RESUMO
OBJECTIVES: The authors describe a case of congenital calvarial hemangioma successfully managed using propranolol therapy. Presenting symptoms, radiological and pathological features, differential diagnosis, and management of this rare congenital mass are described. CASE PRESENTATION: A 2-year-old boy presented with a 1-year history of a growing right parietal skull mass. No obvious etiology was apparent. No focal neurological deficits or associated craniofacial anomalies were identified. Plain film imaging demonstrated focal thickening of the right parietal bone with internal trabeculations in a sunburst appearance. Computed tomography (CT) scan showed bone thickening with coarsening of the bony trabeculae, minor irregularity of the outer table, unaffected inner table, and no evidence of aggressive features. A diagnostic biopsy of the lesion was performed in the operating room. Microscopic examination was consistent with hemangioma. Based on histological and radiological features of the lesion, it was identified as a cavernous hemangioma. Medical treatment utilizing propranolol was initiated for over 3 years with interval reduction in the lesion size. MRI head following treatment with propranolol demonstrated reduction of the mass compared to preoperative imaging. CONCLUSIONS: Although a rare entity, it is important to consider congenital calvarial hemangioma in the differential diagnosis of slow growing skull lesions due to the possibility of complications as a result of the hemangioma's intracranial extension, and the potential for treatment. En bloc resection has classically been described as a treatment for such lesions, although our case demonstrates that medical treatment with propranolol therapy may be appropriate in certain situations.
Assuntos
Hemangioma Cavernoso/diagnóstico , Hemangioma Cavernoso/tratamento farmacológico , Propranolol/uso terapêutico , Neoplasias Cranianas/diagnóstico , Neoplasias Cranianas/tratamento farmacológico , Vasodilatadores/uso terapêutico , Pré-Escolar , Hemangioma Cavernoso/congênito , Humanos , Masculino , Osso Parietal , Neoplasias Cranianas/congênitoRESUMO
The hydatid cyst is a parasitic infection included within the category of zoonoses, in which there exists a direct or indirect relation with animals, particularly with dogs. We report a clinical case of a patient who has undergone surgery of hydatid cyst in the right hepatic lobe. Seven years later the patient presents hydatid cyst in portal vein with secondary cavernomatosis, which is a rare complication. There are few cases described in the literature. The symtomatology presented by hydatid cyst is variable and the diagnosis is made by ultrasonography, TC and/or RNM. The treatment of choice is the surgical removal of the cyst, prior to surgery Albendazol must be administered for 1-2 weeks and be maintained for 4 more weeks after surgery.
Assuntos
Equinococose/patologia , Hemangioma Cavernoso/patologia , Veia Porta/patologia , Idoso de 80 Anos ou mais , Albendazol/uso terapêutico , Antiparasitários/uso terapêutico , Equinococose/complicações , Equinococose/tratamento farmacológico , Hemangioma Cavernoso/complicações , Hemangioma Cavernoso/tratamento farmacológico , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
Idiopathic non-cirrhotic portal hypertension is a rare disease of unknown etiology. Patients with idiopathic non-cirrhotic portal hypertension have an increased risk of developing portal vein thrombosis and this is especially prevalent when HIV is also present. We describe a unique case of a patient with idiopathic non-cirrhotic portal hypertension associated to HIV, who developed acute portal vein thrombosis that despite anticoagulation transformed in portal cavernoma and disappeared completely after five years of follow-up on continuous anticoagulation.
Assuntos
Anticoagulantes/uso terapêutico , Hemangioma Cavernoso/tratamento farmacológico , Hipertensão Portal/complicações , Cirrose Hepática/complicações , Pancitopenia/complicações , Veia Porta , Esplenomegalia/complicações , Trombose Venosa/tratamento farmacológico , Infecções por HIV/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Hipertensão Portal não Cirrótica IdiopáticaRESUMO
Kaposiform hemangioendothelioma is a rare vascular tumor in children. Especially, in association with the Kasabach-Merritt Phenomenon it can be life threatening. The management of these patients is very difficult and an aggressive treatment regime is required. Several multimodality and chemotherapeutic regimens have been described but with variable success and many side effects. We present a 6-week-old boy with Kaposiform hemangioendothelioma and Kasabach-Merritt Phenomenon. Ongoing propranolol treatment with only 4 initial courses of vincristine resulted in a remission that lasted at least 1 year.
Assuntos
Antagonistas Adrenérgicos beta/administração & dosagem , Propranolol/administração & dosagem , Antineoplásicos Fitogênicos/administração & dosagem , Coagulação Intravascular Disseminada/tratamento farmacológico , Coagulação Intravascular Disseminada/etiologia , Quimioterapia Combinada , Hemangioendotelioma/complicações , Hemangioendotelioma/tratamento farmacológico , Hemangioma Capilar/tratamento farmacológico , Hemangioma Capilar/etiologia , Hemangioma Cavernoso/complicações , Hemangioma Cavernoso/tratamento farmacológico , Humanos , Lactente , Síndrome de Kasabach-Merritt , Masculino , Indução de Remissão , Sarcoma de Kaposi/complicações , Sarcoma de Kaposi/tratamento farmacológico , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/tratamento farmacológico , Trombocitopenia/complicações , Trombocitopenia/tratamento farmacológico , Neoplasias Vasculares/complicações , Neoplasias Vasculares/tratamento farmacológico , Vincristina/administração & dosagemRESUMO
The therapeutic arsenal for hemangiomas in early childhood can now be considered to include oral ß-blockers, mainly propranolol. These drugs are thought to act as vasoconstrictors, regulating angiogenic pathways and inducing apoptosis of vascular endothelial cells. Although infantile hemangioma is not among the approved indications for ß-blockers, many specialized clinics will prescribe propranolol before resorting to corticosteroids. A dosage of 2 mg/kg/d, is usually employed with a dosing interval of 8 hours. Propranolol is safe, causing few side effects, although cases of hypoglycemia, hypotension, diarrhea, reflux, cold hands and feet, bronchospasm, and hyperkalemia have been described. Generally, these adverse effects have not had serious consequences. Prescription in PHACE syndrome is controversial. In all cases, a cardiologist should assess the patient before treatment begins, blood pressure should be monitored, and pediatric follow-up should be scheduled. This review covers our current understanding of the indications, clinical response, and adverse effects of propranolol, a drug has revolutionized our attitude toward infantile hemangioma and the way we approach therapy. Clinical trials under way are also reviewed.
Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Hemangioma Cavernoso/tratamento farmacológico , Propranolol/uso terapêutico , Neoplasias Cutâneas/tratamento farmacológico , Vasoconstrição/efeitos dos fármacos , Corticosteroides/uso terapêutico , Antagonistas Adrenérgicos beta/administração & dosagem , Antagonistas Adrenérgicos beta/efeitos adversos , Antagonistas Adrenérgicos beta/farmacologia , Bradicardia/induzido quimicamente , Espasmo Brônquico/induzido quimicamente , Ensaios Clínicos como Assunto , Relação Dose-Resposta a Droga , Monitoramento de Medicamentos , Hemangioma Cavernoso/complicações , Humanos , Hipoglicemia/induzido quimicamente , Hipotensão/induzido quimicamente , Lactente , Estudos Multicêntricos como Assunto , Neovascularização Patológica/tratamento farmacológico , Propranolol/administração & dosagem , Propranolol/efeitos adversos , Propranolol/farmacologia , Neoplasias Cutâneas/complicações , Úlcera Cutânea/tratamento farmacológico , Úlcera Cutânea/etiologia , Simpatomiméticos/administração & dosagem , Simpatomiméticos/efeitos adversos , Simpatomiméticos/farmacologia , Simpatomiméticos/uso terapêutico , Vasoconstrição/fisiologiaAssuntos
Neoplasias do Colo/tratamento farmacológico , Hemangioma Cavernoso/tratamento farmacológico , Propranolol/uso terapêutico , Neoplasias Gástricas/tratamento farmacológico , Vasodilatadores/uso terapêutico , Adolescente , Anemia/etiologia , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/fisiopatologia , Endoscopia Gastrointestinal , Fadiga/etiologia , Hemangioma Cavernoso/diagnóstico , Hemangioma Cavernoso/fisiopatologia , Humanos , Masculino , Índice de Gravidade de Doença , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/fisiopatologia , Resultado do TratamentoRESUMO
Kaposiform hemangioendothelioma (KHE) is a rare tumor that occurs nearly exclusively during infancy and childhood. It has features common to both capillary hemangioma and Kaposi sarcoma and for that reason many terms have been used for these tumors including "Kaposi-like infantile hemangioendothelioma" and "hemangioma with Kaposi sarcoma-like features." KHE typically presents as an ill-defined, red to purple, indurated plaque and is often complicated by the Kasabach-Merritt phenomenon (KMP), a condition of severe thrombocytopenia and consumptive coagulopathy. Knowledge of the radiological findings of this uncommon tumor might be helpful for diagnosis. We present the MRI features of a case of KHE with neither typical skin lesions nor the Kasabach-Merritt phenomenon.
Assuntos
Neoplasias de Cabeça e Pescoço/diagnóstico , Antineoplásicos Hormonais/uso terapêutico , Músculo Deltoide/patologia , Músculo Deltoide/ultraestrutura , Diagnóstico Diferencial , Coagulação Intravascular Disseminada , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Neoplasias de Cabeça e Pescoço/ultraestrutura , Hemangioendotelioma/diagnóstico , Hemangioendotelioma/tratamento farmacológico , Hemangioendotelioma/ultraestrutura , Hemangioma Capilar , Hemangioma Cavernoso/diagnóstico , Hemangioma Cavernoso/tratamento farmacológico , Hemangioma Cavernoso/ultraestrutura , Humanos , Lactente , Síndrome de Kasabach-Merritt , Imageamento por Ressonância Magnética/métodos , Masculino , Prednisolona/uso terapêutico , Sarcoma de Kaposi/diagnóstico , Sarcoma de Kaposi/tratamento farmacológico , Sarcoma de Kaposi/ultraestrutura , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/ultraestrutura , Trombocitopenia/diagnóstico , Trombocitopenia/tratamento farmacológico , Resultado do Tratamento , Neoplasias Vasculares/diagnóstico , Neoplasias Vasculares/tratamento farmacológico , Neoplasias Vasculares/ultraestruturaRESUMO
Radiation-induced cavernous hemangiomas (RICH) are a known complication of radiation exposure, especially in young children. The current treatment approaches to these lesions include observation and surgical resection. We report the case of a 4-year-old male with recurrent medulloblastoma who had resolution of an incidental RICH lesion while being treated with bevacizumab for his recurrent brain tumor. There was no evidence of worsening hemorrhage with this therapy and the RICH did not recur upon discontinuation of the chemotherapy regimen. This is the first documented case of a RICH lesion responding to antiangiogenic therapy, suggesting the possible use of this class of agents in the treatment of symptomatic patients who are not considered appropriate candidates for surgical resection. Although the risk of bleeding must be taken into consideration, antiangiogenic therapies have the potential to be a novel treatment modality for symptomatic RICH lesions.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Neoplasias Cerebelares/tratamento farmacológico , Hemangioma Cavernoso/tratamento farmacológico , Meduloblastoma/tratamento farmacológico , Neoplasias Induzidas por Radiação/tratamento farmacológico , Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais Humanizados , Bevacizumab , Neoplasias Cerebelares/patologia , Neoplasias Cerebelares/radioterapia , Pré-Escolar , Terapia Combinada , Hemangioma Cavernoso/etiologia , Hemangioma Cavernoso/patologia , Humanos , Achados Incidentais , Imageamento por Ressonância Magnética , Masculino , Meduloblastoma/patologia , Meduloblastoma/radioterapia , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/patologia , Neoplasias Induzidas por Radiação/patologiaRESUMO
Cavernous angioma (CA) is a vascular pathology caused by loss of function in one of the 3 CA genes (CCM1, CCM2, and CCM3) that result in rho kinase (ROCK) activation. We investigated a novel ROCK2 selective inhibitor for the ability to reduce brain lesion formation, growth, and maturation. We used genetic methods to explore the use of a ROCK2-selective kinase inhibitor to reduce growth and hemorrhage of CAs. The role of ROCK2 in CA was investigated by crossing Rock1 or Rock2 hemizygous mice with Ccm1 or Ccm3 hemizygous mice, and we found reduced lesions in the Rock2 hemizygous mice. A ROCK2-selective inhibitor, BA-1049 was used to investigate efficacy in reducing CA lesions after oral administration to Ccm1+/- and Ccm3+/- mice that were bred into a mutator background. After assessing the dose range effective to target brain endothelial cells in an ischemic brain model, Ccm1+/- and Ccm3+/- transgenic mice were treated for 3 (Ccm3+/-) or 4 months (Ccm1+/-), concurrently, randomized to receive one of three doses of BA-1049 in drinking water, or placebo. Lesion volumes were assessed by micro-computed tomography. BA-1049 reduced activation of ROCK2 in Ccm3+/-Trp53-/- lesions. Ccm1+/-Msh2-/- (n=68) and Ccm3+/-Trp53-/- (n=71) mice treated with BA-1049 or placebo showed a significant dose-dependent reduction in lesion volume after treatment with BA-1049, and a reduction in hemorrhage (iron deposition) near lesions at all doses. These translational studies show that BA-1049 is a promising therapeutic agent for the treatment of CA, a disease with no current treatment except surgical removal of the brain lesions.
Assuntos
Encéfalo/efeitos dos fármacos , Encéfalo/patologia , Hemangioma Cavernoso/tratamento farmacológico , Hemangioma Cavernoso/patologia , Inibidores de Proteínas Quinases/administração & dosagem , Quinases Associadas a rho/antagonistas & inibidores , Administração Oral , Animais , Proteínas Reguladoras de Apoptose/genética , Proteína KRIT1/genética , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Proteína Supressora de Tumor p53/genética , Quinases Associadas a rho/genéticaRESUMO
BACKGROUND: Cavernous angiomas (CAs) are vascular malformations that may result in stroke. CASE DESCRIPTION: Herein, we evaluate a CA patient with chronic migraine who experienced 2 documented symptomatic hemorrhages after receiving respective high doses of botulinum toxin (Btx). CONCLUSIONS: Recently, bacterial lipopolysaccharide has been reported to contribute to CA development through Toll-like receptor signaling, causing hemorrhagic angiogenic proliferation. Lipopolysaccharide and Btx share a common intracellular signaling pathway driving CA development and hemorrhage. Significance of these observations is demonstrated by previous works on plasma molecules showing prognostic associations with symptomatic hemorrhages in human CA, related to the same canonical pathways. Authors suggest careful tracking of the association of Btx and hemorrhage in CA patients.
Assuntos
Toxinas Botulínicas Tipo A/efeitos adversos , Neoplasias Encefálicas/tratamento farmacológico , Hemangioma Cavernoso/tratamento farmacológico , Hemorragias Intracranianas/etiologia , Neurotoxinas/efeitos adversos , Adulto , Toxinas Botulínicas Tipo A/administração & dosagem , Dor Crônica , Feminino , Humanos , MAP Quinase Quinase Quinase 3/metabolismo , Angiografia por Ressonância Magnética , Transtornos de Enxaqueca/etiologia , Neurotoxinas/administração & dosagem , Receptores Toll-Like/metabolismoRESUMO
PURPOSE: To report a case of retinal cavernous hemangioma with intralesional phleboliths, simulating retinoblastoma. METHODS: A healthy 5-month-old girl developed left esotropia and was noted to have atraumatic vitreous hemorrhage with underlying partially calcified mass, suspicious for retinoblastoma. RESULTS: On examination, the visual acuity was fix and follow in the right eye and absent fixation in the left eye. Evaluation of the right eye revealed normal findings. The left eye demonstrated healthy anterior segment and dense vitreous hemorrhage with no view of the postequatorial structures, but with hazy view of the flat peripheral retina and a superonasal retinal mass, covered with fresh hemorrhage. Three white intralesional flecks, consistent with calcification, each measuring 300 µm, were visualized. B-scan ultrasonography confirmed the dense mass with several foci of calcification, suspicious for retinoblastoma, despite poor visualization on funduscopy. Prophylactic intravenous chemotherapy was delivered for globe salvage and systemic protection. At 12-month follow-up, the hemorrhage showed resolution, revealing a superonasal dark blue multilobulated mass with saccular aneurysms, measuring 16 mm in diameter, and with 3 phleboliths (intralesional calcification). Fluorescein angiography demonstrated early and midphase hypofluorescence with late-phase filling and with plasma-erythrocyte separation in some larger aneurysms, characteristic of retinal cavernous hemangioma. CONCLUSION: Retinal cavernous hemangioma can be associated with intralesional calcification (phleboliths).
Assuntos
Hemangioma Cavernoso/complicações , Neoplasias da Retina/complicações , Calcificação Vascular/complicações , Antineoplásicos/uso terapêutico , Feminino , Angiofluoresceinografia , Hemangioma Cavernoso/diagnóstico , Hemangioma Cavernoso/tratamento farmacológico , Humanos , Lactente , Infusões Intravenosas , Neoplasias da Retina/diagnóstico , Neoplasias da Retina/tratamento farmacológico , Tomografia Computadorizada por Raios X , Ultrassonografia , Calcificação Vascular/diagnóstico , Calcificação Vascular/tratamento farmacológico , Acuidade Visual , Hemorragia Vítrea/complicações , Hemorragia Vítrea/diagnóstico , Hemorragia Vítrea/tratamento farmacológicoRESUMO
Diffuse cavernous haemangioma is a rare disease of the rectum. It usually presents with a history of rectal bleeding in children and young adults. When conservative methods fail to control bleeding, traditionally resection is recommended. A 50-year-old man presented with per rectal bleeding and was diagnosed with diffuse cavernous haemangioma of the sigmoid and rectum extending up to 40 cm in the left colon through endoscopy, magnetic resonance imaging and computed tomography. The diagnosis was confirmed by biopsy. This patient was successful managed conservatively with tranexamic acid as needed, avoiding the need for resection.
Assuntos
Antifibrinolíticos/administração & dosagem , Tratamento Conservador/métodos , Hemangioma Cavernoso/tratamento farmacológico , Neoplasias Retais/tratamento farmacológico , Neoplasias do Colo Sigmoide/tratamento farmacológico , Ácido Tranexâmico/administração & dosagem , Administração Oral , Colonoscopia , Hemorragia Gastrointestinal/etiologia , Hemangioma Cavernoso/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Neoplasias Retais/diagnóstico , Neoplasias do Colo Sigmoide/diagnóstico , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Conduta ExpectanteRESUMO
Giant hemangiomas are rare in newborn babies and may cause some life-threatening complications such as congestive heart failure and coagulopathies including severe thrombocytopenia, microangiopathic hemolytic anemia and bleeding such as Kasabach-Merritt syndrome. We have presented here one infant case with a right lower brachial plexus paralysis due to giant hemangioma treated successfully with interferon alpha and have discussed the treatment. This is the first case of Kasabach-Merritt syndrome associated with a right lower brachial plexus paralysis treated with interferon in the literature to our knowledge. The administration of interferon-alpha might be indicated as a therapy for severe, life-threatening and giant hemangiomas such as Kasabach-Merritt syndrome, especially when there is resistance to steroid. However, more extensive data and new patients are needed to clarify this issue.
Assuntos
Inibidores da Angiogênese/uso terapêutico , Neuropatias do Plexo Braquial , Hemangioma Cavernoso , Interferon-alfa/uso terapêutico , Adulto , Neuropatias do Plexo Braquial/tratamento farmacológico , Neuropatias do Plexo Braquial/etiologia , Feminino , Hemangioma Cavernoso/complicações , Hemangioma Cavernoso/tratamento farmacológico , Humanos , Recém-Nascido , Interferon alfa-2 , Masculino , Proteínas Recombinantes , Síndrome , Resultado do TratamentoRESUMO
RATIONALE: Cavernous hemangiomas referred to as venous malformations (VMs), are not true vascular tumors. The treatment of cavernous hemangiomas is controversial. PATIENT CONCERNS: A five-year-old girl with a cavernous hemangioma on her right buttock had undergone surgery but recurred 1âmonth after the operation. DIAGNOSES: Cavernous hemangioma was diagnosed on the basis of physical examination, magnetic resonance imaging (MRI) and postoperative pathologic examination. INTERVENTIONS: We treated her with intralesional injection of triamcinolone acetonide (TCA) for 8 times. OUTCOMES: She was cured and had no recurrence during the 3-month follow-up. LESSONS: This prompts that TCA may provide a more effective and safer choice for the treatment of cavernous hemangiomas.
Assuntos
Antineoplásicos/administração & dosagem , Hemangioma Cavernoso/tratamento farmacológico , Neoplasias de Tecidos Moles/tratamento farmacológico , Triancinolona Acetonida/administração & dosagem , Nádegas , Pré-Escolar , Feminino , Hemangioma Cavernoso/diagnóstico por imagem , Hemangioma Cavernoso/patologia , Hemangioma Cavernoso/cirurgia , Humanos , Injeções Intralesionais , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/patologia , Neoplasias de Tecidos Moles/cirurgiaRESUMO
BACKGROUND: More than a million Americans harbor a cerebral cavernous angioma (CA), and those who suffer a prior symptomatic hemorrhage have an exceptionally high rebleeding risk. Preclinical studies show that atorvastatin blunts CA lesion development and hemorrhage through inhibiting RhoA kinase (ROCK), suggesting it may confer a therapeutic benefit. OBJECTIVE: To evaluate whether atorvastatin produces a difference compared to placebo in lesional iron deposition as assessed by quantitative susceptibility mapping (QSM) on magnetic resonance imaging in CAs that have demonstrated a symptomatic hemorrhage in the prior year. Secondary aims shall assess effects on vascular permeability, ROCK activity in peripheral leukocytes, signal effects on clinical outcomes, adverse events, and prespecified subgroups. METHODS: The phase I/IIa placebo-controlled, double-blinded, single-site clinical trial aims to enroll 80 subjects randomized 1-1 to atorvastatin (starting dose 80 mg PO daily) or placebo. Dosing shall continue for 24-mo or until reaching a safety endpoint. EXPECTED OUTCOMES: The trial is powered to detect an absolute difference of 20% in the mean percent change in lesional QSM per year (2-tailed, power 0.9, alpha 0.05). A decrease in QSM change would be a signal of potential benefit, and an increase would signal a safety concern with the drug. DISCUSSION: With firm mechanistic rationale, rigorous preclinical discoveries, and biomarker validations, the trial shall explore a proof of concept effect of a widely used repurposed drug in stabilizing CAs after a symptomatic hemorrhage. This will be the first clinical trial of a drug aimed at altering rebleeding in CA.
Assuntos
Atorvastatina/uso terapêutico , Hemorragia Cerebral/tratamento farmacológico , Hemangioma Cavernoso do Sistema Nervoso Central/tratamento farmacológico , Hemangioma Cavernoso/tratamento farmacológico , Estudo de Prova de Conceito , Inibidores de Proteínas Quinases/uso terapêutico , Atorvastatina/farmacologia , Hemorragia Cerebral/diagnóstico por imagem , Método Duplo-Cego , Feminino , Seguimentos , Hemangioma Cavernoso/diagnóstico por imagem , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Estudos Prospectivos , Inibidores de Proteínas Quinases/farmacologia , Resultado do Tratamento , Proteína rhoA de Ligação ao GTP/antagonistas & inibidores , Proteína rhoA de Ligação ao GTP/metabolismoAssuntos
Manuseio das Vias Aéreas/métodos , Hemangioma Cavernoso/complicações , Ventilação Monopulmonar/métodos , Neoplasias da Língua/complicações , Idoso de 80 Anos ou mais , Anti-Inflamatórios/uso terapêutico , Dexametasona/uso terapêutico , Feminino , Hemangioma Cavernoso/tratamento farmacológico , Hemotórax/cirurgia , Humanos , Intubação Intratraqueal , Neoplasias da Língua/tratamento farmacológicoRESUMO
Hemangiomas are the most common benign tumors of infancy. Capillary hemangioma generally is presented as a spot or well-defined purple lesion. The diagnosis of these tumors is based on physical examination. Giant hemangioma is a rare and extensive variation of capillary hemangioma, that generally occurs in newborns and suckling infants. There are several therapeutical modalities, as the intralesional injection of steroids, laser therapy, intralesional injection of sclerosing solutions, surgery, radiotherapy and embolization. New therapeutical modalities have been developed, with the objective of getting better results and to make possible the treatment of the lesions of difficult surgical access or refractory cases to the used therapeutical modalities. The best results have been observed with interferon-alpha. This is a case of a patient with three months of age, that presented since birth, a purplish tumor in the superior eyelid of the right eye, plain and purplish cutaneous lesions in the temporal and parietal right region. On computed tomography of the skull, an orbital expansive vascularized process with intracranial extension could be observed. Systemic therapy with steroids was the initial treatment, during forty days, with gradual reduction for four weeks. With the practically unchanged clinical findings, the treatment with interferon-alpha was indicated, in the dose of subcutaneous 3.000.000 U/m(2), three times a week. After 9 months of treatment, a small residual orbital lesion was observed. In this case, interferon-alpha is presented as a good option for the treatment of craniofacial giant hemangioma.
Assuntos
Antineoplásicos/uso terapêutico , Anormalidades Craniofaciais/tratamento farmacológico , Neoplasias Faciais/tratamento farmacológico , Hemangioma Cavernoso/tratamento farmacológico , Interferon-alfa/uso terapêutico , Feminino , Humanos , LactenteRESUMO
INTRODUCTION: Parotid haemangiomas account for the majority of salivary gland tumours in children. This articles highlights the use of medical treatment for the treatment of parotid haemangioma. CASE SUMMARY: A 4 year old male underwent a superficial parotidectomy for a parotid mass that was found to be a a parotid haemangioma on histology. At the age of 14 years he presented again with a parotid mass. He had imaging which aided the diagnosis of a parotid haemangioma being made. He was treated with successfully propranolol over a period of 6 months. DISCUSSION: There are no clear guidelines for treatment of parotid haemangiomas. These lesions can represent a clinical challenge and optimal management is controversial. It was proposed that propranolol be used for treatment in this particular case. This is a non-invasive form of treatment with minimal side effects.
Assuntos
Hemangioma Cavernoso/tratamento farmacológico , Neoplasias Parotídeas/tratamento farmacológico , Propranolol/uso terapêutico , Vasodilatadores/uso terapêutico , Adolescente , Humanos , Masculino , RecidivaRESUMO
PURPOSE: To report the response of cavernous haemangioma of the disc to PDT. METHODS AND PATIENTS: A 32 years old lady presented to us with complaints of sudden onset of blurry vision in her right eye. What seemed initially as polypoidal choroidal vasculopathy turned out as cavernous haemangioma of the disc after pneumatic displacement of the sub-retinal haeme. She was treated with PDT as she was prone to recurrent haemorrhage from the lesion due to her low platelet count. RESULTS: Complete regression of the cavernous haemangioma was noted as early as the second week itself and remained regressed for 4 months. CONCLUSION: PDT can be safe option for patients presenting with symptomatic cavernous haemangioma of the disc or retina.
Assuntos
Hemangioma Cavernoso/tratamento farmacológico , Disco Óptico/patologia , Neoplasias do Nervo Óptico/tratamento farmacológico , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Adulto , Feminino , Angiofluoresceinografia , Fundo de Olho , Hemangioma Cavernoso/diagnóstico , Humanos , Neoplasias do Nervo Óptico/diagnóstico , Acuidade VisualRESUMO
OBJECTIVE: To evaluate the efficacy and safety of 2% topical propranolol cream in the treatment of proliferating infantile strawberry hemangiomas. METHODS: A total of 40 infants were enrolled; 2% propranolol cream was applied three times daily. In the subsequent monthly visit, dynamic changes in tumor size, texture, and color were recorded. The adverse events (AEs) were observed. Treatment outcomes were scored on a four-point scale. All patients were followed up for 12 mo after treatment. RESULTS: The overall response was graded Scale 1 (poor response) in 2 patients, Scale 2 (moderate response) in 15 patients, Scale 3 (good response) in 17 patients, and Scale 4 (excellent response) in 6 patients. No significant differences were seen in treatment outcomes between female and male patients, among lesion locations/size, or in the age at the start of the treatment. No obvious AEs were reported. CONCLUSIONS: 2% topical propranolol cream is safe and effective for the treatment of proliferating infantile strawberry hemangiomas.