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1.
Medicina (B Aires) ; 80(1): 84-86, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32044745

RESUMO

Klippel-Trenaunay-Weber syndrome (KTWS) is a rare venous malformation that generally affects the lower limbs and, more infrequently, the upper limbs. It is characterized by cutaneous angiomatous formations, varicose veins and hypertrophy of the affected limb. The involvement of the genitourinary tract is extremely infrequent. We expose the case of a 14 years old female patient who was admitted for macroscopic hematuria of 48 hours of evolution and metrorrhagia with severe hemodynamic decompensation. The patient was under study for presenting a hemangioma in the lower left limb that extended to the pelvic region. Urethrocystofibroscopy showed the presence of multiple wide-spread angiomatous lesions in the bladder, some of them with active bleeding. The angio-resonance showed a voluminous hypervascular formation in contact with the bladder wall showing several arteriovenous fistulas at the pelvic level and in the left lower limb confirming the etiological diagnosis. A selective arterial embolization of the internal and external iliac territories was performed and then, a laser endocoagulation of the bleeding angiomatous foci was carried out. The hematuria completely stopped within 24 hours later of the procedure. The metrorrhagia associated with KTWS was controlled by the use of LHRH analogs and progestogens.


Assuntos
Procedimentos Endovasculares/métodos , Síndrome de Klippel-Trenaunay-Weber/cirurgia , Metrorragia/cirurgia , Adolescente , Feminino , Doenças da Vesícula Biliar/patologia , Doenças da Vesícula Biliar/cirurgia , Hemangioma/patologia , Hemangioma/cirurgia , Hematúria/patologia , Hematúria/cirurgia , Humanos , Síndrome de Klippel-Trenaunay-Weber/diagnóstico por imagem , Síndrome de Klippel-Trenaunay-Weber/patologia , Angiografia por Ressonância Magnética/métodos , Metrorragia/patologia , Pelve
2.
World Neurosurg ; 133: e327-e341, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31520760

RESUMO

BACKGROUND: Medical implications of 3-dimensional (3D) printing technology have evolved and are increasingly used. Surgical spine oncology involves at times complex resection using various surgical approaches and unique spinal reconstruction. As high general complication rates, including hardware failure, are reported, careful preoperative planning and optimized fixation techniques should be performed. 3D printing technology allows the improvement of preoperative planning, practice and exploration of various surgical approaches, and designing customized surgical tools and patient specific implants. OBJECTIVE: To investigate the use of 3D printing technology in complex spine surgeries. METHODS: Between 2015 and 2018, all complex spine oncological cases were evaluated and assessed for the possible benefit of use of 3D printing technology. Following high-quality imaging, a computerized integrated 3D model was created. Based on the planned procedure considering the various surgical steps, a customized 3D model was planned and printed, and in select cases a 3D custom-made implant was designed and printed in various sizes with matching trials. RESULTS: A total of 7 cases were selected for the use of a 3D printing technology. For all, a custom-made model was created. In 3 of these cases, a customized 3D-printed implant was used. Special customized intraoperative instruments were made for 2 cases, and a simulated surgical approach was performed in 5 cases. In 2 cases, pre-bent rods were made based on the model created and were used in surgery later on. CONCLUSIONS: For complex spine oncology cases, the use of 3D printing allowed better preoperative planning, simplified the operative procedure, and enabled improved reconstruction.


Assuntos
Imagem por Ressonância Magnética , Modelos Anatômicos , Impressão Tridimensional , Próteses e Implantes , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias da Coluna Vertebral/cirurgia , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Transplante Ósseo , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/secundário , Carcinoma Ductal de Mama/cirurgia , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/secundário , Carcinoma de Células Renais/cirurgia , Condrossarcoma/diagnóstico por imagem , Condrossarcoma/patologia , Condrossarcoma/cirurgia , Desenho de Equipamento , Feminino , Tumores de Células Gigantes/diagnóstico por imagem , Tumores de Células Gigantes/patologia , Tumores de Células Gigantes/cirurgia , Hemangioma/diagnóstico por imagem , Hemangioma/patologia , Hemangioma/cirurgia , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoma Osteoide/diagnóstico por imagem , Osteoma Osteoide/patologia , Osteoma Osteoide/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Sarcoma de Ewing/diagnóstico por imagem , Sarcoma de Ewing/secundário , Sarcoma de Ewing/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/patologia , Neoplasias da Coluna Vertebral/secundário , Cirurgia Assistida por Computador/instrumentação , Instrumentos Cirúrgicos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/patologia , Vértebras Torácicas/cirurgia , Adulto Jovem
3.
World Neurosurg ; 133: e129-e134, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31476453

RESUMO

OBJECTIVE: Choroidal hemangioma (CH) is a benign vascular tumor that induces subretinal fluid collection or exudative retinal detachment and consequent visual symptoms. Current standard treatments for CH include cryotherapy, diathermy, photocoagulation, photodynamic therapy, transpupillary thermotherapy, and radiation therapy. Stereotactic radiosurgery has recently been applied to the treatment of CH because of its characteristic stiff dose-fall-off and accuracy. We have adopted gamma knife radiosurgery (GKRS) to treat CH and have retrospectively assessed tumor volume reductions and improvements to visual acuity achieved thereby. METHODS: Fourteen patients with CHs were treated with GKRS from November 2006 to December 2017. Eight patients had circumscribed CH, and 6 exhibited diffuse CHs and were diagnosed with Sturge-Weber syndrome. The mean age of patients was 27.1 years (range: 8-68 years) and the mean duration of clinical or radiological follow-up was 40.2 months (range: 5-105 months). The mean volume of the tumors at the time of GKRS was 533.5 mm3 (range: 124-1150 mm3), and the mean prescribed marginal dose was 11.6 Gy (range: 10-16 Gy) with 50% isodose lines. RESULTS: The tumor volume decreased by the last follow-up in all patients. The visual acuity improved in 9 patients (64%) and decreased in 1 (7%). Six patients (43%) required trans-pars plana vitrectomy before or after GKRS. There were no symptomatic complications from radiation injury during the follow-up periods. CONCLUSIONS: GKRS could be an acceptable alternative treatment for symptomatic CH when standard therapy is not feasible.


Assuntos
Neoplasias da Coroide/cirurgia , Hemangioma/cirurgia , Radiocirurgia , Adolescente , Adulto , Idoso , Criança , Neoplasias da Coroide/complicações , Neoplasias da Coroide/patologia , Neoplasias da Coroide/terapia , Terapia Combinada , Feminino , Seguimentos , Hemangioma/complicações , Hemangioma/patologia , Hemangioma/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Carga Tumoral , Transtornos da Visão/etiologia , Adulto Jovem
4.
Medicine (Baltimore) ; 98(50): e18285, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852104

RESUMO

RATIONALE: Compressive myelopathy and compression fracture of aggressive vertebral hemangioma after parturition is a rare condition. Vertebral body compression fracture and high serum progesterone lead to extraosseous hemangioma enlargment cause narrowing the spinal canal which contribute to compressive myelopathy relate to pregnancy. PATIENT CONCERNS: We report a case of compressive myelopathy and compression fracture of aggressive vertebral hemangioma after parturition in a 35-year-old woman. The patient complained unable to walk and experienced intense pain in the back. DIAGNOSIS: Based on the clinical features and imaging studies, the patient underwent a T4-T6 laminectomy. Histopathology consistent with vertebral hemangioma. INTERVENTIONS: The patient underwent laminectomy for decompression. After subperiosteal dissection of the paraspinal muscles and exposure of the laminae, there was no involvement of the lamina by the tumor. The epidural tumor was removed through the spaces lateral to the thecal sac. Vertebroplasty was performed through T5 pedicles bilaterally and 7 ml of polymethylmethacrylate (PMMA) cement was injected. T4-T6 pedicle screw fixation was performed for segmental fixation and fusion. OUTCOMES: Six months after resection of the tumor the patient remained asymptomatic. She reported no low back pain and had returned to her normal daily activities, with no radiographic evidence of recurrence on MRI. Physical examination revealed that superficial and deep sensation was restored to normal levels in the lower extremities. LESSONS: The occurrence of compressive myelopathy of pregnancy related vertebral hemangiomas is quite unusual. It can lead to serious neurologic deficits if not treated immediately. So, prompt diagnosis is important in planning optimal therapy and preventing morbidity for patients.


Assuntos
Fraturas por Compressão/complicações , Hemangioma/complicações , Parto , Compressão da Medula Espinal/etiologia , Fraturas da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/complicações , Vértebras Torácicas , Adulto , Descompressão Cirúrgica/métodos , Feminino , Fraturas por Compressão/diagnóstico , Fraturas por Compressão/cirurgia , Hemangioma/diagnóstico , Hemangioma/cirurgia , Humanos , Imagem por Ressonância Magnética , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/cirurgia , Vertebroplastia/métodos
5.
J Cardiothorac Surg ; 14(1): 186, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690322

RESUMO

BACKGROUND: Cardiac hemangiomas are rare cardiac neoplasia usually diagnosed in autopsies, from being asymptomatic to debuting with sudden death. The largest hemangioma published in the literature is of 130 mm size, we present the following case of a successful cardiac hemangioma excision of 280 × 35 mm in size, diagnosed due to recurrent cardiac symptoms. CASE PRESENTATION: A 48-year-old female patient, Jehovah's Witness, with no previous diagnoses, is admitted due to recurrent syncopal episodes in the previous months. A transthoracic echocardiogram diagnosed a tumor in the right atrium and inferior vena cava producing a diastolic right ventricular, with preservation of the left ventricular ejection fraction at 55%. Given the high mortality risk, a surgical intervention was performed immediately. Successful excision was completed confirming a 280 × 35 mm mass without any complications, consistent with hemangioma on histopathology. Postoperative recovery showed no recurrence or complications. CONCLUSIONS: Cardiac hemangiomas are rare and its clinical course can be varied from patient to patient. We present excision of a large cardiac mass with a high mortality risk due to its size and the patient's spiritual beliefs.


Assuntos
Átrios do Coração , Neoplasias Cardíacas/diagnóstico , Hemangioma/diagnóstico , Veia Cava Inferior , Diagnóstico Diferencial , Ecocardiografia , Feminino , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Hemangioma/complicações , Hemangioma/diagnóstico por imagem , Hemangioma/cirurgia , Humanos , Testemunhas de Jeová , Pessoa de Meia-Idade , Síncope/etiologia
6.
Rev Port Cir Cardiotorac Vasc ; 26(3): 235-238, 2019.
Artigo em Português | MEDLINE | ID: mdl-31734979

RESUMO

Synovial hemangioma is a rare nonneoplastic vascular malformation of the synovial membrane described by Bouchut in 1856. Fewer than 200 cases have been described in the literature, corresponding to 1% of all hemangiomas. The presenting symptoms are often non-specific, which often leads to a delay in diagnosis of many years and can result in arthropathy if left undetected. The early diagnosis of a synovial haemangioma is important as recurrent haemarthrosis may lead to irreversible joint damage and chronic inflammatory synovitis. In practice, there is no consensus on the best treatment of synovial hemangiomas in children. Total resection of the tumor can be performed by arthroscopy in localized forms and for small lesions. Open resection associated with synovectomy is necessary when the hemangioma occupies most of synovial membrane.


Assuntos
Hemangioma/diagnóstico por imagem , Artropatias/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Membrana Sinovial/diagnóstico por imagem , Criança , Hemangioma/cirurgia , Humanos , Artropatias/cirurgia , Articulação do Joelho/cirurgia , Imagem por Ressonância Magnética , Sinovectomia
7.
Orv Hetil ; 160(41): 1639-1643, 2019 Oct.
Artigo em Húngaro | MEDLINE | ID: mdl-31587577

RESUMO

The endoscopic middle ear surgery as a new technique has been introduced during the past few years in our country and it is available in only a few hospitals. Beyond the lack of external incision, endoscopic transcanal approach provides wide field of view to previously hidden middle ear spaces compared to the traditional microscopic technique. In this case report, we present an endoscopic surgery of middle ear capillary haemangioma that is a rare entity in tympanic cavity, therefore little has been published in the literature. Generally, these kind of vascular tumours occur in the internal auditory canal or in the perigeniculate ganglion area while this lesion originated from the inner surface of the inferior part of the bony tympanic ring. We discuss the difficulties in differential diagnosis and imaging tests then the treatment options. Orv Hetil. 2019; 160(41): 1639-1643.


Assuntos
Neoplasias da Orelha/cirurgia , Orelha Média/diagnóstico por imagem , Hemangioma/cirurgia , Timpanoplastia/métodos , Neoplasias da Orelha/patologia , Endoscopia , Feminino , Hemangioma/patologia , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento
8.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(5): 233-237, sept.-oct. 2019. ilus
Artigo em Inglês | IBECS | ID: ibc-183877

RESUMO

Vertebral hemangiomas are relatively common, but those causing spinal cord compression are rare. A 19-year-old male presented with thoracic back pain. The neurologic examination was normal and radiological examinations demonstrated an aggressive vertebral hemangioma centered within the T11 vertebral body. Damaged vertebral bone and soft tissue components of the mass were observed in the epidural space. Surgery was performed using a new technique involving radiofrequency ablation, injection of a hemostatic agent (FLOSEAL, Baxter, USA), and bone autograft placement in the affected vertebral body. There were no complications intra- or postoperatively, and the patient's back pain resolved completely during the postsurgical period. Bleeding is a serious issue in cases of aggressive vertebral hemangioma. This new technique provides improved bleeding control and strengthens the affected vertebra through autograft placement


Los hemangiomas vertebrales son relativamente comunes, pero los que causan la compresión de la médula espinal son raros. Un hombre de 19 años presentó dolor de espalda torácica. El examen neurológico fue normal y los exámenes radiológicos demostraron un hemangioma vertebral agresivo centrado en el cuerpo vertebral T11. Se observaron componentes óseos y vertebrales dañados de la masa en el espacio epidural. La cirugía se realizó utilizando una nueva técnica que incluía ablación por radiofrecuencia, inyección de un agente hemostático (FLOSEAL, Baxter, EE. UU.) Y colocación de autoinjerto de hueso en el cuerpo vertebral afectado. No hubo complicaciones intra y postoperatorias, y el dolor de espalda del paciente se resolvió completamente durante el período posquirúrgico. El sangrado es un problema grave en los casos de hemangioma vertebral agresivo. Esta nueva técnica proporciona un mejor control de la hemorragia y fortalece la vértebra afectada a través de la colocación del autoinjerto


Assuntos
Humanos , Masculino , Adulto Jovem , Hemangioma/diagnóstico por imagem , Hemangioma/cirurgia , Ablação por Radiofrequência/métodos , Hemostáticos/administração & dosagem , Transplante Autólogo/métodos , Medula Espinal/patologia , Dor nas Costas/etiologia , Espaço Epidural/diagnóstico por imagem , Espaço Epidural/cirurgia
9.
BMJ Case Rep ; 12(8)2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31451469

RESUMO

We present a rare and unusual case of a 16-year-old girl, with no significant medical history, presenting with right nasal obstruction and suspected sinusitis with occasional epistaxis and haemoptysis. On examination, she had a mass lesion in the right nasal cavity, with no evidence of other pathology on assessment of the ears, nose, throat or head and neck. A CT scan revealed an opacified right maxillary sinus with polypoidal mucosa, extending and passing through the accessory ostium into the right nasal cavity. Examination under anaesthesia with functional endoscopic sinus surgery and excision of the lesion was subsequently undertaken. Histological analysis confirmed the mass lesion as a haemangioma. This case report is the first to present a maxillary haemangioma presenting as nasal obstruction with intermittent sinusitis symptoms in a child. The authors discuss the incidence, presentation and management of maxillary haemangiomas in the paediatric population.


Assuntos
Hemangioma , Neoplasias do Seio Maxilar , Sinusite Maxilar , Obstrução Nasal/diagnóstico , Cirurgia Endoscópica por Orifício Natural/métodos , Adolescente , Diagnóstico Diferencial , Feminino , Hemangioma/patologia , Hemangioma/fisiopatologia , Hemangioma/cirurgia , Humanos , Seio Maxilar/diagnóstico por imagem , Seio Maxilar/patologia , Neoplasias do Seio Maxilar/patologia , Neoplasias do Seio Maxilar/fisiopatologia , Sinusite Maxilar/diagnóstico , Sinusite Maxilar/etiologia , Cavidade Nasal/diagnóstico por imagem , Cavidade Nasal/patologia , Obstrução Nasal/etiologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
10.
J Dermatol ; 46(10): 835-842, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31373042

RESUMO

Kaposiform hemangioendothelioma (KHE) and tufted angioma (TA) primarily occurring in infants are difficult to distinguish. This study evaluated ultrasonography (US) and magnetic resonance imaging (MRI) features of KHE and TA. Pathologically proven TA (n = 21) and KHE (n = 40 [11 KHE + Kasabach-Merritt phenomenon [KMP]]) occurring between January 2015 and December 2017 were reviewed. US (n = 61) and MRI (n = 50) findings were retrospectively evaluated. On US, KHE and TA lesions were subcutaneous, while 40% of KHE exhibited an infiltrative pattern extending into adjacent muscles. Of TA lesions, 42.9% were hyperechoic and 96.15% of KHE lesions exhibited mixed echogenicity. Of TA lesions, 76.2% exhibited well-defined margins and all KHE lesions exhibited ill-defined margins. The depth and vascular density of KHE and KHE + KMP were significantly increased compared with TA. The arterial peak systolic blood flow velocity of KHE + KMP was significantly higher than that in TA and KHE. KHE and KHE + KMP were significantly harder than TA on elastography. 3-D color Doppler revealed branch-shape blood flow for KHE and KHE + KMP lesions; for TA, it revealed a dot-like and striped pattern. Considering MRI findings, KHE and KHE + KMP were more likely to exhibit diffuse heterogeneous enhancement after contrast than TA. KHE was infiltrative and more likely to be thick, hypoechoic, ill-defined, richly vascular and hard than TA on US. KHE lesions were subcutaneous and reticular, with heterogeneous enhancement on MRI. Awareness of these features should prompt radiologists in the differential diagnosis of pediatric masses.


Assuntos
Hemangioendotelioma/diagnóstico por imagem , Hemangioma/diagnóstico por imagem , Síndrome de Kasabach-Merritt/diagnóstico por imagem , Sarcoma de Kaposi/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Adolescente , Adulto , Criança , Pré-Escolar , Meios de Contraste/administração & dosagem , Diagnóstico Diferencial , Técnicas de Imagem por Elasticidade/métodos , Feminino , Gadolínio DTPA/administração & dosagem , Hemangioendotelioma/cirurgia , Hemangioma/cirurgia , Humanos , Imagem Tridimensional , Lactente , Síndrome de Kasabach-Merritt/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Estudos Retrospectivos , Sarcoma de Kaposi/cirurgia , Pele/irrigação sanguínea , Pele/diagnóstico por imagem , Neoplasias Cutâneas/cirurgia , Ultrassonografia Doppler em Cores , Adulto Jovem
11.
J Craniofac Surg ; 30(5): e402-e404, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31299792

RESUMO

Subglottic and mediastinal hemangioma are rare benign vascular tumors of childhood. They cause potentially life threatening condition which requires intervention. Several therapeutic options have been described in the literature with varying degrees of success and complications. We report a case of a stridulous 2-month old female infant with mediastinal and subglottic hemangioma. The child was treated with propranolol without the need for tracheostomy or any other surgical intervention, and with no reported side effects. Propranolol is an effective, non-invasive treatment for life threatening infantile hemangiomas compressing the airway, should be used as a firstline treatment for subglottic hemangiomas when intervention is required.


Assuntos
Hemangioma Capilar/cirurgia , Hemangioma/cirurgia , Neoplasias Laríngeas/cirurgia , Neoplasias do Mediastino/cirurgia , Feminino , Hemangioma/tratamento farmacológico , Hemangioma Capilar/tratamento farmacológico , Humanos , Lactente , Neoplasias Laríngeas/tratamento farmacológico , Neoplasias Laríngeas/patologia , Neoplasias do Mediastino/tratamento farmacológico , Neoplasias do Mediastino/patologia , Propranolol/uso terapêutico , Traqueostomia , Resultado do Tratamento
12.
J Nippon Med Sch ; 86(3): 179-182, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31292330

RESUMO

Littoral cell angioma (LCA), a rare vascular neoplasm that occurs in the spleen, is difficult to definitively diagnose preoperatively because histological examination is the only accurate means of diagnosing this condition. Thus, the preoperative diagnosis is often incorrect. Splenectomy is the appropriate treatment and can be performed laparoscopically or by open surgery depending on the size of the tumor. Here we present a case of a 38-year-old man who presented with a history of slight non-specific abdominal distension for 2 months. An abdominal CT scan showed a huge spleen measuring 35×18 cm and containing multiple lesions, the largest being 11.3×9.2 cm. The patient underwent open splenectomy and recovered well. Histological examination showed LCA of the spleen. To our knowledge, this is the largest reported LCA thus far and may advance our understanding of this condition.


Assuntos
Hemangioma/patologia , Hemangioma/cirurgia , Baço/diagnóstico por imagem , Baço/patologia , Esplenectomia/métodos , Neoplasias Esplênicas/patologia , Neoplasias Esplênicas/cirurgia , Adulto , Seguimentos , Hemangioma/diagnóstico por imagem , Humanos , Masculino , Neoplasias Esplênicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
13.
Medicine (Baltimore) ; 98(27): e16410, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277198

RESUMO

RATIONALE: Hepatic hemangioma (HH) is a common benign tumor with a high number of normal or abnormal blood vessels. Intrahepatic cholangiocarcinoma (ICC) is a relatively common malignant primary hepatic carcinoma (10%-15%) with high incidence rate and high fatality, yet low discovery rate in the early stages. Ultrasonography (US), computed tomography, and magnetic resonance imaging (MRI) are frequently used and indispensable imaging techniques for the diagnosis of hepatic lesions. It is possible to differentiate a liver lesion from HH with high accuracy owing to their different patterns and hemodynamic characteristics. PATIENT CONCERNS: A 59-year-old Asian woman was referred to hospital for a hepatic mass, which was 9.0 × 6.5 cm in size, The patient was tested positive for hepatitis B antigen but negative for serum alpha-fetoprotein and carbohydrate antigen 199 and had a slightly elevated carcinoembryonic antigen level (3.56 ng/ml). DIAGNOSIS: Liver US and MRI were performed. Grey-scale US revealed a huge heterogeneous mass on the right lobe with a point and line-like blood flow signal on Doppler US. Dynamic contrast-enhanced MRI showed heterogeneous annular nodular enhancement in the arterial phase. An initial diagnosis of HH was made based on the clinical history and imaging results; however, histopathologic examination of the liver lesions revealed modest to severe atypical hyperplasia of intrahepatic bile duct epithelium, cancerization, and mid to high differentiated mass-forming type cholangiocarcinoma combined with focal organized hemangioma. INTERVENTIONS: The intrahepatic mass-forming cholangiocarcinoma (IMCC) lesion was considered a focal organization of hemangioma during operation and was surgically removed. No routine chemotherapy was performed after the operation. OUTCOMES: The IMCC recurred 23 months after surgery, with elevated serum CA19-9 and CA125. Liver damage was evident, and the patient developed jaundice. The patient was discharged without active treatment and died in 4 months. LESSONS: Although preoperative imaging of focal hepatic lesions is indispensable, intraoperative frozen section analysis and histopathological examination remain essential for definitive diagnosis. This is particularly important for high-risk patients and those with suspected malignancy.


Assuntos
Neoplasias dos Ductos Biliares/diagnóstico , Colangiocarcinoma/diagnóstico , Hemangioma/diagnóstico , Hemangioma/cirurgia , Neoplasias Hepáticas/diagnóstico , Neoplasias dos Ductos Biliares/cirurgia , Colangiocarcinoma/cirurgia , Feminino , Humanos , Neoplasias Hepáticas/cirurgia , Pessoa de Meia-Idade
15.
Int J Hyperthermia ; 36(1): 632-639, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31244349

RESUMO

Purpose: Microwave ablation (MWA) has become increasingly popular as a minimally invasive treatment for benign and malignant liver tumors. However, few studies have demonstrated the benefits and disadvantages of MWA compared to surgical resection (SR) for large hepatic hemangiomas. This study aimed to evaluate the safety and effectiveness of MWA compared to SR for large (5-10 cm) hepatic hemangiomas. Methods and materials: This retrospective comparative study included 112 patients with large, symptomatic hepatic hemangiomas who had been treated with MWA (n = 44) or SR (n = 68) and followed up for a median of 44 months using enhanced computed tomography (CT) or magnetic resonance imaging (MRI). Intraoperative information, postoperative recovery time, postoperative discomfort and complications and treatment effectiveness between groups were compared using a chi-square test or an independent t-test. Results: The operative time was significantly shorter (31.3 ± 21.76 versus 148.1 ± 59.3 min, p < .001) and the blood loss (10.2 ± 60.6 versus 227.9 ± 182.9 mL, p < .0001) and rate of prophylactic abdominal drainage [1 (2.3%) versus 57 (83.8%), p < .001] were significantly lower in the MWA group than in the SR group. Postoperative recovery of the MWA group in regard to indwelling catheter time, normal diet time, incision cicatrization time and hospital stay (p < .001) was significantly better than the SR group. However, no statistically significant difference in effectiveness was noted between the groups (p = .58). Conclusions: MWA may be as effective as SR, and potentially safer for treating large, symptomatic hepatic hemangiomas. To confirm our findings, large-sample, multicentered, randomized controlled trials are needed.


Assuntos
Ablação por Cateter/métodos , Hemangioma/cirurgia , Neoplasias Hepáticas/cirurgia , Micro-Ondas/uso terapêutico , Feminino , Hemangioma/diagnóstico por imagem , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Ultrassonografia
16.
Vet Surg ; 48(8): 1507-1513, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31179565

RESUMO

OBJECTIVE: To describe the use of an identifiable tumor plane (ITP) during myelotomy to excise an intramedullary hemangioma in a dog and report the outcome. STUDY DESIGN: Case report. ANIMALS: One 5.5-year-old 42.9-kg spayed female Leonberger dog. METHODS: Clinical signs included progressive proprioceptive deficits of both pelvic limbs. Magnetic resonance imaging was consistent with a dorsal intramedullary mass at L3-L4. A laminectomy of the third and fourth lumbar vertebrae provided access for dorsal myelotomy. A clear surgical ITP was identified between the intramedullary mass and the spinal cord facilitating complete surgical resection. RESULTS: Histopathological examination was consistent with a hemangioma. Postoperative MRI was consistent with complete excision of the mass. No evidence of recurrence was found by MRI at 3 months and at 22 months after surgery. Mild proprioceptive deficits persisted in the right pelvic limb. CONCLUSION: A clear ITP was present, and gross-total resection (GTR) was achieved without significant morbidity. Persistent clinical remission resulted from surgery as the sole therapy. CLINICAL SIGNIFICANCE: For an intramedullary tumor, GTR is the absence of visible tumor on intraoperative inspection combined with the absence of intramedullary contrast enhancement on postoperative MRI. When an ITP is present, GTR and resultant long-term remission may be more likely.


Assuntos
Doenças do Cão/cirurgia , Hemangioma/veterinária , Neoplasias da Medula Espinal/veterinária , Animais , Doenças do Cão/diagnóstico por imagem , Cães , Feminino , Hemangioma/diagnóstico por imagem , Hemangioma/cirurgia , Imagem por Ressonância Magnética/veterinária , Neoplasias da Medula Espinal/cirurgia , Resultado do Tratamento
17.
BMJ Case Rep ; 12(6)2019 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-31229987

RESUMO

The majority of epistaxes are anterior in nature, resolve with simple first aid measures and require no further follow-up. However, some cases pose more of a diagnostic challenge and prove resistant to standard investigation and treatment. We present a case of recurrent epistaxis, refractory to multiple treatment modalities and with CT imaging suggestive of a vascular aetiology which was ultimately disproved. The case highlights the shortcomings of CT imaging and importance of thorough examination technique. Nasal haemangiomas are a rare but recognised cause of epistaxis and should be considered in refractory cases.


Assuntos
Epistaxe/etiologia , Hemangioma/complicações , Nariz/patologia , Idoso , Aneurisma , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/patologia , Angiografia por Tomografia Computadorizada/métodos , Angiografia por Tomografia Computadorizada/estatística & dados numéricos , Diagnóstico Diferencial , Feminino , Hemangioma/diagnóstico por imagem , Hemangioma/cirurgia , Humanos , Nariz/irrigação sanguínea , Nariz/diagnóstico por imagem , Resultado do Tratamento
19.
Ir Med J ; 112(4): 921, 2019 04 11.
Artigo em Inglês | MEDLINE | ID: mdl-31081300

RESUMO

Introduction Primary cardiac tumours are rare. We report the first known case of congenital cardiac haemangioma in Ireland. Case A neonate presented with symptoms arising from a congenital atrial haemangioma on day three of life. The mass was successfully excised via median sternotomy and bicaval cannulation for cardiopulmonary bypass. The patient was discharged day ten postoperatively and remained well at one year follow-up. Discussion The degree of debulking surgery required varies depending on tumour type. This report serves to aid clinicians in accurately suspecting, investigating and diagnosing patients with cardiac tumours.


Assuntos
Neoplasias Cardíacas/congênito , Hemangioma/congênito , Feminino , Átrios do Coração/cirurgia , Neoplasias Cardíacas/cirurgia , Hemangioma/cirurgia , Humanos , Recém-Nascido
20.
Prog Neurol Surg ; 34: 223-231, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31096251

RESUMO

Leksell stereotactic radiosurgery has proven to be effective for less common tumors encountered in the brain, including hemangiomas of the orbit or cavernous sinus, recurrent hemangiopericytomas, and both sporadic hemangioblastomas as well as those encountered in the context of von Hippel-Lindau (VHL) disease. While all three tumors are responsive to single-session radiosurgery, hemangiomas and hemangiopericytomas are the most likely to demonstrate tumor regression. Hemangiopericytomas that recur after initial resection can be lower grade or anaplastic and have both higher local as well as distant recurrence risks. Sporadic hemangioblastomas undergo Leksell radiosurgery at the time of recurrence after initial surgery. In the context of VHL, growing or recurrent tumors are treated with tumor control rates exceeding 90%. Tumor control improves with higher dose delivery, typically >15 Gy at the margin. Dose-limiting structures may include the optic apparatus for hemangiomas and brain stem locations for hemangioblastomas.


Assuntos
Neoplasias Encefálicas/radioterapia , Hemangioblastoma/radioterapia , Hemangioma/radioterapia , Hemangiopericitoma/radioterapia , Recidiva Local de Neoplasia/radioterapia , Radiocirurgia/métodos , Doença de von Hippel-Lindau/radioterapia , Neoplasias Encefálicas/cirurgia , Hemangioblastoma/cirurgia , Hemangioma/cirurgia , Hemangiopericitoma/cirurgia , Humanos , Recidiva Local de Neoplasia/cirurgia , Doença de von Hippel-Lindau/cirurgia
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