Comprehensive Therapy for Hemangioma Presenting With Kasabach-Merritt Syndrome in the Maxillofacial Region

Treatment of Kasabach-Merritt syndrome in infants' maxillofacial regions with local, accurate administration of urea combined with methylprednisolone

BACKGROUND

Kasabach-Merritt syndrome (KMS) is a rear but dangerous type of hemangioma, which seriously threatens the life safety of KMS patients. The aim of this study is to explore the therapeutic and side effects of local administration of urea combined with methylprednisolone for the treatment of KMS in the maxillofacial region of infants.

CASE PRESENTATION

A total of 14 cases of KMS in infants' maxillofacial region were treated with local injection of 40% urea solution and methylprednisone after the external carotid artery ligation. After 10-36 months of follow-up, 13 out of 14 cases were cured and 1 case was improved. Two cases relapsed and were effectively managed with additional urea injections over 6-10 days. Observed over a 1-2-month period post-treatment, external carotid artery catheterization with urea and methylprednisolone injection is effective for the treatment of maxillofacial KMS in infants.

CONCLUSION

The present study demonstrates that, external carotid artery ligation combined with urea and methylprednisolone can be curative for the treatment KMS in maxillofacial regions of infants, with little trauma and minimal side effect. The combined therapy is recommended for treating severe hemangiomas complicated by Kasabach-Merritt syndrome in maxillofacial region of infants.

Kasabach-Merritt Phenomenon of the Parotid Gland: Case Report and Literature Review

Kasabach-Merritt phenomenon (KMP) is a rare but life-threatening condition characterized by consumptive coagulopathy associated with a vascular tumor. This phenomenon usually presents in early infancy and commonly reported sites of tumor include extremities, trunk, and neck. We report a newborn with KMP, presenting with parotid gland hemangioma and associated vascular complications. This case report and literature review, aim to describe the imaging features of KMP in an infant, along with a compilation of cases from the literature, with a particular focus on the radiological findings of the vascular tumor. Sixteen patients described in seven articles published between 1993 and 2021 were analyzed. Most of the cases were males (56%), with a median age of 13.5 days, an interquartile range (IQR) of 2.75 to 30 days, and lesions primarily located in the parotid gland. The most commonly affected side was 87.5% of cases involved the main gland, 6.25% the thoracic wall and 6.25 the supraclavicular region. The lesions also involved secondary sites such as the temporal region, submandibular area, neck, facial region, and extensive areas involving the thorax and extremities. KMP in the parotid gland is a rare manifestation. Advanced radiological imaging, particularly MRI and contrast-enhanced CT, plays a critical role in the diagnosis, staging, and detection of associated complications. The integration of imaging findings with clinical and laboratory data is essential for timely therapeutic decisions. Continued efforts to refine imaging protocols and gather epidemiological data will improve the prognosis of patients with this complex condition, emphasizing the need for a multidisciplinary approach.

Standards of care for Kasabach-Merritt phenomenon in China

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.

Successful transarterial embolization with cellulose porous beads for occipital haemangioma in an infant with Kasabach-Merritt syndrome

We report a 3-month-old boy with Kasabach-Merritt Syndrome (KMS) with an occipital haemangioma who underwent successful transarterial embolization (TAE) with cellulose porous beads (CPBs). As his response to steroids and coil embolization was inadequate, we performed TAE with CPBs, carefully preventing their migration via dangerous anastomoses. The tumour blush decreased, there were no complications, all coagulation tests were immediately normalized and the tumor size decreased gradually. TAE with CPBs is useful for the treatment of KMS.

Excellent outcome of medical treatment for Kasabach-Merritt syndrome: a single-center experience

Background

Kasabach-Merritt syndrome (KMS) is a rare but life-threatening illness. The purpose of this study is to report our single-center experience with KMS.

Methods

We reviewed the medical records of 13 patients who were diagnosed with KMS between 1997 and 2012 at Samsung Medical Center. Treatment response was defined as follows: 1) hematologic complete response (HCR) – platelet count >130×10⁹/L without transfusion; 2) clinical complete response (CCR) – complete tumor disappearance or small residual vascular tumor displaying lack of proliferation for at least 6 months after treatment discontinuation.

Results

Participants included 7 male and 6 female patients. The median initial hemoglobin levels and platelet counts were 9.7 g/dL (range, 6.6–11.6 g/dL) and 11×10⁹/L (range, 3–38×10⁹/L), respectively. Twelve patients received corticosteroid and interferon-alpha as initial treatment, and the remaining patient received propranolol instead of corticosteroid. Two patients with unsatisfactory response to the initial treatment received weekly vincristine. Successful discontinuation of medication was possible at a median of 301 days (range, 137–579) in all patients except one who was lost to follow-up. The median times to achieve HCR and CCR were 157 days and 332 days, respectively. The probabilities of achieving HCR and CCR were 77% and 54% at 1 year, and 88% and 86% at 2.5 years, respectively.

Conclusion

The prognosis of KMS in our cohort was excellent. Our data suggest that individualized treatment adaptation according to response may be very important for the successful treatment of patients with KMS.

Interferon-alpha therapy for refractory kaposiform hemangioendothelioma: a single-center experience

Kaposiform hemangioendothelioma (KHE) is a relatively rare vascular tumor with an aggressive and infiltrating nature. Previous studies have revealed an exclusive relationship between KHE and Kasabach-Merritt Phenomenon (KMP), which is associated with high morbidity and mortality. No universally accepted treatment modality exists for refractory KHE with or without KMP. The aim of this study was to evaluate the safety and efficacy of interferon-alpha (IFN-α) therapy for treatment of refractory KHE. Twelve consecutive patients with KHE were treated with subcutaneous injections of IFN-α after other treatments had failed. Eleven patients exhibited a reduction in tumor size of more than 50%, and the platelet count for all five patients with KMP returned to normal level after IFN-α therapy. The duration of IFN-α treatment ranged from 3 months to 9 months (mean: 6.3 months). The response time for IFN-α treatment ranged from 10 days to 5 weeks (mean: 3.6 weeks). Additionally, no severe complications, such as neurological damage or spastic diplegia, were observed in these patients. In conclusion, our study suggested that IFN-α therapy is effective and safe for refractory KHE, and IFN-α may be used as an alternative after other treatments have failed.

Enucleation is Better for a Giant Hemangioma Proximal to the Hepatic Portal Vascular Structures

The aim of this study is to compare the effect of liver enucleation with resection of a giant hemangioma proximal to the hepatic portal vascular structures. From 2008 to 2014, 53 patients with giant hemangiomas proximal to the hepatic portal vascular structures underwent surgery in our hospital by the same surgical team. The indications for surgery included a tumor size greater than 8 cm, a middle size greater than 4 cm but with abdominal pain, a rapidly increased tumor size with uncertain malignancy, or tumor rupture. Thirty-two patients (60 %) had pain only, 15 (29 %) had pain with tumor growth, 5 patients (9 %) had an uncertain diagnosis, and 1 patient (2 %) had tumor rupture. Enucleation was performed in 31 patients and liver resection was performed in 22 patients. There were no significant differences in the size of the hemangioma (13.9 ± 3.1 vs 12.3 ± 5.5 cm; P > 0.05), preoperative liver function tests, hemoglobin levels, and platelet counts between the enucleation and resection groups. The mean intraoperative blood loss was significantly less in the enucleation group compared with the resection group (350.9 ± 89.8 vs 988 ± 91.7 mL; P < 0.01), and the enucleation group had a significantly shorter mean operative time (1.7 ± 0.4 vs 2.9 ± 0.9 h; P < 0.01) and significantly shorter duration of hospital stay (9.6 ± 4.2 vs 14.7 ± 3.7 days; P < 0.05). Five patients in the resection group and only 1 patient in the enucleation group had major postoperative complications. Compared to liver resection, enucleation is safer and faster for liver hemangiomas proximal to the hepatic portal vascular structures and is associated with fewer complications.