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1.
Medicine (Baltimore) ; 100(1): e24146, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429792

RESUMO

ABSTRACT: Since 2008, oral propranolol has evolved as the first-line therapy for infantile hemangiomas (IHs). Meanwhile, oral atenolol gradually shows comparative effectiveness versus oral propranolol with few side effects. Here, we conducted a mobile internal survey among a group of Chinese clinicians about how they choose the dosage, dose regimen, and dose escalation methods of propranolol and atenolol for the treatment of IH.A mobile-ready internal survey on the application of oral propranolol and oral atenolol for IH in mainland China was performed and distributed to 333 potential clinicians from different levels of healthcare institutions in mainland China. Eighty-one doctors responded to the survey. All the respondents had the experience of treating IH with oral propranolol and 32 had the experience with oral atenolol.Most of the doctors from tertiary hospitals chose 2 mg/kg/d twice daily, while most of those with the experience of propranolol from private hospitals chose 1 mg/kg/d once daily. More doctors from tertiary hospitals had the experience of atenolol than those from private hospitals.Oral atenolol has become another medication intervention option for IH in mainland China. This survey is helpful to standardize and develop a guideline of oral atenolol therapy for IH.


Assuntos
Atenolol/farmacologia , Hemangioma/tratamento farmacológico , Propranolol/farmacologia , Administração Oral , Anti-Hipertensivos/farmacologia , Anti-Hipertensivos/uso terapêutico , Atenolol/uso terapêutico , China , Feminino , Hemangioma/complicações , Humanos , Lactente , Masculino , Propranolol/uso terapêutico , Inquéritos e Questionários , Resultado do Tratamento
2.
Medicine (Baltimore) ; 99(33): e21741, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872061

RESUMO

RATIONALE: Hemangiomas are usually found in cutaneous or mucosal layers, less than 1% of hemangiomas develop in skeletal muscles. Intramuscular hemangioma (IH) in the head and neck areas is relatively infrequent, accounting for 15% of IH. Most of them are identified as a benign mass, and rapid changes in size or internal bleeding are rare. PATIENT CONCERNS: A 60-year-old female patient presented with a 2-week history of sudden onset posterior neck pain. There was no neurological deficit except limited neck motion due to pain. The palpable mass was noted on the paraspinal muscles of cervicothoracic junction, which was located midline to left side portion with tenderness. DIAGNOSES: Magnetic resonance imaging demonstrated a round shaped, multi-lobulated, and well-defined mass lesion (4.1 × 2.6 × 0.9 cm) embedded from the inter-spinous space of T1-2 to the left paraspinal muscles. The lesion was iso-intense on T2-weighted images (WI), iso- to slightly low-intense on T1-WI, heterogeneous enhancement of intra- and peri-mass lesion on contrast-enhanced T1-WI. Vascular structures presented as signal voids were identified internally and around the mass lesion. Histological examination revealed a mixed-type hemangioma. INTERVENTIONS: The mass was removed completely including some of the surrounding muscles where boundaries were unclear between the mass and surrounding muscles with ligation of peritumoral vessels. Dark-brown colored blood was drained from the ruptured tumor capsule during the dissection. There was no bony invasion. OUTCOMES: The preoperative symptoms improved immediately after the operation. There is no residual or recurrence lesion by the 15-months follow-up. LESSONS: IH with hemorrhagic transformation in the head and neck is extremely rare. In the case of intramuscular tumors accompanied by a sudden onset of severe acute pain, we recommend considering a differential diagnosis of IH with hemorrhagic transformation. Complete resection of the tumor mass including surrounding muscles is required to prevent recurrence.


Assuntos
Neoplasias de Cabeça e Pescoço/patologia , Hemangioma/patologia , Músculos Paraespinais/patologia , Feminino , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/cirurgia , Hemangioma/complicações , Hemangioma/diagnóstico por imagem , Hemangioma/cirurgia , Hemorragia/etiologia , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Músculos Paraespinais/diagnóstico por imagem , Músculos Paraespinais/cirurgia
5.
Ann Vasc Surg ; 69: 453.e1-453.e4, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32653614

RESUMO

A 16-year-old male was brought to our hospital presenting with acute onset of a painful protruding left neck mass within a day, associated with left upper-arm tenderness. Chest computed tomography revealed high attenuation masses at the left supraclavicular and mediastinal regions, suspected of being venous vascular tumors. Surgery was arranged and then ruptured venous tumor was noted, with pathology results determining a venous malformation.


Assuntos
Implante de Prótese Vascular , Veias Braquiocefálicas/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Hemangioma/cirurgia , Veias Jugulares/cirurgia , Cervicalgia/etiologia , Adolescente , Veias Braquiocefálicas/diagnóstico por imagem , Veias Braquiocefálicas/patologia , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/patologia , Hemangioma/complicações , Hemangioma/diagnóstico por imagem , Hemangioma/patologia , Humanos , Veias Jugulares/diagnóstico por imagem , Veias Jugulares/patologia , Ligadura , Masculino , Cervicalgia/diagnóstico , Ruptura Espontânea , Resultado do Tratamento
6.
Ann R Coll Surg Engl ; 102(9): e1-e4, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32538112

RESUMO

Liver haemangiomas are common, but their size very rarely exceeds 40cm. Most people with liver haemangiomas are asymptomatic, and diagnosis is usually made incidentally during imaging for other complaints. When a liver haemangioma is symptomatic or produces complications, surgical intervention may be warranted. Kasabach-Merritt syndrome is an uncommon complication reported in certain rare vascular tumours in children, with only a few cases reported in adults. The syndrome describes a consumptive coagulopathy initiated within a vascular tumour, mainly tufted angiomas and kaposiform haemangioendotheliomas and, less commonly, giant haemangiomas. The process can extend beyond the tumour and become disseminated in certain cases due to trauma or surgery. The definitive treatment for giant liver haemangiomas can include arterial embolisation, surgical excision, hepatectomy or even liver transplantation. We report the case of a 32-year-old woman with a 42 × 32 × 27cm (18,870ml) liver haemangioma associated with Kasabach-Merritt syndrome. The diagnosis was challenging, even with proper imaging, owing to the rarity of the condition. It was achieved with an exploratory laparotomy with biopsy.


Assuntos
Hemangioma/complicações , Síndrome de Kasabach-Merritt/etiologia , Neoplasias Hepáticas/complicações , Adulto , Feminino , Hemangioma/diagnóstico , Hemangioma/patologia , Humanos , Síndrome de Kasabach-Merritt/diagnóstico , Síndrome de Kasabach-Merritt/patologia , Fígado/patologia , Fígado/cirurgia , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia
7.
Vasc Endovascular Surg ; 54(6): 540-543, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32452288

RESUMO

A 70-year-old man was referred to our hospital for an abnormal chest shadow. Enhanced computed tomography (CT) revealed 2-humped bronchial artery aneurysms (BAAs) associated with racemose hemangioma. The combined therapy of transcatheter bronchial artery embolization and thoracic endovascular aortic repair was performed. Postoperative CT confirmed the complete exclusion of the aneurysms with no evidence of an endoleak. Our result suggests that this combined therapy is a safe and effective treatment for BAA.


Assuntos
Aneurisma/terapia , Aorta Torácica/cirurgia , Implante de Prótese Vascular , Artérias Brônquicas , Neoplasias Brônquicas/complicações , Embolização Terapêutica , Procedimentos Endovasculares , Hemangioma/complicações , Idoso , Aneurisma/diagnóstico por imagem , Aneurisma/etiologia , Aorta Torácica/diagnóstico por imagem , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Artérias Brônquicas/diagnóstico por imagem , Neoplasias Brônquicas/diagnóstico por imagem , Terapia Combinada , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Hemangioma/diagnóstico por imagem , Humanos , Masculino , Resultado do Tratamento
10.
Radiology ; 295(1): 240-244, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32176598

RESUMO

HistoryA 34-year-old man presented to the emergency department of our hospital for progressive shortness of breath and worsening productive cough of 2 weeks duration. He reported a 10-kg weight loss over 4 months but denied experiencing fever, chills, night sweats, or gastrointestinal, musculoskeletal, or neurologic symptoms. His medical history was unremarkable. Although he was a native of Morocco, he had lived in Europe for many years and worked as a truck driver. The patient had a smoking history but had quit smoking 5 years prior to presentation. He denied alcohol abuse or recreational drug use. He did not have any allergies. Besides bilateral clubbing, the physical examination findings were normal. At the time of admission, he had an oxygen (O2) saturation of 87% at ambient air, which increased to 100% with 1 L of O2 administered via a nasal cannula. The blood sample revealed a slight increase in his hemoglobin concentration (18.7 g/dL; normal range, 13.6-17.2 g/dL) and hematocrit level (50.8%; normal range, 39%-49%). His inflammatory parameters were normal, as were his hepatic and renal function. The arterial blood gas test showed partially compensated pulmonary alkalosis (pH, 7.43; normal range, 7.35-7.42; PCO2, 26 mmHg; normal range, 38-42 mmHg; PO2, 89 mmHg; normal range, 75-100 mmHg; bicarbonate level, 17 mEq/L [17 mmol/L]; normal range 22-26 mEq/L [22-26 mmol/L]). The results of the pulmonary function tests were expressed as the percentage of predicted values and were 92% for forced vital capacity, 93% for forced expiratory volume in 1 second, 116% for total lung capacity, and 60% for diffusing capacity of carbon monoxide. Anteroposterior chest radiography and enhanced chest CT were also performed at admission.


Assuntos
Hemangioma/complicações , Neoplasias Pulmonares/complicações , Pneumopatia Veno-Oclusiva/complicações , Adulto , Capilares , Hemangioma/irrigação sanguínea , Humanos , Neoplasias Pulmonares/irrigação sanguínea , Masculino
11.
Spine Deform ; 8(4): 663-668, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32072489

RESUMO

STUDY DESIGN: Cross-sectional comparative study. OBJECTIVES: Evaluate prevalence and clinical relevance of an underlying pathology in painful adolescent idiopathic scoliosis (AIS) patients after a non-diagnostic history, physical examination and spinal X-ray using Magnetic Resonance Image (MRI) as diagnostic tool. Discrepancies regarding indications of routine MRI screening in painful AIS patients are multifactorial. Few studies have investigated relationship and practical importance of painful AIS with an underlying pathology by MRI. METHOD: A total of 152-consecutive AIS patients complaining of back pain during a 36-month period were enrolled. All patients underwent whole-spine MRI after a non-diagnostic history, physical examination and spinal X-ray. Underlying pathologies were reported as neural and non-neural axis abnormalities based on MRI reports. Variables such as sex, age, constant or intermittent pain, night pain, back pain location (thoracic or lumbar pain), Cobb-angle and follow-up were evaluated as clinical markers to predict presence of underlying MRI pathologies. RESULTS: The presence of an underlying pathology was found by MRI in 54 painful AIS patients (35.5%). Isolated syringomyelia was the only neural axis abnormality found in 6 patients (3.9%). Non-neural axis abnormalities (31.6%) were composed by: 32 herniated nucleus pulposus, 5 vertebral disc desiccation, 4 ovarian cysts, 3 renal cysts, 2 sacral cysts, and 2 vertebral hemangiomas. There was no association with gender, age of presentation, initial coronal Cobb angle and follow up; with presence of an underlying pathology. Lumbar pain location was identified as an adequate clinical marker that correlated with presence of an underlying pathology (p = 0.01). CONCLUSIONS: Prevalence of underlying pathologies diagnosed by MRI in painful AIS was found high (35.5%), but it's clinical relevance and implication are debatable. The use of MRI did not affect orthopedic management of painful AIS patients who showed an underlying pathology. A thorough evaluation must be performed by clinicians; and discussed with patients and family prior to undergo further imaging management. LEVEL OF EVIDENCE: Level III.


Assuntos
Dor nas Costas/etiologia , Escoliose/complicações , Coluna Vertebral/diagnóstico por imagem , Adolescente , Vértebra Cervical Áxis/anormalidades , Criança , Estudos Transversais , Feminino , Hemangioma/complicações , Hemangioma/epidemiologia , Humanos , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/epidemiologia , Imagem por Ressonância Magnética , Masculino , Cistos Ovarianos/complicações , Cistos Ovarianos/enzimologia , Prevalência , Escoliose/diagnóstico por imagem , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/epidemiologia , Siringomielia/complicações , Siringomielia/diagnóstico por imagem , Siringomielia/epidemiologia
14.
Spine (Phila Pa 1976) ; 45(2): E99-E110, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31365517

RESUMO

STUDY DESIGN: Meta-analysis. OBJECTIVE: To understand the benefits and limitations of surgical management and adjuvant therapies for patients presenting with neurological deficits from vertebral hemangiomas (VH). SUMMARY OF BACKGROUND DATA: VH is the most common benign spine tumor but rarely causes symptoms. Patients with back pain alone are treated with conservative management (kyphoplasty and radiation therapy), while those with neurological deficits require complex multi-modal treatment plans. METHODS: A PubMed literature search for "symptomatic vertebral hemangioma with spinal cord compression" identified 47 articles. From these articles and their references, 19 observational studies on patients who underwent surgery for VH met inclusion criteria. Meta-analyses were performed comparing outcomes of the surgical and adjuvant therapies using Stata13 software. For those with insufficient data for meta-analyses, descriptive analyses of variables were completed. RESULTS: One hundred ninety seven surgical cases of VH with neurologic deficits were identified. Surgery provided a complete remission of symptoms in 84% of patients, however 18% of patients had recurrence of hemangioma. Adjuvant interventions included radiation, embolization, and kyphoplasty. Radiation therapy (XRT) was associated with a lower recurrence rate and an increase in minor transient adverse effects. Preoperative embolization performed in 98 patients was associated with improved symptoms, reduced complications, lower recurrence rate, less blood loss, and higher incidence of pathologic vertebral fractures. Meta-analyses did not yield statistically significant results, likely due to the heterogeneity amongst the studies and small sample sizes, but the results compiled together provide insight on potential benefits of preoperative embolization for symptomatic relief and reduced risk of recurrence with XRT that deserves further study. CONCLUSION: For patients with neurologic deficits from spinal cord or nerve root compression, surgery provides improvement in symptoms. Recurrence of VH and symptoms refractory to surgery can be further reduced by adjuvant therapies such as embolization, kyphoplasty, and radiation with some unique risks to each therapy. LEVEL OF EVIDENCE: 2.


Assuntos
Embolização Terapêutica , Hemangioma/complicações , Hemangioma/terapia , Recidiva Local de Neoplasia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/terapia , Terapia Combinada , Descompressão Cirúrgica , Hemangioma/patologia , Humanos , Cifoplastia/efeitos adversos , Recidiva Local de Neoplasia/cirurgia , Radiculopatia/etiologia , Radiculopatia/cirurgia , Radioterapia Adjuvante , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/cirurgia
15.
Artigo em Inglês | MEDLINE | ID: mdl-31397400

RESUMO

Background: Tufted angioma is a rare benign lesion with vascular proliferation. Aim: To retrospectively analyze the clinicopathological manifestations and immunohistochemical features of tufted angioma. Methods: Clinical and histopathological features of tufted angioma (n = 54) were evaluated and analyzed retrospectively in the Department of Dermatology, Xijing Hospital from 2003 to 2014. Results: Clinically, tufted angioma usually presented as erythematous plaques and papules on the head and neck (n = 11), trunk (n = 21) and extremities (n = 22), mainly in children (n = 48), without gender difference (24 males and 30 females). A total of 45 cases showed solitary lesions and nine cases showed multiple lesions. Common symptoms included pain (n = 11), tenderness (n = 7), itching (n = 1), hypertrichosis (n = 7), hyperhidrosis (n = 6) and Kasabach-Merritt phenomenon (n = 1). Histopathologically, typical tufted angioma (n = 37) showed proliferation of endothelial cells in a so-called cannonball pattern, while in the early (n = 4) and regressed (n = 13) stages the tufted appearance was not prominent. The proliferated endothelial cells were diffusely positive for CD31 and Wilms tumor 1, focally positive for D2-40 and Prox1, and negative for Glut-1. Limitations: Our research was confined to patients of Chinese origin and our sample size was limited. Conclusions: Tufted angioma is a rare vascular neoplasm with diverse clinical manifestations and unique pathological features. It should be recognized as a vascular tumor with lymphatic differentiation. We emphasize the importance of considering tufted angioma in the differential diagnoses of any congenital or acquired vascular tumor.


Assuntos
Hemangioma/metabolismo , Hemangioma/patologia , Neoplasias Cutâneas/metabolismo , Neoplasias Cutâneas/patologia , Adolescente , Criança , Pré-Escolar , China , Feminino , Hemangioma/complicações , Humanos , Lactente , Masculino , Estudos Retrospectivos , Neoplasias Cutâneas/complicações , Adulto Jovem
16.
Spine (Phila Pa 1976) ; 45(2): E67-E75, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31404054

RESUMO

STUDY DESIGN: Clinical case series. OBJECTIVE: The aim of this study was to describe the treatment of aggressive vertebral hemangiomas (VHs) with neurological deficit treated with total en bloc spondylectomy (TES) in a single institute. SUMMARY OF BACKGROUND DATA: Despite increasing utilization of surgery to treat aggressive VHs, owing to the rarity, the diagnosis and treatment protocols of aggressive VHs are still questionable and disputable. METHODS: All patients with Enneking stage 3 aggressive thoracic or lumbar VHs with neurological deficit and treated with TES from January 2005 to January 2013 were included. Clinical characteristics and surgery outcomes of patients, including Tomita classification, operation time, blood loss, pre- and postoperative American Spinal Injury Association (ASIA) impairment scale, visual analogue score (VAS), and Spinal Instability Neoplastic Score (SINS), were retrospectively reviewed. RESULTS: A total of 23 VHs patients were enrolled in this study, including 17 in the thoracic spine and six in the lumbar spine. All patients suffered neurological deficits caused by direct spinal cord compression with or without associated mechanical instability. The average SINS score was 9.78 ±â€Š1.51. The mean operation time of patients with preoperative embolization was 426.6 ±â€Š104.3 minutes and the mean blood loss was 1883.3 ±â€Š932.1 mL. There were no technical difficulties or serious complications. After surgery, all patients recovered to ASIA-E levels. The VAS pain score decreased from 8.0 ±â€Š0.9 to 2.8 ±â€Š0.8 (P < .05). CONCLUSION: TES is a good treatment option for patients with aggressive VHs with bony destruction and neurological deficit. LEVEL OF EVIDENCE: 4.


Assuntos
Embolização Terapêutica , Hemangioma/terapia , Vértebras Lombares/cirurgia , Neoplasias da Coluna Vertebral/terapia , Vértebras Torácicas/cirurgia , Adolescente , Adulto , Perda Sanguínea Cirúrgica , Feminino , Hemangioma/complicações , Hemangioma/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Duração da Cirurgia , Medição da Dor , Cuidados Pré-Operatórios , Estudos Retrospectivos , Compressão da Medula Espinal/etiologia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/patologia , Adulto Jovem
17.
Ann Thorac Surg ; 109(3): e157-e159, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31430463

RESUMO

We report an extremely rare tumor in an adult patient who presented with recurrent pericardial effusion. The mass was an extracardiac tumor on the left atrial roof, which was excised by open heart surgery. Histologic examination confirmed a cardiac anastomosing hemangioma.


Assuntos
Átrios do Coração , Neoplasias Cardíacas/complicações , Hemangioma/complicações , Derrame Pericárdico/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva
18.
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
19.
Am J Surg Pathol ; 44(2): 255-262, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31633489

RESUMO

In this study, we aimed to present the clinicopathologic and molecular features of a distinct group of hemangioma with GNA mutations that exhibited prominent thrombosis and organization changes with florid intravascular endothelial cell proliferation that we provisionally termed "thrombotic hemangioma with organizing/anastomosing features." Twenty-six cases were included. No sex predilection was seen (male:female=13:13). Patients' age ranged from 17 to 89 years (median: 51 y). All but 1 occurred in the skin whereas the remaining tumor involved the neck soft tissue. Remarkably, the majority (18) occurred in the lower abdominal/inguinal regions. Histologically, thrombotic hemangioma with organizing/anastomosing features were circumscribed tumors composed of variably sized and congested thin-walled vessels. The most striking features were prominent thrombosis and organization with florid intravascular endothelial cell proliferation. The proliferating endothelial cells exhibit a streaming pattern with focal anastomosing-like feature resembling anastomosing hemangioma. The stroma was sclerotic or hyalinized but could also be myxoid/edematous. Other features included vessels with nuclear hobnailing and perivascular hyalinization, cherry hemangioma-like component, cavernous-like or sinusoidal hemangioma-like areas, Masson hemangioma-like feature, and spindle cell fascicular pattern. Mitotic activity was usually low and nuclei were bland but 2 tumors exhibited moderate nuclear atypia and higher mitotic activity. Extramedullary hematopoiesis and hyaline globules were not identified. Genetically, by Sanger sequencing and MassARRAY analysis, mutually exclusive GNAQ, GNA11, and GNA14 exon 5 mutations were identified in 15, 5, and 2 tumors, respectively, with a combined mutation rate of 85% (22/26). In conclusion, we described a distinct group of hemangioma and expanded the clinicopathologic features of GNA-mutated hemangiomas.


Assuntos
Biomarcadores Tumorais/genética , Subunidades alfa de Proteínas de Ligação ao GTP/genética , Hemangioma/patologia , Neoplasias Cutâneas/patologia , Trombose/etiologia , Abdome , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Hemangioma/complicações , Hemangioma/diagnóstico , Hemangioma/genética , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , Pele/patologia , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/genética , Adulto Jovem
20.
Phys Ther ; 100(2): 317-323, 2020 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-31588510

RESUMO

BACKGROUND AND PURPOSE: Contracture and toe-walking in children due to vascular anomaly of the calf musculature is rarely described, and there is limited evidence regarding treatment. The purpose of this case is to describe the novel use of serial casting, combining the knee and ankle, to reduce contracture in a child with hemangioma of the calf. CASE DESCRIPTION: An 11-year-old girl received 12 casts of the ankle and knee, followed by custom orthotics, to address chronic contracture and gait impairments caused by a vascular anomaly in the posterior compartment of the lower extremity. OUTCOMES: After casting, the patient had fully restored knee range of motion and improved ankle range of motion by 45 degrees. She received custom orthotics and maintained her range of motion 4 months after casting. DISCUSSION: Serial casting of the knee and ankle may be a useful alternative to surgical lengthenings in patients with chronic contractures caused by vascular anomalies of the lower extremity.


Assuntos
Tornozelo , Moldes Cirúrgicos , Contratura/terapia , Hemangioma/complicações , Joelho , Perna (Membro)/irrigação sanguínea , Criança , Contratura/etiologia , Pé Equino/etiologia , Pé Equino/terapia , Feminino , Hemangioma/diagnóstico por imagem , Humanos , Perna (Membro)/diagnóstico por imagem , Desigualdade de Membros Inferiores/etiologia , Desigualdade de Membros Inferiores/terapia , Recidiva Local de Neoplasia/complicações , Aparelhos Ortopédicos , Fotografação , Amplitude de Movimento Articular
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