Hippel-Lindau hemangioblastoma imaging" was conducted on PUBMED and SCOPUS databases. (3) Results: After reviewing 455 titles and abstracts, 20 publications fulfilling the inclusion criteria were analyzed. The analysis included studies describing MRI, CT, optical coherence tomography, and PET/CT. (4) Conclusion: While MRI remains the gold standard for diagnosing head tumors in Von Hippel-Lindau syndrome, various PET/CT methods show promise as alternative imaging modalities.

Heme-Inducing Endothelial Pyroptosis Plays a Key Role in Radiofrequency Ablation of Hepatic Hemangioma Leading to Systemic Inflammatory Response Syndrome

Purpose

Systemic inflammatory response syndrome (SIRS) is a common complication of radiofrequency ablation (RFA) for hepatic hemangiomas. RFA can cause hemolytic reactions during hepatic hemangioma ablation. However, the mechanisms underlying RFA-induced SIRS remain unclear.

Methods

We established an orthotopic liver hemangioma model and performed radiofrequency ablation. The levels of interleukin (IL)-1β and IL-18 and the production of ROS were measured. The wet-to-dry lung ratio, inflammation score, and in vivo endothelial cell permeability were examined. GSDMD-/- mice were used to investigate the effect of heme-inducing SIRS. RNA sequencing (RNA-seq) was performed to identify the main pathways underlying heme-induced SIRS. Western blotting and immunoprecipitation were used to determine the changes and interactions of associated proteins.

Results

The levels of heme, IL-1β, and IL-18 were significantly increased after RFA. The wet-to-dry lung ratio increased in hepatic hemangiomas after RFA, indicating that SIRS occurred. Heme induced increased levels of IL-1β and IL-18, cell death, wet-to-dry lung radio, and inflammation score in vitro and in vivo, indicating that heme induced SIRS and pyroptosis. Furthermore, GSDMD participates in heme-induced SIRS in mice, and GSDMD deletion in mice reverses the effect of heme. Heme regulates NLRP3 activation through the NOX4/ROS/TXNIP-TRX pathway, and an N-acetyl-L-cysteine (NAC) or NOX4 inhibitor (GLX351322) reverses heme-induced SIRS.

Conclusion

Our findings suggest that heme induces endothelial cell pyroptosis and SIRS in mice and decreasing heme levels and ROS scavengers may prevent SIRS in hepatic hemangioma after RFA.

The Regulatory Role and Mechanism of Energy Metabolism in Vascular Diseases

Vascular diseases are amongst the most serious diseases affecting human life and health globally. Energy metabolism plays a crucial role in multiple vascular diseases, and the imbalance of energy metabolism in cells from the blood vessel wall can cause various vascular diseases. Energy metabolism studies have often focused on atherosclerosis (AS) and pulmonary hypertension (PH). However, the roles of energy metabolism in the development of other vascular diseases is becoming increasingly appreciated as both dynamic and essential. This review summarizes the role of energy metabolism in various vascular diseases, including AS, hemangioma, aortic dissection, PH, vascular aging, and arterial embolism. It also discusses how energy metabolism participates in the pathophysiological processes of vascular diseases and potential drugs that may interfere with energy metabolism. This review presents suggestions for the clinical prevention and treatment of vascular diseases from the perspective of energy metabolism.

Cavernous hemangioma of the breast: a case report

Background

Hemangioma is a common benign tumor resulting from abnormal blood vessel growth but is infrequent in the breast. Preoperatively, it is challenging to diagnose breast hemangioma using clinical and conventional imaging modalities because of their lack of pathognomonic characteristics. An excisional biopsy can be used for tissue diagnosis in cases of diagnostic uncertainty.

Case presentation

The authors report a case of cavernous hemangioma of the breast in a 15-year-old adolescent female complaining of a rapidly enlarging firm and mobile lump in the right breast. Breast ultrasonography revealed a well-circumscribed, encapsulated, heteroechoic mass with smooth margins in the retroareolar region of the right breast. Subsequent excision of the lump revealed features of a cavernous hemangioma, and the follow-up was uneventful.

Discussion

Cavernous hemangioma of the breast is a rare entity, and its diagnosis poses a significant challenge for clinicians, as the lump may not be noticeable. The clinical diagnosis is challenging; therefore, imaging is required. Breast ultrasonography typically shows a hypoechoic lobulated mass with clear borders, although isoechoic and hyperechoic appearances are also possible. Breast mammography revealed a well-defined mass with areas of calcification. Surgical excision is often necessary when there is a discordance between imaging and histopathological findings, lesions greater than 2 cm, and atypical/malignant features.

Conclusion

Breast hemangiomas are rare benign tumors with nonspecific imaging features that require tissue sampling for diagnosis. Clinicians should be familiar with these characteristics to ensure proper management.

A Huge Hemangioma of the Urinary Bladder: A Case Report and Literature Review

Cavernous hemangioma of the bladder is a benign and very rare vascular tumor. It can be isolated or part of a syndrome. Neither clinical symptoms nor imaging modalities lead to a definitive diagnosis as there are no specific findings on imaging studies or specific symptoms. Painless gross hematuria is the most common chief complaint and presentation and should never be underestimated. Here, we report a case of a large hemangioma of the urinary bladder in a young man who presented with recurrent recent episodes of painless gross hematuria and, surprisingly, with a previous episode of painless hematuria 15 years ago, which was treated successfully with partial cystectomy. We discuss the clinical features, evaluation, diagnosis, biopsy, management, the challenges encountered in treatment, and assert the value of tissue diagnosis and follow-up pattern and period. Due to the rarity of the tumor and lack of trials and evidence-based guidelines for management, treatment modalities vary and the risk for recurrence is questionable and not known.

Unusual presentation and histopathology of bilateral nasal polypi; cavernous hemangioma (right) and inverted papilloma (left)

Hemangiomas are common lesions in medical practice, but those arising in the nasal cavity and/or paranasal sinuses are rare. Inverted papilloma is a rare benign tumor with a high incidence rate in both the nasal cavity and sinuses. The presence of both lesions in the same patient is even rarer. Here we present a case of a male patient with an unusual presentation and dual pathologies of cavernous hemangioma and inverted papilloma of the sinonasal tract that underwent endoscopic surgery and showed no recurrence of disease after a 2-year follow-up. The association of nasal cavernous hemangioma at one side and inverted papilloma at the other side is a very rare occasion that requires further studies and histopathology is the only diagnostic tool.

Acquired arteriovenous hemangioma on the nose of a middle-aged man: A case report

Arteriovenous hemangioma is a rare, benign vascular lesion that presents with an asymptomatic red or violaceous papule which is frequently asymptomatic but pruritus, pain and enlargement may be seen in some patients. In histology it is composed of thick-walled and thin-walled blood vessels distributed in superficial and mid dermis. The treatment of choice in such cases is complete excision and recurrence is rare. In this article we describe an acquired form of arteriovenous hemangioma on the nose of a middle-aged man.

Papillary Hemangioma Harbors Somatic GNA11 and GNAQ Mutations

Papillary hemangioma (PH) is a small, primarily dermal lesion occurring predominantly in the head and neck in both children and adults. Its signature characteristics are dilated thin-walled channels containing papillary clusters of mainly capillary-sized vessels and endothelial cytoplasmic eosinophilic inclusions. Given certain histopathologic similarities to congenital hemangioma which harbor mutations in GNAQ and GNA11 , we investigated whether similar mutations are present in PH. Seven PH specimens were studied. All presented in the first 4 years of life, with one being noted at birth. With the exception of one lesion, all were in the head and neck. Lesions were bluish and ranged in size from 0.5 to 2.8 cm. Four samples had GNA11 p.Q209L and 3 had GNAQ p.Q209L missense mutations. Mutations in GNA11 and GNAQ are associated with other types of somatic vascular lesions including capillary malformation, congenital hemangioma, anastomosing hemangioma, thrombotic anastomosing hemangioma, and hepatic small cell neoplasm. Shared mutations in GNA11 and GNAQ may account for some overlapping clinical and pathologic features in these entities, perhaps explicable by the timing of the mutation or influence of the germline phenotype.

Intestinal hemangiomas in 8 horses

This retrospective study describes 8 cases of intestinal hemangioma diagnosed in horses during postmortem examination or surgical biopsy at the University of Tennessee College of Veterinary Medicine. In all cases, the intestine was the sole organ affected, and lesions were focal (3/8) or multifocal (5/8). Nodules were most commonly within the small intestine (7/8), particularly the jejunum (5/7). One case was in the left dorsal colon, which is the first report of hemangioma in the large colon of a horse. Lesions were discrete, raised, smooth, black to red, and ranged from 2 to 15 mm in diameter. Microscopically, all lesions were cavernous type and mural, most frequently within the muscularis (6/8). A majority of cases occurred in middle aged to older horses (average age of 19.3 years), and no breed or sex predilections were identified. The hemangiomas were considered incidental findings.

A cutaneous epithelioid vascular tumor harboring a TPM3::ALK fusion

Substantial progress has been made in understanding the molecular pathways associated with vascular tumors over the last two decades. In addition to mutations and copy number aberrations, fusions have emerged as significant contributors to the pathogenesis of a notable subset of vascular tumors. In this report, we present a case of an unusual intradermal vascular tumor with epithelioid cytomorphology. Immunohistochemistry revealed diffuse positivity for CD31, ERG and Factor VIII, supporting its endothelial lineage. RNA sequencing (ArcherFusion Plex) revealed the presence of an in-frame fusion between the genes TPM3 Exon 8 and ALK Exon 20. Immunohistochemistry confirmed ALK expression by the endothelial cells. To our knowledge, this is the first documented case of a vascular tumor harboring an ALK fusion. It may fall within the spectrum of epithelioid hemangiomas; nevertheless, we cannot definitively exclude the possibility of it being a distinct and potentially unique benign entity on its own.

Benign Vascular Lesions of the Breast: A Clinical, Radiographic, and Pathologic Review

Vascular lesions of the breast are uncommon, however, these are increasingly encountered now due to more frequent use of magnetic resonance imaging. They comprise a spectrum of lesions including benign, atypical, and malignant tumors. The prototype is a hemangioma, which is most often nonpalpable and is detected on routine screening. Different histopathologic subtypes of hemangioma have been described, including perilobular, venous, cavernous, and capillary hemangioma. Other benign vascular lesions include anastomosing hemangioma, a well-circumscribed proliferation of anastomosing blood vessels with lobular or diffuse growth pattern which affects a large segment of the breast, presenting as a painless slow enlarging palpable mass. Recent data suggest that benign vascular lesions diagnosed on core needle biopsy with concordant radiologic and pathologic findings do not require excision and have an excellent prognosis, except angiomatosis, which can be locally aggressive and may recur. The main focus of this study is to present the radiographic, gross, and histopathologic characteristics of benign vascular lesions of the breast and their differential diagnoses.

Lipid-poor vertebral hemangioma mimicking a vertebral metastasis of cervical carcinoma

Vertebral hemangiomas are classified into typical and atypical forms. On imaging, atypical forms may look like malignant lesions. The confrontation of data from different imaging modalities (MRI; CT; scintigraphy) facilitates the diagnosis.

Excessively High Chronic Propranolol Overdose in Infantile Hemangioma: A Case Report

BACKGROUND Infantile hemangiomas are the most common benign tumors of childhood, occurring in approximately 5% of infants. Oral propranolol at 2 to 3 mg/kg daily is recommended for systemic treatment of high-risk infantile hemangiomas. Multiple propranolol formulations exist, and propranolol overdose can occur due to improper patient counseling. Propranolol acute toxicity in the pediatric population and its management are well described in the literature. However, data are lacking on chronic propranolol overdose and how to manage it, with the awareness that abrupt discontinuation of therapeutic doses of propranolol can lead to rebound sinus tachycardia. CASE REPORT A 7-month-old girl was prescribed a therapeutic dose of propranolol (1 mg/kg/day) to treat infantile hemangioma. However, due to an administration error, the patient received approximately 8 times the recommended dose (7.6 mg/kg/day for 2 months, then increased to 15.5 mg/kg/day for 2 weeks) and, surprisingly, remained asymptomatic. Her electrocardiogram was normal, and all routine laboratory tests were within the reference range. Propranolol was successfully tapered over 3 weeks by reducing the dose by 50% weekly until it reached the therapeutic dose. After tapering, the patient was asymptomatic, with a mild increase in hemangioma size. After 6 weeks of the therapeutic dose, the hemangioma was fading away. CONCLUSIONS This case is one of the few cases reported in the literature of high, chronic propranolol overdose in pediatric patients. The patient remained asymptomatic, and the overdose was successfully managed with gradual tapering over several weeks. This case report can serve as a guide in managing subsequent cases.

Right Parapharyngeal Cavernous Hemangioma, A Rare Entity: Case Report and Literature Review

Cavernous hemangioma is a noncancerous vascular growth that arises from different parts of the head and neck region. However, parapharyngeal space contributes a very small percentage for its occurrence. We present a case of right parapharyngeal cavernous hemangioma, a very rare clinical presentation. This is a 57-year-old female presented with throat discomfort for 3 months. Examination finding showed a soft, diffuse, and non-pulsating mass over the right upper jugulodigastric region. A contrasted computed topographic scan revealed multiple calcifications in right parapharyngeal space. T2-weighted magnetic resonance imaging showed right parapharyngeal space mass with high signal and multiple phleboliths and dynamic angiogram unremarkable. Surgical resection done via transcervical approach and histopathological report revealed cavernous hemangioma with calcified thrombi. In conclusion, surgical intervention is the mainstay treatment and transcervical approach which is adopted in this case is the commonest approach used in surgical resection of cavernous hemangioma.

A giant head and neck hemangioma of the fetus: A case report

RATIONALE

Hemangioma is a common benign disease in clinical practice, but it is rare to find a giant hemangioma in the fetal period.

PATIENT CONCERNS

Here, we report a case of a giant hemangioma of the fetal head and neck measuring approximately 10.1 × 6.5 cm.

DIAGNOSES

At first, only ultrasonography was used to diagnose the suspected hemangioma. The pregnant woman refused to undergo further testing and requested induction of labor, after which the tumor was finally sent for pathological examination to confirm hemangioma.

INTERVENTIONS AND OUTCOMES

Additionally, the fetus developed severe edema (fluid accumulation in the thoracic, abdominal, and pericardial cavities), which can be fatal to the fetus. Finally, the mother refused to continue the pregnancy and underwent induction of labor with rivanol.

LESSONS

Most hemangiomas are small and asymptomatic. Giant hemangiomas are rare and associated with a variety of maternal and fetal complications. Therefore, this article aims to summarize the knowledge related to hemangioma through this case, strengthen doctors' understanding of this disease, and bring the attention of pregnant women to this disease to ensure early diagnosis and treatment and prevent a poor prognosis.

Rare adrenal cavernous hemangioma: a case report highlighting diagnostic challenges

Introduction

Adrenal cavernous hemangiomas are rare benign vascular tumors that pose significant diagnostic challenges. Despite their benign nature, features overlapping with malignancies often complicate management decisions.

Case presentation

A 64-year-old male presented with a 4.4 cm necrotic left adrenal mass discovered incidentally on imaging. His medical history included papillary thyroid carcinoma, with subsequent thyroidectomy and radioactive iodine ablation. Evaluations for hiccups revealed multiple lung nodules, hypertrophic cardiomyopathy, and anemia. Given the patient's previous cancer history, elevated aldosterone/renin ratio, and mass size, our multidisciplinary tumor board decided to proceed with a left adrenalectomy. Post-surgical pathology confirmed a diagnosis of adrenal cavernous hemangioma.

Conclusion

The occurrence of ambiguous adrenal mass with other pathologies, such as our patient's papillary thyroid carcinoma, complicates the diagnostic and therapeutic landscape. As demonstrated in our case, opting for surgery remains a viable solution for adrenal cavernous hemangiomas, especially for masses greater than 4 cm. Interdisciplinary collaboration, exemplified by our tumor board's decision-making process, is crucial for optimal management. This case underscores the need for a multifaceted approach when confronting adrenal masses with such diagnostic ambiguity.

Oral rehabilitation of a 14-year-old quadriplegic child with cerebral palsy under general anesthesia: A case report

Cerebral palsy is a neuromuscular disorder in which patients deal with dysfunction in motor coordination in addition to other problems like epilepsy. Due to disrupted motor functions, the oromotor coordination is also affected, leading to higher incidence of dental caries, which is also due to increased consumption of medications. This case report deals with the oral rehabilitation of a quadriplegic 14-year-old child with cerebral palsy, suffering from severe dental pain and who was treated under general anesthesia.

Retroperitoneal capillary arteriovenous malformation mimicking a malignant neoplasm

Introduction

Retroperitoneal tumors account for 0.2% of all neoplasms. Among these tumors, retroperitoneal vascular malformations are particularly rare, with most previously reported cases being venous malformations.

Case presentation

A 72-year-old woman was diagnosed with a retroperitoneal tumor on abdominal computed tomography. The 27-mm diameter tumor was located away from the right kidney and major vessels in the right perirenal adipose tissue. Contrast-enhanced computed tomography revealed a heterogeneously enhanced tumor with well-defined borders. Dynamic contrast-enhanced magnetic resonance imaging revealed rapid enhancement in the arterial phase and a progressive filling-in pattern in the delayed phase. Although vascular malformation was suspected, a definitive diagnosis could not be established. The retroperitoneal tumor was excised laparoscopically for therapeutic and diagnostic purposes, and the histopathological diagnosis confirmed it as a capillary arteriovenous malformation.

Conclusion

Herein, we presented a rare case of retroperitoneal capillary arteriovenous malformation that was difficult to definitively diagnose preoperatively.

A case of large airway and orbital hemangiomas with facial capillary malformation

Infantile hemangiomas (IHs) are the most common pediatric vascular tumors, although their genetic etiology is largely unknown. Congenital capillary malformations (CMs) are associated with known somatic pathogenic variants, including GNAQ, GNA11, PIK3CA, and PIK3R1. Co-occurrence of a facial CM such as port wine stain and IH is not associated with any recognized vascular anomaly syndromes and rarely reported in the literature. We describe a case of a 5-week-old female patient with a large facial CM and extensive IHs of the lower lip, airway, and orbit who presented with airway compromise and responded to propranolol therapy.

Endoscopic removal of sinonasal hemangioma using vessel sealing device without tumor embolization

When massive bleeding is anticipated during endoscopic sinonasal tumor removal, a vessel sealing device is useful for successful tumor removal.

A rare case of ovarian hemangioma

We report a case of a 55-year-old woman who was accidentally discovered an ovarian mass during physical examination, which was eventually proved as hemangioma of the right ovarian by pathological findings.

The Mechanism of Oxymatrine Targeting miR-27a-3p/PPAR-γ Signaling Pathway through m6A Modification to Regulate the Influence on Hemangioma Stem Cells on Propranolol Resistance

OBJECTIVE

The proliferation and migration of hemangioma stem cells (HemSCs) induced apoptosis and adipose differentiation as well as increased the sensitivity of HemSCs to propranolol (PPNL). MiR-27a-3p negatively controlled the peroxisome-proliferator-activated receptor γ (PPAR-γ) level, counteracting the effect of PPAR-γ on HemSC progression and PPNL resistance. OMT accelerated HemSC progression and adipocyte differentiation via modulating the miR-27a-3p/PPAR-γ axis, inhibiting HemSC resistance to PPNL. In tumor-forming experiments, OMT exhibited a dose-dependent inhibitory effect on the volume of IH PPNL-resistant tumors, which was partially dependent on the regulation of m6A methylation transfer enzyme METTL3 and the miR-27a-3p/PPAR-γ axis, thereby inducing apoptosis.

CONCLUSIONS

We conclude that OMT regulates IH and influences PPNL resistance via targeting the miR-27a-3p/PPAR-γ signaling pathway through m6A modification.

A successful treatment with oral beta-blocker: A case report of a recurrent pyogenic granuloma in the external auditory canal

Pyogenic granuloma or lobular capillary hemangioma is a vascular proliferation of the skin and mucosal surface, most commonly in the oral or nasal cavity. To the best of our knowledge, a few cases of auricular pyogenic granuloma were published in the literature. In our case, a 14-year-old female complained of a recurrent pyogenic granuloma in the external auditory canal that regressed successfully with the oral beta-blocker treatment.

Scar Endometriosis vs Hemangioma: A Diagnostic Conundrum

Scar endometriosis refers to the presence of endometrial glands and stroma at the site of a scar. Hemangiomas, on the other hand, are benign vascular tumors. In this case report, we unravel the clinical enigma around a patient who presented with a painful mass at the previous cesarean section scar site. Initially, we were confident that this was ectopic endometrium presenting as scar endometriosis. However, our journey took an unexpected turn when histopathological findings contradicted our clinical suspicions. Here, we delve into the intricate details of this captivating case, shedding light on the complexities of the diagnosis we faced.

Mechanism of the HIF-1α/VEGF/VEGFR-2 pathway in the proliferation and apoptosis of human haemangioma endothelial cells

Haemangiomas (HAs) are prevalent vascular endothelial cell tumours. With respect to the possible involvement of HIF-1α in HAs, we have explored its role in haemangioma endothelial cell (HemEC) proliferation and apoptosis. shRNA HIF-1α and pcDNA3.1 HIF-α were manipulated into HemECs. HIF-α, VEGF, and VEGFR-2 mRNA and protein levels were assessed by qRT-PCR and Western blotting. Cell proliferation and viability, cell cycle and apoptosis, migration and invasion, and ability to form tubular structures were assessed by colony formation assay, CCK-8, flow cytometry, Transwell assay, and tube formation assay. Cell cycle-related protein levels, and VEGF and VEGFR-2 protein interaction were detected by Western blot and immunoprecipitation assays. An Haemangioma nude mouse model was established by subcutaneous injection of HemECs. Ki67 expression was determined by immunohistochemical staining. HIF-1α silencing suppressed HemEC neoplastic behaviour and promoted apoptosis. HIF-1α facilitated VEGF/VEGFR-2 expression and the VEGF had interacted with VEGFR-2 at protein - protein level. HIF-1α silencing arrested HemECs at G0/G1 phase, diminished Cyclin D1 protein level, and elevated p53 protein level. VEGF overexpression partially abrogated the effects of HIF-1α knockdown on inhibiting HemEC malignant behaviours. Inhibiting HIF-1α in nude mice with HAs repressed tumour growth and Ki67-positive cells. Briefly, HIF-1α regulated HemEC cell cycle through VEGF/VEGFR-2, thus promoting cell proliferation and inhibiting apoptosis.

Application of Lasers in Vascular Anomalies

Laser technology has significantly improved giving better results, which in turn has led to an increase in the indications for laser therapy. Vascular anomalies comprise vascular tumors and malformations. They are classified according to the type of vessels involved including arteries, capillaries, postcapillary venules, veins, lymphatic vessels, and a combination of two or more of these. Laser needs a chromophore to get absorbed and act. Hemoglobin, both oxy and deoxy, is one of the naturally occurring chromophore that is abundant in vascular lesions. Therefore, in most of the vascular lesions, lasers can bring improvement of a varying degree, while for superficial hemangiomas and port wine stain (PWS) laser treatment is now the standard of care. However, even though there is increase in the use of lasers in clinical practice, many surgeons are still unaware of its versatility and they are unsure about its safety. This article provides a brief overview of laser and intense pulsed light (IPL) technology, and describes the key principles in using these energy sources in vascular malformations. Readers are also familiarized with possible adverse effects and measures to prevent and treat them.

Usefulness of a Low-Dose Sclerosing Agent for the Treatment of Vascular Lesions in the Tongue

Hemangiomas and vascular malformations are common benign lesions of vessels in the cervical region. However, the lesions may not completely disappear and may require surgical or nonsurgical intervention. Several treatment options, including surgical excision, steroid injection, laser therapy, and sclerotherapy, are available. Surgical excision is a commonly used treatment; however, in cases of hemangiomas of the tongue, excision of the lesion may cause esthetic or functional impairments, including speech and swallowing. Sclerotherapy is a simple and safe method for treating vascular lesions conservatively. In this case report, two patients with a vascular lesion of the tongue underwent conservative sclerotherapy without surgical excision using a sclerosing agent (sodium tetradecyl sulfate). Both patients showed regression of the lesion without complications. As presented in these cases, repeated injections of low-dose 1% sodium tetradecyl sulfate as a sclerosing agent were safe and showed satisfactory outcomes.

A Case of Unilateral, Segmental Vascular Lesions: An Unusual Presentation

We present a case of a diffuse, vascular eruption localized to the left thigh and left abdomen in an otherwise apparently healthy 63-year-old male. The patient reported that the eruption was not bothersome and had been present for as long as he could remember. Due to its benign appearance in nature, the patient declined a biopsy or further follow-up. While reports of diffuse vascular eruptions have been associated with many genetic diseases, this case offers an example of a diffuse vascular eruption in a healthy patient. Further research is needed to understand the potential genetic or environmental factors contributing to the development of such lesions in healthy patients.

Halo Phenomenon in Lobular Capillary Hemangioma: A Case Report of a Pyogenic Granuloma With Surrounding Cutaneous Hypopigmentation and Review of Tumors With Halo Phenomenon

A halo phenomenon describes a skin neoplasm that is surrounded by a hypopigmented or white halo. Halo lesions have been observed in association with an epithelial neoplasm (seborrheic keratosis), a fibrous lesion (surgical scar), a keratinocyte malignancy (basal cell carcinoma), melanocytic neoplasms, and vascular lesions. Benign lesions (café au lait macules and nevi) and malignant tumors (primary and metastatic melanoma) are melanocytic neoplasms that have developed perilesional halos. Halo nevi are a commonly occurring manifestation of a halo phenomenon; however, perilesional hypopigmented halos have also been observed around nevi in patients following treatment with antineoplastic drugs, acquisition of COVID-19 (infection and vaccine), the occurrence of a visceral tumor (including not only melanoma, but also papillary thyroid carcinoma and neuroendocrine cancer of the lung), surgery (such as the excision of a primary melanoma), and Turner syndrome. A halo phenomenon has also been observed in patients with congenital (capillary malformation-arteriovenous malformation and congenital hemangioma) or acquired (angioma, eruptive pseudoangiomatosis, infantile hemangioma, and lobular capillary hemangioma) vascular lesions. In summary, a halo phenomenon can occur in association with primary lesions of various embryologic derivations. Most commonly, they have been observed in around nevi and vascular tumors. Halo lobular capillary hemangioma can be added to the list of acquired vascular lesions with the potential to develop a halo phenomenon. The preservation of melanocytes with loss of melanin pigment expression in the reported patient suggests the possibility that a post-inflammatory etiology may be responsible for the genesis of her halo lobular capillary hemangioma.