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Cheng J, Zou Y, Fu R, Jin P, Huang M, Wu Z, Bai H, Huang X, Yuan H. Sirolimus combined with glucocorticoids in the treatment of Kasabach-Merritt phenomenon in a neonate: A case report. Medicine (Baltimore) 2024; 103:e37706. [PMID: 38579031 PMCID: PMC10994472 DOI: 10.1097/md.0000000000037706] [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: 12/17/2023] [Accepted: 03/04/2024] [Indexed: 04/07/2024] Open
Abstract
RATIONALE Kaposiform hemangioendothelioma is an aggressive vascular tumor that is often associated with life-threatening coagulopathies and Kasabach-Merritt phenomenon. Pathologic biopsies can provide a good basis for diagnosis and treatment. Therapy with srolimus combined with glucocorticoids may offer patients a favorable prognosis. PATIENT CONCERNS A large purplish-red mass on the knee of a child with extremely progressive thrombocytopenia and refractory coagulation abnormalities. Conventional doses of glucocorticoids alone failed to improve coagulation abnormalities and the child developed large cutaneous petechiae and scalp hematomas. DIAGNOSIS Kaposiform hemangioendothelioma combined with Kasabach-Merritt phenomenon. INTERVENTIONS The patient received prednisolone 2.0 mg/kg*d for 4 days. Blood products were transfused to ensure vital signs and to complete the pathologic biopsy. Sirolimus combined with prednisolone was given after clarifying the diagnosis of Kaposiform hemangioendothelioma. OUTCOMES The tumor basically disappeared on examination and the ultrasound showed a subcutaneous hyperechoic mass with normal blood flow. LESSONS Sirolimus combined with glucocorticoids is effective in controlling Kasabach-Merritt phenomenon and pathologic biopsy is important for definitive diagnosis.
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Affiliation(s)
- Jun Cheng
- Department of Plastic Surgery, Jiangxi Provincial Children’s Hospital, Nanchang, China
| | - Yun Zou
- Department of Plastic Surgery, Jiangxi Provincial Children’s Hospital, Nanchang, China
| | - Ronghua Fu
- Department of Plastic Surgery, Jiangxi Provincial Children’s Hospital, Nanchang, China
| | - Pingliang Jin
- Department of Plastic Surgery, Jiangxi Provincial Children’s Hospital, Nanchang, China
| | - Mengyu Huang
- Department of Plastic Surgery, Jiangxi Provincial Children’s Hospital, Nanchang, China
| | - Zhiping Wu
- Department of Plastic Surgery, Jiangxi Provincial Children’s Hospital, Nanchang, China
| | - Hanxiang Bai
- Department of Plastic Surgery, Jiangxi Provincial Children’s Hospital, Nanchang, China
| | - Xiangqun Huang
- Department of Plastic Surgery, Jiangxi Provincial Children’s Hospital, Nanchang, China
| | - Hua Yuan
- Department of Plastic Surgery, Jiangxi Provincial Children’s Hospital, Nanchang, China
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Tongruang C, Wananukul S, Chatproedprai S, Narkbunnam N, Nitiyarom R, Sirachainan N, Natesirinilkul R, Chaweephisal P, Sosothikul D. Cost and effectiveness comparison of sirolimus versus standard treatment in Kasabach-Merritt phenomenon: a real-world evidence study in Thailand. Pediatr Hematol Oncol 2024; 41:229-239. [PMID: 38235681 DOI: 10.1080/08880018.2023.2300485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/18/2023] [Indexed: 01/19/2024]
Abstract
The conventional treatment of Kasabach-Merritt Phenomenon (KMP) consists of corticosteroids with vincristine/vinblastine or others. The aim of the study is to compare the first-year direct costs and effectiveness between sirolimus and conventional treatment. A retrospective case-control study of KMP patients was conducted at a mean age of 9 months (1 day to 12 years) between 2000 and 2022 from four tertiary centers in Thailand. The direct costs, hematologic and clinical complete response (HCR, CCR), hospitalization, length of stay, and complications were compared. Of 29 patients, 13 underwent sirolimus (four upfront and nine were refractory to the conventional). The first-year total cost had no statistically significant difference between sirolimus VS conventional treatment (8,852.63 VS 9,083.56 USD: p value: 0.94). The therapeutics achievement was the same in both HCR (244.75 VS 168.94 days; p value: 0.60) and CCR (419.77 VS 399.87 days; p value: 0.90). The subgroup analysis of the first-line sirolimus (n = 4) compared with the conventional (n = 25) showed a more reduced total cost (4,907.84 VS 9,664.05 USD; p value: 0.26) rendered net total cost of -4,756.21 USD per patient (cost saving). A more significant contrast of therapeutic achievement by reduction of both HCR (11.67 VS 224.20 days; p value: 0.36) and CCR (38.50 VS 470.88 days; p value: 0.04) was shown. The sirolimus had no difference in hospitalization, length of stay, and complications. Even though, it was unable to identify significant differences in cost-effectiveness. Sirolimus is suitable for all patients who have diagnosis of KMP either for rescue therapy or first-line treatment.
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Affiliation(s)
- Chanikarn Tongruang
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Siriwan Wananukul
- Division of Dermatology, Department of Pediatrics, Faculty of Medicine King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Susheera Chatproedprai
- Division of Dermatology, Department of Pediatrics, Faculty of Medicine King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Nattee Narkbunnam
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rattanavalai Nitiyarom
- Division of Dermatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nongnuch Sirachainan
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Rungrote Natesirinilkul
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Chiang Mai University Hospital, Chiang Mai University, Chiang Mai, Thailand
| | - Phumin Chaweephisal
- The Integrative and Innovative Hematology/Oncology Research Unit, Faculty of Medicine Chulalongkorn University, Bangkok, Thailand
| | - Darintr Sosothikul
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
- The Integrative and Innovative Hematology/Oncology Research Unit, Faculty of Medicine Chulalongkorn University, Bangkok, Thailand
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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 B, Zhang C, Zhao L, Chen N, Hu Y, Li Z, Kang S, Blake A, Xiao S. Diverse clinical presentations of pseudomyogenic hemangioendothelioma associated with EGFL7::FOSB fusion: a second case. Histopathology 2024; 84:708-712. [PMID: 38012540 DOI: 10.1111/his.15108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/08/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Bin Li
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Changliang Zhang
- Molecular Genetics Laboratory, Suzhou Sano Precision Medicine Ltd, Suzhou, China
| | - Lina Zhao
- Molecular Genetics Laboratory, Suzhou Sano Precision Medicine Ltd, Suzhou, China
| | - Nan Chen
- Molecular Genetics Laboratory, Suzhou Sano Precision Medicine Ltd, Suzhou, China
| | - Yongbin Hu
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhiyuan Li
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Suya Kang
- Department of Pathology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Angella Blake
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sheng Xiao
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Xie S, Wang X, Zhang Y, Cheng J. Intracranial pseudomyogenic hemangioendothelioma: A case report. Asian J Surg 2023; 46:6067-6068. [PMID: 37777418 DOI: 10.1016/j.asjsur.2023.09.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/12/2023] [Indexed: 10/02/2023] Open
Affiliation(s)
- Shanshan Xie
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
| | - Xiao Wang
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yong Zhang
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Jingliang Cheng
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
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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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Al-Refai R, Morrar D, Bendari A, Sham S, Unger P, Edelman M. Locally Invasive Papillary Intralymphatic Angioendothelioma Arising Within a Lymphatic/Venous Malformation. Am J Case Rep 2023; 24:e940602. [PMID: 37803820 PMCID: PMC10569077 DOI: 10.12659/ajcr.940602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/18/2023] [Accepted: 08/09/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Papillary intralymphatic angioendothelioma (PILA) is a rare vascular tumor affecting children and young adults, with less than 50 cases reported in the literature. This tumor typically presents in the extremities, exhibits borderline behavior, and has a prominent lymphatic phenotype. Originally thought to be malignant, PILA was later recognized for its borderline behavior and lymphatic features, leading to its current classification as a "rarely metastasizing lymphatic vascular neoplasm". CASE REPORT We present the case of a 10-year-old girl with a 6-year history of a right facial venous malformation, which was ultimately diagnosed as PILA in the background of lymphatic/venous malformation (LVM). After undergoing surgical excision of a right facial soft-tissue tumor, histopathological examination revealed scattered lymphatics and thin-walled vascular channels with blood in skeletal muscle and fibroadipose tissue. Intraluminal papillary proliferation of vascular spaces lined by cytologically bland spindle cells was observed, along with Kaposiform morphology and small-vessel proliferation. Immunohistochemical staining confirmed endothelial cell markers (D2-40, ERG, CD34, and CD31) and numerous CD3(+) lymphocytes in the lumen, surrounded by CD3(+) T lymphocytes and CD20(+) B lymphocytes in the surrounding stroma. The tumor lacked pleomorphism, significant mitotic activity, and necrosis. CONCLUSIONS PILA presents a diagnostic challenge and should be considered in the differential diagnosis of cutaneous vascular neoplasms. Long-term follow-up is crucial due to its borderline behavior and potential for local invasiveness and metastasis. Accurate diagnosis, aided by characteristic histological and immunohistochemical features, is essential for appropriate management of this rare vascular tumor.
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Affiliation(s)
- Reham Al-Refai
- Department of Pathology and Laboratory Medicine, Northwell Health– Lenox Hill Hospital, New York City, NY, USA
| | - Doaa Morrar
- Department of Pathology and Laboratory Medicine, Northwell Health– Lenox Hill Hospital, New York City, NY, USA
| | - Ahmed Bendari
- Department of Pathology and Laboratory Medicine, Northwell Health– Lenox Hill Hospital, New York City, NY, USA
| | - Sunder Sham
- Department of Pathology and Laboratory Medicine, Northwell Health– Lenox Hill Hospital, New York City, NY, USA
| | - Pamela Unger
- Department of Pathology and Laboratory Medicine, Northwell Health– Lenox Hill Hospital, New York City, NY, USA
| | - Morris Edelman
- Department of Pathology and Laboratory Medicine, Long Island Jewish Medical Hospital, Northwell Health Cancer Institute, New Hyde Park, NY, USA
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Martyanov AA, Tesakov IP, Khachatryan LA, An OI, Boldova AE, Ignatova AA, Koltsova EM, Korobkin JJD, Podoplelova NA, Svidelskaya GS, Yushkova E, Novichkova GA, Eble JA, Panteleev MA, Kalinin DV, Sveshnikova AN. Platelet functional abnormalities in pediatric patients with kaposiform hemangioendothelioma/Kasabach-Merritt phenomenon. Blood Adv 2023; 7:4936-4949. [PMID: 37307200 PMCID: PMC10463204 DOI: 10.1182/bloodadvances.2022009590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/05/2023] [Accepted: 05/21/2023] [Indexed: 06/14/2023] Open
Abstract
Kaposiform hemangioendothelioma (KHE) is a rare vascular tumor of infancy that is commonly associated with a life-threatening thrombocytopenic condition, Kasabach-Merritt phenomenon (KMP). Platelet CLEC-2, tumor podoplanin interaction is considered the key mechanism of platelet clearance in these patients. Here, we aimed to assess platelet functionality in such patients. Three groups of 6 to 9 children were enrolled: group A with KHE/KMP without hematologic response (HR) to therapy; group B with KHE/KMP with HR; and group C with healthy children. Platelet functionality was assessed by continuous and end point flow cytometry, low-angle light scattering analysis (LaSca), fluorescent microscopy of blood smears, and ex vivo thrombi formation. Platelet integrin activation in response to a combination of CRP (GPVI agonist) and TRAP-6 (PAR1 agonist), as well as calcium mobilization and integrin activation in response to CRP or rhodocytin (CLEC-2 agonist) alone, were significantly diminished in groups A and B. At the same time, platelet responses to ADP with or without TRAP-6 were unaltered. Thrombi formation from collagen in parallel plate flow chambers was also noticeably decreased in groups A and B. In silico analysis of these results predicted diminished amounts of CLEC-2 on the platelet surface of patients, which was further confirmed by immunofluorescence microscopy and flow cytometry. In addition, we also noted a decrease in GPVI levels on platelets from group A. In KHE/KMP, platelet responses induced by CLEC-2 or GPVI activation are impaired because of the diminished number of receptors on the platelet surface. This impairment correlates with the severity of the disease and resolves as the patient recovers.
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Affiliation(s)
- Alexey A. Martyanov
- Dmitry Rogachev National Medical Research Centеr of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Ivan P. Tesakov
- Dmitry Rogachev National Medical Research Centеr of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Lili A. Khachatryan
- Dmitry Rogachev National Medical Research Centеr of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Olga I. An
- Center for Theoretical Problems of Physico-Сhemical Pharmacology, Russian Academy of Sciences, Moscow, Russia
| | - Anna E. Boldova
- Center for Theoretical Problems of Physico-Сhemical Pharmacology, Russian Academy of Sciences, Moscow, Russia
| | - Anastasia A. Ignatova
- Dmitry Rogachev National Medical Research Centеr of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
- Center for Theoretical Problems of Physico-Сhemical Pharmacology, Russian Academy of Sciences, Moscow, Russia
| | - Ekaterina M. Koltsova
- Dmitry Rogachev National Medical Research Centеr of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
- Center for Theoretical Problems of Physico-Сhemical Pharmacology, Russian Academy of Sciences, Moscow, Russia
| | - Julia-Jessica D. Korobkin
- Center for Theoretical Problems of Physico-Сhemical Pharmacology, Russian Academy of Sciences, Moscow, Russia
| | - Nadezhda A. Podoplelova
- Dmitry Rogachev National Medical Research Centеr of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
- Center for Theoretical Problems of Physico-Сhemical Pharmacology, Russian Academy of Sciences, Moscow, Russia
| | - Galina S. Svidelskaya
- Dmitry Rogachev National Medical Research Centеr of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
- Center for Theoretical Problems of Physico-Сhemical Pharmacology, Russian Academy of Sciences, Moscow, Russia
| | - Eugenia Yushkova
- Center for Theoretical Problems of Physico-Сhemical Pharmacology, Russian Academy of Sciences, Moscow, Russia
| | - Galina A. Novichkova
- Dmitry Rogachev National Medical Research Centеr of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Johannes A. Eble
- Institute of Physiological Chemistry and Pathobiochemistry, University of Münster, Münster, Germany
| | - Mikhail A. Panteleev
- Dmitry Rogachev National Medical Research Centеr of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
- Center for Theoretical Problems of Physico-Сhemical Pharmacology, Russian Academy of Sciences, Moscow, Russia
- Lomonosov Moscow State University, Moscow, Russia
| | - Dmitrii V. Kalinin
- Institute of Pharmaceutical and Medicinal Chemistry, University of Münster, Münster, Germany
| | - Anastasia N. Sveshnikova
- Dmitry Rogachev National Medical Research Centеr of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
- Center for Theoretical Problems of Physico-Сhemical Pharmacology, Russian Academy of Sciences, Moscow, Russia
- Lomonosov Moscow State University, Moscow, Russia
- Sechenov First Moscow State Medical University, Moscow, Russia
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Xing J, Zhang N, Chen B, Tong ZC, Liu HM, Zhou HZ. Rare adult Kaposiform hemangioendothelioma with multiple-bone invasion - clinical experience and literature review. Eur Rev Med Pharmacol Sci 2023; 27:6653-6661. [PMID: 37522676 DOI: 10.26355/eurrev_202307_33135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
BACKGROUND Kaposiform hemangioendothelioma (KHE) is a borderline vascular tumor between hemangioma and malignant angiosarcoma. While KHE has strong local invasion with rare spontaneous regression, it is not observed with distant metastasis. Even if KHE is asymptomatic or without the Kasabach-Merritt phenomenon (KMP), bone or joint invasion should clearly receive proactive treatment. KHE commonly affects infants/children but is rarely seen in adults. CASE REPORT We reported a rare adult KHE case with an invasion of >10 separate forearm/hand bones, who underwent multiple-lesion resection and finger amputation after tumor recurrence. Tumor recurrence and KMP were not observed during the 6-month follow-up after the final operation. During the hospitalization and follow-up period, the patient only received medications for infection prevention and pain relief. CONCLUSIONS Multiple resectable lesions were found in the distal limb, for which complete resection might not present typical features (high-intensity T2-weighted MRI), which might fail to detect all KHE lesions. Therefore, complete excision is not optimal for multiple resectable KHE lesions.
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Affiliation(s)
- J Xing
- Department of Orthopedics and Traumatology, Honghui Hospital, Xi'an JiaoTong University, Xi'an, China.
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11
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Ning J. A rare case of retroperitoneal kaposiform haemangioendothelioma with Kasabach-Merritt phenomenon. Asian J Surg 2022; 46:1904-1905. [PMID: 36347741 DOI: 10.1016/j.asjsur.2022.10.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Junjie Ning
- Department of Pediatrics, First People's Hospital of Zigong City, Sichuan Province, Zigong, 643000, China.
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12
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Murguía-Pérez M, Enríquez-Brena SZ, Mendoza-Ramírez S, Fosado-Ramos R, García-Mendoza YI, Ramírez-Balderrama L, Verazaluce-Rodríguez BE, Hernández-González MA, Murillo-Ortiz BO. [Aggressive multifocal extensive cutaneous epithelioid haemagioendothelioma. A case report]. Rev Esp Patol 2022; 55:254-258. [PMID: 36154733 DOI: 10.1016/j.patol.2021.03.004] [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] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/27/2021] [Accepted: 03/21/2021] [Indexed: 06/16/2023]
Abstract
Epithelioid haemangioendothelioma is a rare vascular tumor, first described in 1975 by Dail and Liebow as a bronchioloalveolar carcinoma. Although it usually behaves like a low-grade neoplasm, cases have been reported in which the tumor shows a high grade of malignancy, spreading rapidly throughout the body. We present the case of a 41-year-old man with dermatosis in the left thigh with rapid extension to the abdomen; the initial differential diagnoses were metastatic carcinoma versus lymphoma. When the histopathology was re-examined, a diagnosis of skin epithelioid hemangioendothelioma was confirmed and treatment with radiotherapy was initiated. This tumour rarely affects the skin; there are only a few previously reported cases.
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Affiliation(s)
- Mario Murguía-Pérez
- Servicio de Anatomía Patológica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; División de Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México.
| | - Sandra Zynzya Enríquez-Brena
- Servicio de Anatomía Patológica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; División de Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México
| | - Saulo Mendoza-Ramírez
- División de Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; Departamento de Anatomía Patológica, Hospital General de México «Dr. Eduardo Liceaga», Ciudad de México, México
| | - Rafael Fosado-Ramos
- Servicio de Anatomía Patológica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; División de Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México
| | - Yunuén Ibiza García-Mendoza
- Servicio de Anatomía Patológica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; División de Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México
| | - Lázaro Ramírez-Balderrama
- Servicio de Anatomía Patológica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; División de Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México
| | - Blanca Elena Verazaluce-Rodríguez
- División de Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; Servicio de Dermatología, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México
| | - Martha Alicia Hernández-González
- Servicio de Anatomía Patológica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; División de Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México
| | - Blanca Olivia Murillo-Ortiz
- Servicio de Anatomía Patológica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; División de Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México
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13
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Plazola-Hernández SI, Arroyo-Garza I, Rodríguez-Reyes A. Rapidly progressive orbital intravascular papillary endothelial hyperplasia in a newborn. Arch Soc Esp Oftalmol (Engl Ed) 2022; 97:413-416. [PMID: 35779898 DOI: 10.1016/j.oftale.2022.02.001] [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] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/27/2021] [Indexed: 06/15/2023]
Abstract
Intravascular papillary endothelial hyperplasia (IPEH), also known as "vegetant intravascular haemangioendothelioma", is a rare benign proliferation of vascular endothelial cells secondary to intravascular thrombosis and thrombus organisation. It can develop from vascular lesions such as haemangiomas, pyogenic granulomas or varicose veins. This vascular tumour of the skin and subcutaneous tissue may exhibit rapid and progressive growth, and is usually located in the neck or head. Ocular presentation is unusual and orbital involvement is even rarer. We report a case of a preterm newborn male with a rapidly growing left orbital mass that was histologically diagnosed as intravascular papillary endothelial hyperplasia. He was successfully managed with total excision of the tumour and propranolol therapy and remains recurrence free after an eight-year follow-up.
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Affiliation(s)
- S I Plazola-Hernández
- Departamento de Órbita y Oculoplástica, Centro Médico Nacional 20 de Noviembre, Mexico City, Mexico.
| | - I Arroyo-Garza
- Departamento de Oftalmología y Ciencias Visuales, Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Nuevo León, Mexico
| | - A Rodríguez-Reyes
- Departamento de Patología Ocular, Hospital Dr. Luis Sánchez Bulnes, Mexico City, Mexico
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14
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Li WW, Liang P, Zhao HP, Zhang YX, Liu YY, Gao JB. Composite hemangioendothelioma of the spleen with multiple metastases: CT findings and review of the literature. Medicine (Baltimore) 2021; 100:e25846. [PMID: 34032697 PMCID: PMC8154451 DOI: 10.1097/md.0000000000025846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 04/18/2021] [Indexed: 01/04/2023] Open
Abstract
Composite hemangioendothelioma (CHE) is a rare vascular neoplasm of intermediate malignant potential. Only 52 cases have been reported in the English literature, and one case previously reported occurred in the spleen. The purpose of our study was to report a 65-year-old man diagnosed as CHE primary arising from the spleen with multiple metastases.Clinical and imaging features, laboratory tests, and pathological results about CHE were described in detail in this study.The patient presented with multiple lesions in bilateral lungs and spleen that had been incidentally detected by computed tomography (CT). Except for thrombocytopenia, other laboratory tests were not significant. The CT scan of the abdomen revealed multiple round-like and irregularly mixed density masses with unclear borders in enlarged spleen. And contrast enhancement showed mild heterogeneous enhancement. CT scan also showed widespread liver, ribs, lungs, and vertebral bodies metastases. This diagnosis was confirmed by histopathological examination. The patient underwent splenectomy and still survives with tumors after six months followed-up.Due to the lack of specificity of clinical features and laboratory tests, it is necessary to combine imaging features and pathological findings to make a correct diagnosis.
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Affiliation(s)
- Wei wei Li
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou
| | - Pan Liang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou
| | - Hui ping Zhao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou
| | - Yan xing Zhang
- Department of Cardiology, The People's Hospital of HEBI, Hebi, Henan Province, China
| | - Yi yang Liu
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou
| | - Jian bo Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou
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15
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Singer C, Mallon D, Auguston B, Lam M, Foster R. Reactive angioendotheliomatosis presenting as livedo racemosa secondary to propylthiouracil. Pathology 2020; 52:494-496. [PMID: 32345519 DOI: 10.1016/j.pathol.2020.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/28/2020] [Accepted: 03/05/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Colin Singer
- Joondalup City Medical Group, Joondalup, WA, Australia.
| | | | | | - Minh Lam
- Cutaneous Pathology, Perth, WA, Australia
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16
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Sun Y, Zhao M, Lao IW, Yu L, Wang J. The clinicopathological spectrum of pseudomyogenic hemangioendothelioma: report of an additional series with review of the literature. Virchows Arch 2020; 477:231-240. [PMID: 31980959 DOI: 10.1007/s00428-020-02753-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/02/2020] [Accepted: 01/10/2020] [Indexed: 12/22/2022]
Abstract
We present here our experience with 24 cases of pseudomyogenic hemangioendothelioma (PMHE) to further delineate its clinicopathological spectrum. There were 18 males and 6 females with a median age of 28 years (range 10~64 years). Most patients presented with erythematous nodules or papules, with or without pain. The majority (63%) occurred in the lower extremities, whereas a minority involved the trunk (25%), upper extremities (8%), and head and neck (4%). Six cases (25%) had a primary bone origin. With physical and radiological examinations, 16 cases (67%) manifested as multifocal disease, involving multiple tissue planes or different bones within the anatomic region. Six cases (25%) involved skin, soft tissue, and bone simultaneously. Histologically, all cases showed features consistent with a PMHE characterized by loose fascicles or sheets of plump spindled to epithelioid cells harboring brightly eosinophilic cytoplasm and vesicular nuclei. In addition, five cases (21%) contained a prominent myxoid matrix, and one case displayed perineural and intravascular invasion. The follow-up information available in 18 patients revealed local recurrence in 4 patients (22%) and persistent disease in 8 patients (44%), respectively. One patient developed bilateral pulmonary metastases which showed significant remission after systemic chemotherapy. None of the patients died of the disease. As the clinical appearance of PMHE can be deceptive, a radiological examination is essential in identifying an insidious multifocal disease. Although PMHE has a predilection for the distal extremities of young males, this rare tumor type could also occur in unusual sites and affect middle-aged adults of both genders. The striking myoid appearance in association with myxoid stromal change may represent a potential diagnostic pitfall. Biologically, PMHE has an indolent clinical behavior, albeit metastatic disease may occur in rare instance.
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Affiliation(s)
- Yuefang Sun
- Department of Pathology, Shanghai Tenth People's Hospital, Tenth People's Hospital of Tongji University, 301 Yanchang Middle Road, Shanghai, 200072, China
| | - Ming Zhao
- Department of Pathology, Zhejiang Provincial People's Hospital, Hangzhou, 310014, China
| | - I Weng Lao
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology Shanghai Medical College, Fudan University, 270 Dong An St, Shanghai, 200032, China
| | - Lin Yu
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology Shanghai Medical College, Fudan University, 270 Dong An St, Shanghai, 200032, China
| | - Jian Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
- Department of Oncology Shanghai Medical College, Fudan University, 270 Dong An St, Shanghai, 200032, China.
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17
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Luu M. Neonatal consultations: vascular lumps, bumps, and tumors in the neonate. Cutis 2019; 104:260-262. [PMID: 31886780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Minnelly Luu
- Children's Hospital, Los Angeles, California, USA
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18
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Cosgun T, Kaba E, Ayalp K, Elbegi IC, Toker A. Haemangioendothelioma: a disease with surgical options from robotic surgery to open superior vena cava replacement. Interact Cardiovasc Thorac Surg 2019; 29:449-452. [PMID: 31115437 DOI: 10.1093/icvts/ivz109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/19/2019] [Revised: 03/24/2019] [Accepted: 04/07/2019] [Indexed: 12/29/2022] Open
Abstract
Epithelioid haemangioendothelioma is a malignant tumour of vascular origin that can occur in the mediastinum. Operative treatment techniques may vary depending on the localization. Our goal was to focus on different surgical techniques, ranging from simple stapling of the vascular structure to replacement of the superior vena cava.
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Affiliation(s)
- Tugba Cosgun
- Thoracic Surgery Department, Demiroglu Bilim University, Istanbul, Turkey
| | - Erkan Kaba
- Thoracic Surgery Department, Demiroglu Bilim University, Istanbul, Turkey
| | - Kemal Ayalp
- Thoracic Surgery Department, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Ipek Coban Elbegi
- Pathology Department, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Alper Toker
- Thoracic Surgery Department, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
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19
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Santos RP, Carvalho S, Joana G, Perdal J. Pseudomyogenic hemangioendothelioma: a little-known tumor. Acta Dermatovenerol Alp Pannonica Adriat 2018; 27:225-229. [PMID: 30564838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Pseudomyogenic hemangioendothelioma (PHE) is a rare indolent vascular tumor that typically has a multifocal presentation and involves multiple tissue planes. This report describes a 34-year-old man with multiple infiltrated brown papules and plaques on his left leg that had evolved for 6 months. The skin biopsy revealed a dermal and subcutaneous neoplasm composed of fascicles of spindle cells with atypia and epithelioid cells with prominent nucleoli and abundant eosinophilic cytoplasm. There was no evidence of necrosis, and the mitotic rate was low. There was strong reactivity with cytokeratin AE1/AE3, ERG, and FLI1, multifocal reactivity with smooth muscle actin, and focal reactivity with CD31. There was no expression of keratin MNF116, CAM5.2, CD34, CAMTA1, S100-protein, epithelial membrane antigen, melan-A, HMB-45, factor XIIIa, HHV8, or CD10. The nuclei of neoplastic cells showed intact expression of INI1. The clinical, histological, and immunophenotypical aspects were consistent with a diagnosis of PHE. A lower limb CT scan showed lesions in the skin, muscle, and bone planes. The patient was sent to an oncology center, where he maintains regular clinical and imagiological follow-up.
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Affiliation(s)
| | | | - Gomes Joana
- Dermatology Department, Braga Hospital, Braga, Portugal
| | - Joana Perdal
- Pathology Department, Braga Hospital, Braga, Portugal
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20
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Ji Y, Yang K, Peng S, Chen S, Xiang B, Xu Z, Li Y, Wang Q, Wang C, Xia C, Li L, Liu X, Lu G, Yang G, Wu H. Kaposiform haemangioendothelioma: clinical features, complications and risk factors for Kasabach-Merritt phenomenon. Br J Dermatol 2018; 179:457-463. [PMID: 29603128 PMCID: PMC11032113 DOI: 10.1111/bjd.16601] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Few studies have reported the clinical features, complications and predictors of Kasabach-Merritt phenomenon (KMP) associated with Kaposiform haemangioendothelioma (KHE). OBJECTIVES To determine the clinical characteristics present at diagnosis and to identify features that may aid clinicians in managing KHE. METHODS We conducted a cohort study of 146 patients diagnosed with KHE. RESULTS KHE precursors or lesions were present at birth in 52·1% of patients. In 91·8% of patients, lesions developed within the first year of life. The median age at diagnosis of KHE was 2·3 months (interquartile range 1·0-6·0). The extremities were the dominant location, representing 50·7% of all KHEs. Among KHEs in the cohort, 63·0% were mixed lesions (cutaneous lesions with deep infiltration). Approximately 70% of patients showed KMP. A KHE diagnosis was delayed by ≥ 1 month in 65·7% of patients with KMP. Patients with KMP were more likely to have major complications than patients without KMP (P = 0·023). Young age (< 6 months), trunk location, large lesion size (> 5·0 cm) and mixed lesion type were associated with KMP in a univariate analysis. In the multivariate analysis, only age [odds ratio (OR) 11·9, 95% confidence interval (CI) 4·07-34·8; P < 0·001], large lesion size (OR 5·08, 95% CI 2·24-11·5; P < 0·001) and mixed lesion type (OR 2·96, 95% CI 1·23-7·13; P = 0·016) were associated with KMP. CONCLUSIONS Most KHEs appeared before 12 months of age. KHEs are associated with various major complications, which can occur in combination and develop early in the disease process. Young age, large lesion size and mixed lesion type are important predictors of KMP.
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Affiliation(s)
- Y Ji
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - K Yang
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - S Peng
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - S Chen
- Pediatric Intensive Care Unit, Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - B Xiang
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Z Xu
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Y Li
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Q Wang
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - C Wang
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - C Xia
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - L Li
- Laboratory of Pathology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - X Liu
- Department of Vascular and Interventional Radiology, Chengdu Women and Children's Central Hospital, Chengdu, 610031, China
| | - G Lu
- Pediatric Intensive Care Unit, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - G Yang
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
- Department of Pediatric Surgery, Chengdu Shangjin Nanhu Hospital, Chengdu, 611730, China
| | - H Wu
- Vascular Biology Program and Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, U.S.A
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21
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Horan NA, DiMaio DJ. Pseudomyogenic hemangioendothelioma. Cutis 2017; 100:E13-E16. [PMID: 29360904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Pseudomyogenic hemangioendothelioma (PMHE) is a rare vascular tumor that was added to the World Health Organization classification of soft tissue tumors. These tumors have a unique clinical presentation and microscopic appearance as compared to other vascular tumors in the differential diagnosis. Unlike its microscopic mimicker epithelioid sarcoma, PMHE rarely metastasizes and long-term survival in affected patients is excellent. In this report, we present a patient with PMHE and review the current literature on clinical presentation and histologic differentiation of this unique tumor, comparing findings to its mimickers.
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Affiliation(s)
- Nicholas A Horan
- Department of Physical Medicine and Rehabilitation, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Dominick J DiMaio
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, USA
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22
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Mayoral-Guisado C, Toro-Zambrano W, López-Macías M, Ruíz-Guerrero A, Rubio-Fernández A, Díaz-Delgado M. [Pseudomyogenic hemangioendothelioma in the upper limb: A case report and literature review]. Rev Esp Patol 2017; 50:49-53. [PMID: 29179965 DOI: 10.1016/j.patol.2015.12.007] [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] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/16/2015] [Accepted: 12/28/2015] [Indexed: 11/18/2022]
Abstract
Pseudomyogenic hemangioendothelioma, also called epithelioid sarcoma-like hemangioendothelioma, is a rare, vascular neoplasm usually with indolent behaviour. It was introduced in the latest World Health Organization (WHO) Classification of Tumours of Soft Tissue. We report a case of a 45 year-old patient presenting with a localized, palpable and slightly painful lesion in the left arm. Histologically it consisted of fascicles of spindle and epithelioid cells with ample eosinophilic cytoplasm, without nuclear pleomorphism or significant mitotic activity. Tumour cells showed diffuse expression for cytokeratin AE1/AE3, CD31 and FLI1, intact expression for INI1 and negativity for CD34. We describe the clinical, histological, molecular and immunohistochemical features of pseudomyogenic hemangioendothelioma and review the pertinent literature.
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Affiliation(s)
- Carlos Mayoral-Guisado
- Servicio de Anatomía Patológica, Complejo Hospitalario Universitario de Badajoz, Badajoz, España.
| | - Weimar Toro-Zambrano
- Servicio de Anatomía Patológica, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | - María López-Macías
- Servicio de Anatomía Patológica, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | - Antonio Ruíz-Guerrero
- Servicio de Anatomía Patológica, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | | | - Mario Díaz-Delgado
- Servicio de Anatomía Patológica, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
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Abstract
RATIONALE Kaposiform hemangioendothelioma (KHE) is an aggressive vascular tumor, mainly occurring in infants and young children and previously reported cases were mainly cutaneous or visceral form. Intestinal kaposiform hemangioma was first reported in 2012. Intestinal type KHE showed better prognosis if the lesion was limited in the gastrointestinal tract and coagulopathy was not accompanied. Since the number of reported cases is small, further study for treatment options and prognosis need to be done. PATIENT CONCERNS We described the case of a 1-month-old female who had abdominal distention and bilious vomiting. DIAGNOSES She was suspected as intestinal obstruction after diagnostic work up. INTERVENTIONS Surgical exploration was performed and jejunal obstruction with a mass was identified. Small bowel segmental resection and anastomosis was performed. OUTCOMES The patient discharged with symptom free. Through the pathological examination, the mass was identified as intestinal type KHE. LESSONS Intestinal KHE can cause bowel obstruction and be managed successfully with complete surgical resection. More cases should be reported and further evaluation for treatment options and prognosis evaluation is necessary.
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Filotico M, Filotico R. Kaposiform hemangioendothelioma in an adult with rheumatoid arthritis. Pathologica 2017; 109:143-147. [PMID: 29154372] [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: 06/07/2023] Open
Abstract
This report describes a case of kaposiform hemangioendothelioma arising in an adult man during the course of rheumatoid arthritis treated with steroids and methotrexate. The vascular proliferation began in the terminal phase of the disease, which culminated in acute renal failure and death. We discuss the possible relationship between rheumatoid arthritis, its treatment, and the onset of vascular proliferation, as well as the role of kaposiform hemangioendothelioma in aggravating the autoimmune disease and leading to its fatal outcome.
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Affiliation(s)
- M Filotico
- Department of Anatomic Pathology, Ospedale Fond. Card. Panico, Tricase (LE), Italy
| | - R Filotico
- Dermatology Unit, Ospedale "Perrino", Brindisi, Italy
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25
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Beutler BD, Cohen PR. Intravascular papillary endothelial hyperplasia of the vulva: report of a patient with Masson tumor of the vulva and literature review. Dermatol Online J 2016; 22:13030/qt0ss9x4vf. [PMID: 27617519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 05/18/2016] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Intravascular papillary endothelial hyperplasia -- also known as Masson tumor -- is a rare, benign vascular condition that manifests on the skin as a firm, blue-black colored nodule or papule. Lesions range in size from 0.25 to 5 centimeters in diameter and may be tender or painless. In some individuals, nodules appear red colored, mimicking hemangioma or pyogenic granuloma. Histologically, intravascular papillary endothelial hyperplasia is characterized by the presence of an organizing thrombus in the vascular lumen with accompanying hyperplastic endothelial cell proliferation. Common sites of presentation include the head, neck, and extremities. However, albeit rarely, lesions may also appear in the genital region. PURPOSE We describe the clinical and pathologic findings of a woman who developed intravascular papillary endothelial hyperplasia of the vulva. We also review the characteristics of other patients with intravascular papillary endothelial hyperplasia of the vulva and summarize the differential diagnosis and treatment options for this condition. MATERIALS AND METHODS The features of a woman with intravascular papillary endothelial hyperplasia of the vulva are presented. Using PubMed, the following terms were searched and relevant citations assessed: intravascular papillary endothelial hyperplasia, IPEH, labia majora, Masson hemangioma, Masson pseudoangiosarcoma, Masson tumor, and vulva. In addition, the literature on intravascular papillary endothelial hyperplasia is reviewed. RESULTS A 32-year-old woman presented with a 3 x 2 millimeter painless, black colored submucosal papule on her left labia majora. The lesion was removed by excisional biopsy. Microscopic examination revealed a re-canalizing thrombus and a proliferation of erythrocytes within a dilated vascular structure. Based on correlation of the clinical presentation and histopathologic findings, a diagnosis of intravascular papillary endothelial hyperplasia was established. The patient applied mupirocin 2% ointment to the biopsy site, which subsequently healed without complication or recurrence. CONCLUSION Intravascular papillary endothelial hyperplasia -- also known as Masson tumor -- is a rare, benign vascular eruption. Cutaneous lesions typically present as red colored or blue-black colored nodules ranging in size from 0.25 to 5 centimeters in diameter. The most common sites of presentation include the head, neck, and extremities. However, albeit rarely, lesions may also appear in the genital region. The histologic hallmark of intravascular papillary endothelial hyperplasia is an organizing thrombus in the vascular lumen with associated hyperplastic endothelial cell proliferation. Lesions often appears similar to other neoplastic and non-neoplastic cutaneous tumors, including hemangiomas, pyogenic granulomas, and cutaneous angiosarcomas. Therefore, pathologic examination is required to confirm the suspected diagnosis and exclude malignancy. The condition can usually be treated with simple local excision.
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Gaytán-Cortés FC, Arteaga-Adame J, Careaga-Reyna G, Lezama-Urtecho C, Álvarez-Sánchez L. [Primary cardiac hemangioendothelioma: early diagnosis and surgical resection]. Rev Med Inst Mex Seguro Soc 2016; 54:392-396. [PMID: 27100987] [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: 06/05/2023]
Abstract
BACKGROUND The term hemangioendothelioma encompasses all tumors that derive from the endothelium of blood vessels. It has an uncertain prognosis, and it is always considered as a low-grade malignancy. CLINICAL CASE Male, 23, who was admitted to the emergency room with chest pain, intermittent paroxysmal nocturnal dyspnea and malaise. He denied having a history of degenerative diseases, and had a weight loss of 6 kg in two months. Chest X-rays suggested pericardial effusion. Patient presented a tendency to hypotension tamponade, which was solved with subxiphoid puncture, and drain 800 mL of liquid from ancient hematological parameters. He presented a tumor in the right atrium of 8x4 cm, attached to the anterior wall of the atrium without involucre of interatrial septum. When patient underwent surgery, it was identified a tumor lesion in the anterior wall of right appendage. It was done the resection of the tumor and of 70% of the right atrial appendage. The latter was replaced with bovine pericardium. Patient showed good outcome; it was discharged after 10 days of follow-up surgery for six months in the outpatient clinic. CONCLUSION The hemangioendothelioma is a vascular tumor of unpredictable behavior, and whose origin rarely comes from the heart. A timely detection, and a radical surgical resection is, so far, the more acceptable management, given the worldwide little experience for handling this type of tumor. Our experience suggests an aggressive clinical approach and surgical removal within the first hours of the suspected diagnosis for the greatest chance of complete resection and reducing the risk of recurrence.
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Affiliation(s)
- Fernando Celso Gaytán-Cortés
- Servicio de Cirugía Cardiotorácica, Hospital General "Dr. Gaudencio González Garza", Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México.
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27
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Dong A, Zhang L, Wang Y, He T, Zuo C. Abdominal Kaposiform Hemangioendothelioma Associated With Lymphangiomatosis Involving Mesentery and Ileum: A Case Report of MRI, CT, and 18F-FDG PET/CT Findings. Medicine (Baltimore) 2016; 95:e2806. [PMID: 26871848 PMCID: PMC4753944 DOI: 10.1097/md.0000000000002806] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Kaposiform hemangioendothelioma (KH) is a rare vascular tumor of intermediate malignancy that occurs mainly in the childhood. Adult patients with KH are rare. Imaging findings of KH have rarely been reported before. We present magnetic resonance imaging (MRI), computed tomography (CT), and fluorine-18-fluorodeoxyglucose (F-FDG) positron emission tomography (PET)/CT findings in an adult patient with KH associated with lymphangiomatosis involving mesentery and ileum.A 22-year-old female complained of a 9-month history of intermittent melena, weakness, and palpitation. Laboratory tests revealed anemia and hypoproteinemia. Fecal occult blood test was positive. Abdominal enhanced MRI and CT showed a large abdominal mass involving mesentery and ileum. On enhanced MRI, there were many hypervascular nodules in the mass. On FDG PET/CT, the mass and the nodules showed slight FDG uptake. Small bowel capsule endoscopy showed numerous grape-shaped red nodules in the luminal wall of the involved ileum. The patient underwent resection of the abdominal mass and a segment of the ileum invaded by the abdominal mass. KH arising within lymphangiomatosis involving mesentery and ileum was confirmed by pathology. After surgery, the patient's symptoms improved.This is the first case of KH associated with lymphangiomatosis involving mesentery and ileum. In this case, the lymphangiomatosis overshadowed the small tumor nodules resulting in unusual imaging findings. Familiarity with these imaging findings is helpful for diagnosis and differential diagnosis of KH.
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Affiliation(s)
- Aisheng Dong
- From the Department of Nuclear Medicine (AD, CZ); Department of Gastroenterology (LZ); Department of Pathology (YW); and Department of Hepatopanreatobiliary Surgery (TH), Changhai Hospital, Second Military Medical University, Shanghai, China
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Boccara O, Fraitag S, Lasne D, Fontaine J, Bughin V, Hamel-Teillac D, Orbach D, Brunelle F, de Prost Y, Hadj-Rabia S, Bodemer C. Kaposiform Haemangioendothelioma-spectrum Lesions with Kasabach-Merritt Phenomenon: Retrospective Analysis and Long-term Outcome. Acta Derm Venereol 2016; 96:77-81. [PMID: 26084625 DOI: 10.2340/00015555-2185] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Kasabach-Merritt phenomenon (KMP) is a rare life-threatening vascular condition of infancy. Prognosis factors and long-term follow-up data are lacking. We retrospectively analysed the records of 24 infants (10 females, 14 males) treated for KMP in the Department of Dermatology of Necker-Enfants Malades Hospital, Paris, France, from 1984 to 2012. Mean duration of thrombocytopaenia (2,000-38,000 platelets/mm3, mean 10,500/µl) was 8.8 months (range 3 days-84 months), which correlated with tumour infiltration depth on imaging. D-dimer levels were always elevated, even before KMP onset. Each patient received a mean of 4.8 different treatments (range 1-10). Median follow-up was 6.5 years (range 2 months-22 years). All infants had residual cutaneous lesions, along with inflammatory manifestations (n = 9), elevated D-dimer (n = 5) and orthopaedic sequelae (n = 5). The permanent coagulopathy (elevated D-dimer) even after resolution of KMP suggests the presence of chronic low-grade platelet trapping, with possible sudden worsening, and raises the possibility of prophylactic anti-platelet therapy.
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Affiliation(s)
- Olivia Boccara
- Department of Dermatology, Hopital Universitaire Necker-Enfants Malades, FR-75000 Paris, France.
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Affiliation(s)
- Serhan Kupeli
- Department of Pediatric Oncology and Pediatric, Bone Marrow Transplantation Unit, Çukurova University, Adana, Turkey
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30
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Abstract
Infantile hepatic hemangioendothelioma (IHH) is rare which can regress spontaneously. Arteriovenous shunts within hemangiomas, however, may result in pulmonary artery hypertension (PAH) and congestive heart failure (CHF).The authors report 2 young infants suffering from multifocal IHH associated with CHF were both treated with glucocorticoid and transcatheter arterial embolization (TAE), but had different outcomes. The PAH decreased immediately and the symptoms of CHF were alleviated after TAE for both of them. For the Tibetan infant, the development was normal with tumor regression by follow-up. For the Han ethnic neonate, PAH increased again in the seventh day with progressive cardiovascular insufficiency. Ultrasound showed a persisting perfusion caused by collateralization around occluded main feeders. Furthermore, a pulmonary infection occurred and ventilation was performed. As a result, the infant died from multiorgan failure caused by CHF and infection.TAE is a treatment of reducing shunting for hemangiomas. Fistula recanalization in multifocal IHH, however, might be an important risk factor affecting the outcome of TAE. TAE should be further evaluated with special attention to anatomy of feeding and draining vessels, and cardiopulmonary conditions. In addition, the patients were susceptible to secondary pulmonary infection because of lung congestion. As well, the infant from the high altitude area showed better adaptability to hypoxia.
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Affiliation(s)
- Tao Wang
- From the Department of Pediatric Cardiology, Sichuan University West China Second University Hospital, Chengdu (TW, YW, GL); and Department of Pediatrics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China (YL)
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31
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Abstract
The diagnosis of vascular tumors is a challenging area in soft tissue pathology. Epithelioid vascular tumors pose a particular challenge. Due to the epithelioid morphology of the tumor cells, they can be misdiagnosed as a variety of other entities, including metastatic carcinoma or epithelioid sarcoma. Furthermore, it can be difficult to distinguish between different epithelioid vascular tumors. This review focuses on vascular tumors characterized by epithelioid endothelial cells, including epithelioid hemangioma, cutaneous epithelioid angiomatous nodule, epithelioid hemangioendothelioma, epithelioid sarcomalike hemangioendothelioma/pseudomyogenic hemangioendothelioma, and epithelioid angiosarcoma.
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Affiliation(s)
- Jennifer S Ko
- Department of Pathology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Steven D Billings
- Department of Pathology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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32
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Abstract
PURPOSE 18F-fluorodeoxyglucose (FDG) PET/CT is invaluable in managing liver lesions, in particular in the evaluation of suspected liver metastases. It is both sensitive and specific in detecting liver metastases from a wide range of primary cancers, and may change clinical management, most commonly by detecting additional lesions and decreasing the number of futile surgeries. However, some benign lesions may also show increased metabolic activity which can lead to false positive PET findings. We describe some of these lesions and their imaging characteristics that may help in differentiating them from malignant metastases. METHODS e reviewed all whole body FDG PET/CT studies performed over a 5-year period in our institution, and identified those with focal liver lesions showing increased FDG uptake for which histological results were available. RESULTS majority of lesions showing increased metabolic activity were due to malignant disease, such as metastases or primary liver tumours. However, we also found increased FDG uptake in non-neoplastic lesions such as Cryptococcosis, abscesses, and secondary inflammation from cholecystitis. Increased metabolic activity was also seen in some benign neoplasms such as hepatic adenomas and hemangioendotheliomas. CONCLUSION DG PET/CT is currently the most sensitive non-invasive imaging modality for the detection of hepatic metastases, particularly from the gastrointestinal tract. False positive results are rare, and have been described mainly in abscesses. However, other lesions can also show increased metabolic activity, and failure to differentiate these from metastases may result in inappropriate treatment.
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Sarandria JJ, Escano M, Kamangar F, Farooqui S, Montgomery E, Cunningham SC. Massive splenomegaly correlates with malignancy: 180 cases of splenic littoral cell tumors in the world literature. MINERVA CHIR 2014; 69:229-237. [PMID: 24987971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Littoral cell tumors (LCT) are rare primary splenic neoplasms, unique for their morphologic and immunolabeling features resembling the endothelial littoral cells lining the sinusoids of the red pulp. They include the more common and typically benign littoral cell angioma, as well as the less common, potentially malignant, littoral cell hemangioendothelioma (LCHE) and the aggressive littoral cell angiosarcoma (LCAS). The most common presentation of these neoplasms is splenomegaly, and diagnosis is made histologically following biopsy or resection. To better understand these tumors, a comprehensive, international literature search was performed. Patient and tumor data, including presenting symptoms, comorbid cancers, immunosuppressive states, splenic mass and tumor size were analyzed. Massive splenomegaly (≥ 1500 g) following splenic resection, which correlates with a splenic length of 20 cm preoperatively, was found to be significantly associated with the presence of malignancy in the LCT (P<0.05).
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Affiliation(s)
- J J Sarandria
- Department of Surgery, Saint Agnes Hospital Center, Baltimore, MD, USA -
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34
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Cyrulnik AA, Dawkins MC, Smalberger GJ, Young S, Mann RE, Jacobson MI, Friedman AJ. Kaposiform hemangioendothelioma with Kasabach-Merritt syndrome mistaken for child abuse in a newborn. Cutis 2014; 93:E17-E20. [PMID: 24738105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Kaposiform hemangioendothelioma is a rare vascular neoplasm of childhood that may have an alarming and potentially misleading clinical presentation. Awareness of this entity is important to provide appropriate and immediate medical care. We report the case of a 24-day-old female newborn who presented with a large bruiselike lesion on the left leg. A diagnosis of cellulitis suspected to be secondary to child abuse was made and the patient subsequently was placed in foster care; however, the lesion did not resolve after treatment and relocation. On reevaluation at our institution, physical examination revealed a round, 3 x 4-cm, violaceous, indurated, fixed, nonblanching, nontender plaque with an ivory center and peripheral erythema over the anteromedial aspect of the left leg. Biopsy demonstrated a vascular neoplasm consistent with kaposiform hemangioendothelioma (KHE), and laboratory evaluation revealed thrombocytopenia, low fibrinogen levels, and elevated D-dimer levels, confirming a diagnosis of Kasabach-Merritt syndrome (KMS).
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Affiliation(s)
| | | | | | | | | | | | - Adam J Friedman
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, 111 E 210th St, New York, NY 10467, USA.
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35
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Rullo R, Addabbo F, Rullo F, Festa VM. Primary polymorphous hemangioendothelioma of the maxillary soft tissue: clinical and immunopathological aspects of a rare vascular neoplasm. In Vivo 2014; 28:249-253. [PMID: 24632981] [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: 06/03/2023]
Abstract
Polymorphous hemangioendothelioma (PH) is an uncommon vascular neoplasm of borderline malignant potential characterized by a considerable variability in patterns of cellular growth. Morphologically, PH may be confused with other lesions, from benign vasoformative neoplasms and reactive inflammatory conditions to malignancies such as angiosarcoma or squamous cell carcinoma. Most occur in the lymph nodes, and to the best of our knowledge, lesions involving the maxillary soft tissue have not been described in the literature to date. A potential for local recurrence, as well as the ability to metastasize, has been for this type of neoplasm. Here we reported on a rare case of polymorphous hemangioendothelioma which presented as an asymptomatic subcutaneous mass in the right zygomatic region of a 22-year-old white female. We discuss the histopathological aspects of this tumor, with emphasis on the role of immunohistochemical analysis in differential diagnosis.
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36
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Croteau SE, Kozakewich HPW, Perez-Atayde AR, Fishman SJ, Alomari AI, Chaudry G, Mulliken JB, Trenor CC. Kaposiform lymphangiomatosis: a distinct aggressive lymphatic anomaly. J Pediatr 2014; 164:383-8. [PMID: 24252784 PMCID: PMC3946828 DOI: 10.1016/j.jpeds.2013.10.013] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 09/09/2013] [Accepted: 10/03/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe the clinical and imaging characteristics of a new lymphatic disorder with a unique histological pattern and poor prognosis. STUDY DESIGN An observational, retrospective study identified and characterized 20 patients with distinct lymphatic histopathology referred to the Vascular Anomalies Center at Boston Children's Hospital between 1995 and 2011. RESULTS The median age at onset was 6.5 years (range, birth to 44 years). Clinical and radiologic findings suggested a generalized process. The most common presentations were respiratory symptoms (50%), hemostatic abnormalities (50%), and an enlarging, palpable mass (35%). All patients had mediastinal involvement; 19 patients developed pericardial (70%) and/or pleural effusions (85%). Extrathoracic disease manifested in bone and spleen and less frequently in abdominal viscera, peritoneum, integument, and extremities. Despite aggressive procedural and medical therapies, the 5-year survival was 51% and the overall survival was 34%. Mean interval between diagnosis and death was 2.75 years (range, 1-6.5 years). CONCLUSIONS We describe a clinicopathologically distinct lymphatic anomaly. We propose the term kaposiform lymphangiomatosis (KLA) because of characteristic clusters or sheets of spindled lymphatic endothelial cells accompanying malformed lymphatic channels. The intrathoracic component is most commonly implicated in morbidity and mortality; however, extrathoracic disease is frequent, indicating that KLA is not restricted to pulmonary lymphatics. The mortality rate of KLA is high despite aggressive multimodal therapy.
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Affiliation(s)
- Stacy E Croteau
- Dana Farber/Boston Children's Cancer and Blood Disorders Center, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Harry P W Kozakewich
- Department of Pathology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Antonio R Perez-Atayde
- Department of Pathology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Steven J Fishman
- Department of Surgery, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Ahmad I Alomari
- Division of Interventional Radiology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Gulraiz Chaudry
- Division of Interventional Radiology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - John B Mulliken
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Cameron C Trenor
- Dana Farber/Boston Children's Cancer and Blood Disorders Center, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
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Drolet BA, Trenor CC, Brandão LR, Chiu YE, Chun RH, Dasgupta R, Garzon MC, Hammill AM, Johnson CM, Tlougan B, Blei F, David M, Elluru R, Frieden IJ, Friedlander SF, Iacobas I, Jensen JN, King DM, Lee MT, Nelson S, Patel M, Pope E, Powell J, Seefeldt M, Siegel DH, Kelly M, Adams DM. Consensus-derived practice standards plan for complicated Kaposiform hemangioendothelioma. J Pediatr 2013; 163:285-91. [PMID: 23796341 DOI: 10.1016/j.jpeds.2013.03.080] [Citation(s) in RCA: 171] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 01/22/2013] [Accepted: 03/29/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Beth A Drolet
- Departments of Pediatrics and Dermatology, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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Fichel F, Eschard C, Zachar D, Munzer M, Bernard P, Grange F. [Kaposiform haemangioendothelioma associated with B-cell acute lymphoblastic leukemia]. Ann Dermatol Venereol 2013; 140:209-14. [PMID: 23466155 DOI: 10.1016/j.annder.2012.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 10/31/2012] [Accepted: 12/03/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Herein, we report the first case of kaposiform haemangioendothelioma (KHE) associated with acute B-lymphoblastic leukemia (B-ALL). PATIENTS AND METHODS A five-month-old infant presented a plaque of angiomatous appearance on the forearm that had increased in volume since birth, as well as pallor and cutaneous haematomas. Kasabach-Merritt syndrome (KMS) was evoked despite hepatomegaly and considerable splenomegaly. Laboratory tests revealed severe anaemia and thrombocytopenia as well as major hyperleukocytosis with 90% blasts. Skin biopsy revealed vast vascular lobules containing cohesive fusiform endothelial cells not expressing Glut1, bound up in a dense infiltrate of B-lymphoblast cells. It was in fact KHE associated with B-ALL confirmed by the myelogram. The child was treated with the INTERFANT 2006 protocol followed by allograft of haematopoietic stem cells, which resulted in complete haematological remission. At the same time, almost total regression of KHE was noted. DISCUSSION In this infant, KHE had an inflammatory appearance and was associated with thrombocytopenia, evocative of KMS. Analysis of blood and marrow samples resulted in a diagnosis of B-ALL. Histopathological examination of the angioma revealed a typical appearance of KHE associated with dense lymphoblastic proliferation. This appearance could have resulted either from passive contamination by circulating blast cells or from active recruitment of tumor cells at the KHE site. CONCLUSION HK mimicking KMS may reveal B-ALL.
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Affiliation(s)
- F Fichel
- Service de dermatologie, hôpital Robert-Debré, CHU de Reims, avenue du Général-Koenig, 51092 Reims cedex, France.
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Croteau SE, Liang MG, Kozakewich HP, Alomari AI, Fishman SJ, Mulliken JB, Trenor CC. Kaposiform hemangioendothelioma: atypical features and risks of Kasabach-Merritt phenomenon in 107 referrals. J Pediatr 2013; 162:142-7. [PMID: 22871490 PMCID: PMC3494787 DOI: 10.1016/j.jpeds.2012.06.044] [Citation(s) in RCA: 243] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Revised: 06/11/2012] [Accepted: 06/21/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine the presentation characteristics of patients with Kaposiform hemangioendothelioma (KHE) to describe the spectrum of disease and risk factors for Kasabach-Merritt phenomenon (KMP). STUDY DESIGN A retrospective review of 163 patients referred to the Vascular Anomalies Center at Children's Hospital Boston for KHE between 1991 and 2009 identified 107 patients with sufficient data for inclusion. RESULTS The prevalence of KHE in Massachusetts is ∼0.91 case per 100000 children. KHE manifested in infancy in 93% of cases, with 60% as neonates. Common presenting features included enlarging cutaneous lesion (75%), thrombocytopenia (56%), and musculoskeletal pain or decreased function (23%). Cutaneous KHE favored the extremities, especially overlying joints. In our cohort, 71% developed KMP (11% after initial presentation), and 11% of patients lacked cutaneous findings. Retroperitoneal and intrathoracic lesions, though less common, were complicated by KMP in 85% and 100% of cases, respectively. Compared with superficial lesions, KHE infiltrating into muscle or deeper was 6.3-fold more likely to manifest KMP and 18-fold higher if retroperitoneal or intrathoracic. KHE limited to bone or presenting after infancy did not manifest KMP. CONCLUSION An enlarging cutaneous lesion is the most common presenting feature of KHE in infancy. Older patients with KHE or those lacking cutaneous manifestations present with musculoskeletal complaints or atypical symptoms. The risk of KMP increases dramatically when tumor infiltrates muscle or when KHE arises in the retroperitoneum or mediastinum.
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Affiliation(s)
- Stacy E Croteau
- Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, MA 02115, USA.
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Odgaard HS, Christensen MK, Gade J. [Kaposiform haemangioendothelioma in the small intestine of a three year-old boy]. Ugeskr Laeger 2012; 174:1679-1680. [PMID: 22681997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Kaposiform haemangioendothelioma is a rare, locally aggressive vascular tumour, which is mainly found in children. Typically, it occurs in the skin. The tumour is borderline malignant due to its rapid infiltrative growth. Metastasis has not been described. Since 1993, when this tumour was first defined, less than 160 cases have been reported. To our knowledge, this is the first case of kaposiform haemangioendothelioma in the gastrointestinal tract. We report a case of a three year-old boy, who presented with small bowel obstruction due to invagination of a kaposiform haemangioendothelioma.
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Affiliation(s)
- Helle Sand Odgaard
- Kirurgisk Afdeling, Regionshospitalet Viborg, Heibergs Allé 4, 8800 Viborg, Denmark.
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Handa U, Khurana U, Singhal N, Punia RPS, Mohan H. Cytologic diagnosis of intravascular papillary endothelial hyperplasia: a report of two cases and review of cytologic literature. Acta Cytol 2012; 56:199-203. [PMID: 22378085 DOI: 10.1159/000332355] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 08/24/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Intravascular papillary endothelial hyperplasia (IPEH), previously known as 'Masson's hemangioma', is a reactive endothelial proliferation that occurs most commonly in the vessels of the head, neck, and extremities. The cytologic findings of the lesion are varied and depend on the age of the lesion. CASES Case 1 is a 61-year-old man who presented with a swelling on the medial aspect of the forearm. The clinical diagnosis was lipoma. Cytologic smears showed spindle cells tagging onto a rich capillary network and smaller round cells arranged around hyaline cores. The cytologic diagnosis was benign vascular tumor. On histolopathogic examination a diagnosis of IPEH was given. Case 2 is a 45-year-old man who presented with swelling on the dorsal aspect of the wrist. The cytologic diagnosis of giant cell tumor was made based on the presence of scattered spindled cells and multinucleate giant cells. The giant cells had various shapes like round or crescent and had 10-25 nuclei. The lesion was excised and a diagnosis of IPEH was rendered. CONCLUSION These two cases highlight the varied cytomorphology of IPEH making the pinpoint diagnosis of this lesion difficult on cytologic smears.
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Affiliation(s)
- Uma Handa
- Department of Pathology, Government Medical College and Hospital, Chandigarh, India
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Kochin IN, Miloh TA, Arnon R, Iyer KR, Suchy FJ, Kerkar N. Benign liver masses and lesions in children: 53 cases over 12 years. Isr Med Assoc J 2011; 13:542-547. [PMID: 21991714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Primary liver masses in children may require intervention because of symptoms or concern about malignant transformation. OBJECTIVES To review the management and outcome of benign liver masses in children. METHODS We conducted a retrospective chart review of children with liver masses referred to our institution during the period 1997-2009. RESULTS Benign liver masses were identified in 53 children. Sixteen of these children (30%) had hemangioma/infantile hepatic hemangioendothelioma (IHH) and 15 (28%) had focal nodular hyperplasia. The remainder had 6 cysts, 4 hamartomas, 3 nodular regenerative hyperplasia, 2 adenomas, 2 vascular malformations, and one each of polyarteritis nodosa, granuloma, hepatic hematoma, lymphangioma, and infarction. Median age at presentation was 6 years, and 30 (57%) were female. Masses were initially noticed on imaging studies performed for unrelated symptoms in 33 children (62%), laboratory abnormalities consistent with liver disease in 11 (21%), and palpable abdominal masses in 9 (17%). Diagnosis was made based on characteristic radiographic findings in 31 (58%), but histopathological examination was required for the remaining 22 (42%). Of the 53 children, 27 (51%) were under observation while 17 (32%) had masses resected. Medications targeting masses were used in 9 (17%) and liver transplantation was performed in 4 (8%). The only death (2%) occurred in a child with multifocal IHH unresponsive to medical management and prior to liver transplant availability. CONCLUSIONS IHH and focal nodular hyperplasia were the most common lesions. The majority of benign lesions were found incidentally and diagnosed radiologically. Expectant management was sufficient in most children after diagnosis, although surgical intervention including liver transplant was occasionally necessary.
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Affiliation(s)
- Israel N Kochin
- Pediatric Hepatology, Division of Pediatric Hepatology and RMTI, Department of Surgery, Mount Sinai School of Medicine, New York City, NY 10029, USA.
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Rojas J, Sarkissian N, Heller DS, Lambert WC. Newtonian dermatopathology: when the reaction to a lesion obfuscates the diagnosis. Skinmed 2010; 8:231-233. [PMID: 21137611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Javier Rojas
- Department of Pathology, Division of Anatomic Pathology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Room C520 MSB, 185 South Orange Avenue, Newark, NJ 07103, USA
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Hebert JC. Getting a handle on managing rare tumors. Arch Surg 2009; 144:1039. [PMID: 19928296 DOI: 10.1001/archsurg.2009.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- James C Hebert
- Department of Surgery, University of Vermont College of Medicine, Fletcher Allen Health Care, Burlington, VT 05401, USA
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Naik V, Arsenovic N, Reed M. Eccrine angiomatous hamartoma: a rare multifocal variant with features suggesting trauma. Dermatol Online J 2009; 15:6. [PMID: 19930993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Eccrine angiomatous hamartoma (EAH) is a rare, benign cutaneous tumor characterized by proliferation of the eccrine gland elements closely associated with capillary angiomatosis and proliferation of other dermal elements, such as adipose tissue, hair and epidermis. Patients usually present with a solitary nodule on the extremities appearing at birth or during the prepubertal years. However multifocal lesions or late onset of this condition may occur. Eccrine angiomatous hamartoma is usually sporadic, but one familial case of the multifocal variant has been reported. The clinical presentation ranges from a simple angiomatous nodule to erythematous--purpuric plaques. Eccrine angiomatous hamartoma is generally asymptomatic but may occasionally be associated with pain and hyperhidrosis. We report a rare case of the multifocal variant of EAH in a 13-year-old girl, with histological features suggesting trauma. Clinically, this condition must be differentiated from other angiomatoses and a definitive diagnosis is based upon histology. Eccrine angiomatous hamartoma is a benign slowly growing lesion for which aggressive treatment is not indicated. Simple excision is reserved for painful or cosmetically disfiguring examples.
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Affiliation(s)
- Veena Naik
- Department of Cellular Pathology, Pathlinks Pathology Services, Lincoln County Hospital, Lincoln, United Kingdom
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Minard-Colin V, Orbach D, Martelli H, Bodemer C, Oberlin O. [Soft tissue tumors in neonates]. Arch Pediatr 2009; 16:1039-48. [PMID: 19398311 DOI: 10.1016/j.arcped.2009.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Revised: 11/20/2008] [Accepted: 03/08/2009] [Indexed: 10/20/2022]
Abstract
Soft tissue tumors account for approximately 25% of neonatal tumors and are most often benign (more than 2/3 of cases). Vascular tumors are the most frequent benign tumors and infantile hemangioma accounts for 32% of these tumors, affecting 1 out of 200 children at birth. Kaposiform hemangioendothelioma (KH) is a rare vascular tumor with locally aggressive behavior. More than 50% of KH are associated with the Kasabach-Merritt phenomenon, a condition characterized by thrombocytopenia and consumptive coagulopathy. Malignant soft tissue tumors are, after neuroblastoma, the second cause of cancer in neonates. Infantile fibrosarcoma (IF) is a rare tumor that most often affects the extremities of children aged 4 years or younger. A recurrent t(12;15) (p13;q25) rearrangement fusing the ETV6 gene with the NTRK3 neurotrophin-3 receptor gene has been identified in IF. Complete conservative surgical resection is usually curative. Chemotherapy is indicated when initial surgical removal cannot be accomplished without unacceptable morbidity. Prognosis of IF is excellent, with reported overall survival rates ranging from 80 to 100%. Neonatal rhabdomyosarcoma (RMS) is a rare tumor (0.5-1% of RMS). The primary tumor predominantly involves the limbs and the genitourinary tract. Treatment is based on age-adapted chemotherapy and surgery. Prognosis of RMS in children less than 1 year old appears to be comparable with that of older children.
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Affiliation(s)
- V Minard-Colin
- Département de pédiatrie, institut Gustave-Roussy, 39, rue Camille-Desmoulins, 94805 Villejuif cedex, France
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Abstract
Kaposiform hemangioendothelioma (KHE) is a rare, locally aggressive vascular neoplasm that mainly occurs during childhood. It generally originates on the skin, usually affecting deeper tissue by infiltrative growth. It appears as one or multiple masses, and in most cases is associated to consumptive coagulopathy (Kasabach-Merritt syndrome), and lymphangiomatosis. Although visceral involvement is very uncommon, several cases with bone, retroperitoneal, or mediastinal involvement have been described. These tumors tend to be locally invasive, but are not known to produce distant metastases. The development of KHE in adolescents or in adults is very rare, but cases have also been described. Several factors are associated with the outcome of patients with KHE: accessibility to surgical excision, location (cutaneous versus visceral), size of tumoral mass, clinical response to interferon and glucocorticoids, and the absence of lymphangiomatosis and Kasabach-Merritt syndrome, may result in partial remissions. On the other hand, bulk visceral masses lead to a 40-50% mortality rate, mainly due to progressive failure of the infiltrated organ(s), in spite of interferon, glucocorticoids, and combined chemotherapy. In conclusion, the onset of a consumptive coagulopathy following the presence of a vascular tumor, in children as well as in older patients, should spark suspicion of KHE, among other entities.
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Affiliation(s)
- Y Fernández
- Medical Oncology Department, Hospitales Universitarios Virgen del Rocío, Sevilla, Spain.
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Yücesoy C, Coban G, Yilmazer D, Oztürk E, Hekimoğlu B. Intravascular papillary endothelial hyperplasia (Masson's hemangioma) presenting as a lateral neck mass. JBR-BTR 2009; 92:20-22. [PMID: 19358481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Intravascular papillary endothelial hyperplasia (Masson's hemangioma) is a benign disease of vascular origin characterized by exuberant endothelial proliferation in normal blood vessels.The most important feature of the disease is its resemblance to hemangiosarcoma and the resulting possible radiologic misinterpretation. We present the radiologic findings in a 45-year-old woman presenting a neck mass extending to the thoracic cavity.
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Affiliation(s)
- C Yücesoy
- Department of Radiology, Ankara Diskapi Training and Research Hospital, Ankara, Turkey.
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Erkan AN, Bal N, Kiroglu E. A case report of hemangioendothelioma of the hard palate. B-ENT 2008; 4:175-178. [PMID: 18949965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Hemangioendothelioma is a rare vascular tumour with potential for malignancy that is intermediate between that of a benign hemangioma and a malignant angiosarcoma. This tumour occurs infrequently in the head and neck regions. In this report, we describe and discuss a case of hemangioendothelioma that originated in the hard palate of a 49-year-old woman.
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Affiliation(s)
- A N Erkan
- Department of Otorhinolaryngology, Baskent University Faculty of Medicine, Ankara, Turkey.
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Abstract
We report an infant with hepatic hemangioendothelioma (HAE) associated with compensated hypothyroidism. The hepatic lesions regressed with steroid therapy and his thyroid function normalized with high doses of thyroxine supplement.
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Affiliation(s)
- Ram Kalpatthi
- Division of Pediatric Hematology/Oncology, Children's Hospital, Columbus, Ohio 43205, USA.
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