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Song S, Li X, Xue X, Dong W, Li C. Progress in the Study of the Role and Mechanism of HTRA1 in Diseases Related to Vascular Abnormalities. Int J Gen Med 2024; 17:1479-1491. [PMID: 38650587 PMCID: PMC11034561 DOI: 10.2147/ijgm.s456912] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/10/2024] [Indexed: 04/25/2024] Open
Abstract
High temperature requirement A1 (HTRA1) is a member of the serine protease family, comprising four structural domains: IGFBP domain, Kazal domain, protease domain and PDZ domain. HTRA1 encodes a serine protease, a secreted protein that is widely expressed in the vasculature. HTRA1 regulates a wide range of physiological processes through its proteolytic activity, and is also involved in a variety of vascular abnormalities-related diseases. This article reviews the role of HTRA1 in the development of vascular abnormalities-related hereditary cerebral small vessel disease (CSVD), age-related macular degeneration (AMD), tumors and other diseases. Through relevant research advances to understand the role of HTRA1 in regulating signaling pathways or refolding, translocation, degradation of extracellular matrix (ECM) proteins, thus directly or indirectly regulating angiogenesis, vascular remodeling, and playing an important role in vascular homeostasis, further understanding the mechanism of HTRA1's role in vascular abnormality-related diseases is important for HTRA1 to be used as a therapeutic target in related diseases.
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Affiliation(s)
- Shina Song
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
- Department of Geriatrics, General Hospital of TISCO, Taiyuan, People’s Republic of China
| | - Xiaofeng Li
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Xuting Xue
- Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, The First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Wenping Dong
- Department of Geriatrics, General Hospital of TISCO, Taiyuan, People’s Republic of China
| | - Changxin Li
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
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2
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Schmidt VF, Kapp FG, Goldann C, Huthmann L, Cucuruz B, Brill R, Vielsmeier V, Seebauer CT, Michel AJ, Seidensticker M, Uller W, Weiß JBW, Sint A, Häberle B, Haehl J, Wagner A, Cordes J, Holm A, Schanze D, Ricke J, Kimm MA, Wohlgemuth WA, Zenker M, Wildgruber M. Extracranial Vascular Anomalies Driven by RAS/MAPK Variants: Spectrum and Genotype-Phenotype Correlations. J Am Heart Assoc 2024; 13:e033287. [PMID: 38563363 DOI: 10.1161/jaha.123.033287] [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: 10/25/2023] [Accepted: 03/05/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND We aimed to correlate alterations in the rat sarcoma virus (RAS)/mitogen-activated protein kinase pathway in vascular anomalies to the clinical phenotype for improved patient and treatment stratification. METHODS AND RESULTS This retrospective multicenter cohort study included 29 patients with extracranial vascular anomalies containing mosaic pathogenic variants (PVs) in genes of the RAS/mitogen-activated protein kinase pathway. Tissue samples were collected during invasive treatment or clinically indicated biopsies. PVs were detected by the targeted sequencing of panels of genes known to be associated with vascular anomalies, performed using DNA from affected tissue. Subgroup analyses were performed according to the affected genes with regard to phenotypic characteristics in a descriptive manner. Twenty-five vascular malformations, 3 vascular tumors, and 1 patient with both a vascular malformation and vascular tumor presented the following distribution of PVs in genes: Kirsten rat sarcoma viral oncogene (n=10), neuroblastoma ras viral oncogene homolog (n=1), Harvey rat sarcoma viral oncogene homolog (n=5), V-Raf murine sarcoma viral oncogene homolog B (n=8), and mitogen-activated protein kinase kinase 1 (n=5). Patients with RAS PVs had advanced disease stages according to the Schobinger classification (stage 3-4: RAS, 9/13 versus non-RAS, 3/11) and more frequent progression after treatment (RAS, 10/13 versus non-RAS, 2/11). Lesions with Kirsten rat sarcoma viral oncogene PVs infiltrated more tissue layers compared with the other PVs including other RAS PVs (multiple tissue layers: Kirsten rat sarcoma viral oncogene, 8/10 versus other PVs, 6/19). CONCLUSIONS This comparison of patients with various PVs in genes of the RAS/MAPK pathway provides potential associations with certain morphological and clinical phenotypes. RAS variants were associated with more aggressive phenotypes, generating preliminary data and hypothesis for future larger studies.
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Affiliation(s)
- Vanessa F Schmidt
- Department of Radiology LMU University Hospital, LMU Munich München Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
| | - Friedrich G Kapp
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine University Medical Center Freiburg, University of Freiburg Germany
| | - Constantin Goldann
- Clinic and Policlinic of Radiology Martin-Luther University Halle-Wittenberg Halle (Saale) Germany
| | - Linda Huthmann
- Clinic and Policlinic of Radiology Martin-Luther University Halle-Wittenberg Halle (Saale) Germany
| | - Beatrix Cucuruz
- Clinic and Policlinic of Radiology Martin-Luther University Halle-Wittenberg Halle (Saale) Germany
| | - Richard Brill
- Clinic and Policlinic of Radiology Martin-Luther University Halle-Wittenberg Halle (Saale) Germany
| | - Veronika Vielsmeier
- Department of Otorhinolaryngology Regensburg University Medical Center Regensburg Germany
| | - Caroline T Seebauer
- Department of Otorhinolaryngology Regensburg University Medical Center Regensburg Germany
| | - Armin-Johannes Michel
- Department of Pediatric and Adolescent Surgery Paracelsus Medical University Hospital Salzburg Austria
| | - Max Seidensticker
- Department of Radiology LMU University Hospital, LMU Munich München Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
| | - Wibke Uller
- Department of Diagnostic and Interventional Radiology University of Freiburg Medical Centre, Medical Faculty of the University of Freiburg Freiburg Germany
| | - Jakob B W Weiß
- Department of Plastic and Hand Surgery University of Freiburg Medical Centre, Medical Faculty of the University of Freiburg Freiburg Germany
| | - Alena Sint
- Department of Radiology LMU University Hospital, LMU Munich München Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
| | - Beate Häberle
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital LMU University Hospital, LMU Munich München Germany
| | - Julia Haehl
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital LMU University Hospital, LMU Munich München Germany
| | - Alexandra Wagner
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital LMU University Hospital, LMU Munich München Germany
| | - Johanna Cordes
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine University Medical Center Freiburg, University of Freiburg Germany
| | - Annegret Holm
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine University Medical Center Freiburg, University of Freiburg Germany
| | - Denny Schanze
- Institute of Human Genetics, University Hospital Magdeburg Magdeburg Germany
| | - Jens Ricke
- Department of Radiology LMU University Hospital, LMU Munich München Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
| | - Melanie A Kimm
- Department of Radiology LMU University Hospital, LMU Munich München Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
| | - Walter A Wohlgemuth
- Clinic and Policlinic of Radiology Martin-Luther University Halle-Wittenberg Halle (Saale) Germany
| | - Martin Zenker
- Institute of Human Genetics, University Hospital Magdeburg Magdeburg Germany
| | - Moritz Wildgruber
- Department of Radiology LMU University Hospital, LMU Munich München Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
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3
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Abbas AM, Jung B, Ngan A, Tan R, Carrier RE, Echevarria AC, Kissin M, Verma RB. Venous Anomalies Complicating Anterior Lumbar Interbody Fusion Exposures. Vasc Endovascular Surg 2024; 58:426-435. [PMID: 37978879 DOI: 10.1177/15385744231217359] [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] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
The effects of anomalous vasculature impeding optimal exposure to an anterior lumbar interbody fusion approach are limited in literature. We present five individual, unique cases of vascular anomalies in patients undergoing two-stage anterior-posterior lumbar interbody fusion. Cases 1, 2, 4, and 5 have yet to be described in literature in context of anterior lumbar interbody fusions. Case 3 presents anomalous vasculature that has only been described in two other case reports. Case 1 presents the right internal iliac vein originating from the left common iliac vein which was transected for L4-L5 vertebral disc exposure. Case 2 presents the left internal iliac vein originating from the right common iliac vein which required an oblique approach. Case 3 presents a duplicated inferior vena cava that was taken into account but did not interfere with the anterior retroperitoneal approach. Case 4 presents large osteophytes adhering to the left common iliac vein which limited safe dissection and mobilization. Case 5 presents the left internal iliac vein with a high takeoff spanning across the L5-S1 vertebral disc space and requiring transection. This case series highlights the need for preoperative imaging and a working detailed knowledge of anatomy to avoid damaging vasculature that can potentially lead to fatal consequences. The information given in this case series should inform both spine and vascular surgeons on proper preoperative planning. To maximize operative efficiency and safety, spine surgeons and vascular surgeons should collaborate to minimize surgical complications.
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Affiliation(s)
- Anas M Abbas
- Department of Orthopedic Surgery, North Shore University Hospital, Manhasset, NY, USA
| | - Bongseok Jung
- Department of Orthopedic Surgery, North Shore University Hospital, Manhasset, NY, USA
| | - Alex Ngan
- Department of Orthopedic Surgery, North Shore University Hospital, Manhasset, NY, USA
| | - Richard Tan
- Department of Surgery, Division of Vascular Surgery, North Shore University Hospital, Manhasset, NY, USA
| | - Robert E Carrier
- Department of Orthopedic Surgery, North Shore University Hospital, Manhasset, NY, USA
| | | | - Mark Kissin
- Department of Surgery, Division of Vascular Surgery, North Shore University Hospital, Manhasset, NY, USA
| | - Rohit B Verma
- Department of Orthopedic Surgery, North Shore University Hospital, Manhasset, NY, USA
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Cossio ML, Rodríguez J, Flores JC, De Barbieri F, Flores Á, Marín J, Florin C, Cuevas F, Gutiérrez M. Four-month-old with severe PIK3CA-related overgrowth spectrum disorder successfully treated with alpelisb. Pediatr Dermatol 2024. [PMID: 38444084 DOI: 10.1111/pde.15582] [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] [Received: 11/24/2023] [Accepted: 02/24/2024] [Indexed: 03/07/2024]
Abstract
PIK3CA-related overgrowth spectrum (PROS) encompasses different clinical entities caused by somatic activating mutations in PIK3CA. Among PROS, CLOVES syndrome represents a severe phenotype with poor survival rate. We present the case of a 4-month-old girl with CLOVES syndrome successfully treated with alpelisib, a PIKC3A inhibitor.
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Affiliation(s)
- María-Laura Cossio
- Department of Dermatology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Dermatology, Hospital Dr. Sótero del Río, Santiago, Chile
| | | | - Juan Carlos Flores
- Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Pediatrics, Hospital Dr. Sótero del Río, Santiago, Chile
| | - Florencia De Barbieri
- Department of Radiology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Álvaro Flores
- Department of Radiology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Pediatric Radiology, Hospital Dr. Sótero del Río, Santiago, Chile
| | - José Marín
- Department of Pediatric Neurology, Hospital Dr. Sótero del Río, Santiago, Chile
| | - Carla Florin
- Department of Pediatric Plastic Surgery, Hospital Dr. Sótero del Río, Santiago, Chile
| | - Francisco Cuevas
- Department of Pediatrics, Hospital Josefina Martínez, Santiago, Chile
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5
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Mologousis MA, Balkin DM, Smith ER, Lidov HGW, Li AM, Yang E, Liang MG. Non-vascular intracranial lesions in three children with PHACE association. Pediatr Dermatol 2024; 41:284-288. [PMID: 37723596 DOI: 10.1111/pde.15423] [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: 05/08/2023] [Accepted: 08/20/2023] [Indexed: 09/20/2023]
Abstract
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.
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Affiliation(s)
- Mia A Mologousis
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Department of Dermatology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Daniel M Balkin
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Edward R Smith
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Hart G W Lidov
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Pathology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Alice M Li
- Department of Pathology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Edward Yang
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Marilyn G Liang
- Department of Dermatology, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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6
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Dykman M, Pillai NR, Lenhart K, Nicholson C, Boull C, Fritz E, Flanagan S, Maguiness S. Arteriovenous malformations as a presenting sign of PTEN hamartoma tumor syndrome: A case series. Pediatr Dermatol 2024; 41:292-295. [PMID: 37800459 DOI: 10.1111/pde.15435] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/12/2023] [Accepted: 09/08/2023] [Indexed: 10/07/2023]
Abstract
High-flow vascular malformations have been associated with multiple syndromes including capillary malformation-arteriovenous malformation (CM-AVM) syndrome, hereditary hemorrhagic telangiectasia syndrome, and less commonly, phosphatase and tensin homolog hamartoma tumor syndrome (PHTS). We present a series of three patients with clinically challenging complex AVMs who were found to have underlying PHTS. In all patients, diagnosis was delayed, and the presence of the AVM prompted sampling and genetic testing for PHTS in the absence of other clinical features of the condition. This series highlights the importance of screening for PHTS in the setting of high-flow vascular malformations.
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Affiliation(s)
- Morgan Dykman
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Nishitha R Pillai
- Division of Genetics and Metabolism, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kelsey Lenhart
- Division of Genetics and Metabolism, Department of Pediatrics, M Health Fairview, Minneapolis, Minnesota, USA
| | - Cynthia Nicholson
- Department of Dermatology, Division of Pediatric Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Christina Boull
- Department of Dermatology, Division of Pediatric Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Erin Fritz
- Division of Hematology/Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Siobhan Flanagan
- Department of Diagnostic and Interventional Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sheilagh Maguiness
- Department of Dermatology, Division of Pediatric Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
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7
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Shelar SS, Dhande R, Parihar P, Shetty ND, Khandelwal S. A Comprehensive Review of Sonographic Assessment of Peripheral Slow-Flow Vascular Malformations. Cureus 2024; 16:e54099. [PMID: 38487131 PMCID: PMC10938085 DOI: 10.7759/cureus.54099] [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] [Received: 01/17/2024] [Accepted: 02/12/2024] [Indexed: 03/17/2024] Open
Abstract
This comprehensive review explores the role of sonographic assessment in diagnosing and characterizing peripheral slow-flow vascular malformations (PSFVM). The review begins with an introduction providing the background and significance of PSFVM, defining these vascular anomalies, and emphasizing the importance of sonography in their diagnosis. The objectives focus on a thorough examination of existing literature, assessing the effectiveness of sonography in delineating morphological and hemodynamic features crucial for accurate classification. The summary of key findings highlights the diagnostic accuracy of sonography while acknowledging its limitations. Implications for clinical practice emphasize the practical utility of sonography in early diagnosis and preoperative planning, suggesting integration into multimodal approaches. The conclusion underscores the need for standardized criteria, ongoing education, and future research, positioning sonography as a valuable tool in the comprehensive management of PSFVM.
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Affiliation(s)
- Sheetal S Shelar
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rajasbala Dhande
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratap Parihar
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neha D Shetty
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shreya Khandelwal
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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8
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Kalbfell R, Cohen-Cutler S, Grisham E, Bereitschaft C, Borst AJ, Green AM, Willis DN, Yaeger L, Blatt J, Sisk BA. Infectious complications of vascular anomalies treated with sirolimus: A systematic review. Pediatr Blood Cancer 2024; 71:e30758. [PMID: 37933207 DOI: 10.1002/pbc.30758] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 09/22/2023] [Revised: 10/19/2023] [Accepted: 10/21/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Initially developed as immunosuppressive agents, mammalian target of rapamycin (mTOR) inhibitors are currently used widely in the management of vascular malformations and tumors. The incidence of infectious complications in the vascular anomalies (VA) population is not well defined. The goal of this systematic review was to better define the types and severity of reported infectious complications in patients with VAs treated with mTOR inhibition. METHODS This was a systematic review conducted following PRISMA guidelines evaluating all research articles focused on infectious complications in patients with VAs treated with sirolimus or everolimus. Thirty articles including 1182 total patients and 316 infections (in 291 unique patients) were ultimately included. RESULTS The majority of infections were viral upper respiratory (n = 137, 54%), followed by pneumonia (n = 53, 20%), and cutaneous infections (n = 20, 8%). There were six total infection-related fatalities, which all occurred in patients younger than 2 years. Two cases of Pneumocystis jirovecii pneumonia (PJP) were reported. These were infants with kaposiform hemangioendothelioma (KHE) who were also treated with steroids and did not receive PJP prophylaxis. Almost one-third (n = 96, 32%) of infectious complications were graded 3-4 according to Common Terminology Criteria for Adverse Events (CTCAE) criteria. Details of patient age, subtype of VA, and timing of infection were lacking from many reports. CONCLUSIONS Most infectious complications reported in patients with VA on mTOR inhibitors were viral respiratory infections and non-severe. Bacteremia, infectious fatalities, and PJP are exceedingly rare. Future studies are needed to clarify the spectrum of infectious risks in VA patients and to provide guidance for infection prevention.
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Affiliation(s)
- Rachel Kalbfell
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sally Cohen-Cutler
- Department of Pediatrics, Division of Pediatric Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Eric Grisham
- St. Louis Children's Hospital, St. Louis, Missouri, USA
| | - Christine Bereitschaft
- Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Alexandra J Borst
- Department of Pediatrics, Division of Pediatric Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Abby M Green
- Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Pediatrics, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Daniel N Willis
- Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Lauren Yaeger
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Julie Blatt
- Department of Pediatrics, Division of Hematology/Oncology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Bryan A Sisk
- Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Medicine, Bioethics Research Center, Washington University School of Medicine, St. Louis, Missouri, USA
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Gupta R, Bhandari A, Navarro OM. Pediatric Vascular Anomalies: A Clinical and Radiological Perspective. Indian J Radiol Imaging 2024; 34:103-127. [PMID: 38106867 PMCID: PMC10723972 DOI: 10.1055/s-0043-1774391] [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] [Indexed: 12/19/2023] Open
Abstract
According to the International Society for the Study of Vascular Anomalies (ISSVA) classification, vascular anomalies include a diverse range of pathologies, classified as either vascular tumors or vascular malformations. This classification, last revised in 2018, aims to explain the biological basis of vascular lesions and help clinicians to manage the anomalies. In vascular tumors, there are proliferative changes of endothelial cells, while vascular malformations primarily consist of structural vascular abnormalities. Infantile hemangioma is the most common soft-tissue vascular tumor. Vascular malformations are an extensive group of malformations of the arterial, venous, and lymphatic systems, either in isolation or in combination. Radiological evaluation plays a key part in the management of pediatric patients with these entities. The understanding of sonography and magnetic resonance imaging findings entails its correlation with clinical findings at the time of scanning.
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Affiliation(s)
- Rahul Gupta
- Department of Paediatric Surgery, SMS Medical College, JLN Marg, Jaipur, Rajasthan, India
| | - Anu Bhandari
- Department of Radiodiagnosis, SMS Medical College, JLN Marg, Jaipur, Rajasthan, India
| | - Oscar M. Navarro
- Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
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10
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Gu Y, Sebaratnam DF. Topical rapamycin and microcystic lymphatic malformations. J Am Acad Dermatol 2024; 90:e29-e30. [PMID: 37717734 DOI: 10.1016/j.jaad.2023.06.066] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/16/2023] [Indexed: 09/19/2023]
Affiliation(s)
- Yaron Gu
- Department of Dermatology, Liverpool Hospital, Liverpool, Australia; Faculty of Medicine, University of New South Wales, Kensington, Australia
| | - Deshan F Sebaratnam
- Department of Dermatology, Liverpool Hospital, Liverpool, Australia; Faculty of Medicine, University of New South Wales, Kensington, Australia.
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Kopeć J, Sałacińska-Łoś E, Orzechowska M, Sokolnicka M, Gawłowska-Marciniak A, Przemysław P. mTOR Pathway Substrates Present High Activation in Vascular Malformations and Significantly Decrease with Age. Diagnostics (Basel) 2023; 14:38. [PMID: 38201347 PMCID: PMC10795840 DOI: 10.3390/diagnostics14010038] [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] [Received: 11/14/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Vascular anomalies often result in aesthetic flaws, pain, and impair the quality of life. They require challenging treatments that frequently do not provide the desired results. The mammalian target of rapamycin (mTOR) is directly involved in the development of these malformations. However, the exact mechanism behind mTOR dysregulation has not been unambiguously defined. The purpose of this study is to investigate the activation of selected substrates of mTOR to partially assess its involvement in the disease process. METHODS We analyzed tissue samples collected from patients with vascular anomalies treated in our department. We included patients with histopathological diagnoses of lymphatic, venous, capillary malformations, mixed lesions, and a control group of healthy skin samples. We stained the samples using H and E and immunohistochemistry. We used primary antibodies against p70 S6 Kinase, 4EBP1, and p-4EBP1. We graded their color reactions. The statistical analyses were performed using the FactoMineR and factoextra R v.4.1 packages. p-values < 0.05 were considered statistically significant. RESULTS The analysis of 82 patients showed that healthy tissue vessels expressed lower levels of tested mTOR pathway substrates compared to high activation in vascular malformations. Elevated substrate expression in a comparison between sexes revealed higher P-4EBP1 expression in the female malformation group. We observed a decrease in mTOR substrate expression with age. CONCLUSION The higher expression of mTOR substrates in vascular malformations compared to healthy tissue confirms their involvement in abnormal vascular development. Age-related changes in mTOR substrate expression highlight the need for timely intervention. Our study contributes to the understanding of the mTOR signaling pathway in vascular malformations and highlights its potential as a therapeutic target, contributing to personalized medicine.
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Affiliation(s)
- Jakub Kopeć
- Pediatric Surgery and Oncology Department, Medical University of Łódź, 90-419 Lodz, Poland; (E.S.-Ł.); (A.G.-M.); (P.P.)
| | - Elżbieta Sałacińska-Łoś
- Pediatric Surgery and Oncology Department, Medical University of Łódź, 90-419 Lodz, Poland; (E.S.-Ł.); (A.G.-M.); (P.P.)
| | - Magdalena Orzechowska
- Molecular Carcinogenesis Department, Medical University of Łódź, 90-752 Lodz, Poland;
| | - Monika Sokolnicka
- Pathomorphology Department, Medical University of Łódź, 90-752 Lodz, Poland;
| | - Aleksandra Gawłowska-Marciniak
- Pediatric Surgery and Oncology Department, Medical University of Łódź, 90-419 Lodz, Poland; (E.S.-Ł.); (A.G.-M.); (P.P.)
| | - Przewratil Przemysław
- Pediatric Surgery and Oncology Department, Medical University of Łódź, 90-419 Lodz, Poland; (E.S.-Ł.); (A.G.-M.); (P.P.)
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12
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Samal SN, Samal SS. Congenital arteriovenous malformation (ISSVA classification for vascular anomalies). Pan Afr Med J 2023; 46:103. [PMID: 38435403 PMCID: PMC10908295 DOI: 10.11604/pamj.2023.46.103.41202] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/15/2023] [Indexed: 03/05/2024] Open
Affiliation(s)
- Subrat Narendra Samal
- Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Sawangi, Meghe, Wardha, Maharashtra, India
| | - Snehal Subrat Samal
- Department of Neuro Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Sawangi, Meghe, Wardha, Maharashtra, India
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13
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Ahmed A, Patel B, Wang R, Luna L, Verde A, Besheli LD, Intrapiromkul J, Nabi M, Edpuganti N, Deng F, Yedavalli V. Clinical applications of arterial spin labeling of the intracranial compartment in vascular anomalies-A case-based review. Neuroradiol J 2023; 36:638-650. [PMID: 36172883 PMCID: PMC10649537 DOI: 10.1177/19714009221130490] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Arterial spin labeling (ASL) is a magnetic resonance perfusion technique that allows for quantification of cerebral blood flow (CBF) without the use of contrast or radiation. Several applications of ASL have been described in diagnosis of strokes and stroke mimics, intracranial tumors, and other conditions. Various vascular anomalies exhibit specific CBF patterns that correlate with different signal intensities on ASL. In this case-based review, we demonstrate the utility of ASL in diagnosis and surveillance of vascular anomalies in the intracranial compartment.
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Affiliation(s)
- Amara Ahmed
- Florida State University College of Medicine, Tallahassee, FL, USA
| | - Bhumi Patel
- Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Richard Wang
- Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Licia Luna
- Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, USA
| | | | - Laleh Daftari Besheli
- Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Jarunee Intrapiromkul
- Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Mehreen Nabi
- Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Namratha Edpuganti
- Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Francis Deng
- Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Vivek Yedavalli
- Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, USA
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14
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Tanugroho RR, Wee LWY, Koh MJA, Chong JH. Approach to clinically significant vascular anomalies in children. Singapore Med J 2023; 64:714-720. [PMID: 34808707 PMCID: PMC10775298 DOI: 10.11622/smedj.2021209] [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] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/23/2021] [Indexed: 11/18/2022]
Abstract
Vascular anomalies consist of tumours or malformations made up of abnormal growth or collections of blood vessels that can result in functional or cosmetic problems. While many vascular anomalies are present at birth, some do not appear until later in life, making diagnosis more challenging. Although many vascular anomalies are benign, some are associated with serious complications and may involve multiple organ systems. This article highlights the important features of clinically significant vascular anomalies to help physicians promptly identify and refer these cases to a specialised multidisciplinary team for evaluation and management. The discussion includes the various presenting complaints of vascular anomalies in children, namely, rapidly growing birthmarks, painful lesions, seizures/neurological manifestations, bleeding diathesis, cardiac/airway abnormalities and part of an overgrowth syndrome.
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Affiliation(s)
| | | | | | - Jin Ho Chong
- Raffles Children’s Centre, Raffles Hospital, Singapore
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15
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Torrado-Cobian LA, Griepentrog GJ, Hodge DO, Mohney BG. Prevalence and clinical features of orbital vascular anomalies in children. Orbit 2023; 42:598-602. [PMID: 36644978 PMCID: PMC10691662 DOI: 10.1080/01676830.2023.2166081] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/03/2023] [Indexed: 01/17/2023]
Abstract
PURPOSE To report the prevalence, clinical characteristics, and natural history of orbital vascular anomalies diagnosed among children over a 50-year period. METHODS The medical records of all patients <19 years diagnosed with any form of an orbital vascular anomaly (OVA) at Mayo Clinic, Rochester, Minnesota from January 1 1966, through December 31 2015, were retrospectively reviewed. RESULTS A total of 109 children were diagnosed with OVA during the 50-year period, of which 24 were from Olmsted County, MN, yielding a birth prevalence of 1 in 4,305 live births. The median age at diagnosis for the 109 patients was 1.2 years (range, 0-17.9 years) and 67 (61.5%) were female. Common presenting symptoms included proptosis in 80 (73.4%) patients, abnormalities in skin color in 45 (41.3%) patients, and pain in 18 (16.5%) patients. There were 55 (50.5%) vascular malformations [50 (91%) low-flow lymphatic malformations, 3 (5.5%) high-flow arteriovenous malformations, and 2 (3.5%) low-flow venous malformations] and 54 (49.5%) vascular tumors [53 (98%) capillary hemangiomas and 1 (2%) kaposiform hemangioendothelioma]. During a mean follow-up of 5.95 years (range 0-27.7 years), amblyopia and/or strabismus were diagnosed in 46 (43.4%) patients. CONCLUSIONS Capillary hemangiomas and low-flow lymphatic malformations comprise most of the orbital vascular anomalies in this cohort of children. Amblyopia and strabismus are common sequelae, highlighting the importance of early diagnosis and appropriate management.
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Affiliation(s)
- Laura A. Torrado-Cobian
- Mayo Clinic Department of Ophthalmology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
| | - Gregory J. Griepentrog
- Department of Ophthalmology & Visual Sciences at the Medical College of Wisconsin, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
| | - David O. Hodge
- Mayo Clinic Division of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
| | - Brian G. Mohney
- Mayo Clinic Department of Ophthalmology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
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16
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Kim M, Hong KT, Park HJ, Kim BK, Choi JY, Kim HY, Kang HJ. Clinical effectiveness and safety of sirolimus in pediatric patients with complex vascular anomalies: necessitating personalized and comprehensive approaches. Front Pediatr 2023; 11:1304133. [PMID: 38034833 PMCID: PMC10687411 DOI: 10.3389/fped.2023.1304133] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/03/2023] [Indexed: 12/02/2023] Open
Abstract
Background Managing complex vascular anomalies in pediatric care requires comprehensive approaches. Sirolimus, an mTOR inhibitor with immunosuppressive and anti-angiogenic properties, offers promise. We evaluated sirolimus's effectiveness and safety in pediatric patients with complex vascular anomalies at a tertiary children's hospital. Methods Our study included 20 patients, aged 1 month to 19 years, with diverse vascular anomalies resistant to conventional therapies or located in high-risk areas precluding surgery. The evaluation of response encompassed measuring the reduction in the size of the targeted vascular or lymphatic lesions as observed on radiologic imaging, along with considering improvements reported by the patients. Results Patients used sirolimus for a median of 2.1 years, ranging from 0.6-4.3 years. Results indicated that 60% of patients achieved complete or partial response (CR/PR), whereas 40% had stable disease (SD). Notably, no disease progression occurred. Lesion size assessment was complex, yet patients' self-reported improvements were considered. Three patients reinitiated sirolimus after discontinuation due to worsening lesions. Sirolimus treatment demonstrated good tolerability, with minor complications except for one case of Pneumocystis jiroveci pneumonia. Group comparisons based on response highlighted better outcomes in patients with vascular tumors (CR/PR group 58.0% vs. SD group 0.0%, P = 0.015) or localized measurable lesions (83.3% vs. 12.5%, P = 0.005). Conclusion Our study underscores sirolimus's potential for treating complex vascular anomalies in pediatric patients. Challenges associated with optimal treatment duration and concurrent interventions necessitate a comprehensive approach and genetic testing to optimize outcomes.
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Affiliation(s)
- Minji Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children’s Hospital, Seoul, Republic of Korea
| | - Kyung Taek Hong
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children’s Hospital, Seoul, Republic of Korea
- Seoul National University Cancer Research Institute, Seoul, Republic of Korea
| | - Hyun Jin Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children’s Hospital, Seoul, Republic of Korea
- Seoul National University Cancer Research Institute, Seoul, Republic of Korea
| | - Bo Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children’s Hospital, Seoul, Republic of Korea
- Seoul National University Cancer Research Institute, Seoul, Republic of Korea
| | - Jung Yoon Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children’s Hospital, Seoul, Republic of Korea
- Seoul National University Cancer Research Institute, Seoul, Republic of Korea
| | - Hyun-Young Kim
- Division of Pediatric Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyoung Jin Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children’s Hospital, Seoul, Republic of Korea
- Seoul National University Cancer Research Institute, Seoul, Republic of Korea
- Wide River Institute of Immunology, Hongcheon, Republic of Korea
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17
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Gautam A, Frieden IJ, Shah SD, Witman PM, Harfmann K, Bradley F, Blei F, Pope E, Alsumait A, Gupta D, Covelli I, Streicher JL, Cotton C, Tollefson M, Nguyen H, Hunt R, Buros A, Fernández Faith E. Clinical characteristics of infantile hemangiomas with aggressive, persistent, and destructive ulceration. Pediatr Dermatol 2023; 40:996-1002. [PMID: 37845188 DOI: 10.1111/pde.15444] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/15/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND/OBJECTIVES Ulceration is a common complication of infantile hemangioma (IH). Severe, persistent ulceration occurs in a minority of patients. This study aims to characterize the clinical features of IH with aggressive ulceration (AU). METHODS Multicenter retrospective study of clinical features of IH with AU. RESULTS Thirty-five patients with AU were identified and included in the study. The majority of AU occurred in segmental IH (23/35, 65%). Segmental IH with AU were large (≥10 cm2 ; 16/23, 69%, p < .001) with a thin (<3 mm) superficial component (16/23, 69%, p < .001). Localized IH with AU had a thick (>3 mm) superficial component (11/12, 92%, p < .001). All diaper area IH with AU (9/35) were segmental with thin superficial component (100%, p = .02). IH with AU in the head/neck (10/35) were more commonly localized (67%) and mixed (62.5%), while segmental, thick superficial morphology was more common on trunk (9/35) and upper extremities (7/35). CONCLUSIONS IH resulting in AU differ in clinical features by anatomic site. Those in the diaper area are nearly always segmental with thin superficial component, whereas other sites tend to be localized, mixed, with thick superficial component. These distinct phenotypes may prove useful in the clinical setting for physicians to identify patterns of IH ulceration with increased risk of aggressive, persistent ulceration.
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Affiliation(s)
- Ayushi Gautam
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Ilona J Frieden
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Sonal D Shah
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California, USA
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Patricia M Witman
- Division of Dermatology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Katya Harfmann
- Division of Dermatology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Flora Bradley
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Francine Blei
- Department of Pediatrics, Lenox Hill Hospital, Northwell Health, New York, New York, USA
| | - Elena Pope
- Division of Pediatric Dermatology, The Hospital for Sick Children and Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anwar Alsumait
- Division of Pediatric Dermatology, The Hospital for Sick Children and Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Deepti Gupta
- Department of Pediatrics, Division of Dermatology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Isabela Covelli
- Department of Pediatrics, Division of Dermatology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jenna L Streicher
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Colleen Cotton
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Dermatology, Children's National Hospital, Washington, DC, USA
| | - Megha Tollefson
- Departments of Dermatology and Pediatrics, Mayo Clinic, Rochester, Minnesota, USA
| | - Henry Nguyen
- Departments of Dermatology and Pediatrics, Mayo Clinic, Rochester, Minnesota, USA
| | - Raegan Hunt
- Departments of Dermatology and Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Amy Buros
- Pediatric Dermatology Research Alliance, Portland, Oregon, USA
| | - Esteban Fernández Faith
- Division of Dermatology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA
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18
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Arnold JD, Yoon S, Shah N, Byrne M, Kieswetter L, Sibbald C, Lara-Corrales I, Kinariwalla N, Garzon MC, Braun M, Shah SD, Frieden IJ, Travis N, Liy Wong C, Snyder AN, Wine Lee L, Collier EK, Hogeling M, Fernandez Faith E, DeVaul N, Kirkorian AY. Characteristics and complications of anogenital infantile hemangiomas: A multicenter retrospective analysis. J Am Acad Dermatol 2023; 89:1015-1021. [PMID: 37451624 DOI: 10.1016/j.jaad.2023.06.049] [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] [Received: 03/05/2023] [Revised: 06/21/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Infantile hemangiomas (IHs) of the anogenital region remain poorly characterized. OBJECTIVE To examine the distribution, ulceration rate, and associated congenital anomalies of anogenital IHs. METHODS Retrospective study at 8 tertiary referral centers. RESULTS A total of 435 infants with an IH of the anogenital region were enrolled (of which, 319 [73%] were girls). Congenital anomalies were present in 6.4% (n = 28) of infants with an anogenital IH. Segmental or partial segmental anogenital IHs ulcerated in 72% (n = 99 of 138) of infants, whereas 45% (n = 133 of 297) of focal anogenital IHs experienced ulceration (P < .001). In a multivariable logistic regression analysis, segmental or partial segmental morphology (adjusted odds ratio [aOR], 2.70; 95% CI, 1.60-4.64), mixed type (aOR, 3.44; 95% CI, 2.01-6.07), and perianal (aOR, 3.01; 95% CI, 1.53-6.12) and buttocks location (aOR, 2.08; 95% CI, 1.17-3.76) had increased odds of ulceration. Segmental or partial segmental IHs of the genitalia were confined to distinct anatomic territories and were predominantly distributed unilaterally, with a linear demarcation at the perineal raphe. LIMITATIONS Possible selection bias, given recruitment at tertiary referral centers. CONCLUSION This study improves our understanding of high-risk features of anogenital IHs and demonstrates that genital segmental or partial segmental IHs develop within distinct anatomic territories.
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Affiliation(s)
- Justin D Arnold
- Department of Dermatology, University of California, Irvine, California; Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - SunJung Yoon
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, Maryland
| | - Nidhi Shah
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Morgan Byrne
- Milken Institute School of Public Health, Department of Epidemiology, George Washington University, Washington, DC
| | - Lukas Kieswetter
- Division of Dermatology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cathryn Sibbald
- Division of Dermatology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Irene Lara-Corrales
- Division of Dermatology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Neha Kinariwalla
- Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Maria C Garzon
- Departments of Dermatology and Pediatrics, Columbia University Vagelos College of Physicians & Surgeons, New York, New York
| | - Mitchell Braun
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Sonal D Shah
- Department of Dermatology, University of California San Francisco, San Francisco, California; Department of Dermatology, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Ilona J Frieden
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Nicole Travis
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Carmen Liy Wong
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Alan N Snyder
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Lara Wine Lee
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Erin K Collier
- Department of Medicine, Division of Dermatology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Marcia Hogeling
- Department of Medicine, Division of Dermatology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Esteban Fernandez Faith
- Division of Dermatology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Nicole DeVaul
- Department of Anatomy and Cell Biology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Anna Yasmine Kirkorian
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC; Division of Dermatology, Children's National Hospital, Washington, DC.
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19
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Sun B, Xu P, Kong P, Fang Y, Fu H. Gastric adenocarcinoma in Situs inversus totalis: a case study and literature review. Front Oncol 2023; 13:1238467. [PMID: 37954083 PMCID: PMC10635521 DOI: 10.3389/fonc.2023.1238467] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 10/09/2023] [Indexed: 11/14/2023] Open
Abstract
Background Situs inversus totalis (SIT) is an uncommon disorder characterized by mirror-image anatomy, which can present unique challenges and potential vascular anomalies in surgical interventions, particularly in gastric cancer patients. Aims We aim to delineate a rare case of gastric adenocarcinoma in a SIT patient and conduct a thorough review of the existing literature concerning surgical strategies, vascular anomalies, and outcomes observed across varied geographic locales and technological approaches. Methods A thorough examination of a case involving a 39-year-old male SIT patient who underwent a successful distal gastrectomy with D2 lymph node dissection is presented alongside an expansive literature review. The review encompasses 47 articles, collating data on surgical approaches and vascular anomalies across 49 patients diagnosed with SIT and gastric cancer. Results The patient underwent curative distal gastrectomy and Billroth II with Braun anastomosis within 95 minutes, incurring minimal intraoperative blood loss (100ml). Postoperative pathology confirmed moderately to poorly differentiated gastric adenocarcinoma (pT3N0M0), with no signs of recurrence or metastasis after 6 months of S-1 adjuvant chemotherapy. The literature review revealed vascular anomalies in approximately 20% of reported cases, accentuating its surgical significance. Noteworthy variations in surgical strategies, operative times, blood loss, and complications across different surgical modalities were observed, providing a comprehensive view into the practical management of such cases. Conclusion Despite the inherent challenges associated with SIT, various surgical techniques can be successfully applied with meticulous preoperative planning and understanding vascular anomalies. This compilation of diverse surgical experiences across numerous documented cases seeks to provide a consolidated resource for refining surgical strategies and enhancing postoperative outcomes for gastric cancer patients with SIT, underscoring the imperativeness of further research in this niche domain.
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Affiliation(s)
- Bo Sun
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ping Xu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Nursing, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Pengfei Kong
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yantian Fang
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hong Fu
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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20
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Patil UA. Application of Lasers in Vascular Anomalies. Indian J Plast Surg 2023; 56:395-404. [PMID: 38026771 PMCID: PMC10663075 DOI: 10.1055/s-0043-1775871] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
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.
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Affiliation(s)
- Uddhav Anandrao Patil
- Dr. D. Y. Patil Medical College and Hospital, Kolhapur, Maharashtra, India
- LakshyaKiran Therapeutic Lasers and Research Institute Pvt. Ltd. Kolhapur, Maharashtra, India
- Savitribai Phule Corporation Hospital, Kolhapur, Maharashtra, India
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21
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Jain S, Dhingra S, Tandon S, Lamba AK, Faraz F. Oral Hemangiolymphangioma Presenting As Gingival Enlargement: A Rare Case With Literature Review. Cureus 2023; 15:e46674. [PMID: 37942374 PMCID: PMC10628606 DOI: 10.7759/cureus.46674] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2023] [Indexed: 11/10/2023] Open
Abstract
Vascular malformations are anomalies that are caused by disturbances in vasculogenesis. Depending upon the dominant structure present histologically, they may be found in different combinations of vascular elements and are named hemangiolymphangioma (HLA) or lymphangiohemangioma (LHA). HLA occurs in multiple anatomical sites, such as the head and neck, axilla, abdominal cavity, extremities, and urinary bladder, but it is infrequent in the oral cavity. An 18-year-old male with a history of abdominal tuberculosis presented with an asymptomatic mandibular gingival swelling that was histologically diagnosed as HLA. A six-month follow-up revealed no recurrence. The observations reported in this case are unusual, and our literature review revealed no previously documented case of gingival HLA.
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Affiliation(s)
- Supriya Jain
- Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, IND
| | - Sachin Dhingra
- Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, IND
| | - Shruti Tandon
- Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, IND
| | - Arundeep K Lamba
- Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, IND
| | - Farrukh Faraz
- Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, IND
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Al-Hammad WE, Fujikura M, Hisatomi M, Okada S, Munhoz L, Kawazu T, Takeshita Y, Fujita M, Yanagi Y, Asaumi JI. An imaging‑based diagnostic approach to vascular anomalies of the oral and maxillofacial region. Oncol Lett 2023; 26:394. [PMID: 37600333 PMCID: PMC10433708 DOI: 10.3892/ol.2023.13980] [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: 03/17/2023] [Accepted: 06/28/2023] [Indexed: 08/22/2023] Open
Abstract
The accurate diagnosis of vascular anomalies (VAs) is considered a challenging endeavor. Misdiagnosis of VAs can lead clinicians in the wrong direction, such as the performance of an unnecessary biopsy or inappropriate surgical procedures, which can potentially lead to unforeseen consequences and increase the risk of patient injury. The purpose of the present study was to develop an approach for the diagnosis of VAs of the oral and maxillofacial region based on computed tomography (CT), magnetic resonance imaging (MRI) and dynamic contrast-enhanced MRI (DCE-MRI). In the present study, the CT and MR images of 87 VAs were examined, and the following imaging features were evaluated: Detectability of the lesion, the periphery of the lesion, the inner nature of the lesion, the density of the lesion on CT, the signal intensity of the lesion on MRI, the detectability of phleboliths and the shape of the lesion. A total of 29 lesions were further evaluated using the contrast index (CI) curves created from the DCE-MRI images. A diagnostic diagram, which is based on the imaging features of VAs and CI curve patterns, was subsequently extrapolated. The results obtained demonstrated that the VAs were detected more readily by MRI compared with CT, whereas the detectability of phleboliths was superior when using CT compared with MRI. VAs showed a propensity for homogeneous isodensity on CT, whereas, by contrast, they exhibited a propensity for heterogeneous hyperdensity on CE-CT. VAs also showed a propensity for homogeneous intermediate signal intensity when performing T1-weighted imaging (T1WI), heterogeneous high signal intensity when performing short tau inversion recovery MRI, and heterogeneous high signal intensity when performing fat-saturated CE-T1WI. The CI curves of VAs were found to exhibit a specific pattern: Of the 29 CI curves, 23 (79.3%) showed early weak enhancement, followed by a plateau leading up to 400-600 sec. An imaging-based diagnostic diagram was ultimately formulated. This diagram can act as an aid for radiologists when they are expecting to find a VA, and hopefully serve the purpose of simplifying the diagnostic process. Taken together, the findings of the present study indicated that DCE-MRI may be considered a useful tool for the diagnosis of VAs.
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Affiliation(s)
- Wlla E. Al-Hammad
- Department of Oral and Maxillofacial Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan
- Department of Oral Medicine and Oral Surgery, Faculty of Dentistry, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Mamiko Fujikura
- Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Miki Hisatomi
- Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Shunsuke Okada
- Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Luciana Munhoz
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo 05508-000, Brazil
| | - Toshiyuki Kawazu
- Department of Oral and Maxillofacial Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan
| | - Yohei Takeshita
- Department of Oral and Maxillofacial Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan
| | - Mariko Fujita
- Department of Oral and Maxillofacial Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan
| | - Yoshinobu Yanagi
- Department of Dental Informatics, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8525, Japan
| | - Jun-Ichi Asaumi
- Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, Okayama 700-8558, Japan
- Department of Oral and Maxillofacial Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan
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Garza D, Hildebrand MS, Penington AJ, Brown N, de Silva MG. Australian healthcare professionals' perspectives on genetic counseling and genetic diagnosis in vascular anomalies. J Genet Couns 2023. [PMID: 37632295 DOI: 10.1002/jgc4.1776] [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] [Received: 04/19/2023] [Revised: 08/13/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023]
Abstract
Genomic technologies are now utilized for the genetic diagnosis of vascular anomalies. This provides the opportunity for genetic counselors to make a significant contribution to patient care for this complex disease. The aim of this study was to explore Australian healthcare professionals' perspectives on the relatively recent integration of molecular diagnostic testing for vascular anomalies, with or without genetic counseling support. Nine semi-structured interviews were conducted with Australian healthcare professionals involved in the provision of care for individuals with vascular anomalies. Thematic analysis identified six themes: (1) Molecular diagnosis is beneficial; (2) psychosocial needs can motivate families to pursue a molecular diagnosis; (3) molecular genetic testing for vascular anomalies is complex; (4) genetic service provision is not a one size fits all; (5) a client-centered approach for genetic service provision can go a long way; and (6) the value of genetic counselors. Based on our findings, implementation of a vascular anomalies genetic diagnostic program inclusive of genetic counseling may be challenging, yet such programs are likely to benefit both patients and their families, as well as healthcare professionals. As this paradigm shift unfolds, genetic counselors have an opportunity to contribute to the vascular anomaly field by educating healthcare professionals and patients, by participating in multidisciplinary clinics to support complex cases and by raising awareness regarding their practice and potential contributions.
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Affiliation(s)
- Denisse Garza
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Tasmanian Clinical Genetics Service, Hobart, Tasmania, Australia
- School of Medicine and Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Michael S Hildebrand
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Epilepsy Research Centre, Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Anthony J Penington
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Plastic and Maxillofacial Surgery, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Natasha Brown
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Michelle G de Silva
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
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Gasparella P, Senica SO, Singer G, Banfi C, Flucher C, Beqo BP, Till H, Haxhija EQ. Pediatric vascular anomalies in Austria. Where are we at? A survey among primary care pediatricians. Front Pediatr 2023; 11:1216460. [PMID: 37664549 PMCID: PMC10473968 DOI: 10.3389/fped.2023.1216460] [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] [Received: 05/04/2023] [Accepted: 08/04/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction Vascular anomalies (VAs) are rare conditions and affected patients often experience a difficult patient journey. Timely diagnosis is only possible if primary caregivers are aware of the anomalies and are connected with dedicated specialists. Aim of our survey was to investigate the knowledge about diagnostic and therapeutic possibilities for children with VAs, and the existing networking among primary pediatric caregivers in Austria. Methods Primary care pediatricians in Austria were invited to complete an online questionnaire consisting of 28 questions focusing on pediatric VAs. Results Out of 373 invited pediatricians 93 (25%) returned the questionnaires, 86 of which were complete. Most physicians (39/93 42%) answered that they see between 15 and 30 patients with infantile hemangiomas per year. Vascular malformations are rarely treated in the primary care setting; most primary care pediatricians (58/86, 67%) reported that they currently treat fewer than 5 patients with such type of VAs. There was unequivocal agreement among the participants (84/86, 98%) on the need to establish a network of specialists and a registry dedicated to pediatric VAs. Conclusions This survey represents the first study shedding light on the awareness of VAs among Austrian pediatricians and can serve as a basis for future investigations and advances in the management of these conditions in Austria and other countries with a similar healthcare setting.
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Affiliation(s)
- Paolo Gasparella
- Department of Pediatric and Adolescent Surgery, VASCERN VASCA European Reference Centre, Medical University of Graz, Graz, Austria
| | - Simone O. Senica
- Department of Pediatric and Adolescent Surgery, VASCERN VASCA European Reference Centre, Medical University of Graz, Graz, Austria
- Faculty of Medicine, Riga Stradins University, Riga, Latvia
| | - Georg Singer
- Department of Pediatric and Adolescent Surgery, VASCERN VASCA European Reference Centre, Medical University of Graz, Graz, Austria
| | - Chiara Banfi
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Christina Flucher
- Department of Pediatric and Adolescent Surgery, VASCERN VASCA European Reference Centre, Medical University of Graz, Graz, Austria
| | - Besiana P. Beqo
- Department of Pediatric and Adolescent Surgery, VASCERN VASCA European Reference Centre, Medical University of Graz, Graz, Austria
- Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Holger Till
- Department of Pediatric and Adolescent Surgery, VASCERN VASCA European Reference Centre, Medical University of Graz, Graz, Austria
| | - Emir Q. Haxhija
- Department of Pediatric and Adolescent Surgery, VASCERN VASCA European Reference Centre, Medical University of Graz, Graz, Austria
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25
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Cullion K, Ostertag-Hill CA, Pan M, Timko B, Boscolo E, Kohane DS. Ablation of Venous Malformations by Photothermal Therapy with Intravenous Gold Nanoshells. Nano Lett 2023; 23:7092-7099. [PMID: 37498114 PMCID: PMC10773554 DOI: 10.1021/acs.nanolett.3c01945] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Venous malformations (VMs) consist of hugely enlarged and dysmorphic veins. These lesions cause significant disfigurement, pain, and complications such as bleeding and coagulopathy. Pharmacotherapy for the treatment of VMs has limited efficacy and potentially limiting toxicity. Current treatment for patients with VMs entails life-long pharmacotherapy or surgical procedures. Here we explored whether intravenously administered agents can be used to destroy VMs by photothermal therapy (PTT), using gold nanoshells (AuNSs) that generated heat following irradiation with near-infrared (NIR) light. In a murine model of VMs, intravenous AuNSs accumulated within the VMs. Irradiation of the VMs induced marked regression and even elimination. Nanoparticle-based photothermal therapy can provide effective therapy for VMs, which are otherwise relatively refractory to treatment.
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Affiliation(s)
- Kathleen Cullion
- Laboratory for Biomaterials and Drug Delivery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Department of Medical Critical Care, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
| | - Claire A Ostertag-Hill
- Laboratory for Biomaterials and Drug Delivery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
| | - Michelle Pan
- Laboratory for Biomaterials and Drug Delivery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Department of Medical Critical Care, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
| | - Brian Timko
- Department of Biomedical Engineering, Tufts University, Medford, Massachusetts 02155, United States
| | - Elisa Boscolo
- Division of Experiment Hematology and Cancer Biology, Cincinnati Children's Hospital, Cincinnati, Ohio 45229, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, United States
| | - Daniel S Kohane
- Laboratory for Biomaterials and Drug Delivery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Department of Anesthesiology, Critical Care, and Pain Management, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
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26
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Raicu AM, Danila GF, Secheli IF, Bratu EC, Minca DG. Infantile Haemangioma in the Romanian Paediatric Population-Characteristics and Therapeutic Approaches. Children (Basel) 2023; 10:1314. [PMID: 37628313 PMCID: PMC10453925 DOI: 10.3390/children10081314] [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] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/20/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023]
Abstract
Infantile haemangioma (IH) is the most common benign tumour in childhood, with an incidence of 4% to 12%. Aim: to describe the characteristics of infantile haemangioma in a sample of Romanian children <2 years old at diagnosis, types of treatment applied, recorded complications and the response to the therapeutic approach. A two-year prospective case series study (August 2019 to August 2021) was carried out. Sample: 117 patients <24 months of age diagnosed with IH at the Emergency Hospital for Children "Marie Sklodowska Curie", in Bucharest, Romania. Five therapeutic approaches were used: oral treatment with propranolol, local treatment with timolol, surgical treatment, topical treatment with steroids and no treatment ("wait and see"). Recorded factors mentioned in the literature were also present in this study population: female patients-68.4%; phototype I-58%. In 53% of cases, IHs had a head and neck location and 10% developed local complications (traumatic bleeding). The majority of patients (86%) required one type of therapy: oral propranolol (51%). A low relapse rate was recorded (4%). We consider that any child with a vascular anomaly should be referred to a highly specialised medical service for therapeutic approach.
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Affiliation(s)
- Anca-Maria Raicu
- Department of Public Health and Management, “Carol Davila” University of Medicine and Pharmacy, 050463 Bucharest, Romania; (E.C.B.); (D.G.M.)
- Department of Paediatric Surgery, Emergency Hospital for Children “M.S.Curie”, 041451 Bucharest, Romania
| | - George-Florin Danila
- Department of Paediatric Surgery, Emergency Hospital for Children “M.S.Curie”, 041451 Bucharest, Romania
| | - Ionut Fernando Secheli
- Department of Paediatric Surgery, Emergency Hospital for Children “M.S.Curie”, 041451 Bucharest, Romania
| | - Eugenia Claudia Bratu
- Department of Public Health and Management, “Carol Davila” University of Medicine and Pharmacy, 050463 Bucharest, Romania; (E.C.B.); (D.G.M.)
| | - Dana Galieta Minca
- Department of Public Health and Management, “Carol Davila” University of Medicine and Pharmacy, 050463 Bucharest, Romania; (E.C.B.); (D.G.M.)
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Fan X, Zhang J, Liu P, Ye Z. Embolo/sclerotherapy for the treatment of hand arteriovenous malformations: a single-center retrospective cohort experience. Front Surg 2023; 10:1191876. [PMID: 37396293 PMCID: PMC10312000 DOI: 10.3389/fsurg.2023.1191876] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Purpose To retrospectively report our preliminary experience of treating hand arteriovenous malformations (AVMs) with embolo/sclerotherapy. Materials and methods Retrospectively review the demographics, treatment detail, outcome data, and complications of 13 consecutive patients with hand AVMs from January 2018 to December 2021. We embolize the dominant outflow vein with elastic coils and then use absolute ethanol or polidocanol for intravascular sclerotherapy and bleomycin for interstitial sclerotherapy. Results Yakes type II presents in four lesions, type IIIa in six, and type IIIb in three. A total of 29 treatment episodes were conducted for the 13 patients (1 episode for 3 patients, 2 for 4 patients, and 3 for 6 patients; the repeated treatment rate was 76.9%). The mean stretched length of coils for 1 treatment episode was 95 cm. The mean absolute ethanol dosage was 6.8 ml (range 4-30 ml). In addition, 10 ml of 3% polidocanol foam was injected and interstitial sclerotherapy with 150,000 IU bleomycin was performed on every patient. The post-operative arterial-dominant outflow vein pressure index (AVI) increased in the 29 procedures (6.55 ± 1.68 vs. 9.38 ± 2.80, P < 0.05). The Mann-Whitney U test showed that the post-operative AVI was higher in patients without re-intervention (P < 0.05). Local swelling occurred after all the procedures. Blistering occurred in 6 of the patients in 13 (44.8%) of the 29 procedures. Superficial skin necrosis occurred in 3 of the patients in 5 (17.2%) of the 29 procedures. The swelling, blistering, and superficial skin necrosis recovered within 4 weeks. No finger amputation occurred. The follow-up time was 6 months. The 6-month assessment of clinical improvement after the last treatment episode showed that 2 patients were cured, 10 were improved, and 1 remained unchanged. With regard to angiographic evaluation, 9 showed partial response and 4 complete response. Conclusion Embolo/sclerotherapy can be effective and safe for hand AVM. The AVI increased significantly after embolo/sclerotherapy, and the index may be valuable in predicting recurrence in further study.
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Dompmartin A, Baselga E, Boon LM, Diociaiuti A, Dvorakova V, El Hachem M, Gasparella P, Haxhija E, Ghaffarpour N, Kyrklund K, Irvine AD, Kapp FG, Rößler J, Salminen P, van den Bosch C, van der Vleuten C, Schultze Kool L, Vikkula M. The VASCERN-VASCA Working Group Diagnostic and Management Pathways for Venous Malformations. J Vasc Anom (Phila) 2023; 4:e064. [PMID: 37332880 PMCID: PMC10275493 DOI: 10.1097/jova.0000000000000064] [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] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/04/2023] [Indexed: 06/20/2023]
Abstract
To elaborate expert consensus patient pathways to guide patients and physicians toward efficient diagnostics and management of patients with venous malformations. Methods VASCERN-VASCA (https://vascern.eu/) is a European network of multidisciplinary centers for Vascular Anomalies. The Nominal Group Technique was used to establish the pathways. Two facilitators were identified: one to propose initial discussion points and draw the pathways, and another to chair the discussion. A dermatologist (AD) was chosen as first facilitator due to her specific clinical and research experience. The draft was subsequently discussed within VASCERN-VASCA monthly virtual meetings and annual face-to-face meetings. Results The Pathway starts from the clinical suspicion of a venous type malformation (VM) and lists the clinical characteristics to look for to support this suspicion. Strategies for subsequent imaging and histopathology are suggested. These aim to inform on the diagnosis and to separate the patients into 4 subtypes: (1) sporadic single VMs or (2) multifocal, (3) familial, multifocal, and (4) combined and/or syndromic VMs. The management of each type is detailed in subsequent pages of the pathway, which are color coded to identify sections on (1) clinical evaluations, (2) investigations, (3) treatments, and (4) associated genes. Actions relevant to all types are marked in separate boxes, including when imaging is recommended. When definite diagnoses have been reached, the pathway also points toward disease-specific additional investigations and recommendations for follow up. Options for management are discussed for each subtype, including conservative and invasive treatments, as well as novel molecular therapies. Conclusion The collaborative efforts of VASCERN-VASCA, a network of the 9 Expert Centers, has led to a consensus Diagnostic and Management Pathways for VMs to assist clinicians and patients. It also emphasizes the role of multidisciplinary expert centers in the management of VM patients. This pathway will become available on the VASCERN website (http://vascern.eu/).
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Affiliation(s)
- Anne Dompmartin
- Dermatology Department CHU Caen Université Caen Normandie CHU Caen Côte nacre 14033 Caen Cedex, France
| | - Eulalia Baselga
- Pediatric Dermatology, Hospital Sant Joan de Deu, Barcelona, Spain; VASCERN VASCA European Reference Centre
| | - Laurence M. Boon
- Center for Vascular Anomalies, Division of Plastic Surgery, University Clinics Saint-Luc, University of Louvain, Brussels, Belgium; VASCERN VASCA European Reference Centre
| | - Andrea Diociaiuti
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165, Rome, Italy; VASCERN VASCA European Reference Centre
| | - Veronika Dvorakova
- Paediatric Dermatology, Children’s Health Ireland; Clinical Medicine, Trinity College Dublin, Ireland; VASCERN VASCA European Reference Centre
| | - May El Hachem
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165, Rome, Italy; VASCERN VASCA European Reference Centre
| | - Paolo Gasparella
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria; VASCERN VASCA European Reference Centre
| | - Emir Haxhija
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria; VASCERN VASCA European Reference Centre
| | - Nader Ghaffarpour
- Department of Plastic and Craniofacial Surgery Karolinska University Hospital Stockholm, Stockholm, Sweden; VASCERN VASCA European Reference Centre
| | - Kristiina Kyrklund
- Department of Pediatric Surgery, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; VASCERN VASCA European Reference Centre
| | - Alan D. Irvine
- Paediatric Dermatology, Children’s Health Ireland; Clinical Medicine, Trinity College Dublin, Ireland; VASCERN VASCA European Reference Centre
| | - Friedrich G. Kapp
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; VASCERN VASCA European Reference Centre
| | - Jochen Rößler
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; VASCERN VASCA European Reference Centre
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Päivi Salminen
- Department of Pediatric Surgery, HUSRare Disease Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; VASCERN VASCA European Reference Centre
| | | | - Carine van der Vleuten
- Department of Dermatology, Radboudumc Expertise Center for Haemangiomas and Congenital Vascular Malformations Nijmegen (Hecovan), Radboud University Medical Center, Nijmegen, the Netherlands; VASCERN VASCA European Reference Centre
| | - Leo Schultze Kool
- Department of Radiology, Radboudumc Expertise Center for Haemangiomas and Congenital Vascular Malformations Nijmegen (Hecovan), Radboud University Medical Center, Nijmegen, the Netherlands; VASCERN VASCA European Reference Centre
| | - Miikka Vikkula
- Center for Vascular Anomalies, Division of Plastic Surgery, University Clinics Saint-Luc, University of Louvain, Brussels, Belgium; VASCERN VASCA European Reference Centre
- Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium
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Mologousis MA, Rork JF, Balkin DM, Berry JG, Liang MG. Metopic ridge presenting to pediatric dermatology and vascular anomalies clinics. Pediatr Dermatol 2023. [PMID: 37253677 DOI: 10.1111/pde.15371] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/13/2023] [Indexed: 06/01/2023]
Abstract
Metopic ridge (MeR) is a midline osseous forehead prominence resulting from physiologic closure of the underlying metopic suture. This mass-like ridge can be mistaken for serious conditions such as a craniosynostosis or vascular anomaly, prompting concern and workup. We reviewed patients presenting for a forehead mass to Vascular Anomalies and Dermatology clinics and diagnosed with MeR to increase familiarity with this finding and to encourage MeR in the differential diagnosis of pediatric midline forehead masses.
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Affiliation(s)
- Mia A Mologousis
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Department of Dermatology, Vascular Anomalies Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jillian F Rork
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
- Department of Dermatology, Dartmouth Hitchcock Medical Center, Manchester, New Hampshire, USA
| | - Daniel M Balkin
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jay G Berry
- Harvard Medical School, Boston, Massachusetts, USA
- Complex Care, Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Marilyn G Liang
- Department of Dermatology, Vascular Anomalies Center, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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30
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Pang C, Abu-Hanna J, Lim CS, Brookes J, Tsui J, Hamilton G, Onuba L, Deroide F. Histopathological analysis of vascular malformations. Phlebology 2023:2683555231175022. [PMID: 37177803 DOI: 10.1177/02683555231175022] [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: 05/15/2023]
Abstract
OBJECTIVE To propose and develop a histopathological criteria to help diagnose vascular malformations. METHODS All patients who underwent surgical resection and had a confirmed histopathological diagnosis of vascular malformations from 01 March 2018-26 February 2020 were included. A criteria based on 10 parameters was developed to help diagnose vascular malformations. Discrepancies between clinical and histopathological diagnosis were evaluated. RESULTS A total of 18 cases were identified. There was a discrepancy between the clinical diagnosis and the initially reported histopathological diagnosis in 16 cases (88.9%). This was reduced to 7 (38.9%) and 6 cases (33.3%) with first and second time revised histopathological analysis using proposed criteria. CONCLUSIONS The discrepancy between clinical and histopathological diagnoses of vascular malformations has highlighted the requirement of an agreed criteria for histopathologists to help formulate their diagnosis. The proposed criteria may be used as a guide in addressing this and guide treatment and improve clinical practice.
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Affiliation(s)
- Calver Pang
- Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, London, UK
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, UK
| | - Jeries Abu-Hanna
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, UK
| | - Chung Sim Lim
- Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, London, UK
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, UK
| | - Jocelyn Brookes
- Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, London, UK
- Department of Interventional Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - Janice Tsui
- Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, London, UK
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, UK
| | - George Hamilton
- Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, London, UK
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, UK
| | - Louisa Onuba
- Department of Cellular Pathology, Royal Free London NHS Foundation Trust, London, UK
| | - Florence Deroide
- Department of Cellular Pathology, Royal Free London NHS Foundation Trust, London, UK
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Triana P, Lopez-Gutierrez JC. Activity of a TIE2 inhibitor (rebastinib) in a patient with a life-threatening cervicofacial venous malformation. Pediatr Blood Cancer 2023:e30404. [PMID: 37158500 DOI: 10.1002/pbc.30404] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/06/2023] [Accepted: 04/16/2023] [Indexed: 05/10/2023]
Abstract
Targeted therapy has become the first therapeutic option in many patients with vascular anomalies. A male 28-year-old patient presented a severe cervicofacial venous malformation involving half-lower face, anterior neck, and oral cavity with progression despite multiple previous treatments, with a somatic variant in TEK (endothelial-specific protein receptor tyrosine kinase) (c.2740C>T; p.Leu914Phe). The patient had facial deformity, daily episodes of pain and inflammation needing massive amount of medication, and difficulty in speech and swallowing, so rebastinib (a TIE2 kinase inhibitor) was approved for compassionate use. After 6 months of treatment, venous malformation had decreased in size and lightened, as well as improved quality-of-life scores.
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Affiliation(s)
- Paloma Triana
- Vascular Anomaly Center, La Paz Children's Hospital, Madrid, Spain
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Gupta R. Propranolol for Vascular Anomalies: Efficacy and Complications in Pediatric Patients. J Indian Assoc Pediatr Surg 2023; 28:194-205. [PMID: 37389387 PMCID: PMC10305951 DOI: 10.4103/jiaps.jiaps_117_22] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 12/25/2022] [Accepted: 12/28/2022] [Indexed: 07/01/2023] Open
Abstract
Context Congenital vascular anomalies are classically subdivided into vascular tumors and vascular malformations. The role of propranolol in the regression of infantile hemangioma (IH), a vascular tumor, is well establishe. Aims This study aimed to analyze the therapeutic efficacy and complications associated with oral propranolol and adjuvant therapy in the treatment of vascular anomalies. Settings and Design A prospective interventional study was undertaken over 10 years duration extending from 2012 to 2022 at a tertiary care teaching institute. Materials and Methods All children with cutaneous hemangiomas and lymphatic and venous malformations under 12 years of age, except those with contraindications for administration of propranolol, were included in the study. Results Out of 382 patients, there were 159 males and 223 females (male: female = 1:1.4). The majority (53.66%) were between ≥3 months and 1 year. There were 481 lesions in 382 patients. There were 348 patients with IH, and 11 were congenital hemangiomas (CHs). There were 23 patients with vascular malformations; lymphatic malformation (n = 19) and venous malformation (n = 4) were present. The size of the lesions ranged from 5 mm to 20 cm; 50.73% were 2-5 cm in size. Ulceration (>5 mm) was the most common complication present in 20/382 (5.24%) patients. Complications related to oral propranolol were seen in 23 (6.02%) patients. Drugs were given for a mean period of 10 months (range from 5 months to 2 years). At the end of the study, 282 (81.03%) out of 348 patients with IH showed an excellent response; 4 (36.36%) patients in the case of CH (n = 11) and 5 (21.74%) patients with vascular malformation (n = 23) showed excellent response. Conclusion The study validates the use of propranolol hydrochloride as the first-line agent for the treatment of IHs and congenital hemangiomas. It may have an additive role in lymphatic malformations, and venous malformations, as a part of a multimodality treatment approach for vascular malformations.
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Affiliation(s)
- Rahul Gupta
- Department of Paediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India
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Tempesta A, Dell'Olio F, Siciliani RA, Favia G, Capodiferro S, Limongelli L. Targeted Diode Laser Therapy for Oral and Perioral Capillary-Venous Malformation in Pediatric Patients: A Prospective Study. Children (Basel) 2023; 10:children10040611. [PMID: 37189860 DOI: 10.3390/children10040611] [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] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/18/2023] [Accepted: 03/20/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND This study describes the management protocol for capillary-venous malformations in pediatric patients and reports the epidemiology of diagnosed and treated cases at the Unit of Odontostomatology of the Aldo Moro University of Bari from 2014 to 2022. METHODS The authors classified the intraoral and perioral capillary-venous malformations by superficial diameter (<1 cm, 1-3 cm, >3 cm) and ultrasonographical depth extension (≤5 mm, >5 mm). All patients underwent pulsed-mode diode laser transmucosal photocoagulation (8-12 W/cm2); those with malformations that were wide (>3 cm) and deep (>5 mm) received intralesional photocoagulation, too (13 W/cm2). The children received general anesthesia based on their compliance and lesions' extension. The follow-up lasted six months. RESULTS A total of 22 females and 14 males (age range 4-18 years) presented 63 capillary-venous malformations. Five patients with Sturge-Weber syndrome, seven with hereditary hemorrhagic telangiectasia, and five with angiomatosis showed multiple malformations. The authors found no intraoperative or postoperative complications. Seventeen patients with lesions >1 cm and >5 mm deep required multiple laser sessions to heal. CONCLUSION The results of the current study support diode laser photocoagulation as the gold standard for the treatment of intraoral and perioral capillary-venous malformations in pediatric patients.
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Affiliation(s)
- Angela Tempesta
- Complex Operating Unit of Odontostomatology, Department of Interdisciplinary Medicine, Aldo Moro University, 70121 Bari, Italy
| | - Fabio Dell'Olio
- Complex Operating Unit of Odontostomatology, Department of Interdisciplinary Medicine, Aldo Moro University, 70121 Bari, Italy
| | - Rosaria Arianna Siciliani
- Complex Operating Unit of Odontostomatology, Department of Interdisciplinary Medicine, Aldo Moro University, 70121 Bari, Italy
| | - Gianfranco Favia
- Complex Operating Unit of Odontostomatology, Department of Interdisciplinary Medicine, Aldo Moro University, 70121 Bari, Italy
| | - Saverio Capodiferro
- Complex Operating Unit of Odontostomatology, Department of Interdisciplinary Medicine, Aldo Moro University, 70121 Bari, Italy
| | - Luisa Limongelli
- Complex Operating Unit of Odontostomatology, Department of Interdisciplinary Medicine, Aldo Moro University, 70121 Bari, Italy
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34
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Appiah-Thompson P, Hanson NAM, Quansah K, Edzie EKM, Babatunde JB. Congenital Laryngeal Hemangioma: A Case Report of a Rare Presentation. Cureus 2023; 15:e34814. [PMID: 36915847 PMCID: PMC10008088 DOI: 10.7759/cureus.34814] [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] [Accepted: 02/08/2023] [Indexed: 02/11/2023] Open
Abstract
Pediatric vascular anomalies are classified into vascular malformations and vascular tumors. While vascular malformations are generally anomalous vessels, vascular tumors arise from endothelial cells characterized by abnormal proliferation. Vascular tumors, also called hemangiomas, are subdivided into infantile and congenital hemangiomas. The differentiation of these anomalies can be challenging, and immunohistochemical staining is often employed for this purpose. The GLUT-1 (erythrocyte-type glucose transporter protein) stain is positive for the infantile type. Hemangiomas are usually found in the head and neck region. Their occurrence in the laryngeal region in infants tends to manifest in the subglottic region. Hemangiomas in the larynx mostly do not cause any symptoms until they are large enough to cause dyspnea, stridor, or hoarseness of voice. They are mostly treated in infants with propranolol or surgical excision. We report a case of an eight-day-old female infant who presented with a mass that recurrently protruded out of the mouth when she cried. The mass stopped protruding out of the mouth when the baby became restless, had respiratory distress, and refused feeds. Endoscopy of the pharynx and larynx showed a pedunculated hemorrhagic mass attached by a stalk to the left arytenoid. With cautery, the stalk of the lesion was severed from its attachment. The baby was discharged on the fourth postoperative day and histology reported a cavernous hemangioma. Seven months after the surgery, the baby is growing normally. Yearly follow-up endoscopies have been scheduled to evaluate for recurrence or residual disease.
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Affiliation(s)
- Peter Appiah-Thompson
- Surgery/Otolaryngology, School of Medical Sciences, University of Cape Coast, Cape Coast, GHA.,Surgery/Otolaryngology, Cape Coast Teaching Hospital, Cape Coast, GHA
| | | | - Kofi Quansah
- Surgery/Otolaryngology, Cape Coast Teaching Hospital, Cape Coast, GHA
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35
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Nunez JH, Strong AL, Comish P, Hespe GE, Harvey J, Sorkin M, Levi B. A Review of Laser Therapies for the Treatment of Scarring and Vascular Anomalies. Adv Wound Care (New Rochelle) 2023; 12:68-84. [PMID: 35951024 DOI: 10.1089/wound.2021.0045] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Significance: Laser use has become part of the gold standard of treatment as an effective adjuvant in multimodal therapy for pathologic scarring caused by burns, trauma, acne, and surgery, as well as vascular anomalies. Understanding indications and applications for laser therapy is essential for physicians to improve patient outcomes. Recent Advances: Since the 1980s, the medical use of lasers has continuously evolved with improvements in technology. Novel lasers and fractionated technologies are currently being studied in the hopes to improve treatment efficacy, while reducing complications. Recent advancements include acne treatment with novel picosecond lasers, new hypertrophic scar therapies with simultaneous laser and intense pulsed light use, and novel systems such as lasers with intralesional optical fiber delivery devices. In addition, optimizing the timing of laser therapy and its use in multimodal treatments continue to advance the field of photothermolysis. Critical Issues: Selecting the correct laser for a given indication is the fundamental decision when choosing a laser balancing effective treatment with minimal complications. This article covers the principles of laser therapy, the preferred lasers used for the treatment of scarring and vascular anomalies, and discusses the current evidence behind these laser choices. Future Directions: To optimize laser therapy, larger randomized control trials and split scar studies are needed. Continued advancement through better randomized controlled studies will help to improve patient outcomes on a broader scale.
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Affiliation(s)
- Johanna H Nunez
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Amy L Strong
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Paul Comish
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Geoffrey E Hespe
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Jalen Harvey
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michael Sorkin
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Benjamin Levi
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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36
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Okorie CL, Salem I, Davis MJ, Mann JA. A case of late ulceration of infantile hemangioma in the setting of SARS-CoV2 infection. JAAD Case Rep 2023; 31:109-111. [PMID: 36406336 PMCID: PMC9639406 DOI: 10.1016/j.jdcr.2022.10.037] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/31/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Iman Salem
- Department of Dermatology and Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Matthew J. Davis
- Department of Dermatology and Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Julianne A. Mann
- Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire,Department of Dermatology and Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire,Correspondence to: Julianne A. Mann, MD, Associate Professor, Dermatology and Pediatrics, Department of Dermatology, Dartmouth Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03756
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37
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Abushkin IA, Chudnovskii VM, Guzev MA, Polyaev YA, Garbuzov RV. Laser Interstitial Thermotherapy in Surgical Treatment of Vascular Anomalies. Bull Exp Biol Med 2023; 174:399-403. [PMID: 36723751 DOI: 10.1007/s10517-023-05716-2] [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] [Received: 07/05/2022] [Indexed: 02/02/2023]
Abstract
The effects of subcooled boiling of water and blood in the experimental cuvette and rabbit hepatic vessels under the influence of optical fiber-guided continuous IR laser radiation (1.94 μm) were studied using optical methods and ultrasonic diagnostics near the tip of the laser optical fiber. The liver was chosen as a model of vascular abnormality with a conglomerate of blood vessels. In the proposed approach, modification (obliteration and coagulation) of the vascular anomalies occurred as a result of intense subcooled boiling of the blood with generation of heated submerged jets.
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Affiliation(s)
- I A Abushkin
- Institute of Applied Mathematics, Far East Division of the Russian Academy of Sciences, Vladivostok, Russia
| | - V M Chudnovskii
- Institute of Applied Mathematics, Far East Division of the Russian Academy of Sciences, Vladivostok, Russia.
| | - M A Guzev
- Institute of Applied Mathematics, Far East Division of the Russian Academy of Sciences, Vladivostok, Russia
| | - Yu A Polyaev
- Institute of Applied Mathematics, Far East Division of the Russian Academy of Sciences, Vladivostok, Russia
| | - R V Garbuzov
- Institute of Applied Mathematics, Far East Division of the Russian Academy of Sciences, Vladivostok, Russia
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38
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Kapp FG, Schneider C, Holm A, Glonnegger H, Niemeyer CM, Rößler J, Zieger B. Comprehensive Analyses of Coagulation Parameters in Patients with Vascular Anomalies. Biomolecules 2022; 12:biom12121840. [PMID: 36551267 PMCID: PMC9775116 DOI: 10.3390/biom12121840] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/03/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Vascular anomalies comprise a diverse group of rare diseases with altered blood flow and are often associated with coagulation disorders. The most common example is a localized intravascular coagulopathy in venous malformations leading to elevated D-dimers. In severe cases, this may progress to a disseminated intravascular coagulopathy with subsequent consumption of fibrinogen and thrombocytes predisposing to serious bleeding. A separate coagulopathy is the Kasabach-Merritt phenomenon in kaposiform hemangioendothelioma characterized by platelet trapping leading to thrombocytopenia and eventually consumptive coagulopathy. Our previous work showed impaired von Willebrand factor and platelet aggregometry due to abnormal blood flow, i.e., in ventricular assist devices or extracorporeal membrane oxygenation. With altered blood flow also present in vascular anomalies, we hypothesized that, in particular, the von Willebrand factor parameters and the platelet function may be similarly impacted. METHODS We prospectively recruited 73 patients with different vascular anomaly entities and analyzed their coagulation parameters. RESULTS Acquired von Willebrand syndrome was observed in both of our patients with Kasabach-Merritt phenomenon. In six out of nine patients with complex lymphatic anomalies, both the vWF antigen and activity were upregulated. Platelet aggregometry was impaired in both patients with Kasabach-Merritt phenomenon and in seven out of eight patients with an arteriovenous malformation. CONCLUSIONS The analysis of coagulation parameters in our patients with vascular anomalies advanced our understanding of the underlying pathophysiologies of the observed coagulopathies. This may lead to new treatment options for the, in part, life-threatening bleeding risks in these patients in the future.
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Affiliation(s)
- Friedrich G. Kapp
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- VASCERN VASCA European Reference Centre, 75108 Paris, France
- Correspondence:
| | - Cedric Schneider
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- VASCERN VASCA European Reference Centre, 75108 Paris, France
| | - Annegret Holm
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- VASCERN VASCA European Reference Centre, 75108 Paris, France
- Vascular Biology Program, Department of Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Hannah Glonnegger
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- VASCERN VASCA European Reference Centre, 75108 Paris, France
| | - Charlotte M. Niemeyer
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- VASCERN VASCA European Reference Centre, 75108 Paris, France
| | - Jochen Rößler
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- VASCERN VASCA European Reference Centre, 75108 Paris, France
- Division of Paediatric Hematology and Oncology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Barbara Zieger
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- VASCERN VASCA European Reference Centre, 75108 Paris, France
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39
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da Silva TJ, de Oliveira DHIP, Nonaka CFW, da Silveira ÉJD, Queiroz LMG. Immunoexpression of proliferation and apoptosis markers in oral vascular anomalies. Braz Dent J 2022; 33:65-70. [PMID: 36477966 PMCID: PMC9733364 DOI: 10.1590/0103-6440202205010] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/13/2022] [Indexed: 12/12/2022] Open
Abstract
The biological behavior of lesions is highly dependent on the imbalance between their proliferative and apoptotic capacity. This study evaluated a correlation between the proliferative and apoptotic rates of different oral vascular anomalies (VAs) by analyzing the immunoexpression of proliferation (Ki-67) and apoptosis (Bcl-2 and Bax) markers in endothelial cells of 20 cases of GLUT-1 positive infantile hemangiomas (IHs), 20 cases of pyogenic granulomas (PGs) and 20 cases of vascular malformations (VMs). Immunoexpression analysis of Ki-67, Bcl-2 and Bax revealed a lower median percentage of positive cells in VMs cases compared to IHs and PGs cases (P <0.001). The Wilcoxon signed-rank test showed significantly higher percentages of immunostaining for Bax than for Bcl-2 in IHs (P = 0.048). In the group of PGs, a positive correlation was observed between the immunoexpressions of Ki-67 and Bax (r = 0.476; P = 0.034). Although oral IHs, PGs and VMs present similar clinical and histopathological features, each of these lesions has its etiopathogenic particularities. The results of this study suggest that different biological behaviors of VAs may be related to differences in the proliferative and apoptotic profiles of their endothelial cells.
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Affiliation(s)
- Tiago João da Silva
- School of Dentistry, State University of Paraíba, Campina Grande, PB, Brazil.
| | | | | | | | - Lélia Maria Guedes Queiroz
- Postgraduate Program in Oral Pathology, Department of Dentistry, Federal University of Rio Grande do Norte, Natal, RN, Brazil
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40
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Mack JM, Peterson EC, Crary SE, Moran JH, Neville K, Pierce CD, Richter GT. Pharmacokinetics of bleomycin sclerotherapy in patients with vascular malformations. Pediatr Blood Cancer 2022; 69:e29733. [PMID: 35484878 DOI: 10.1002/pbc.29733] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/25/2022] [Accepted: 03/21/2022] [Indexed: 11/10/2022]
Abstract
Bleomycin, a chemotherapy agent that inhibits synthesis of DNA, has been increasingly utilized in sclerotherapy for patients with vascular malformations. A serious long-term risk of intravenous bleomycin is dose-dependent interstitial pneumonitis. Little is known about absorption and circulating levels of bleomycin when used in sclerotherapy for patients with vascular malformations. This is an Institutional Review Board (IRB)-approved prospective study on patients receiving bleomycin sclerotherapy in the management of vascular malformations. Depending on the type of vascular malformation, bleomycin was administered either in the lumen or interstitial space of the involved lesion. A bleomycin assay measured serum bleomycin plasma concentrations versus time at seven intervals following treatment. Pharmacokinetic parameters were obtained for each participant and included peak plasma concentration (Cmax ), time to reach peak plasma concentration (Tmax ), volume of distribution (Vd ), elimination half-life (t1/2 ), the volume of plasma cleared of the drug per unit time (CL), and total systemic exposure area under the curve (AUC). Fifteen patients were enrolled (5: lymphatic, 4: venous, 6: arteriovenous malformations). Bleomycin was administered interstitially (IS) in 11 patients and intraluminal (IL) in four; median age of 13 years (range: 2-67). Pharmacokinetic analysis revealed terminal elimination half-life (t1/2λz ) of 88.51 (±23.09) and 111.61 (±37.75) minutes for the IS and IL groups, respectively. Vd was 4.86 L (±6.74) and 1.55 L (±0.54) for the IS and IL groups, respectively. AUC was 53.9 (±23.45) and 129.17 (±93.57) mg min/L for the IS and IL groups, respectively. There were no statistically significant differences in t1/2λz , Vd , or AUC parameters between groups. Bleomycin is absorbed systemically when used as a sclerosant for vascular malformations when injected either IS or IL.
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Affiliation(s)
- Joana M Mack
- Department of Pediatrics, Division of Hematology/Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Eric C Peterson
- Department of Pharmacology and Toxicology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Shelley E Crary
- Department of Pediatrics, Division of Hematology/Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Jeffery H Moran
- Department of Pharmacology and Toxicology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Kathleen Neville
- Department of Pediatrics, Division of Hematology/Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Arkansas Children's Hospital, Little Rock, Arkansas, USA.,Johnson and Johnson, Raritan, New Jersey, USA
| | - C D'ann Pierce
- Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Gresham T Richter
- Arkansas Children's Hospital, Little Rock, Arkansas, USA.,Department of Surgery, Division of Otolaryngology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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41
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Shimano KA, Eng W, Adams DM. How we approach the use of sirolimus and new agents: Medical therapy to treat vascular anomalies. Pediatr Blood Cancer 2022; 69 Suppl 3:e29603. [PMID: 35253343 DOI: 10.1002/pbc.29603] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 01/11/2022] [Accepted: 01/18/2022] [Indexed: 12/11/2022]
Abstract
Vascular anomalies (VAs) are a heterogeneous group of primarily congenital tumors and malformations. The International Society for the Study of Vascular Anomalies (ISSVA) has developed a standard classification of these disorders, creating a uniform approach to their diagnosis. Recent discoveries evaluating the genetic causes of VAs have revealed that they are due to mutations in cancer pathways, including the PI3K/AKT/mTOR and RAS/MAPK/MEK pathways. These discoveries have led to improved phenotype-genotype correlation and have expanded medical therapy for this group of unique disorders.
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Affiliation(s)
- Kristin A Shimano
- Division of Allergy, Immunology, and Bone Marrow Transplant, UCSF Benioff Children's Hospital, University of California, San Francisco, California, USA
| | - Whitney Eng
- Division of Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Denise M Adams
- Division of Oncology, Comprehensive Vascular Anomalies Program/Frontier Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Division of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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42
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Heym KM, Masand PM, Margolin JF. How we approach the diagnosis of a vascular anomaly. Pediatr Blood Cancer 2022; 69 Suppl 3:e29802. [PMID: 35709330 DOI: 10.1002/pbc.29802] [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] [Received: 12/17/2021] [Revised: 04/14/2022] [Accepted: 05/08/2022] [Indexed: 11/11/2022]
Abstract
Vascular anomalies represent a diverse group of complex disorders that can cause significant complications, including coagulopathies, pain, and decreased function. The diagnosis of vascular anomalies is often challenging due to heterogeneity of presenting phenotypes and overlapping clinical features with other pediatric conditions. Pediatric hematologists/oncologists (PHO) are uniquely positioned for an essential role in diagnosing, managing, and coordinating the multidisciplinary care required to maximize the quality of life of these patients. Here, we review the diagnostic approach involved in patients with vascular anomalies and utilize cases to highlight the challenges involved, and how PHOs can play a vital part in the care of these patients.
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Affiliation(s)
- Kenneth M Heym
- Department of Hematology/Oncology, Cook Children's Medical Center, Fort Worth, Texas, USA
| | - Prakash M Masand
- Department of Radiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Judith F Margolin
- Department of Pediatrics, Division of Hematology/Oncology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
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43
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Mack JM, Crary SE. How we approach coagulopathy with vascular anomalies. Pediatr Blood Cancer 2022; 69 Suppl 3:e29353. [PMID: 36070211 DOI: 10.1002/pbc.29353] [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] [Received: 04/07/2021] [Revised: 08/14/2021] [Accepted: 08/31/2021] [Indexed: 01/19/2023]
Abstract
Some vascular anomalies can present with challenging hematologic aberrations. Kaposiform hemangioendothelioma (KHE) may be complicated with Kasabach-Merritt phenomenon (KMP) and stagnant blood flow in slow-flow malformations can promote activation and consumption of coagulation factors, which results in bleeding and clotting known as localized intravascular coagulopathy (LIC). These patients can experience significant morbidity secondary to pain due to thrombosis and are at higher risk of hematologic complications during surgical procedures. No standard of care has been established to prevent or manage these complications. This review focuses on the management of coagulopathy in children and adults with vascular anomalies.
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Affiliation(s)
- Joana M Mack
- Department of Pediatrics, Division of Hematology/Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Shelley E Crary
- Department of Pediatrics, Division of Hematology/Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Arkansas Children's Hospital, Little Rock, Arkansas, USA
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44
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Al-Samkari H, Eng W. A precision medicine approach to hereditary hemorrhagic telangiectasia and complex vascular anomalies. J Thromb Haemost 2022; 20:1077-1088. [PMID: 35343049 PMCID: PMC10044495 DOI: 10.1111/jth.15715] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 11/29/2022]
Abstract
Vascular anomalies represent a diverse group of disorders classified broadly as malformations or tumors and include the second most common hereditary bleeding disorder worldwide, hereditary hemorrhagic telangiectasia (HHT). Patients with HHT and other vascular anomalies suffer morbid consequences of these diseases, including bleeding, thrombosis, anemia, localized intravascular coagulation, tissue overgrowth, infections, and other complications. The International Society for the Study of Vascular Anomalies (ISSVA) has developed a standard classification of these disorders, creating a uniform approach to their diagnosis, and the treatments for vascular anomalies are rapidly evolving. Recent discoveries have elucidated the molecular basis of a number of common and uncommon vascular anomalies. HHT occurs due to mutations in the transforming growth factor beta (TGF-β) pathway, resulting in vascular endothelial growth factor excess. Complex vascular anomalies including Klippel-Trénaunay syndrome (KTS) and arteriovenous malformation (AVM) may occur due to mutations in the PI3K/AKT/mTOR and RAS/MAPK/MEK pathways. The discovery of the pathophysiologic mechanisms driving these diseases has led to improved phenotype-genotype correlation and the opportunity to target molecular pathways with medical therapies. Therefore, targeted agents have quickly become a standard of care in the treatment of vascular disorders (particularly HHT). Herein, we provide a case-based approach to the use of antiangiogenic therapies including bevacizumab and pazopanib for the treatment of bleeding in HHT and the use of mammalian target of rapamycin (sirolimus), PIK3CA (alpelisib), and MEK (trametinib) inhibitors in the treatment of complex vascular anomalies.
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Affiliation(s)
- Hanny Al-Samkari
- Division of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Whitney Eng
- Harvard Medical School, Boston, Massachusetts, USA
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts, USA
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45
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Gocal W, Hilal E, Tragon T. Nd:YAG Laser Treatment of Massive Tongue Venous Malformation: A Case Report. Ear Nose Throat J 2022:1455613221086030. [PMID: 35323070 DOI: 10.1177/01455613221086030] [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: 11/16/2022] Open
Abstract
Venous malformations (VM) are slow-flow vascular lesions that result from morphogenesis errors. Composed of dysfunctional veins lacking smooth muscle cells, VMs grow slowly and may initially be managed by observation. Treatment is indicated for lesions that cause functional impairment. One treatment option is laser therapy, which is very effective due to its tissue penetration and relative selectivity. The Nd:YAG laser has been shown to treat small and moderately sized mucosal vascular lesions; in this case, it was applied in a staged approach for treatment of a massive venous malformation of the tongue. A 66-year-old male presented with a venous malformation involving the tongue and lower lip, the lesion estimated to be 10 x 14 x 15 cm in size. The Nd:YAG laser was used in three separate stages to photocoagulate the venous lesion. Follow-up for recurrence is ongoing, but currently shows complete malformation ablation with a 36.2% volume reduction after treatment. The Nd:YAG laser is an effective tool in the treatment of large vascular lesions. Successful laser application in a staged approach for the treatment of a venous malformation of this size and complexity further supports its clinical value. Monitoring for possible recurrence of the venous malformation should be ongoing.
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Affiliation(s)
- Wiktoria Gocal
- Allegheny General Hospital, PA, USA
- 6618Drexel University College of Medicine, PA, USA
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46
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Wang H, Guo Z. Commentary: Transarterial Embolization in Neonatal Kasabach-Merritt Syndrome. Front Pediatr 2022; 10:846207. [PMID: 35795336 PMCID: PMC9251004 DOI: 10.3389/fped.2022.846207] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Huaijie Wang
- Department of Pediatric Surgery, Xi'an International Medical Center Hospital, Xi'an, China
| | - Zhengtuan Guo
- Department of Pediatric Surgery, Xi'an International Medical Center Hospital, Xi'an, China
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47
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Karastaneva A, Gasparella P, Tschauner S, Crazzolara R, Kropshofer G, Modl M, Pfleger A, Burmas A, Pocivalnik M, Ulreich R, Zenz W, Schwinger W, Beqo BP, Urban C, Haxhija EQ, Lackner H, Benesch M. Indications and Limitations of Sirolimus in the Treatment of Vascular Anomalies-Insights From a Retrospective Case Series. Front Pediatr 2022; 10:857436. [PMID: 35676905 PMCID: PMC9168223 DOI: 10.3389/fped.2022.857436] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 01/18/2022] [Accepted: 04/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite recent developments, the role of sirolimus in the heterogeneous spectrum of vascular anomalies is yet to be defined, in terms of indication, dosage, and therapy duration, recognizing both its potential and limitations. METHODS We retrospectively analyzed 16 children with vascular anomalies treated with sirolimus in two pediatric centers between 2014 and 2020 [male: n = 7, the median age at diagnosis: 4.6 months (range, 0-281.4)]. In addition, repetitive volumetric analyses of the vascular anomalies were performed when possible (11 cases). RESULTS Ten patients were diagnosed with vascular malformations and 6 with vascular tumors. The mean therapy duration was 27.2 months (range, 3.5-65). The mean sirolimus level was 8.52 ng/ml (range, 5.38-12.88). All patients except one with central conducting lymphatic anomaly responded to sirolimus, with the most noticeable volume reduction in the first 4-6 months. Additional administration of vincristine was needed in five patients with kaposiform hemangioendothelioma and yielded a response, even in cases, refractory to sirolimus monotherapy. As a single agent, sirolimus led to impressive improvement in a patient with another vascular tumor-advanced epithelioid hemangioendothelioma. Complicated vascular malformations required long-term sirolimus therapy. Side effects of sirolimus included mucositis and laboratory abnormalities. No major infectious episodes were recorded. An infant with COVID-19, diagnosed while on sirolimus therapy, presented with a mild course. CONCLUSION In the current series, we reported limitations of sirolimus as monotherapy, addressing the need to redefine its indications, and explore combination regimens and multimodal treatment strategies. Tools for objective evaluation of response trends over time could serve as a basis for the establishment of future therapeutic algorithms.
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Affiliation(s)
- Anna Karastaneva
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Paolo Gasparella
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | | | - Roman Crazzolara
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Gabriele Kropshofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Manfred Modl
- Division of Pediatric Pulmonology and Allergology, Department of Pediatric and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Andreas Pfleger
- Division of Pediatric Pulmonology and Allergology, Department of Pediatric and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Ante Burmas
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Mirjam Pocivalnik
- Pediatric Intensive Care Unit, Department of Pediatric and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Raphael Ulreich
- Pediatric Intensive Care Unit, Department of Pediatric and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Werner Zenz
- Division of General Pediatrics, Department of Pediatric and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Wolfgang Schwinger
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Besiana P Beqo
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria.,Global Clinical Scholars Research Training, Department of Postgraduate Medical Education, Harvard Medical School, Boston, MA, United States
| | - Christian Urban
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Emir Q Haxhija
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Herwig Lackner
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Martin Benesch
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, Medical University of Graz, Graz, Austria
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48
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Colmenero I, Knöpfel N. Venous Malformations in Childhood: Clinical, Histopathological and Genetics Update. Dermatopathology (Basel) 2021; 8:477-93. [PMID: 34698142 DOI: 10.3390/dermatopathology8040050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/17/2021] [Accepted: 09/19/2021] [Indexed: 01/10/2023] Open
Abstract
Our knowledge in vascular anomalies has grown tremendously in the past decade with the identification of key molecular pathways and genetic mutations that drive the development of vascular tumors and vascular malformations. This has led us to better understand the pathogenesis of vascular lesions, refine their diagnosis and update their classification while also exploring the opportunity for a targeted molecular treatment. This paper aims to provide an overview of venous malformations (VM) in childhood. Specific entities include common VMs, cutaneo-mucosal VM, blue rubber bleb nevus syndrome or Bean syndrome, glomuvenous malformation, cerebral cavernous malformation, familial intraosseous vascular malformation and verrucous venous malformation. The clinicopathological features and the molecular basis of each entity are reviewed.
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Antúnez-Conde R, Navarro Cuéllar C, Salmerón Escobar JI, Díez-Montiel A, Navarro Cuéllar I, Dell’Aversana Orabona G, del Castillo Pardo de Vera JL, Navarro Vila C, Cebrián Carretero JL. Intraosseous Venous Malformation of the Zygomatic Bone: Comparison between Virtual Surgical Planning and Standard Surgery with Review of the Literature. J Clin Med 2021; 10:jcm10194565. [PMID: 34640581 PMCID: PMC8509390 DOI: 10.3390/jcm10194565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/02/2021] [Revised: 09/22/2021] [Accepted: 09/22/2021] [Indexed: 01/02/2023] Open
Abstract
Intraosseous venous malformations affecting the zygomatic bone are infrequent. Primary reconstruction is usually accomplished with calvarial grafts, although the use of virtual surgical planning, cutting guides and patient-specific implants (PSI) have had a major development in recent years. A retrospective study was designed and implemented in patients diagnosed with intraosseous venous malformation during 2006–2021, and a review of the scientific literature was also performed to clarify diagnostic terms. Eight patients were treated, differentiating two groups according to the technique: four patients were treated through standard surgery with resection and primary reconstruction of the defect with calvarial graft, and four patients underwent resection and primary reconstruction through virtual surgical planning (VSP), cutting guides, STL models developed with CAD-CAM technology and PSI (titanium or Polyether-ether-ketone). In the group treated with standard surgery, 75% of the patients developed sequelae or morbidity associated with this technique. The operation time ranged from 175 min to 210 min (average 188.7 min), the length of hospital ranged from 4 days to 6 days (average 4.75 days) and the postoperative CT scan showed a defect surface coverage of 79.75%. The aesthetic results were “excellent” in 25% of the patients, “good” in 50% and “poor” in 25%. In the VSP group, 25% presented sequelae associated with surgical treatment. The operation time ranged from 99 min to 143 min (average 121 min), the length of hospital stay ranged from 1 to 2 days (average of 1.75 days) and 75% of the patients reported “excellent” results. Postoperative CT scan showed 100% coverage of the defect surface in the VSP group. The multi-stage implementation of virtual surgical planning with cutting guides, STL models and patient-specific implants increases the reconstructive accuracy in the treatment of patients diagnosed with intraosseous venous malformation of the zygomatic bone, reducing sequelae, operation time and average hospital stay, providing a better cover of the defect, and improving the precision of the reconstruction and the aesthetic results compared to standard technique.
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Affiliation(s)
- Raúl Antúnez-Conde
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (R.A.-C.); (J.I.S.E.); (A.D.-M.); (I.N.C.); (C.N.V.)
| | - Carlos Navarro Cuéllar
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (R.A.-C.); (J.I.S.E.); (A.D.-M.); (I.N.C.); (C.N.V.)
- Correspondence:
| | - José Ignacio Salmerón Escobar
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (R.A.-C.); (J.I.S.E.); (A.D.-M.); (I.N.C.); (C.N.V.)
| | - Alberto Díez-Montiel
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (R.A.-C.); (J.I.S.E.); (A.D.-M.); (I.N.C.); (C.N.V.)
| | - Ignacio Navarro Cuéllar
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (R.A.-C.); (J.I.S.E.); (A.D.-M.); (I.N.C.); (C.N.V.)
| | | | | | - Carlos Navarro Vila
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (R.A.-C.); (J.I.S.E.); (A.D.-M.); (I.N.C.); (C.N.V.)
| | - José Luis Cebrián Carretero
- Maxilofacial Surgery Department, Hospital Universitario La Paz, 28046 Madrid, Spain; (J.L.d.C.P.d.V.); (J.L.C.C.)
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50
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Ramsay D, Stevenson H, Jerjes W. From Basic Mechanisms to Clinical Research: Photodynamic Therapy Applications in Head and Neck Malignancies and Vascular Anomalies. J Clin Med 2021; 10:4404. [PMID: 34640423 DOI: 10.3390/jcm10194404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/13/2021] [Accepted: 09/17/2021] [Indexed: 01/10/2023] Open
Abstract
Head and neck cancers are largely squamous cell carcinomas derived from the epithelial lining of the structures in the region, and are often classified anatomically into oral, oropharyngeal, nasopharyngeal and laryngeal carcinomas. The region’s component structures serve complex and intricate functions, such as speaking, swallowing and breathing, which are often compromised by these neoplasms. Such lesions may also cause disfigurement, leading to distressing social and psychological issues. Conventional treatments of these neoplasms usually involve surgical intervention with or without chemoradiotherapy. These have shown to be efficacious; however, they can also cause damage to healthy as well as diseased tissue, exacerbating the aforementioned problems. Access to a given region to deliver the treatments is also often a problem, due to the complex anatomical structures involved. The use of photodynamic therapy in the head and neck region has been established for about two decades. In this review, we looked at the basic mechanisms of this intervention, examined its use in common head and neck malignancies and vascular anomalies, and reported on the most recent clinical studies. We further included a clinical guide which can help replicate the use of this technology by any unit. Based on this review, photodynamic therapy has been shown to be efficacious in the treatment of head and neck malignancies and vascular tumours. This therapy can be targeted to the diseased tissue and causes no damage to underlying structures. Recent studies have shown this therapy to be as effective as conventional therapies, without causing major adverse effects.
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