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Bhari N, Agarwal A, Asritha CVV, Panda M, Mahajan R. Vascular Malformations. Indian Dermatol Online J 2024; 15:415-430. [PMID: 38845674 PMCID: PMC11152494 DOI: 10.4103/idoj.idoj_633_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/19/2023] [Accepted: 12/24/2023] [Indexed: 06/09/2024] Open
Abstract
Vascular malformations are intricate anomalies of the circulatory system, presenting a diverse array of clinical manifestations, and posing significant challenges in diagnosis and treatment. The pathogenesis of vascular malformations is explored through the lens of genetic and molecular mechanisms, shedding light on the pivotal role of somatic mutations and dysregulated signaling pathways. Clinical presentations of vascular malformations are widely variable, ranging from cosmetic concerns to life-threatening complications. The utility of imaging techniques, such as magnetic resonance imaging (MRI), computed tomography (CT), and angiography, are discussed in detail, emphasizing their role in precise delineation and characterization. Therapeutic strategies for vascular malformations are multifaceted, considering factors such as lesion size, location, potential complications, and patient-specific factors. Traditional interventions, including surgical excision and embolization, are appraised alongside emerging approaches like targeted molecular therapies and minimally invasive procedures. The manuscript underscores the need for an individualized treatment approach, optimizing outcomes while minimizing risks and complications. In summation, this manuscript offers a comprehensive analysis of vascular malformations, encompassing their underlying pathogenesis, clinical nuances, diagnostic methods, and therapeutic considerations. By synthesizing current knowledge and highlighting gaps in understanding, this review serves as a valuable resource for clinicians, researchers, and medical practitioners, fostering an enhanced comprehension of vascular malformations and paving the way for improved patient care and innovative research endeavors.
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Affiliation(s)
- Neetu Bhari
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Akash Agarwal
- Department of Dermatology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - C. V. V. Asritha
- Department of Dermatology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Maitreyee Panda
- Department of Dermatology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Rahul Mahajan
- Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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2
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Gonzalez-Magaña R, García-Romero MT, Durán-McKinster C. Blue rubber bleb nevus syndrome successfully treated with sirolimus: a report of five pediatric patients. Int J Dermatol 2024. [PMID: 38679758 DOI: 10.1111/ijd.17217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/15/2024] [Indexed: 05/01/2024]
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3
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Patel R, Shames A, Sarkodieh J. Ultrasound features of benign paediatric lumps: radiology-pathology correlation. Clin Radiol 2024; 79:255-262. [PMID: 38320943 DOI: 10.1016/j.crad.2023.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 12/12/2023] [Accepted: 12/31/2023] [Indexed: 02/08/2024]
Abstract
Ultrasonography is an appropriate first-line imaging technique for the characterisation of paediatric lumps, given its relative accessibility and absence of radiation exposure. Together with a thorough history and examination, ultrasonography can help to distinguish benign lesions from malignancy. It can also aid further characterisation of benign lesions to inform onward investigation and management. This review features the evaluation of common benign paediatric lumps together with their characteristic sonographic features, following correlation with histopathology results or clinical follow-up.
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Affiliation(s)
- R Patel
- Whipps Cross Hospital, Barts Health NHS Trust, Whipps Cross Road, London, UK.
| | - A Shames
- Whipps Cross Hospital, Barts Health NHS Trust, Whipps Cross Road, London, UK
| | - J Sarkodieh
- Whipps Cross Hospital, Barts Health NHS Trust, Whipps Cross Road, London, UK
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Álvaro-Martinez M, Cuesta-Urquía C, Ortiz-Peces L, Noguera-Tomás J, González-Otero T, Cebrián-Carretero JL. Venous malformation differential diagnosis with an odontogenic abscess on a pediatric patient. Case report and review of the literature. J Clin Exp Dent 2024; 16:e387-e390. [PMID: 38600938 PMCID: PMC11003280 DOI: 10.4317/jced.61416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 02/05/2024] [Indexed: 04/12/2024] Open
Abstract
Venous malformations (VMs) are aberrant venous vessel angiogenesis present at birth. However, they can become apparent later in life, debuting in early childhood. This poses a clinical quest for surgeons, dentists, and pediatricians, as they might appear as a compressible mass in the head and neck region, not uncommonly mistaking them for odontogenic abscesses or other soft tissue tumors. The differential diagnosis can be challenging and imaging techniques are often needed. Ultrasounds are extremely useful initially as other diagnostic tools can be potentially harmful in the context of a VM. MRI is key as it provides accurate extension and location information, and allows to plan invasive treatment alternatives if the patient requires it. In this article, we present the case of a 6-year-old girl who was treated by mistake for an infection upon the diagnosis of an incipient odontogenic abscess instead of a venous malformation, and a literature review on VMs. Key words:Venous malformation, odontogenic abscess, differential diagnosis.
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Affiliation(s)
- María Álvaro-Martinez
- Department of Oral and Maxillofacial Surgery, Hospital Universitario La Paz. Paseo de la Castellana 261. 28046 Madrid, Spain
| | - Carolina Cuesta-Urquía
- Department of Oral and Maxillofacial Surgery, Hospital Universitario La Paz. Paseo de la Castellana 261. 28046 Madrid, Spain
| | - Luis Ortiz-Peces
- Department of Oral and Maxillofacial Surgery, Hospital Universitario La Paz. Paseo de la Castellana 261. 28046 Madrid, Spain
| | - Jorge Noguera-Tomás
- Department of Oral and Maxillofacial Surgery, Hospital Universitario La Paz. Paseo de la Castellana 261. 28046 Madrid, Spain
| | - Teresa González-Otero
- Department of Oral and Maxillofacial Surgery, Hospital Universitario La Paz. Paseo de la Castellana 261. 28046 Madrid, Spain
| | - José-Luis Cebrián-Carretero
- Department of Oral and Maxillofacial Surgery, Hospital Universitario La Paz. Paseo de la Castellana 261. 28046 Madrid, Spain
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Hirose K, Hori Y, Ozeki M, Motooka D, Hata K, Tahara S, Matsui T, Kohara M, Maruyama K, Imanaka-Yoshida K, Toyosawa S, Morii E. Comprehensive phenotypic and genomic characterization of venous malformations. Hum Pathol 2024; 145:48-55. [PMID: 38367816 DOI: 10.1016/j.humpath.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/19/2024]
Abstract
Venous malformations (VMs) are the most common vascular malformations. TEK and PIK3CA are the causal genes of VMs, and may be involved in the PI3K/AKT pathway. However, the downstream mechanisms underlying the TEK or PIK3CA mutations in VMs are not completely understood. This study aimed to identify a possible association between genetic mutations and clinicopathological features. A retrospective clinical, pathological, and genetic study of 114 patients with VMs was performed. TEK, PIK3CA, and combined TEK/PIK3CA mutations were identified in 49 (43%), 13 (11.4%), and 2 (1.75%) patients, respectively. TEK-mutant VMs more commonly occurred in younger patients than TEK and PIK3CA mutation-negative VMs (other-mutant VMs), and showed more frequent skin involvement and no lymphocytic aggregates. No significant differences were observed in sex, location of occurrence, malformed vessel size, vessel density, or thickness of the vascular smooth muscle among the VM genotypes. Immunohistochemical analysis revealed that the expression levels of phosphorylated AKT (p-AKT) were higher in the TEK-mutant VMs than those in PIK3CA-mutant and other-mutant VMs. The expression levels of p-mTOR and its downstream effectors were higher in all the VM genotypes than those in normal vessels. Spatial transcriptomics revealed that the genes involved in "blood vessel development", "positive regulation of cell migration", and "extracellular matrix organization" were up-regulated in a TEK-mutant VM. Significant genotype-phenotype correlations in clinical and pathological features were observed among the VM genotypes, indicating gene-specific effects. Detailed analysis of gene-specific effects in VMs may offer insights into the underlying molecular pathways and implications for targeted therapies.
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Affiliation(s)
- Katsutoshi Hirose
- Department of Oral and Maxillofacial Pathology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Yumiko Hori
- Department of Pathology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan; Department of Central Laboratory and Surgical Pathology, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, 540-0006, Japan.
| | - Michio Ozeki
- Department of Pediatrics, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan.
| | - Daisuke Motooka
- Genome Information Research Center, Research Institute for Microbial Diseases, Osaka University, 3-1 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Kenji Hata
- Department of Molecular and Cellular Biochemistry, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Shinichiro Tahara
- Department of Pathology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Takahiro Matsui
- Department of Pathology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Masaharu Kohara
- Department of Pathology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Kazuaki Maruyama
- Department of Pathology and Matrix Biology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu. Mie, 514-8507, Japan.
| | - Kyoko Imanaka-Yoshida
- Department of Pathology and Matrix Biology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu. Mie, 514-8507, Japan.
| | - Satoru Toyosawa
- Department of Oral and Maxillofacial Pathology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Eiichi Morii
- Department of Pathology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
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Zhou J, Guo L, Wang L, Li J, Liu Z, Sun J. The risk of muscle involvement in focal venous malformations in children. Phlebology 2024; 39:44-48. [PMID: 37859422 DOI: 10.1177/02683555231209081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
BACKGROUND Venous malformations (VMs) are the most common vascular malformations, which can be classified as focal, multifocal, or diffuse types. But the risk of focal venous malformations with muscle involvement is not well defined. METHODS This is a single-center, retrospective review of patients treated for focal VMs between February 2021 and February 2022. RESULTS We assessed 26 patients focal VMs with 47 lesions; 18 (69%) were unifocal, 3 (12%) were dual-focal, and 5 (19%) were multifocal type VMs, and 29 (62%) were intramuscular VMs. The lower limbs intramuscular VMs had a significantly elevated risk of focal VMs (relative risk [RR],1.7; 95% confidence interval [CI], 1.148-2.394). CONCLUSION Intramuscular involvement of the body should be considered in focal VMs. The lower limbs intramuscular VMs had a significantly elevated risk of focal VMs.
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Affiliation(s)
- Jie Zhou
- Department of Vascular anomalies and Interventional Radiology, Children's Hospital Affiliated to Shandong University, Jinan, China
| | - Lei Guo
- Department of Vascular anomalies and Interventional Radiology, Children's Hospital Affiliated to Shandong University, Jinan, China
| | - Liang Wang
- Department of Vascular anomalies and Interventional Radiology, Children's Hospital Affiliated to Shandong University, Jinan, China
| | - Jing Li
- Department of Vascular anomalies and Interventional Radiology, Children's Hospital Affiliated to Shandong University, Jinan, China
| | - Zhuang Liu
- Department of Vascular anomalies and Interventional Radiology, Children's Hospital Affiliated to Shandong University, Jinan, China
| | - Jiali Sun
- Department of Vascular anomalies and Interventional Radiology, Children's Hospital Affiliated to Shandong University, Jinan, China
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Rauterberg J, Schreml J, Tantcheva-Poór I. Cutaneous Vascular Malformations in a 53-Year-Old Woman With Neurologic Symptoms. JAMA Dermatol 2023; 159:1133-1134. [PMID: 37703032 DOI: 10.1001/jamadermatol.2023.3216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
A woman in her 50s presented with bluish, keratotic papules and nodules on the lower legs and lipolymphedema of the lower legs. What is your diagnosis?
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Affiliation(s)
- Jonas Rauterberg
- Department of Dermatology and Venereology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Julia Schreml
- Institute of Human Genetics, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Iliana Tantcheva-Poór
- Department of Dermatology and Venereology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
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Fernandez-Flores A, Cassarino D, Colmenero I. Vascular Malformations: A Histopathologic and Conceptual Appraisal. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T213-T228. [PMID: 36690143 DOI: 10.1016/j.ad.2022.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 01/22/2023] Open
Abstract
In the field of vascular anomalies, distinguishing between vascular malformations and tumors has become crucial for a correct therapeutic approach. However, the differential diagnosis between these two groups is not always well explained in classical texts, mainly because many vascular malformations are still known with old names that suggest a tumoral nature. Also, genetic and pathogenic knowledge of these entities has greatly increased in recent decades, so researchers and clinicians now have a better understanding of vascular malformations. In this paper, we present the main histopathological tips to recognize and identify a vascular malformation as such. We also contextualize such information in the clinical and pathogenic knowledge for a better understanding of these entities.
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Affiliation(s)
- A Fernandez-Flores
- Departamento de Histopatología, Hospital Universitario El Bierzo, Ponferrada, León, España; Departamento de Patología Celular, Hospital de la Reina, Ponferrada, León, España; Departamento de Investigación, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidad de A Coruña, A Coruña, España.
| | - D Cassarino
- Los Angeles Medical Center (LAMC), Southern California Kaiser Permanente, Department of Dermatology, Los Ángeles, CA, EE. UU
| | - I Colmenero
- Departamento de Histopatología Pediátrica, Hospital Universitario Niño Jesús, Madrid, España
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9
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Fernandez-Flores A, Cassarino D, Colmenero I. Vascular Malformations: A Histopathologic and Conceptual Appraisal. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:213-228. [PMID: 36309042 DOI: 10.1016/j.ad.2022.10.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 12/13/2022] Open
Abstract
In the field of vascular anomalies, distinguishing between vascular malformations and tumors has become crucial for a correct therapeutic approach. However, the differential diagnosis between these two groups is not always well explained in classical texts, mainly because many vascular malformations are still known with old names that suggest a tumoral nature. Also, genetic and pathogenic knowledge of these entities has greatly increased in recent decades, so researchers and clinicians now have a better understanding of vascular malformations. In this paper, we present the main histopathological tips to recognize and identify a vascular malformation as such. We also contextualize such information in the clinical and pathogenic knowledge for a better understanding of these entities.
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Affiliation(s)
- A Fernandez-Flores
- Department of Histopathology, University Hospital El Bierzo, Ponferrada, Spain; Department of Cellular Pathology, Hospital de la Reina, Ponferrada, Spain; Research Department, Institute for Biomedical Research of A Coruña (INIBIC), University of A Coruña (UDC), A Coruña, Spain.
| | - D Cassarino
- Los Angeles Medical Center (LAMC), Southern California Kaiser Permanente, Department of Dermatology, Los Angeles, CA, USA
| | - I Colmenero
- Department of Pediatric Histopathology, University Hospital Niño Jesús, Madrid, Spain
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The Genetic Architecture of Vascular Anomalies: Current Data and Future Therapeutic Perspectives Correlated with Molecular Mechanisms. Int J Mol Sci 2022; 23:ijms232012199. [PMID: 36293054 PMCID: PMC9603778 DOI: 10.3390/ijms232012199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 11/17/2022] Open
Abstract
Vascular anomalies (VAs) are morphogenesis defects of the vascular system (arteries, capillaries, veins, lymphatic vessels) singularly or in complex combinations, sometimes with a severe impact on the quality of life. The progress made in recent years with the identification of the key molecular pathways (PI3K/AKT/mTOR and RAS/BRAF/MAPK/ERK) and the gene mutations that lead to the appearance of VAs has allowed the deciphering of their complex genetic architecture. Understanding these mechanisms is critical both for the correct definition of the phenotype and classification of VAs, as well as for the initiation of an optimal therapy and the development of new targeted therapies. The purpose of this review is to present in synthesis the current data related to the genetic factors involved in the etiology of VAs, as well as the possible directions for future research. We analyzed the data from the literature related to VAs, using databases (Google Scholar, PubMed, MEDLINE, OMIM, MedGen, Orphanet) and ClinicalTrials.gov. The obtained results revealed that the phenotypic variability of VAs is correlated with genetic heterogeneity. The identification of new genetic factors and the molecular mechanisms in which they intervene, will allow the development of modern therapies that act targeted as a personalized therapy. We emphasize the importance of the geneticist in the diagnosis and treatment of VAs, as part of a multidisciplinary team involved in the management of VAs.
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New Insights in Paediatric Dermatopathology. Dermatopathology (Basel) 2021; 8:531-534. [PMID: 34940033 PMCID: PMC8700294 DOI: 10.3390/dermatopathology8040056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022] Open
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