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Folpe AL. Vascular tumors of intermediate malignancy: An update. Hum Pathol 2024; 147:114-128. [PMID: 38360216 DOI: 10.1016/j.humpath.2024.01.014] [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: 01/22/2024] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/17/2024]
Abstract
The term "hemangioendothelioma" is used for endothelial neoplasms of intermediate malignancy and describes a group of rare neoplasms having biologic behavior falling in between that of the benign hemangiomas and fully malignant angiosarcomas. The hemangioendotheliomas fall into several specific, clinicopathologically and genetically distinct entities, specifically epithelioid hemangioendothelioma, kaposiform hemangioendothelioma, papillary intralymphatic angioendothelioma and retiform hemangioendothelioma (hobnailed hemangioendothelioma), pseudomyogenic hemangioendothelioma, composite hemangioendothelioma, and YAP1::TFE3-fused hemangioendothelioma. The clinical, morphologic, immunohistochemical, and genetic features, and the differential diagnosis of each of these rare entities are discussed in this review.
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Affiliation(s)
- Andrew L Folpe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55902, United States.
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Gong X, Zhou J, Chen S, Ji Y. Coexistence of kaposiform hemangioendothelioma and capillary malformation: More than a coincidence? Two case reports. Heliyon 2024; 10:e28802. [PMID: 38576567 PMCID: PMC10990900 DOI: 10.1016/j.heliyon.2024.e28802] [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: 04/12/2023] [Revised: 03/25/2024] [Accepted: 03/25/2024] [Indexed: 04/06/2024] Open
Abstract
The coexistence of kaposiform hemangioendothelioma (KHE) and capillary malformation (CM) is quite rare, and few relevant studies can be found to confirm whether this phenomenon is accidental. We diagnosed and treated two such patients, revealing interesting phenomena associated with the development of vascular diseases. These cases offer the possibility that the coexistence of KHE and CM is not accidental and open up a new field of research related to pediatric vascular tumors and vascular malformations. Personalization and precision are required in the diagnosis and treatment of such patients, and the present findings provide a reliable theoretical and practical basis for further research on the pathogenesis and therapy of patients with multiple vascular diseases.
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Affiliation(s)
- Xue Gong
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Jiangyuan Zhou
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Siyuan Chen
- Pediatric Intensive Care Unit, Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yi Ji
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Nakamura S, Ozeki M, Hayashi D, Yasue S, Endo S, Ohnishi H. Sirolimus monotherapy for Kasabach-Merritt phenomenon in a neonate; Case report. Int J Surg Case Rep 2024; 117:109497. [PMID: 38518465 PMCID: PMC10972789 DOI: 10.1016/j.ijscr.2024.109497] [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: 12/29/2023] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/24/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE The Kasabach-Merritt Phenomenon (KMP), characterized by thrombocytopenia and consumptive coagulopathy due to endothelial cell growth in the infantile vascular tumor kaposiform hemangioendothelioma, presents a therapeutic challenge. This case highlights the novel use of sirolimus in a neonate, an approach less explored in this age group. CASE PRESENTATION A female neonate presented with a right anterior chest mass, progressing to respiratory distress and congestive heart failure. Diagnosed with KMP, she exhibited low platelet count and coagulation abnormalities. Treatment with sirolimus (0.06 mg/day) led to mass reduction, improved bleeding, and a stable tumor after 12 months, without side effects. This case contrasts with existing literature advocating for combination therapy or higher sirolimus concentrations for effective treatment. Yet, our patient achieved favorable outcomes with low-dose monotherapy, suggesting a potentially safer approach in neonates with immature hepatic and renal metabolism. CLINICAL DISCUSSION This case demonstrates the efficacy of low-dose sirolimus monotherapy in treating KMP in a neonate, challenging current preferences for combination therapies or higher doses. It emphasizes the need for further research into age-specific treatment protocols in KMP, considering the unique metabolic profiles of neonates and infants. CONCLUSION Sirolimus has demonstrated potential in treating KMP in pediatric patients. While initial results are promising, determining optimal dosages and trough concentrations, especially in neonates and infants, remains essential.
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Affiliation(s)
- Shoji Nakamura
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Michio Ozeki
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan.
| | - Daichi Hayashi
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Shiho Yasue
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Saori Endo
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Hidenori Ohnishi
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
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Qiu T, Zhang Z, Liu J, Zhou J, Gong X, Lan Y, Zhang X, Chen S, Ji Y. Kaposiform Hemangioendothelioma with Bone Destruction: A 16-Year Follow-Up Cohort Study of the Clinical Characteristics and Prognosis. J Pediatr Surg 2024; 59:599-604. [PMID: 38158257 DOI: 10.1016/j.jpedsurg.2023.12.003] [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: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Kaposiform hemangioendothelioma (KHE) is a rare, locally aggressive vascular tumor that often occurs in infants and young children. The goal of this study was to analyze the clinical characteristics of KHE patients with bone destruction and provide clinical guidance for diagnosis and treatment. METHODS We conducted a descriptive cohort study with follow-up from January 2007 to January 2023 to collect demographic information and tumor-related clinical information from KHE patients with bone destruction. RESULTS A total of 269 KHE patients were included in the study, of whom 70 (26.0%) patients had tumors with bone destruction. The median age at diagnosis of patients with bone destruction was 19.0 months, which was much later than that of patients without bone destruction (P < 0.001). Patients with bone destruction were more likely to have a decreased range of motion (ROM) (P < 0.001). Metaphysis involvement was more likely to occur in the lower limb bones (P = 0.039), and the lower limb bones were more likely to be associated with decreased ROM (P = 0.001). Tumors involving extracompartmental bone were more likely to have decreased ROM (P = 0.003) and exhibit the Kasabach-Merritt phenomenon (P = 0.006). CONCLUSIONS Based on the rarity and significant heterogeneity of KHE patients with bone destruction, we should give full play to the role of multidisciplinary teams in addressing disease to reduce the long-term complications of KHE with bone destruction and improve the quality of life of patients. TYPE OF STUDY Prognostic Study. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Tong Qiu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China; Med-X Center for Informatics, Sichuan University, Chengdu, 610041, China
| | - Zixin Zhang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China; Med-X Center for Informatics, Sichuan University, Chengdu, 610041, China
| | - Jie Liu
- Department of Pediatric Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Jiangyuan Zhou
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China; Med-X Center for Informatics, Sichuan University, Chengdu, 610041, China
| | - Xue Gong
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yuru Lan
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xuepeng Zhang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Siyuan Chen
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yi Ji
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China; Med-X Center for Informatics, Sichuan University, Chengdu, 610041, China.
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Li Y, Zhu X, Li L, Bao C, Liu Q, Zhang N, He Z, Ji Y, Bao J. Construction and applications of the EOMA spheroid model of Kaposiform hemangioendothelioma. J Biol Eng 2024; 18:21. [PMID: 38486263 PMCID: PMC10941415 DOI: 10.1186/s13036-024-00417-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/05/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Kaposiform hemangioendothelioma (KHE) is a rare intermediate vascular tumor with unclear pathogenesis. Recently, three dimensional (3D) cell spheroids and organoids have played an indispensable role in the study of many diseases, such as infantile hemangioma and non-involuting congenital hemangiomas. However, few research on KHE are based on the 3D model. This study aims to evaluate the 3D superiority, the similarity with KHE and the ability of drug evaluation of EOMA spheroids as an in vitro 3D KHE model. RESULTS After two days, relatively uniform morphology and high viability of EOMA spheroids were generated by the rotating cell culture system (RCCS). Through transcriptome analysis, compared with 2D EOMA cells, focal adhesion-related genes such as Itgb4, Flt1, VEGFC, TNXB, LAMA3, VWF, and VEGFD were upregulated in EOMA spheroids. Meanwhile, the EOMA spheroids injected into the subcutaneous showed more obvious KMP than 2D EOMA cells. Furthermore, EOMA spheroids possessed the similar characteristics to the KHE tissues and subcutaneous tumors, such as diagnostic markers (CD31 and LYVE-1), cell proliferation (Ki67), hypoxia (HIF-1α) and cell adhesion (E-cadherin and N-cadherin). Based on the EOMA spheroid model, we discovered that sirolimus, the first-line drug for treating KHE, could inhibit EOMA cell proliferation and downregulate the VEGFC expression. Through the extra addition of VEGFC, the effect of sirolimus on EOMA spheroid could be weakened. CONCLUSION With a high degree of similarity of the KHE, 3D EOMA spheroids generated by the RCCS can be used as a in vitro model for basic researches of KHE, generating subcutaneous tumors and drug screening.
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Affiliation(s)
- Yanan Li
- Department of Pediatric Surgery, Division of Oncology, West China Hospital of Sichuan University, 37# Guo-Xue-Xiang, Chengdu, 610041, China
- Med-X Center for Informatics, Sichuan University, Chengdu, 610041, China
| | - Xinglong Zhu
- Department of Pathology, Institute of Clinical Pathology, Key Laboratory of Transplant Engineering and Immunology, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan Province, China
| | - Li Li
- Department of Pathology, Institute of Clinical Pathology, Key Laboratory of Transplant Engineering and Immunology, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan Province, China
| | - Chunjuan Bao
- Department of Pathology, Institute of Clinical Pathology, Key Laboratory of Transplant Engineering and Immunology, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan Province, China
| | - Qin Liu
- Department of Pathology, Institute of Clinical Pathology, Key Laboratory of Transplant Engineering and Immunology, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan Province, China
| | - Ning Zhang
- Department of Pediatric Surgery, Division of Oncology, West China Hospital of Sichuan University, 37# Guo-Xue-Xiang, Chengdu, 610041, China
| | - Ziyan He
- Department of Pediatric Surgery, Division of Oncology, West China Hospital of Sichuan University, 37# Guo-Xue-Xiang, Chengdu, 610041, China
- Med-X Center for Informatics, Sichuan University, Chengdu, 610041, China
| | - Yi Ji
- Department of Pediatric Surgery, Division of Oncology, West China Hospital of Sichuan University, 37# Guo-Xue-Xiang, Chengdu, 610041, China.
- Med-X Center for Informatics, Sichuan University, Chengdu, 610041, China.
| | - Ji Bao
- Department of Pathology, Institute of Clinical Pathology, Key Laboratory of Transplant Engineering and Immunology, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan Province, China.
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Abstract
Vascular anomalies, broadly classified as nonmalignant tumors and malformations, consist of a multitude of disorders that have a wide range of symptoms and complications as well as overlapping clinical, radiologic, and histologic findings. Although usually difficult, distinguishing between nonmalignant vascular tumors and malformations, as well as the precise diagnosis within these distinctions, is critical because prognosis, therapy, and chronicity of care vary greatly. In contrast to normal endothelial turnover in vascular malformations, vascular tumors are characterized by the abnormal proliferation of endothelial cells and aberrant blood vessels.
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Affiliation(s)
- Jorie Gatts
- Hemangioma and Vascular Malformation Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7015, Cincinnati, OH 45229, USA
| | - Srinivasa Chandra
- Department of Oral and Maxillofacial Surgery-Head and Neck Oncology and Microvascular Reconstruction, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Deepak Krishnan
- Department of Surgery, Section of Oral & Maxillofacial Surgery, University of Cincinnati, 200 Albert Sabin Way, ML 0461, Cincinnati, OH 45219, USA; University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267-0558, USA
| | - Kiersten Ricci
- Hemangioma and Vascular Malformation Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7015, Cincinnati, OH 45229, USA; University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267-0558, USA.
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Liu L, Gu W, Teng L, Xu Y, Zheng F, Hu M, Lu M, Xu X. Kaposiform hemangioendothelioma presented with raynaud phenomenon: a case report. BMC Pediatr 2023; 23:574. [PMID: 37978357 PMCID: PMC10655467 DOI: 10.1186/s12887-023-04407-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Kaposiform hemangioendothelioma (KHE) is a rare vascular neoplasm affecting infants or young children. KHE includes a spectrum of lesions, ranging from small and superficial tumors to large and invasive lesions with Kasabach-Merritt phenomenon (KMP). Currently, no published studies have reported a KHE presenting as thrombocytopenia and Raynaud phenomenon. CASE PRESENTATION A 2-year-old boy with right hand swelling and thrombocytopenia was admitted to our hospital. His right hand turned swelling and red, even occasionally cyanotic. This condition became worse in response to cool environments and improved with warming, and platelet counts were between 50 ~ 80 × 10^9/L. Physical examination on admission revealed the swelling and frostbite-like rash of the right-hand fingers, and the skin temperature of the right hand was lower than the left. On day 3 of admission, chest CT results showed an irregular mass on the right side of the spine. The puncture biopsy demonstrated positive CD31, D2-40, and FLI1 immunohistochemical staining, but negative GLUT1 staining, confirming the diagnosis of KHE. Furthermore, endothelin-1 (ET1) expression levels significantly increased, and eNOS and A20 expression levels significantly decreased comparing with control patients. The patient received methylprednisolone and sirolimus treatments, and his condition gradually improved during the follow-up. CONCLUSIONS We reported the first case of KHE presenting with thrombocytopenia and Raynaud phenomenon. The development of Raynaud phenomenon could be associated with increased ET-1 and reduced eNOS and A20 expressions. Careful differential diagnosis of hidden KHE should be considered in children with thrombocytopenia and Raynaud phenomenon.
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Affiliation(s)
- Lingke Liu
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Rd 3333, Binjiang District, Hangzhou, 310052, P.R. China
- Pediatrics, The Affiliated Hospital of Shaoxing University, Shaoxing, 312000, PR China
| | - Weizhong Gu
- Pathology, National Clinical Research Center for Child Health, Hangzhou, 310003, PR China
| | - Liping Teng
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Rd 3333, Binjiang District, Hangzhou, 310052, P.R. China
| | - Yiping Xu
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Rd 3333, Binjiang District, Hangzhou, 310052, P.R. China
| | - Fei Zheng
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Rd 3333, Binjiang District, Hangzhou, 310052, P.R. China
| | - Minfei Hu
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Rd 3333, Binjiang District, Hangzhou, 310052, P.R. China
| | - Meiping Lu
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Rd 3333, Binjiang District, Hangzhou, 310052, P.R. China
| | - Xuefeng Xu
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Rd 3333, Binjiang District, Hangzhou, 310052, P.R. China.
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Fan D, Cui Y, Chen J, He X. Kaposiform hemangioendothelioma of the heart: a case report and literature review. Cardiol Young 2023; 33:2411-2414. [PMID: 37332166 DOI: 10.1017/s1047951123001269] [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] [Indexed: 06/20/2023]
Abstract
Kaposiform hemangioendothelioma is a rare tumour of vascular origin that rarely occurs in the heart. We provided a rare case of a 26-day-old infant with tachypnoea. Echocardiography showed a solid tumour in the pericardial cavity and a large amount of pericardial effusion. The solid tumour was confirmed by surgery, and the pathology was kaposiform hemangioendothelioma. We analysed this case and reviewed the related literature to explore the clinical features and echocardiographic manifestations to improve the understanding, diagnosis, and treatment of this disease for clinicians and sonographers.
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Affiliation(s)
- Di Fan
- Department of Ultrasound Diagnosis, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Yun Cui
- Department of Ultrasound Diagnosis, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Jing Chen
- Department of Ultrasound Diagnosis, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Xinjian He
- Department of Ultrasound Diagnosis, Children's Hospital of Hebei Province, Shijiazhuang, China
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Jung SC, Jung TY, Lee TK, Kim YJ, Baek HJ, Kim SS. Kaposiform hemangioendothelioma of skull base with dura invasion in a pediatric patient: a case report. Childs Nerv Syst 2023; 39:3289-3294. [PMID: 37354290 DOI: 10.1007/s00381-023-06025-9] [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: 12/28/2022] [Accepted: 06/10/2023] [Indexed: 06/26/2023]
Abstract
Kaposiform hemangioendothelioma is an extremely rare vascular tumor which shows aggressive local growth. We present a case of rapid growing vascular skull tumor with dura invasion in a pediatric patient with neurofibromatosis type 1. A 14-year-old male complained of headache and dizziness for 1 month after minor head trauma. Brain magnetic resonance imaging (MRI) revealed a 5-cm-sized tumor in the left frontotemporal bone with internal hemorrhage and cystic changes. The gross total resection of tumor was done. At the 7-month follow-up, brain MRI revealed a recurrent skull tumor with intracranial dura mass. He underwent second surgery, and the pathologic diagnosis was suggestive of Kaposiform hemangioendothelioma. For this vascular proliferative tumor, mTOR inhibitor was treated for 6 months, and there was the recurred nodular-enhancing mass along the sphenoid ridge. After additional 2 months of medication, the following MRI revealed a decreased nodular-enhancing mass.
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Affiliation(s)
- Seong-Chan Jung
- Department of Neurosurgery, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Tae-Young Jung
- Department of Neurosurgery, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea.
| | - Tae-Kyu Lee
- Department of Neurosurgery, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Yeong Jin Kim
- Department of Neurosurgery, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Hee Jo Baek
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Sung Soon Kim
- Department of Pathology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea
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Helligsø L, Mikkelsen TS, Hvas A. Kaposiform hemangioendothelioma complicated by Kasabach-Merritt phenomenon in an infant girl. Clin Case Rep 2023; 11:e7859. [PMID: 37720715 PMCID: PMC10500048 DOI: 10.1002/ccr3.7859] [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: 03/23/2023] [Revised: 07/21/2023] [Accepted: 08/19/2023] [Indexed: 09/19/2023] Open
Abstract
Key Clinical Message We report a successful treatment course of an infant with mediastinal Kaposiform hemangioendothelioma. As the current complex of diseases is rare and calls for highly specialized treatment, large prospective studies are lacking. This case provides an example of balanced treatment complicated by Kasabach-Merritt phenomenon, life-threatening infections, and pericardial effusion. Abstract Kaposiform hemangioendothelioma (KHE) and tufted angioma are vascular benign tumors that can be associated with the rare condition Kasabach-Merritt Phenomenon (KMP). KMP is characterized by consumption coagulopathy with severe thrombocytopenia, hypofibrinogenemia, and elevated D-dimer. We here report successful treatment of a female infant with a mediastinal KHE where treatment was complicated by KMP, life-threatening infections, and pericardial effusion. Due to the absence of randomized clinical trials, there is currently no standardized treatment protocol available for KHE. In our case, the infant was treated successfully with prednisolone, vincristine, and sirolimus.
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Affiliation(s)
- Louise Helligsø
- Present address:
Department of OphtalmologyAarhus University HospitalAarhusDenmark
| | | | - Anne‐Mette Hvas
- Present address:
Faculty of HealthAarhus UniversityAarhusDenmark
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Morgado M, Alves FB, Pedrosa S, Garcia M, Dias SC, Madureira AJ. Kaposiform hemangioendothelioma of the thigh: A case report. Radiol Case Rep 2023; 18:3152-3156. [PMID: 37409100 PMCID: PMC10318450 DOI: 10.1016/j.radcr.2023.05.052] [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: 04/10/2023] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 07/07/2023] Open
Abstract
Kaposiform hemangioendothelioma is a rare, locally aggressive or borderline vascular tumor that typically affects infants. It presents as a purpuric cutaneous lesion and may be associated with life-threatening coagulation disorders, such as the Kasabach-Merritt phenomenon. The differential diagnosis can be challenging based on clinical presentation alone. Imaging plays a crucial role in the diagnostic workup, particularly magnetic resonance imaging. We present a case report of a 4-month-old patient with an enlarging vinous cutaneous mass on the thigh and coagulation abnormalities. Magnetic resonance imaging revealed a large, infiltrative, soft-tissue lesion with poorly defined margins and heterogeneous enhancement, that involved all muscle compartments of the thigh and was associated with lymphedema, stranding of the subcutaneous fat and cutaneous thickening. These findings were consistent with kaposiform hemangioendothelioma of the thigh and the diagnosis was confirmed by histopathological characterization.
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Affiliation(s)
- Margarida Morgado
- Department of Radiology, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - Filipe Barros Alves
- Department of Radiology, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - Sofia Pedrosa
- Department of Pathology, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - Maria Garcia
- Department of Pediatric Surgery, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - Sílvia Costa Dias
- Department of Radiology, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - António J. Madureira
- Department of Radiology, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal
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Chowdhary S, Sekar R, Saxena SK, Badhe B. Kaposiform Haemangioendothelioma of the Sublingual Gland in an Adult. Indian J Otolaryngol Head Neck Surg 2023; 75:958-962. [PMID: 37275074 PMCID: PMC10235245 DOI: 10.1007/s12070-022-03233-8] [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: 05/26/2022] [Accepted: 10/11/2022] [Indexed: 06/07/2023] Open
Abstract
Kaposiform haemangioendotheliomas (KHE) are extremely rare, borderline malignant, locally aggressive vascular tumours. KHE is usually found in the retroperitoneum, over the extremities, the soft tissues of the trunk, mediastinum and the head and neck regions. We present a very rare case of KHE of the sublingual gland in an adult, which was not associated with Kasabach-Merritt phenomenon and was resected completely without any recurrence. To the best of our knowledge, this is the first reported case in the literature of a KHE arising from the salivary glands in an adult.
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Affiliation(s)
- Stuti Chowdhary
- Department of Otorhinolaryngology (E.N.T.), Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006 India
| | - Raghul Sekar
- Department of Otorhinolaryngology (E.N.T.), Saveetha Medical College and Hospital, Chennai, 602105 India
| | - Sunil Kumar Saxena
- Department of Otorhinolaryngology (E.N.T.), Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006 India
| | - Bhawana Badhe
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006 India
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13
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Wang Z, Yan H, Ma Y, Yao W, Zheng S, Li K. Case Report: Kaposiform hemangioendothelioma with PIK3CA mutation successfully treated with sirolimus. Front Oncol 2023; 13:1132702. [PMID: 37274236 PMCID: PMC10235594 DOI: 10.3389/fonc.2023.1132702] [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: 12/27/2022] [Accepted: 04/27/2023] [Indexed: 06/06/2023] Open
Abstract
Kaposiform hemangioendothelioma (KHE) is an extremely rare, locally aggressive vascular neoplasm. The etiopathogenesis of KHE is still poorly understood. In the present study, we found a new mutation in KHE (c.685delA, p.Thr229fs). The KHE patient with the PIK3CA mutation showed complete regression after sirolimus treatment. We propose that the presence of the PIK3CA mutation in KHE may correlate with good response to sirolimus.
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Affiliation(s)
- Zuopeng Wang
- Department of Pediatric Surgery, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Hanlei Yan
- Department of Pediatric Surgery, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Yangyang Ma
- Department of Pathology, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Wei Yao
- Department of Pediatric Surgery, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Shan Zheng
- Department of Pediatric Surgery, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Kai Li
- Department of Pediatric Surgery, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
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14
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Shyam K, Thippeswamy PB, Kamashi J, Kanakeshwar RB, Rajasekaran S. Multivertebral Kaposiform hemangioendothelioma presenting as scoliosis - A case report and review of literature. J Clin Orthop Trauma 2023; 39:102147. [PMID: 37021123 PMCID: PMC10068252 DOI: 10.1016/j.jcot.2023.102147] [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: 01/18/2023] [Accepted: 03/15/2023] [Indexed: 04/07/2023] Open
Abstract
Kaposiform hemangioendothelioma (KHE) is a rare, locally invasive vascular tumour of childhood that may occur in soft tissue or bones, and is associated with cutaneous plaques and Kasabach-Merritt phenomenon (KMP). We present an instance of a 9-year-old girl with primary vertebral involvement of KHE, whose clinical presentation was with painless, progressive scoliosis alone, sans cutaneous markers. We highlight the imaging features of this rare manifestation and importance of histopathological diagnosis for optimal management.
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Affiliation(s)
- Karthik Shyam
- Department of Radiology, Ganga Medical Center and Hospital, Mettupalayam Road, Coimbatore, Tamil Nadu, 641043, India
| | - Pushpa Bhari Thippeswamy
- Department of Radiology, Ganga Medical Center and Hospital, Mettupalayam Road, Coimbatore, Tamil Nadu, 641043, India
| | - Jayanthi Kamashi
- Department of Pathology, Ganga Medical Center and Hospital, Mettupalayam Road, Coimbatore, Tamil Nadu, 641043, India
| | - Raja Bhaskara Kanakeshwar
- Department of MSK Oncology, Ganga Medical Center and Hospital, Mettupalayam Road, Coimbatore, Tamil Nadu, 641043, India
| | - Shanmuganathan Rajasekaran
- Department of Orthopedics and Spine Surgery, Ganga Medical Center and Hospital, Mettupalayam Road, Coimbatore, Tamil Nadu, 641043, India
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15
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Ying H, Qiao C, Wang L, Lin X. Progressive kaposiform hemangioendothelioma and sirolimus-related severe thrombocytopenia. Indian J Dermatol Venereol Leprol 2023; 89:54-59. [PMID: 36688881 DOI: 10.25259/ijdvl_799_19] [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: 09/01/2019] [Accepted: 04/01/2020] [Indexed: 12/15/2022]
Abstract
Kaposiform hemangioendothelioma is a locally invasive tumor and we were unable to find any previous reports of multifocal progression. Sirolimus, a mammalian target of rapamycin inhibitor, has been widely used to treat kaposiform hemangioendothelioma. Herein, we report a case of multifocal progressive kaposiform hemangioendothelioma, wherein sirolimus treatment caused severe thrombocytopenia. A 12-year-old East Asian girl presented with indurated dark-purple masses on her back. The patient had received three surgical interventions following the first appearance of the masses in 2012 and subsequent reappearances in 2014 and 2016. Kaposiform hemangioendothelioma was diagnosed based on radiological and pathological findings. Two more masses appeared in the following year. The patient was treated with oral sirolimus (2.5 mg/ m2/day) and developed grade 3 thrombocytopenia 8 days later. The patient was uneventfully relieved 5 days later after the withdrawal of sirolimus and the administration of appropriate medications. This rare case indicated that kaposiform hemangioendothelioma could be progressive with local metastatic characteristics in children. Besides, the severe sirolimus-induced complication highlights the importance of serum drug level monitoring during treatment. Physicians should be extremely cautious while treating kaposiform hemangioendothelioma patients with sirolimus.
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Affiliation(s)
- Hanru Ying
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Congzhen Qiao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lizhen Wang
- Department of Oral Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoxi Lin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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16
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Watanabe E, Hashizume N, Yoneda A, Kasahara M, Ozeki G, Saito T, Fujiogi M, Kano M, Yamamoto Y, Miyazaki O, Maekawa T, Nakano N, Yoshioka T, Fujino A, Kanamori Y. Infantile Kaposiform hemangioendothelioma in a female patient complicated with severe obstructed jaundice: a case report. Surg Case Rep 2022; 8:225. [PMID: 36580178 PMCID: PMC9800675 DOI: 10.1186/s40792-022-01581-9] [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: 11/30/2022] [Accepted: 12/20/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Kaposiform hemangioendothelioma (KHE) is a rare locally aggressive vascular neoplasm that occurs mainly in the pediatric population. KHE usually originates just underneath the skin and affects deeper tissues through infiltrative growth; however, visceral tissue involvement is quite rare. CASE PRESENTATION An 8-month-old girl with jaundice and acholic stool was referred to our hospital for further evaluation of a hepatoduodenal ligament tumor. A blood examination revealed high bilirubin and liver enzyme levels, but no signs of coagulopathy. The first attempt at a diagnostic surgical procedure did not provide sufficient diagnostic information. However, the histopathological diagnosis of the cystic duct excised in the second surgery indicated KHE. Therefore, in our case, KHE was considered a cause of obstructive jaundice. Sirolimus (rapamycin) was initiated, and the patient was discharged 7 months after admission. CONCLUSIONS In cases of atypical hypervascular lesions in the abdominal cavity, especially in the pediatric population, it is important to consider the possibility of KHE, and surgical intervention with proper strategies is required for diagnosis, followed sequentially by promising treatments.
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Affiliation(s)
- Eiichiro Watanabe
- grid.63906.3a0000 0004 0377 2305Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan
| | - Naoki Hashizume
- grid.63906.3a0000 0004 0377 2305Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan
| | - Akihiro Yoneda
- grid.63906.3a0000 0004 0377 2305Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan ,grid.63906.3a0000 0004 0377 2305Division of Pediatric Surgical Oncology, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan
| | - Mureo Kasahara
- grid.63906.3a0000 0004 0377 2305Organ Transplantation Center, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan
| | - Genta Ozeki
- grid.63906.3a0000 0004 0377 2305Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan
| | - Takeshi Saito
- grid.63906.3a0000 0004 0377 2305Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan
| | - Michimasa Fujiogi
- grid.63906.3a0000 0004 0377 2305Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan
| | - Motohiro Kano
- grid.63906.3a0000 0004 0377 2305Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan
| | - Yuki Yamamoto
- grid.63906.3a0000 0004 0377 2305Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan
| | - Osamu Miyazaki
- grid.63906.3a0000 0004 0377 2305Department of Radiology, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan
| | - Takanobu Maekawa
- grid.63906.3a0000 0004 0377 2305Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan
| | - Noriyuki Nakano
- grid.63906.3a0000 0004 0377 2305Department of Pathology, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan
| | - Takako Yoshioka
- grid.63906.3a0000 0004 0377 2305Department of Pathology, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan
| | - Akihiro Fujino
- grid.63906.3a0000 0004 0377 2305Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan
| | - Yutaka Kanamori
- grid.63906.3a0000 0004 0377 2305Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan
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17
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Khoei AA, Arias-Shah A, Kralik S, Mahajan P, Iacobas I, Fernandes CJ. Multidisciplinary management of a neonate with kaposiform hemangioendothelioma with extensive cranial fossa destruction. SAGE Open Med Case Rep 2022; 10:2050313X221142685. [PMID: 36545011 PMCID: PMC9761797 DOI: 10.1177/2050313x221142685] [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: 06/27/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2022] Open
Abstract
Kaposiform hemangioendothelioma is a rare, benign, locally destructive vascular tumor. Kasabach-Merritt phenomenon, a consumptive coagulopathy, is a life-threatening complication associated with kaposiform hemangioendothelioma. We describe a case of kaposiform hemangioendothelioma complicated by Kasabach-Merritt phenomenon in a neonate born with a large facial mass with deep extension toward the cranium and airway. The mass was not identified prenatally. The patient was a 37-week gestation age female neonate born via spontaneous vaginal delivery and noted to have a large left-sided facial mass that was not noted on the most recent prenatal ultrasound at 22 weeks gestation age. At birth, the patient was in respiratory distress and required continuous positive airway pressure support. Imaging revealed a large highly vascularized soft tissue mass adjacent to the airway with intracranial extension and bony destruction. Fine needle aspiration confirmed kaposiform hemangioendothelioma. On day of life 6, the patient was noted to have thrombocytopenia, elevated d-dimer, anemia, and hypofibrinogenemia, consistent with Kasabach-Merritt phenomenon, which resolved at day of life 12. Given the location and extent of the mass, medical therapy with single agent oral sirolimus was chosen over surgery. At 13-month follow-up, the infant is well on sirolimus therapy, and the mass has decreased in size, both clinically and on imaging. This case highlights the importance of prompt diagnosis and management of kaposiform hemangioendothelioma with extensive craniofacial and bony involvement with Kasabach-Merritt phenomenon with single oral therapy of sirolimus. Fibrinogen concentrate may be considered in the Kasabach-Merritt phenomenon refractory to cryoprecipitate.
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Affiliation(s)
| | - AnnaMarie Arias-Shah
- Division of Neonatology, Department of
Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX,
USA
- Section of Neonatology, Children’s
Health of Orange County, Orange, CA, USA
| | - Stephen Kralik
- Department of Radiology, Baylor College
of Medicine, Houston, TX, USA
| | - Priya Mahajan
- Division of Neonatology, Department of
Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX,
USA
- Section of Hematology-Oncology, Baylor
College of Medicine, Houston, TX, USA
| | - Ionela Iacobas
- Division of Neonatology, Department of
Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX,
USA
- Section of Hematology-Oncology, Baylor
College of Medicine, Houston, TX, USA
| | - Caraciolo Joseph Fernandes
- Division of Neonatology, Department of
Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX,
USA
- Caraciolo Joseph Fernandes, Division of
Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas
Children’s Hospital, 6621 Fannin Street, Houston, TX 77030, USA.
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18
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Wang Z, Han Q, Wang J, Yao W, Wang L, Li K. Rapamycin induces autophagy and apoptosis in Kaposiform hemangioendothelioma primary cells in vitro. J Pediatr Surg 2022; 57:1274-1280. [PMID: 35428493 DOI: 10.1016/j.jpedsurg.2022.02.032] [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: 02/02/2022] [Accepted: 02/23/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rapamycin has been recommended to treat Kaposiform hemangioendothelioma (KHE) with Kasabach-Merritt phenomenon (KMP), but the underlying mechanism of the clinical effect has not been established. Therefore, we determined rapamycin cytotoxicity on KHE cells in vitro and the underlying mechanism. METHODS KHE primary cells were derived from a tumor specimen and treated with rapamycin. Immunofluorescence was applied to identify the cells. Cell viability was measured using the Cell Counting Kit-8 (CCK-8) assay. Cell cycle and apoptosis were assessed using flow cytometry (FCM). Western blots (WB) were performed to determine phosphorylation of mammalian target of rapamycin (mTOR), p70 S6 kinase (S6K1), and eukaryotic translation initiation factor 4E-binding protein 1 (4E-BP1), as well light chain 3 (LC3) expression. RESULTS Rapamycin inhibited the growth of KHE primary cells in a dose- and time-dependent manner. Cell cycle progression was arrested in the G0/G1 phase and apoptosis was induced. WB results showed that LC3-II/I expression was significantly elevated in KHE primary cells treated with rapamycin, while the level of p-mTOR, p-S6K1, and p-4E-BP1 expression was reduced. LC3 fluorescent spots were increased in the rapamycin treatment group. CONCLUSIONS Rapamycin inhibited KHE primary cell proliferation, induced apoptosis and autophagy, and blocked the mTOR signaling pathway.
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Affiliation(s)
- ZuoPeng Wang
- Department of Pediatric Oncology, Children's Hospital of Fudan University, Shanghai, China
| | - Qilei Han
- Department of Pediatric Oncology, Children's Hospital of Fudan University, Shanghai, China
| | - Jing Wang
- Department of Pediatric Oncology, Children's Hospital of Fudan University, Shanghai, China
| | - Wei Yao
- Department of Pediatric Oncology, Children's Hospital of Fudan University, Shanghai, China
| | - LiuHui Wang
- Department of Dermatology, Children's Hospital of Fudan University, Shanghai, China
| | - Kai Li
- Department of Pediatric Oncology, Children's Hospital of Fudan University, Shanghai, China.
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19
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Thangaraju S, Relan J, Sinha A, Arava SK, Khanna N, Raju SN. Vascular neoplasia masquerading as cellulitis and persistent hemorrhagic pericardial effusion. Ann Pediatr Cardiol 2022; 15:304-307. [PMID: 36589655 PMCID: PMC9802615 DOI: 10.4103/apc.apc_140_21] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 11/17/2022] Open
Abstract
Tufted angioma and kaposiform hemangioendothelioma are considered to represent two ends of the spectrum of benign vascular neoplasms that predominantly present during infancy or early childhood. We report a rare case of a 5-month-old infant with complicated vascular neoplasm involving the pericardial cavity and skin over cervical region, masquerading as infective pericarditis with cellulitis. The patient responded dramatically to therapy with oral prednisolone and sirolimus, with a significant reduction of size of skin lesions and complete resolution of pericardial effusion over 8 weeks. The report also highlights the importance of a multidisciplinary team in managing such complicated cases.
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Affiliation(s)
- Sharan Thangaraju
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Jay Relan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Aditi Sinha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sudheer Kumar Arava
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Neena Khanna
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Sreenivasa Narayana Raju
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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20
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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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21
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Bhattacharya S, Roy P, Chatterjee U, Bhattacharyya A. Kaposiform hemangioendothelioma in an unusual site: A report of two cases in children. INDIAN J PATHOL MICR 2022; 65:167-169. [PMID: 35074987 DOI: 10.4103/ijpm.ijpm_489_20] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
Kaposiform hemangioendothelioma (KHE) is a locally aggressive vascular tumor usually seen in children. It is frequently associated with Kasabach-Merritt phenomenon. Here we report two cases of KHE: the first case being an 11-month-old boy who came with massive swelling on the face and violaceous discoloration. The second case was a 7-year-old boy who presented with respiratory distress and bleeding manifestations. CT scan chest showed a large mass involving the anterior mediastinum. Histologic examination of resected masses from both these cases showed features of KHE involving subcutaneous tissue and thymus, respectively. Although cutaneous and subcutaneous location is common, thymic involvement is unusual. It is important to distinguish KHE from infantile haemangioma, tufted angioma, spindle-cell haemangioma, verrucous malformation and Kaposi sarcoma. Histologic features, supportive immunohistochemistry and the clinical profile together are helpful to differentiate KHE from other vascular lesions.
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Affiliation(s)
- Sumanta Bhattacharya
- Department of Pathology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Paromita Roy
- Department of Pathology, TMC, Kolkata, West Bengal, India
| | - Uttara Chatterjee
- Department of Pathology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
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22
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Kuo C, Warren M, Malvar J, Miller JM, Shah R, Navid F, Luu M, Anselmo DM, Mascarenhas L. Kaposiform hemangioendothelioma of the bone in children and adolescents. Pediatr Blood Cancer 2022; 69:e29392. [PMID: 34606171 DOI: 10.1002/pbc.29392] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 04/19/2021] [Revised: 09/06/2021] [Accepted: 09/16/2021] [Indexed: 12/18/2022]
Abstract
Kaposiform hemangioendothelioma (KHE) is a rare, locally aggressive vascular tumor that mainly occurs during infancy or early childhood. Approximately 70% of cases are complicated by Kasabach-Merritt phenomenon. Although osseous extension of the primary lesion is relatively common, primary bone involvement by KHE is rare. Given the paucity of literature on primary KHE of the bone, we report a case series of primary KHE of the bone treated at our institution and describe the clinical presentation, radiologic and pathologic findings, management and outcomes.
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Affiliation(s)
- Christopher Kuo
- Cancer and Blood Disease Institute, Division of Hematology-Oncology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Mikako Warren
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jemily Malvar
- Cancer and Blood Disease Institute, Division of Hematology-Oncology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Joseph M Miller
- Keck School of Medicine, University of Southern California, Los Angeles, California.,Department of Radiology, Children's Hospital Los Angeles, Los Angeles, California
| | - Rachana Shah
- Cancer and Blood Disease Institute, Division of Hematology-Oncology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Fariba Navid
- Cancer and Blood Disease Institute, Division of Hematology-Oncology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Minnelly Luu
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Dean M Anselmo
- Keck School of Medicine, University of Southern California, Los Angeles, California.,Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Leo Mascarenhas
- Cancer and Blood Disease Institute, Division of Hematology-Oncology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles, California
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23
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Harbers VEM, van der Salm N, Pegge SAH, van der Vleuten CJM, Verhoeven BH, Vrancken SLAG, Schultze Kool LJ, Fuijkschot J, Te Loo DMMWM. Effective low dose sirolimus regimen for kaposiform hemangioendothelioma with Kasabach-Merrit Phenomenon in young infants. Br J Clin Pharmacol 2021; 88:2769-2781. [PMID: 34957601 PMCID: PMC9303919 DOI: 10.1111/bcp.15202] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 10/13/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022] Open
Abstract
AIM Management of kaposiform hemangioendotheliomas (KHE) with Kasabach-Merrit phenomenon is challenging in young infants who are subjected to developmental pharmacokinetic changes. Sirolimus, sometimes combined with corticosteroids, can be used as an effective treatment of KHE. Simultaneously, toxicities like interstitial pneumonitis related to the use of sirolimus may be fatal. As infants have a very low CYP3-enzyme expression at birth, which rises during ageing, we hypothesize, that a reduced metabolization of sirolimus might lead to high sirolimus serum levels and low dose may be sufficient without the side effects. METHODS A case series of five infants with kaposiform hemangioendothelioma with Kasabach-Merrit phenomenon was analysed retrospectively. All infants were treated with sirolimus - 0.2 mg/m2 every 24 or 48 hours according to their age. Prednisone was added to the therapy for additional effect in four patients. RESULTS In all patients low dose of sirolimus led to therapeutic sirolimus levels (4-6 ng/mL). All infants (aged 4 days - 7 months) had a complete haematological response, without serious adverse events. In all patients, the Kasabach-Merrit phenomenon resolved, the coagulation profile normalized and tumour size reduction was seen. CONCLUSION Low dose sirolimus treatment is safe for infants with kaposiform hemangioendothelioma and Kasabach-Merit phenomenon. Essential is to realize that during the first months of life, metabolism is still developing and enzymes necessary to metabolise drugs like sirolimus still have to mature. To avoid toxic levels, the sirolimus dosage should be based on age and the associated pharmacological developments.
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Affiliation(s)
| | | | - Sjoert A H Pegge
- Radboud University Medical centre (Radboudumc), Nijmegen, Gelderland
| | | | - Bas H Verhoeven
- Radboud University Medical centre (Radboudumc), Nijmegen, Gelderland
| | | | | | - Joris Fuijkschot
- Radboud University Medical centre (Radboudumc), Nijmegen, Gelderland
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Carli D, Kalantari S, Manicone R, Coppo P, Francia di Celle P, La Selva R, Santoro F, Ranieri C, Cardaropoli S, Fagioli F, Ferrero GB, Resta N, Mussa A. Kaposiform hemangioendothelioma further broadens the phenotype of PIK3CA-related overgrowth spectrum. Clin Genet 2021; 100:624-627. [PMID: 34402524 DOI: 10.1111/cge.14047] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/25/2021] [Accepted: 08/13/2021] [Indexed: 12/12/2022]
Abstract
Kaposiform hemangioendothelioma (KHE) is a rare locally aggressive mixed vascular tumor, with typical onset in early childhood and characterized by progressive angio- and lymphangiogenesis. Its etiopathogenesis and molecular bases are still unclear. Here, we report the first case of congenital KHE harboring a PIK3CA mosaic pathogenic variant (c.323G > A, p.Arg108His) in a boy with very subtle PIK3CA-related overgrowth spectrum (PROS) features. This finding provides insights into the pathophysiology of KHE, offering targeted therapeutic options by inhibition of the PI3K/Akt/mTOR pathway. We propose the inclusion of this mixed lymphatic and vascular anomaly within the PROS.
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Affiliation(s)
- Diana Carli
- Pediatric Clinical Genetics Unit, Department of Public Health and Pediatric Sciences, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Pediatric Onco-Hematology, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Silvia Kalantari
- Immunogenetics and Transplant Biology Service, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Rosaria Manicone
- Pediatric Onco-Hematology, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Paola Coppo
- Pediatric Dermatology, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Paola Francia di Celle
- Molecular Pathology Laboratory, Pathology Division, Città della Salute e della Scienza University Hospital, Torino, Italy
| | - Roberta La Selva
- Pediatric Dermatology, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Federica Santoro
- Department of Medical Sciences, Pathology Unit, Città della Salute e della Scienza Hospital, University of Torino, Torino, Italy
| | - Carlotta Ranieri
- Department of Biomedical Sciences and Human Oncology (DIMO), Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | - Simona Cardaropoli
- Pediatric Clinical Genetics Unit, Department of Public Health and Pediatric Sciences, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Franca Fagioli
- Pediatric Onco-Hematology, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Giovanni Battista Ferrero
- Pediatric Clinical Genetics Unit, Department of Public Health and Pediatric Sciences, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Nicoletta Resta
- Department of Biomedical Sciences and Human Oncology (DIMO), Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | - Alessandro Mussa
- Pediatric Clinical Genetics Unit, Department of Public Health and Pediatric Sciences, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
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Gómez-Villegas CP, Pérez-Téllez C, Ochoa-Gaviria J, Builes N. [Refractory kaposiforme hemangioendothelioma in the pediatric population: case report and literature review.]. Bol Med Hosp Infant Mex 2021; 78:376-384. [PMID: 34351887 DOI: 10.24875/bmhim.20000304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCCIÓN El hemangioendotelioma kaposiforme (HEK) es un tumor vascular poco frecuente caracterizado por una invasión local agresiva y un síndrome de atrapamiento de plaquetas conocido como fenómeno de Kasabach-Merritt. Aunque muchos casos de HEK se tratan con éxito con control local o quimioterapia de baja intensidad, otros son resistentes y se cuenta con pocas opciones terapéuticas. El objetivo de este reporte es mostrar la experiencia del tratamiento con sirolimus por vía oral en un paciente pediátrico con HEK asociado a fenómeno de Kasabach-Merritt refractario al tratamiento de primera línea, quien mostró excelente respuesta al tratamiento. CASO CLÍNICO Paciente de sexo masculino de 3 meses con un HEK refractario al manejo de primera línea (corticoides, propranolol, vincristina), sin posibilidad de hacer control local, por lo que se decide terapia combinada con sirolimus, presentando control local y resolución de la coagulopatía desde la primera semana de iniciado el manejo y con resolución de la malformación vascular después de 12 meses de seguimiento. CONCLUSIONES Aunque no existen pautas claras para el tratamiento del HEK refractario en la edad pediátrica, la evidencia actual demuestra que el sirolimus es un medicamento eficaz que puede ser considerado como opción terapéutica de primera línea en estos pacientes. BACKGROUND Kaposiform hemangioendothelioma (KHE) is a rare vascular tumor characterized by aggressive local invasion and a platelet entrapment syndrome known as the Kasabach-Merritt phenomenon. Although many cases of KHE are successfully treated with local control or low-intensity chemotherapy, some cases are often resistant, with few therapeutic options available. Here, we report a pediatric patient with KHE associated with Kasabach-Merritt phenomenon refractory to first-line treatment, who demonstrated excellent response to treatment. CASE REPORT We present the case of a 3-month-old male patient with a KHE refractory to first-line treatment (vincristine, corticosteroids, propranolol), without possibility of local control treatment. Therefore, combined therapy with sirolimus was decided, presenting local control and resolution of the coagulopathy from the first week after starting the management and with resolution of vascular malformation after 12 months of follow-up. CONCLUSIONS Although there are no clear guidelines for the treatment of refractory KHE in the pediatric population, current evidence demonstrate that sirolimus is an effective option that could be considered as a first-line treatment in such patients.
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Affiliation(s)
| | | | - Jorge Ochoa-Gaviria
- Servicio de Radiología, Hospital Pablo Tobón Uribe y Hospital Infantil San Vicente Fundación, Medellín. Colombia
| | - Natalia Builes
- Servicio de Hematología Pediátrica, Hospital Pablo Tobón Uribe, Medellín. Colombia
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Wang J, Han Q, Yan H, Yao W, Wang Z, Li K. Overexpression Prox1 in HemECs resembles Kaposiform hemangioendothelioma and cytotoxicity of sirolimus in vitro. J Pediatr Surg 2021; 56:1203-1210. [PMID: 33865602 DOI: 10.1016/j.jpedsurg.2021.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Kaposiform hemangioendothelioma (KHE) is a rare vascular tumor that occurs in children. Prox1 is a specific lymphatic marker for KHE. We intended to establish a Prox1 transgenic cell line resembling KHE and investigate the mechanism of sirolimus in treating KHE. METHODS Prox1 was stably expressed in infantile hemangioma cell HemECs. RT-qPCR and Western blot were conducted to measure the expression of target genes. CCK-8, EdU assay, and cell cycle analysis were conducted to detect cell proliferation. Wound healing and transwell assay were used to evaluate cell migration and invasion. RESULTS Both mRNA and protein levels of Prox1, LYVE-1, Podoplanin were upregulated in Prox1+ HemECs. An acceleration of cell growth and a rise in migration and invasion were observed with Prox1 overexpression. Sirolimus inhibited cell proliferation, promoted apoptosis and led to G1 phase arrest in Prox1+ HemECs. The expression of p-mTOR, p-4EBP1, and p-P70S6K decreased and the ratio of LC-3 II/LC-3 I elevated after treatment of sirolimus. CONCLUSIONS Stable overexpression of Prox1 in HemECs induced a lymphatic endothelial reprogramming, and enhanced aggressive biological effects, partly resembled the invasion of KHE, and could serve as a novel model for KHE. Sirolimus may block mTOR-mediated pathways and induced autophagy in KHE.
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Affiliation(s)
- Jing Wang
- Department of Pediatric Surgery, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai 201102, China
| | - Qilei Han
- Department of Pediatric Surgery, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai 201102, China
| | - Hanlei Yan
- Department of Pediatric Surgery, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai 201102, China
| | - Wei Yao
- Department of Pediatric Surgery, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai 201102, China
| | - Zuopeng Wang
- Department of Pediatric Surgery, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai 201102, China.
| | - Kai Li
- Department of Pediatric Surgery, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai 201102, China.
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Das S, Deora H, Rao S, Kandregula S, Narayana SM. Intracranial kaposiform hemangioendothelioma presenting as epistaxis: a rare case report with review of literature. Childs Nerv Syst 2021; 37:2057-62. [PMID: 32989498 DOI: 10.1007/s00381-020-04905-y] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Kaposiform hemangioendothelioma (KHE) is a rare vascular tumor of intermediate malignancy with tendency for local invasion and recurrence. The tumor almost exclusively occurs in children, especially in infants. Intracranial KHE are extremely rare with only two cases reported in the literature. REPORT We report the clinical and pathological features of this rare tumor arising from basitemporal region in a 21-month child. Our case did not present with Kasabach-Merritt phenomenon. Histopathological examination confirmed the diagnosis of KHE. CONCLUSION KHE should be considered in the differential diagnosis of intracranial extra-axial neoplasm in children, and histopathological examination plays an important role in distinguishing KHE from its morphologic mimics. It is essential to diagnose KHE due to its locally aggressive nature.
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Yao W, Li KL, Qin ZP, Li K, Zheng JW, Fan XD, Ma L, Zhou DK, Liu XJ, Wei L, Li L, Tai MZ, Wang JH, Ji Y, Zhou L, Huang HJ, Gao XY, Huang ZJ, Gu S, Yang HY. Standards of care for Kasabach-Merritt phenomenon in China. World J Pediatr 2021; 17:123-30. [PMID: 32851561 DOI: 10.1007/s12519-020-00379-9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/10/2020] [Indexed: 02/05/2023]
Abstract
Kasabach-Merritt phenomenon (KMP) is a rare disease that is characterized by severe thrombocytopenia and consumptive coagulation dysfunction caused by kaposiform hemangioendothelioma or tufted hemangioma. This condition primarily occurs in infants and young children, usually with acute onset and rapid progression. This review article introduced standardized recommendations for the pathogenesis, clinical manifestation, diagnostic methods and treatment process of KMP in China, which can be used as a reference for clinical practice.
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Abstract
Vascular anomalies, further classified into vascular tumors and malformations, often involve the head and neck region of children. These entities may raise diagnostic dilemmas, as they often demonstrate heterogenous and overlapping histologic features. The aim of this paper is to provide an overview of the common vascular anomalies in the head and neck region of children. Specific entities discussed include infantile hemangioma, congenital hemangioma, tufted angioma, kaposiform hemangioendothelioma, and various vascular malformations. Clinicopathologic features and associated molecular associations are reviewed.
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30
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Chundriger Q, Tariq MU, Abdul-Ghafar J, Ahmed A, Din NU. Kaposiform Hemangioendothelioma: clinicopathological characteristics of 8 cases of a rare vascular tumor and review of literature. Diagn Pathol 2021; 16:23. [PMID: 33722245 PMCID: PMC7962213 DOI: 10.1186/s13000-021-01080-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Kaposiform Hemangioendothelioma (KHE) is a rare vascular tumor of intermediate malignant potential which shows locally aggressive growth but only rarely metastasizes. It is mostly considered to be a tumor of pediatric population but its occurrence in the adults is not uncommon as once considered. Histologically, KHE can mimic other soft tissue neoplasms of different behaviors (e.g. Kaposi Sarcoma, hemangioma) and establishing the correct diagnosis is important for appropriate treatment. Herein, we describe the clinicopathological features of 8 cases of KHE which will be helpful in making their diagnosis. METHODS We reviewed pathology reports, microscopy glass slides and obtained follow up information about 8 cases of KHE which were diagnosed at our institution from January 2008 till June 2020. Immunohistochemical stain for HHV8 was also performed. RESULTS Age ranged from 7 months to 25 years. Seven patients were less than 20 years of age and one patient was 25 years old. Equal gender distribution was observed. Extremities were the most common sites of involvement, followed by head and neck, pancreas and ischiorectal region. 2 cases were resection specimen and all others were incisional biopsies. The largest tumor size was 5.5 cm in one of the resections. The incisional/fragmented tissues were all less than 5 cm in aggregate. Most cases showed predominance of nodular growth and a minor component of spindle cell population along with lymphangiomatosis like vascular channels, with evidence of microthrombi in 2 cases. Few multinucleated giant cells were observed in 2 cases. None of the cases exhibited significant nuclear atypia or mitotic activity. One of the cases arising in dermis showed underlying bone involvement. HHV8 was negative in 7/7 cases. CONCLUSIONS KHE can also involve adult population and it should always be considered in the differential diagnoses of a vascular lesion. Presence of multinucleated giant cells is a rare finding. Knowledge about histological features and potential mimics is helpful in avoiding misdiagnosis.
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Affiliation(s)
- Qurratulain Chundriger
- Section of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Usman Tariq
- Section of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Jamshid Abdul-Ghafar
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan.
| | - Arsalan Ahmed
- Section of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Nasir Ud Din
- Section of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Brill R, Uller W, Huf V, Müller-Wille R, Schmid I, Pohl A, Häberle B, Perkowski S, Funke K, Till AM, Lauten M, Neumann J, Güttel C, Heid E, Ziermann F, Schmid A, Hüsemann D, Meyer L, Sporns PB, Schinner R, Schmidt VF, Ricke J, Rössler J, Kapp FG, Wohlgemuth WA, Wildgruber M. Additive value of transarterial embolization to systemic sirolimus treatment in kaposiform hemangioendothelioma. Int J Cancer 2020; 148:2345-2351. [PMID: 33231291 DOI: 10.1002/ijc.33406] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 09/15/2020] [Revised: 10/16/2020] [Accepted: 11/09/2020] [Indexed: 01/19/2023]
Abstract
Kaposiform hemangioendothelioma (KHE) is a rare vascular tumor in children, which can be accompanied by life-threatening thrombocytopenia, referred to as Kasabach-Merritt phenomenon (KMP). The mTOR inhibitor sirolimus is emerging as targeted therapy in KHE. As the sirolimus effect on KHE occurs only after several weeks, we aimed to evaluate whether additional transarterial embolization is of benefit for children with KHE and KMP. Seventeen patients with KHE and KMP acquired from 11 hospitals in Germany were retrospectively divided into two cohorts. Children being treated with adjunct transarterial embolization and systemic sirolimus, and those being treated with sirolimus without additional embolization. Bleeding grade as defined by WHO was determined for all patients. Response of the primary tumor at 6 and 12 months assessed by magnetic resonance imaging (MRI), time to response of KMP defined as thrombocyte increase >150 × 103 /μL, as well as rebound rates of both after cessation of sirolimus were compared. N = 8 patients had undergone additive embolization to systemic sirolimus therapy, sirolimus in this group was started after a mean of 6.5 ± 3 days following embolization. N = 9 patients were identified who had received sirolimus without additional embolization. Adjunct embolization induced a more rapid resolution of KMP within a median of 7 days vs 3 months; however, tumor response as well as rebound rates were similar between both groups. Additive embolization may be of value for a more rapid rescue of consumptive coagulopathy in children with KHE and KMP compared to systemic sirolimus only.
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Affiliation(s)
- Richard Brill
- Klinik und Poliklinik für Radiologie, Universitätsklinikum Halle, Halle/Saale, Germany
| | - Wibke Uller
- Institut für Röntgendiagnostik, Universitätsklinik Regensburg, Regensburg, Germany
| | - Veronika Huf
- Institut für Röntgendiagnostik, Universitätsklinik Regensburg, Regensburg, Germany
| | - René Müller-Wille
- Institut für diagnostische und interventionelle Radiologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Irene Schmid
- Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Klinikum der Universität München, Munich, Germany
| | - Alexandra Pohl
- Kinderchirurgische Klinik und Poliklinik im Dr. von Haunerschen Kinderspital, Klinikum der Universität München, Munich, Germany
| | - Beate Häberle
- Kinderchirurgische Klinik und Poliklinik im Dr. von Haunerschen Kinderspital, Klinikum der Universität München, Munich, Germany
| | - Sybille Perkowski
- Abteilung für Kinderchirurgie, Universitätsklinikum Münster, Münster, Germany
| | - Katrin Funke
- Abteilung für Kinderchirurgie, Universitätsklinikum Münster, Münster, Germany
| | - Anne-Marie Till
- Klinik für Kinder- und Jugendmedizin, Pädiatrische Hämatologie und Onkologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Melchior Lauten
- Klinik für Kinder- und Jugendmedizin, Pädiatrische Hämatologie und Onkologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Jacob Neumann
- Klinik für Kinder- und Jugendmedizin, Helios Kliniken Schwerin, Schwerin, Germany
| | - Christian Güttel
- Klinik für Kinder- und Jugendmedizin, Helios Kliniken Schwerin, Schwerin, Germany
| | - Esther Heid
- Klinik für Kinder und Jugendmedizin, Klinikum rechts der Isar, TU München, Munich, Germany
| | - Franziska Ziermann
- Klinik für Kinder und Jugendmedizin, Klinikum rechts der Isar, TU München, Munich, Germany
| | - Axel Schmid
- Radiologisches Institut Universitätsklinikum Erlangen, Erlangen, Germany
| | - Dieter Hüsemann
- Klinik für Kinder- und Jugendmedizin, Werner Forßmann Krankenhaus, Eberswalde, Germany
| | - Lutz Meyer
- Abteilung Kinderchirurgie-Zentrum für Vasculäre Malformationen Eberswalde (ZVM), Klinik für Kinder- und Jugendmedizin, Werner Forßmann Krankenhaus, Eberswalde, Germany
| | - Peter B Sporns
- Diagnostische und Interventionelle Neuroradiologie, Universitätsspital Basel, Basel, Switzerland
| | - Regina Schinner
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany
| | - Vanessa F Schmidt
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany
| | - Jens Ricke
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany
| | - Jochen Rössler
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - 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, Freiburg, Germany
| | - Walter A Wohlgemuth
- Klinik und Poliklinik für Radiologie, Universitätsklinikum Halle, Halle/Saale, Germany
| | - Moritz Wildgruber
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany
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Ji Y, Chen S, Xia C, Zhou J, Jiang X, Xu X, Yang K, Zhang X, Kong F, Lu G, Zhang Y. Chronic lymphedema in patients with kaposiform hemangioendothelioma: incidence, clinical features, risk factors and management. Orphanet J Rare Dis 2020; 15:313. [PMID: 33160383 PMCID: PMC7648422 DOI: 10.1186/s13023-020-01595-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 08/25/2020] [Accepted: 10/26/2020] [Indexed: 02/08/2023] Open
Abstract
Objectives There are no cohort studies of chronic lymphedema in patients with kaposiform hemangioendothelioma (KHE). We sought to characterize the incidence, clinical features, risk factors and management of chronic lymphedema in patients with KHE. Methods We conducted a multicenter retrospective analysis of patients who had a minimum of 3 years of follow-up after the onset of KHE and/or Kasabach–Merritt phenomenon (KMP). Clinical features were reviewed to determine the possible cause of chronic lymphedema. The degree of lymphedema, risk factors and management strategies were analyzed. Results Among the 118 patients, chronic lymphedema was confirmed by lymphoscintigraphy 1 year after the onset of KHE and/or KMP in 13 patients. In 8 patients with lymphedema, extremity swelling was evident in the presence of KHE and/or KMP. In all patients with lymphedema, a unilateral extremity was affected, along with ipsilateral KHE. Most (84.6%) patients reported moderate lymphedema. Lymphedema was more common in patients with larger (≥ 10 cm) and mixed lesions involving the extremities (P < 0.01). A history of KMP and sirolimus treatment were not predictors of lymphedema (P > 0.05). Overall, 76.9% of patients received sirolimus treatment after referral, including 53.8% who presented extremity swelling before referral. Seven (53.8%) patients received compression therapy. Five (38.5%) patients reported lymphedema-associated decreased range of motion at the last follow-up. Conclusions Chronic lymphedema is a common sequela of KHE and can occur independently of KMP and sirolimus treatment. Patients with large and mixed KHE involving extremities should be closely monitored for this disabling complication.
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Affiliation(s)
- Yi Ji
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China.
| | - Siyuan Chen
- Pediatric Intensive Care Unit, Department of Critical Care Medicine, West China Hospital of Sichuan University, #37# Guo-Xue-Xiang, Chengdu, 610041, China.
| | - Chuncao Xia
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Jiangyuan Zhou
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Xian Jiang
- Department of Dermatology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Xuewen Xu
- Department of Burn and Plastic Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Kaiying Yang
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Xuepeng Zhang
- Pediatric Intensive Care Unit, Department of Critical Care Medicine, West China Hospital of Sichuan University, #37# Guo-Xue-Xiang, Chengdu, 610041, China
| | - Feiteng Kong
- Department of Pediatric Surgery, Sichuan Women and Children's Hospital, Chengdu, 610045, China
| | - Guoyan Lu
- Pediatric Intensive Care Unit, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Yongbo Zhang
- Department of Pediatric Surgery, Chengdu Women and Children's Central Hospital, Chengdu, 610031, China
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Abstract
Vascular tumors are a rare subset of vascular anomalies. These are classified based on their malignant potential or local destruction potential. Classification has been historically difficult and treatment recommendations are based on case series. The purpose of this chapter is to review the presentation, pathologic and imaging characteristics. Treatment recommendations are summarized based on the current literature. Congenital and infantile hemangiomas are covered separately in a separate chapter in this issue.
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Affiliation(s)
- Sara A Mansfield
- Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Regan F Williams
- Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Ionela Iacobas
- Cancer and Hematology Center, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin Street, Houston, TX 77030, United States.
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Verma S, Dhamija E, Barwad A, Kumar VS, Rastogi S. A case report of Kaposiform haemangioendothelioma; response with propranolol and steroids. Clin Sarcoma Res 2020; 10:12. [PMID: 32765826 PMCID: PMC7394668 DOI: 10.1186/s13569-020-00134-8] [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: 01/20/2020] [Accepted: 07/20/2020] [Indexed: 11/24/2022] Open
Abstract
Background Kaposiform haemangioendothelioma is a rare vascular tumor and may involve skin, deep soft tissue or bone. It is a locally aggressive tumor usually seen in infants. Here we report a case of kaposiform hemagioendothelioma in a child who responded to propranolol and steroids. Case presentation A 3-year-old male child presented with a swelling below his right knee with characteristic violet skin lesion. There was no evidence of Kasabach–Merritt phenomenon. After no improvement with several attempts at debridement and anti-tubercular treatment; a diagnosis of Kaposiform Haemangioendothelioma was reached on the basis of overall clinical picture and histology. The child was treated with propranolol and steroids and had an excellent clinical response and a near complete resolution on imaging at 5 months. Conclusions These cases are often misdiagnosed and despite a delay in diagnosis have good outcomes with appropriate multimodality management. This case highlights the unique and typical characteristics of kaposiform haemangioendothelioma.
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Affiliation(s)
- Saurav Verma
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Ekta Dhamija
- Department of Radiodiagnosis, Dr. B.R.A Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Adarsh Barwad
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Venkatesan S Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Rastogi
- Sarcoma Medical Oncology Clinic, Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
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Ji Y, Chen S, Yang K, Xia C, Li L. Kaposiform hemangioendothelioma: current knowledge and future perspectives. Orphanet J Rare Dis 2020; 15:39. [PMID: 32014025 PMCID: PMC6998257 DOI: 10.1186/s13023-020-1320-1] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/28/2020] [Indexed: 02/06/2023] Open
Abstract
Kaposiform hemangioendothelioma (KHE) is a rare vascular neoplasm with high morbidity and mortality. The initiating mechanism during the pathogenesis of KHE has yet to be discovered. The main pathological features of KHE are abnormal angiogenesis and lymphangiogenesis. KHEs are clinically heterogeneous and may develop into a life-threatening thrombocytopenia and consumptive coagulopathy, known as the Kasabach-Merritt phenomenon (KMP). The heterogeneity and the highly frequent occurrence of disease-related comorbidities make the management of KHE challenging. Currently, there are no medications approved by the FDA for the treatment of KHE. Multiple treatment regimens have been used with varying success, and new clinical trials are in progress. In severe patients, multiple agents with variable adjuvant therapies are given in sequence or in combination. Recent studies have demonstrated a satisfactory efficacy of sirolimus, an inhibitor of mammalian target of rapamycin, in the treatment of KHE. Novel targeted treatments based on a better understanding of the pathogenesis of KHE are needed to maximize patient outcomes and quality of life. This review summarizes the epidemiology, etiology, pathophysiology, clinical features, diagnosis and treatments of KHE. Recent new concepts and future perspectives for KHE will also be discussed.
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Affiliation(s)
- Yi Ji
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China.
| | - Siyuan Chen
- Pediatric Intensive Care Unit, Department of Critical Care Medicine, West China Hospital of Sichuan University, #37 Guo-Xue-Xiang, Chengdu, 610041, China.
| | - Kaiying Yang
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Chunchao Xia
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Li Li
- Laboratory of Pathology, West China Hospital of Sichuan University, Chengdu, 610041, China
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Wang Z, Zheng C, Sun H, Yao W, Li K, Ma Y, Zheng S. Immunohistochemical Analysis of mTOR Pathway-Related Proteins in Kaposiform Hemangioendothelioma. Dermatology 2020; 236:262-270. [PMID: 31896113 DOI: 10.1159/000503604] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 06/20/2019] [Accepted: 09/19/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mammalian target of rapamycin (mTOR) inhibitors have been shown to have excellent effects in the management of kaposiform hemangioendothelioma (KHE); however, the mechanism of action is unclear. This study identified the expressions of mTOR pathway-related proteins in different vascular tumors to provide insight into the pathogenesis of KHE. METHODS We retrospectively reviewed the pathologic specimens of 30 patients (KHE, 15; tufted angioma [TA], 5; infantile hemangioma [IH], 5; and lymphatic malformation [LM], 5). The immunohistochemical expression of mTOR-related proteins tuberous sclerosis complex 2 (TSC2), phosphatase and tensin homologue (PTEN), phosphorylated eukaryotic translation initiation factor 4E binding protein 1 (p-4EBP1), phosphorylated mTOR (p-mTOR), and phosphorylated ribosomal protein S6 kinase B1 (p-P70S6K) were analyzed using Image-Pro Plus software. KHE had the following pattern of expression in the spindle vascular endothelial cells: TSC2 (-); PTEN (-); p-4EBP1 (+); p-mTOR (+); and p-P70S6K (+). RESULTS All 3 patients treated with sirolimus had good responses. The TA results were similar to KHE with no significant differences (p-4EBP1: p = 0.0687; p-mTOR: p = 0.0832). The expressions of TSC2, PTEN, p-4EBP1, p-mTOR, and p-P70S6K were negative or weakly positive in IH with a statistically significant difference compared to KHE (p-4EBP1: p < 0.001; p-mTOR: p < 0.001; p-P70S6K: p < 0.001). LM had no significant differences when compared to KHE. CONCLUSIONS The absence of TSC2 and PTEN caused abnormal activation of the mTOR signaling pathway and may be involved in the pathogenesis of KHE. The expression of mTOR-related proteins in TA and LM was similar to KHE, unlike IH. The KHE pattern of expression [PTEN (-), TSC2 (-), p-mTOR (+), p-P70S6K (+), and p-4EBP1 (+)] suggested that sirolimus may be a good therapeutic choice.
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Affiliation(s)
- Zuopeng Wang
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Chao Zheng
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Hongqiang Sun
- Department of Pediatric Surgery, Shandong Dezhou People's Hospital, Shandong, China
| | - Wei Yao
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Kai Li
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China,
| | - Yangyang Ma
- Department of Pathology, Children's Hospital of Fudan University, Shanghai, China
| | - Shan Zheng
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
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Ten Broek RW, Koelsche C, Eijkelenboom A, Mentzel T, Creytens D, Vokuhl C, van Gorp JM, Versleijen-Jonkers YM, van der Vleuten CJ, Kemmeren P, van de Geer E, von Deimling A, Flucke U. Kaposiform hemangioendothelioma and tufted angioma - (epi)genetic analysis including genome-wide methylation profiling. Ann Diagn Pathol 2019; 44:151434. [PMID: 31887709 DOI: 10.1016/j.anndiagpath.2019.151434] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 11/02/2019] [Accepted: 11/08/2019] [Indexed: 11/17/2022]
Abstract
Kaposiform hemangioendothelioma (KHE) is a locally aggressive vascular condition of childhood and is clinicopathologically related to tufted angioma (TA), a benign skin lesion. Due to their rarity molecular data are scarce. We investigated 7 KHE and 3 TA by comprehensive mutational analysis and genome-wide methylation profiling and compared the clustering, also with vascular malformations. Lesions were from 7 females and 3 males. The age range was 2 months to 9 years with a median of 10 months. KHEs arose in the soft tissue of the thigh (n = 2), retroperitoneum (n = 1), thoracal/abdominal (n = 1), supraclavicular (n = 1) and neck (n = 1). One patient presented with multiple lesions without further information. Two patients developed a Kasabach-Merritt phenomenon. TAs originated in the skin of the shoulder (n = 2) and nose/forehead (n = 1). Of the 5 KHEs and 2 TAs investigated by DNA sequencing, one TA showed a hot spot mutation in NRAS, and one KHE a mutation in RAD50. Unsupervised hierarchical clustering analysis indicated a common methylation pattern of KHEs and TAs, which separated from the homogeneous methylation pattern of vascular malformations. In conclusion, methylation profiling provides further evidence for KHEs and TAs potentially forming a spectrum of one entity. Using next generation sequencing, heterogeneous mutations were found in a subset of cases (2/7) without the presence of GNA14 mutations, previously reported in KHE and TA.
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Affiliation(s)
- Roel W Ten Broek
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Christian Koelsche
- Department of General Pathology, University of Heidelberg, Heidelberg, Germany
| | - Astrid Eijkelenboom
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - David Creytens
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Christian Vokuhl
- Department of Pediatric Pathology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Joost M van Gorp
- Department of Pathology, St Antonius Hospital, Nieuwegein, the Netherlands
| | | | | | - Patrick Kemmeren
- Princess Màxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Ellen van de Geer
- Princess Màxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Andreas von Deimling
- Department of Neuropathology, University of Heidelberg, Heidelberg, Germany; CCU Neuropathology, German Cancer Center, Heidelberg, Germany
| | - Uta Flucke
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands; Princess Màxima Center for Pediatric Oncology, Utrecht, the Netherlands.
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Tribolet S, Hoyoux C, Boon LM, Cheruy C, Demarche M, Jamblin P, Roberti A, Willemaers V, Viellevoye R, Rigo V, Broux I. A not so harmless mass: Kaposiform hemangioendothelioma complicated by a Kasabach-Merritt phenomenon. Arch Pediatr 2019; 26:365-9. [PMID: 31353149 DOI: 10.1016/j.arcped.2019.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 04/25/2019] [Accepted: 06/18/2019] [Indexed: 11/20/2022]
Abstract
A vascular mass localized in the face and the neck was displayed by ultrasonography in a 38-week-old male fetus. At birth, the mass was bulky and purplish. The newborn breathed spontaneously but with severe desaturation. During laryngoscopy, we observed an obstruction of the larynx with a left-shift caused by the hemorrhagic mass. Blood analysis revealed anemia, severe thrombocytopenia, and coagulation disorders. The diagnosis of kaposiform hemangioendothelioma (KHE) complicated by a Kasabach-Merritt phenomenon (KMP) was put forward and treatment with propranolol, corticoids, and vincristine was initiated. Platelets were transfused daily for 8 days but did not resolve the thrombocytopenia. At day 8, we added sirolimus to the treatment and noted a rapid response with the normalization of the platelet count within 1 week and a significant regression of the mass. In this paper, we review the clinical and biological features of hemangioendothelioma associated with KMP and discuss its current and future treatment. Sirolimus seems to be very promising.
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Ji Y, Chen S, Peng S, Xia C, Li L. Kaposiform lymphangiomatosis and kaposiform hemangioendothelioma: similarities and differences. Orphanet J Rare Dis 2019; 14:165. [PMID: 31277673 PMCID: PMC6612206 DOI: 10.1186/s13023-019-1147-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 12/17/2018] [Accepted: 06/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Kaposiform lymphangiomatosis (KLA) and kaposiform hemangioendothelioma (KHE) are rare and aggressive vascular disorders. The aim of this study was to examine the clinical features and prognosis of KLA and KHE involving the thorax. METHODS The clinical features, imaging and pathological findings, treatments and outcome were retrospectively reviewed for 6 patients with KLA and 7 patients with KHE involving the thorax. RESULTS The mean ages at the time of the presentation of signs/symptoms were 26.7 months and 4.1 months for KLA and KHE, respectively. Respiratory symptoms, pericardial and pleural effusion, thrombocytopenia and coagulopathy were common in both KLA and KHE. Diffuse lesions involving the lung and extrathoracic sites were observed in KLA but not in KHE. Histopathologically, all lesions had spindled tumor cells, which were immunoreactive for CD31 and D2-40. In KLA, the spindle cells were distributed in sparse and poorly marginated clusters, whereas the spindle cells formed more defined and confluent vascularized nodules in KHE. Unlike the refractory behavior of KLA, the majority of patients with KHE responded to medical treatments with regression of the lesion and normalization of the hematologic parameters. CONCLUSIONS The presenting and histological characteristics of KLA can overlap with those of KHE. The presence of diffuse vascular lesions in the mediastinum and lung with refractory thrombocytopenia and coagulopathy should suggest the diagnosis of KLA. Given the rarity and high morbidity and mortality of these disorders, the diagnostic process and therapeutic approach should include a multidisciplinary team review and consensus.
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Affiliation(s)
- Yi Ji
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China.
| | - Siyuan Chen
- Pediatric Intensive Care Unit, Department of Critical Care Medicine, West China Hospital of Sichuan University, #37# Guo-Xue-Xiang, Chengdu, 610041, China.
| | - Suhua Peng
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Chunchao Xia
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Li Li
- Laboratory of Pathology, West China Hospital of Sichuan University, Chengdu, 610041, China
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Giménez-Aleixandre C, Méndez-Aguirre NA, Martínez-Menchón T, Girón Vallejo Ó, Fernández-Ibieta M, Ferri-Ñíguez B, Villamil V, Sánchez-Sánchez Á, Montoya-Rangel CA, Hernández-Bermejo JP. [Our experience with sirolimus for the treatment of complicated vascular anomalies]. Cir Pediatr 2019; 32:28-33. [PMID: 30714698] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIM OF THE STUDY mTOR inhibitors are being used to treat complex vascular anomalies (VA) without response to conventional treatments. We report our results in pediatric patients treated with sirolimus. METHODS Retrospective review of patients treated with sirolimus between 2014 and 2017, analyzing vascular anomaly type, treatment response and complications. Treatment protocol included patients with complex vascular anomalies, after signing the informed consent. The initial dose was 0.8 mg/m2/12 h, verifying plasmatic levels. Favorable response was defined both in clinical and radiological terms. MAIN RESULTS Sirolimus was employed in nine patients, median age 14 months old (1 month-14 years), 66% girls. Five complex micro-cystic lymphatic malformations (LM), one multifocal lynphangioendotheliomatosis with thrombocytopenia, one kaposiform lymphangiomatosis, one lymphatic-venous malformation and one kaposiform hemangioendothelioma (KHE) were treated. Median treatment was 4 months (IQR 2-18 months). Resolution or improvement was objectified in four patients (44%). KHE patient presented complete resolution after two months of treatment. Two patients with micro-cystic LM and the one with lymphatic-venous malformation improved after a median treatment of three months. Two patients presented rebound effect after discontinuing treatment. Three patients had hypertransaminasemia and hypercholesterolemia without requiring medical treatment. CONCLUSION Sirolimus presented mild effects for treatment of complex VA in our study, but was highly resolutive at KHE.
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Affiliation(s)
- C Giménez-Aleixandre
- Servicio de Cirugía Pediátrica. Hospital Clínico Universitario Virgen de la Arrixaca. Murcia
| | - N A Méndez-Aguirre
- Servicio de Cirugía Pediátrica. Hospital Clínico Universitario Virgen de la Arrixaca. Murcia
| | - T Martínez-Menchón
- Servicio de Dermatología. Hospital Clínico Universitario Virgen de la Arrixaca. Murcia
| | - Ó Girón Vallejo
- Servicio de Cirugía Pediátrica. Hospital Clínico Universitario Virgen de la Arrixaca. Murcia
| | - M Fernández-Ibieta
- Servicio de Cirugía Pediátrica. Hospital Clínico Universitario Virgen de la Arrixaca. Murcia
| | - B Ferri-Ñíguez
- Servicio de Anatomía Patológica. Hospital Clínico Universitario Virgen de la Arrixaca. Murcia
| | - V Villamil
- Servicio de Cirugía Pediátrica. Hospital Clínico Universitario Virgen de la Arrixaca. Murcia
| | - Á Sánchez-Sánchez
- Servicio de Cirugía Pediátrica. Hospital Clínico Universitario Virgen de la Arrixaca. Murcia
| | - C A Montoya-Rangel
- Servicio de Cirugía Pediátrica. Hospital Clínico Universitario Virgen de la Arrixaca. Murcia
| | - J P Hernández-Bermejo
- Servicio de Cirugía Pediátrica. Hospital Clínico Universitario Virgen de la Arrixaca. Murcia
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Ji Y, Chen S, Li L, Yang K, Xia C, Li L, Yang G, Kong F, Lu G, Liu X. Kaposiform hemangioendothelioma without cutaneous involvement. J Cancer Res Clin Oncol 2018; 144:2475-2484. [PMID: 30293120 DOI: 10.1007/s00432-018-2759-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 09/24/2018] [Indexed: 02/05/2023]
Abstract
PURPOSE We sought to characterize the clinical features and management of patients diagnosed as Kaposiform hemangioendothelioma (KHE) without cutaneous involvement. METHODS The electronic patient chats at six Triple A hospitals in China were searched to find all patient diagnoses with KHE without cutaneous involvement. RESULTS Of 30 patients (mean age at diagnosis, 55.6 months), 17 (56.7%) were male. Fourteen (46.7%) patients were associated with Kasabach-Merritt phenomenon (KMP). Patients with KMP were significantly more likely to have lesions involving truck compared to patients without KMP (odds ratio 10.000; 95% confidence interval 1.641-60.921; P = 0.011). Other common complication included severe anemia and decreased range of motion. In the majority of cases (93.3%), the lesions were highly infiltrative and locally invasive with ill-defined margins. Histological examination was required in all patients without KMP for precise diagnosis. In all, 16 (53.3%) patients received corticosteroid treatment, 19 (63.3%) received oral sirolimus treatment, 7 (23.3%) received intravenous vincristine, and 5 (16.7%) patients used propranolol. Patients had varied responses to conventional drugs, whereas all patients receiving sirolimus treatment had better response. In all, three patients (10%) died of disease, all presented with KMP. Feature of these recalcitrant cases (death) included young age, visceral location, extensive involvement, and lack of improvement with high-dose corticosteroids. CONCLUSIONS Our study clearly demonstrated that KHE without cutaneous involvement could be associated with important complication, which might result in death or severe morbidity. Increased awareness of KHE without cutaneous involvement is required for early diagnosis and aggressive therapy in an attempt to prevent complication.
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Affiliation(s)
- Yi Ji
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, #37# Guo-Xue-Xiang, Chengdu, 610041, China.
| | - Siyuan Chen
- Pediatric Intensive Care Unit, Department of Critical Care Medicine, West China Hospital of Sichuan University, #37# Guo-Xue-Xiang, Chengdu, 610041, China.
| | - Lizhi Li
- Department of Pediatric Surgery, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Kaiying Yang
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, #37# Guo-Xue-Xiang, Chengdu, 610041, China
| | - Chunchao Xia
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Li Li
- Laboratory of Pathology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Gang Yang
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, #37# Guo-Xue-Xiang, Chengdu, 610041, China.,Department of Pediatric Surgery, Chengdu Shangjin Nanfu Hospital, Chengdu, 611730, China
| | - Feiteng Kong
- Department of Pediatric Surgery, Sichuan Women and Children's Hospital, Chengdu, 610045, China
| | - Guoyan Lu
- Pediatric Intensive Care Unit, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Xingtao Liu
- Department of Vascular and Interventional Radiology, Chengdu Women and Children's Central Hospital, Chengdu, 610031, China
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Schmid I, Klenk AK, Sparber-Sauer M, Koscielniak E, Maxwell R, Häberle B. Kaposiform hemangioendothelioma in children: a benign vascular tumor with multiple treatment options. World J Pediatr 2018; 14:322-9. [PMID: 30054848 DOI: 10.1007/s12519-018-0171-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Kaposiform hemangioendothelioma (KHE) is a rare vascular tumor affecting infants and young children. Although benign, it can be associated with an aggressive locally growing tumor and/or a life-threatening Kasabach-Merritt phenomenon (KMP). To date, only reviews of limited cases have been performed. We, therefore, conducted a comprehensive literature search to collect relevant data and make recommendations for future treatment trials. METHODS Review of the available literature between 1993 and 2017 revealed a total of 105 publications involving 215 patients of less than 21 years of age. To this, we added 12 from our department and 4 from the Cooperative Weichteilsarkomstudie database. RESULTS We found that KMP was present in 79% of the infants, in 47% of the 1-5-year olds, in 43% of the 6-12-year olds, and in 10% of the 13-21-year-old patients. KMP was present in nearly all (94%) patients with retroperitoneal tumors and in all patients with extra-regional tumors. The median size of a KHE without KMP was 12 cm2 as compared to 49 cm2 when associated with a KMP. With complete (not further classifiable if R0 or R1) resection, all patients were cured. If inoperable, response regarding KMP/regression of tumor size was seen in 29/28% with steroid-, 47/39% with vincristine-, 44/43% with interferon alpha-, 65/61% with anti-platelet agents-, and in 97/100% with sirolimus-containing therapies. CONCLUSIONS Patients with progressive KHE should undergo resection whenever it is considered a safe option. If inoperable, sirolimus should be the first choice for treating KMP and reducing tumor size.
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Abstract
Vascular tumors are benign neoplasms, which result from proliferating endothelial cells. These lesions present during infancy or childhood, may affect any location, and exhibit postnatal growth. Local complications include bleeding, tissue destruction, and pain whereas systemic sequelae include thrombocytopenia, congestive heart failure, and death. Vascular tumors should be differentiated from vascular malformations, which present at birth, have a quiescent endothelium, and grow in proportion to the child. Together, vascular tumors and malformations comprise the field of vascular anomalies.
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Affiliation(s)
- Jeremy A Goss
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue Boston, MA, 02115, USA
| | - Arin K Greene
- Department of Plastic and Oral Surgery, Vascular Anomalies Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue Boston, MA, 02115, USA.
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44
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Erdem Toslak I, Stegman M, Reiter MP, Barkan GA, Borys D, Lim-Dunham JE. Atypically presenting kaposiform hemangioendothelioma of the knee: ultrasound findings. J Med Ultrason (2001) 2018; 45:653-656. [PMID: 29637402 DOI: 10.1007/s10396-018-0878-x] [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: 12/27/2017] [Accepted: 03/23/2018] [Indexed: 11/25/2022]
Abstract
Kaposiform hemangioendothelioma (KHE) is a rare vascular tumor of early childhood and infancy. Kasabach-Merritt phenomenon, a common complication of KHE, is characterized by life-threatening thrombocytopenia, hemolytic anemia, and consumption coagulopathy. There may be atypical cases that do not present with Kasabach-Merritt phenomenon and do have atypical imaging findings. Knowledge of atypical imaging features may assist radiologists in identifying KHE. In this report, we present a 4-year-old case of KHE with atypical ultrasound findings.
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Affiliation(s)
- Iclal Erdem Toslak
- Department of Radiology, Loyola University Medical Center, Maywood, IL, USA. .,Loyola University Medical Center and Chicago Stritch School of Medicine, 2160 S. First Ave, Maywood, IL, 60153, USA.
| | - Matthew Stegman
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Michael P Reiter
- Department of Radiology, Loyola University Medical Center, Maywood, IL, USA
| | - Güliz A Barkan
- Department of Pathology, Loyola University Medical Center, Maywood, IL, USA
| | - Dariusz Borys
- Department of Pathology, Loyola University Medical Center, Maywood, IL, USA
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45
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Abstract
Vascular tumors with a spindled morphology represent a diagnostic challenge in soft tissue pathology. It may be difficult to distinguish certain benign entities in this category from spindled vascular tumors of intermediate malignancy or even spindled variants of angiosarcoma. This article focuses on vascular tumors characterized by a predominantly spindled morphology, including spindle cell hemangioma, acquired tufted angioma (angioblastoma of Nakagawa), kaposiform hemangioendothelioma, Kaposi sarcoma, and spindle cell variants of angiosarcoma.
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Affiliation(s)
- Zlatko Marušić
- Department of Pathology, University Hospital Center Zagreb, Kišpatićeva 12, Zagreb 10 000, Croatia
| | - Steven D Billings
- Department of Pathology, Cleveland Clinic, 9500 Euclid Avenue, L25, Cleveland, OH 44195, USA.
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46
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Guo X, Gong Y, Dong C. Surgical treatment of a huge kaposiform hemangioendothelioma in the chest wall: A case study. SAGE Open Med Case Rep 2017; 4:2050313X16684742. [PMID: 28228957 PMCID: PMC5308515 DOI: 10.1177/2050313x16684742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 11/21/2016] [Indexed: 12/02/2022] Open
Abstract
Kaposiform hemangioendothelioma, a rare vascular pediatric tumor often associated with Kasabach–Merritt phenomenon, is characterized by severe thrombocytopenia and consumptive coagulopathy. Kaposiform hemangioendothelioma is a severe disease and may progress quickly, resulting in a high mortality. However, standard treatment regimens for Kasabach–Merritt phenomenon have not yet been established. We reported here an infant with a large congenital kaposiform hemangioendothelioma in his chest wall who responded extremely well to surgical excision.
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Affiliation(s)
- Xiaonan Guo
- Department of Hemangioma & Vascular Malformation, Henan Provincial People's Hospital, Zhengzhou, P.R. China
| | - Yubin Gong
- Department of Hemangioma & Vascular Malformation, Henan Provincial People's Hospital, Zhengzhou, P.R. China
| | - Changxian Dong
- Department of Hemangioma & Vascular Malformation, Henan Provincial People's Hospital, Zhengzhou, P.R. China
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Le Cras TD, Mobberley-Schuman PS, Broering M, Fei L, Trenor CC 3rd, Adams DM. Angiopoietins as serum biomarkers for lymphatic anomalies. Angiogenesis 2017; 20:163-73. [PMID: 27990590 DOI: 10.1007/s10456-016-9537-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 12/03/2016] [Indexed: 01/08/2023]
Abstract
Vascular anomalies can cause significant morbidity and mortality. Advances in diagnosis will be improved if noninvasive biomarkers can be identified, as obtaining a tissue biopsy can worsen the disease and precipitate complications. The goal of this study was to identify biomarkers for vascular anomaly patients to aid diagnosis and potentially give insights into pathogenesis. Blood was collected at baseline and then 6 and 12 months after treatment with the mTOR inhibitor sirolimus. Patients groups included generalized lymphatic anomaly (GLA), kaposiform lymphangiomatosis (KLA) and kaposiform hemangioendothelioma (KHE) with or without the Kasabach-Merritt phenomenon (KMP) coagulopathy. Serum was obtained from healthy controls selected to match the age and sex of the patients (21 days-28.5 years; 42% males; 58% females). Angiogenic and lymphangiogenic factors (VEGF-A, C, D, Ang-1 and Ang-2) were measured in serum using ELISA. In lymphatic anomaly patients, baseline levels of VEGF-A and VEGF-D were not different compared to controls. Angiopoietin-2 (Ang-2) levels were near controls levels in GLA patients but 10-fold greater in KLA patients and 14-fold greater in KHE patients when the KMP coagulopathy was present but not when it was absent. VEGF-C and angiopoietin-1 (Ang-1) levels were lower in KHE patients with KMP. Our analyses suggest that Ang-2 and Ang-1 can be used as biomarkers to help identify KLA and KHE patients with KMP coagulopathy with high sensitivity and specificity. After 12 months of sirolimus treatment, Ang-2 levels were lower in KLA and KHE with KMP patients compared to baseline levels and with most patients showing a clinical response. Hence, serum Ang-2 and Ang-1 levels may help in the diagnosis of patients with lymphatic anomalies and are concordant to sirolimus response.
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48
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Vashi P, Abboud E, Bier-Laning C, Gupta D. Adult-onset Kaposiform hemangioendothelioma of the tongue: case report and review of the literature. ACTA ACUST UNITED AC 2016; 23:e517-e520. [PMID: 27803613 DOI: 10.3747/co.23.3239] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 11/15/2022]
Abstract
We present here a very rare clinical case of a 38-year-old man with Kaposiform hemangioendothelioma (khe) of the tongue who presented to our institution with a growth under the left side of the tongue with no pain or discomfort. There were no enlarged lymph nodes and no significant neurologic findings. Diagnostic histopathology confirmed the lesion to be khe. The tumour was removed surgically, and the surgical specimen confirmed the diagnosis. Follow-up at 3 months shows no clinical evidence of recurrence.
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Affiliation(s)
- P Vashi
- Department of Gastroenterology/Nutrition and Metabolic Support, Zion, IL, U.S.A
| | - E Abboud
- Department of Pathology and Laboratory Medicine, Zion, IL, U.S.A
| | - C Bier-Laning
- Department of Otolaryngology, Cancer Treatment Centers of America at Midwestern Regional Medical Center, Zion, IL, U.S.A
| | - D Gupta
- Department of Gastroenterology/Nutrition and Metabolic Support, Zion, IL, U.S.A
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49
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Mota JM, Scaranti M, Fonseca LG, Tolói DA, de Camargo VP, Munhoz RR, Feher O, Hoff PM. Response to Paclitaxel in an Adult Patient with Advanced Kaposiform Hemangioendothelioma. Case Rep Oncol 2016; 9:481-487. [PMID: 27721772 PMCID: PMC5043218 DOI: 10.1159/000448111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 07/01/2016] [Accepted: 07/01/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Kaposiform hemangioendothelioma (KHE) is a rare neoplasm of vascular origin that typically arises from the skin or soft tissues as a solitary tumor. The optimal therapy for this disease is still unknown. We report the case of an adult patient presenting with metastatic KHE of the spleen, who had a partial response after treatment with paclitaxel. CASE PRESENTATION A 36-year-old man presented in November 2012 with a nontraumatic rupture of the spleen. A splenectomy was performed, and the pathology was consistent with a nonspecific vascular proliferation. Follow-up scans revealed lytic bone lesions and liver metastasis. A biopsy of the liver was performed and confirmed KHE. The decision was made to proceed with treatment with gemcitabine and docetaxel, which was discontinued due to myelotoxicity. The patient was then transferred to our institution, and a pathology review supported the diagnosis of metastatic KHE. His disease remained stable until February 2014, when he developed progression in the liver. Chemotherapy was restarted with paclitaxel, and a partial response was documented after 3 cycles. Unfortunately, disease progression occurred after 24 weeks, and subsequent treatments included prednisone, doxorubicin, interferon-α, gemcitabine, and ifosfamide, without any response. The patient developed Kasabach-Merritt phenomenon and passed away 1 week later due to a major gastrointestinal bleeding. CONCLUSIONS This case report suggests that paclitaxel could be considered as a treatment option for advanced KHE, a rare condition for which no standard treatment exists.
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Affiliation(s)
- José Maurício Mota
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Mariana Scaranti
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Leonardo G Fonseca
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Diego Araújo Tolói
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Veridiana Pires de Camargo
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Rodrigo Ramella Munhoz
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Olavo Feher
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Paulo M Hoff
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
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50
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Shabtaie SA, Wang B, Owyong M, Ruiz-Mesa C, Corrales-Medina FF, Rojas CP, Infante JC, Neville HL, Perez EA, Sola JE, Hogan AR. Neonatal kaposiform hemangioendothelioma of the spleen associated with Kasabach-Merritt phenomenon. J Pediatr Surg 2016; 51:1047-50. [PMID: 27342010 DOI: 10.1016/j.jpedsurg.2016.03.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/10/2016] [Accepted: 03/29/2016] [Indexed: 12/16/2022]
Abstract
Kaposiform hemangioendothelioma is a rare locally aggressive vascular tumor that usually manifests during early childhood. Typically the lesion presents with skin, soft tissue and bone involvement and is characterized histologically by ill-defined nodularity and the presence of spindle cells with resemblance to Kaposi's sarcoma. We report a rare neonatal case of a splenic kaposiform hemangioendothelioma associated with Kasabach-Merritt phenomenon that was diagnosed with radiographic imaging. Because of the rapid onset of thrombocytopenia and anemia, the patient required urgent splenectomy with subsequent resolution of the blood dyscrasias.
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