Periocular infantile hemangioma masquerading as dacryocele

Clinico-radiologic characteristics of lacrimal sac area swellings misdiagnosed as dacryocystocele or mucocele

PURPOSE

Several non-lacrimal lesions can present with lacrimal sac area swelling mimicking a dacryocystocele or mucocele with a possibility of misdiagnosis. This study investigates the clinic-radiologic characteristics of the mimicking conditions compared to true lacrimal sac distension.

DESIGN

Retrospective, comparative, interventional case series.

PARTICIPANTS

Patients referred by primary care ophthalmologists between January 2015 and October 2021 with a misdiagnosis of dacryocystocele or lacrimal sac mucocele (n = 39) and an age-matched group of proven true lacrimal sac swelling (TLS group, n = 44).

METHODS

Data collected included demographics, presenting features, investigations, management, histopathology, and outcomes. Both groups were statistically compared for several clinical and radiological variables.

RESULTS

Final diagnoses in the mimicking group were skin/subcutaneous swellings (14/39, 35.9%), vascular malformations (10/39, 25.6%), inferomedial anterior orbital cysts (7/39, 17.9%), sino-orbital masses (5/39, 12.8%). Female gender (<0.001), epiphora (p = 0.001), and discharge (p < 0.001) were significantly more frequent in the TLS group. The mimicking group was more likely to be associated with a longer swelling duration (p < 0.001), a swelling extending beyond the lacrimal sac area (p <0.001), orbital signs (p <0.001), and periorbital abnormality. Non-patent lacrimal irrigation (p < 0.001) was significantly more frequent in the TLS group. On imaging, all swellings in the mimicking group were separate from the lacrimal pathway and 94.9% (37/39) extended beyond the lacrimal sac fossa.

CONCLUSION

Various cutaneous, subcutaneous, vascular, inferomedial orbital cystic, and sinonasal pathologies can present with lacrimal sac area swelling and mimic a TLS. A high index of suspicion, a thorough clinical evaluation and proper imaging are essential to avoid a misdiagnosis.

FOXF1 Was Identified as a Novel Biomarker of Infantile Hemangioma by Weighted Coexpression Network Analysis and Differential Gene Expression Analysis

Background

The most frequent benign tumor in newborns is infantile hemangioma. The majority of infantile hemangiomas has a favorable prognosis and generally fades away on their own. Some people, however, do experience major consequences. Transcriptome alterations in infantile hemangiomas are yet unclear. The use of transcriptome analysis to uncover diagnostic markers for infantile hemangioma has clinical implications.

Methods

The dataset GSE127487 for infantile hemangioma was obtained from the GEO database. The gene set most related with infantile hemangioma was investigated using weighted coexpression network analysis. Differential expression analysis was performed to see whether genes were up or downregulated in infantile hemangiomas. The enrichment of gene sets in pathways or functions is determined via enrichment analysis. Hub genes were discovered via protein-protein interaction network analysis. The relationship between hub genes and immune cells was investigated using immunomicroenvironment analysis.

Results

Turquoise and Pink modules were revealed to be the most linked with infantile hemangioma in a weighted coexpression network analysis (p < 0.001). The genes in the two modules were mostly concentrated in actin filament organization, embryonic organ development, reproductive structure development, cell substrate adhesion, extracellular matrix organization, and so on, according to GO enrichment analysis (p < 0.05). These gene enrichment pathways comprised the PI3K-Akt signaling pathway, human papillomavirus infection, focal adhesion, and hepatitis C pathways, according to KEGG enrichment analyzes (p < 0.05). Differential expressed gene analysis showed 43 upregulated and 21 downregulated genes in infantile hemangiomas. We found the gene set most associated to infantile hemangioma by intersecting the elevated genes with the genes acquired by WGCNA, with FOXF1 serving as the hub gene. FOXF1 was linked to the degree of monocyte infiltration, according to immunocorrelation analysis (p < 0.05). B cell memory, dendritic cells resting, macrophage M0, neutrophils, and T cells helper are all negatively connected (p < 0.05). In the FOXF1 hyperexpression group, GSEA analysis revealed that cholesterol homeostasis and cell cycle-associated pathways G2M checkpoint were primarily activated (p < 0.05).

Conclusion

FOXF1 was found to be a reliable biomarker of infantile hemangiomas in our research of transcriptome changes in infantile hemangiomas.

Infantile hemangioma. Part 1: Epidemiology, pathogenesis, clinical presentation and assessment

Infantile hemangioma (IH) is the most common pediatric vascular tumor. Its pathogenesis is poorly understood but thought to represent an aberrant response of pluripotent stem cells to stimuli such as hypoxia and the renin-angiotensin-system. IH usually appears during the first few weeks of life and follows a characteristic natural trajectory of proliferation and involution. Their clinical appearance depends on their depth and distribution. Classification comprises superficial, mixed and deep IH as well as IH with minimal or arrested growth. Multifocal IHs are more likely to be associated with infantile hepatic hemangioma, and although the need for screening based on a specific number of IH has been recently debated, 5 remains the most widely acceptable cut off point. Large facial or lumbar IH warrants investigation for PHACE and LUMBAR syndrome, respectively. Complications of IH include ulceration, obstruction or functional impairment, hypothyroidism, and cosmetic sequelae. Differential diagnoses mostly consist of other vascular tumors and vascular malformations, though IH may sometimes mimic non-vascular tumors or developmental anomalies. Diagnosis is usually clinical and biopsy rarely indicated. High-frequency ultrasonography may help with the differential diagnosis, particularly with subcutaneous lesions. Referral to other specialists may be required in specific cases.