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Concept: Hemangioma

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Vascular lesions such as hemangiomas and lymphangiomas can cause significant mortality and morbidity, as well as amblyopia when located in the orbit. Oral propranolol can regress infantile hemangioma during infancy and up to 23 months of age, but its effect on lymphangioma has not been demonstrated. We present two cases of lymphatic malformations treated with oral propranolol. Patient 1 is a 2-year-old boy with macrocystic bilateral cervical lymphangioma extending to the pharynx and larynx and microcystic lymphangioma of the tongue. The patient was started on propranolol 2 mg/kg/day starting at 17 months of age, and after 3 months only a very slight decrease in tongue volume was noted. Patient 2 is a 3.5-year-old boy with magnetic resonance imaging evidence of right facial complex lymphangioma with venous malformation. The patient was placed on oral propranolol 2 mg/kg/day. After 3 months of treatment, no change in the lesion was noted except for a transient decrease in the size of the conjunctival telangiectasia. Propranolol 2 mg/kg/day was not effective in treating lymphatic malformations in two children, both older than 17 months at the time of treatment.

Concepts: Nuclear magnetic resonance, Magnetic resonance imaging, Congenital disorder, Amblyopia, Hemangioma, Congenital disorders, Dermal and subcutaneous growths, Lymphangioma

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Abstract Objectives: β-blocker propranolol was discovered to be highly effective for the treatment of IHs (infantile hemangiomas) since 2008. However, no serious side effects of its use have been reported so far in Asia, especially in China. To determine the safety of this therapy, we analyzed the side effects in 97 infants who used propranolol (2 mg· kg-1· d-1) against hemangioma from 2010 to 2011. Materials and methods: We performed routine blood and urine tests, hepatic and renal function tests, myocardial enzyme, electrolytes and blood sugar levels at baseline. Electrocardiogram (ECG) monitoring was performed 48 h after administration of the first dose (2 mg· kg-1· d-1). Every patient (n = 97) was required to report to our hospital once a month. Results: The following adverse effects were observed: bronchial hyperactivity (n = 5), cyanosis and cold extremities (n = 1), agranulocytosis (n = 1), and low body temperature (n = 1). These side effects were reported for the first time in Asia. Conclusions: Although propranolol is effective against IHs, its potential side effects should be considered and appropriate monitoring performed. Further studies need to be conducted to determine the optimal dose and duration of propranolol treatment for large and complex hemangiomas.

Concepts: Therapeutic effect, Enzyme, Glucose, Renal function, Blood sugar, Electrolyte, Sugar, Hemangioma

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Cardiac hemangiomas represent 1 to 2% of all detected benign heart tumors. Tumors in the coronary sinus have been reported; however, to our knowledge, there have been no reports of masses in a persistent left superior vena cava. We report here the first case of a 58-year-old man with a rare huge unicamerate cardiac hemangiomas in a persistent left superior vena cava. A communication vein between the coronary sinus and hemangiomas could be identified, and thrombus formation was found in the hemangiomas as well.

Concepts: Heart, Report, Artery, Vein, Inferior vena cava, Superior vena cava, Hemangioma, Sinus venosus

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Genetic lesions in proto-oncogenes result in the perturbation of angiogenesis, the formation of neovessels from a pre-existing microvasculature. Similarly, the subversion of tumor suppressor genes promotes tumor vascularization. Excessive neovessel formation is associated with various neoplasms such as infantile hemangiomas (IH). Hemangiomas are the most common tumors in pediatric patients and at present have no definitive treatment. The pathogenesis of IH is not well understood; however, both vasculogenesis and angiogenesis are associated with hemangioma genesis. A number of factors that modulate angiogenesis and vasculogenesis have been shown to be dysregulated in IH. Several of the oncogenes and tumor suppressors linked to the promotion of angiogenesis are also altered in infantile hemangioma. In this review, the roles of oncogenes and tumor suppressor genes during neovascularization and hemangioma genesis are explored. In addition, the potential for targeting these genes in IH therapy is discussed.

Concepts: Cancer, Oncology, Tumor, Neoplasm, Oncogene, Tumor suppressor gene, Amblyopia, Hemangioma

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Vertebral hemangiomas are benign vascular lesions that are almost always incidentally found in the spine. Their classic typical hyperintense appearance on T1- and T2-weighted MR images is diagnostic. Unfortunately, not all hemangiomas have the typical appearance, and they can mimic metastases on routine MR imaging. These are generally referred to as atypical hemangiomas and can result in misdiagnosis and ultimately additional imaging, biopsy, and unnecessary costs. Our objective was to assess the utility of dynamic contrast-enhanced MR imaging perfusion in distinguishing vertebral atypical hemangiomas and malignant vertebral metastases. We hypothesized that permeability and vascular density will be increased in metastases compared with atypical hemangiomas.

Concepts: Cancer, Metastasis, Oncology, Nuclear magnetic resonance, Magnetic resonance imaging, IMAGE, Hemangioma, The Spine

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Infantile haemangiomas are the most common tumour of infancy. Whilst the majority are left untreated to involute spontaneously, residual skin changes commonly occur, particularly in superficial haemangiomas. The current first line treatment for problematic lesions is oral propranolol, however due to the risk of systemic adverse effects, the use of off-label topical preparations has recently been investigated. Our systematic review was conducted in accordance with PRISMA guidelines. Four databases were searched to identify original articles evaluating the use of topical propranolol as the primary therapy for infantile haemangiomas. Twelve articles with a total of 597 patients and 632 haemangiomas were included. Three topical propranolol preparations were used, creams, ointments and gels, and were all prepared by local pharmaceutical laboratories. The concentration of propranolol ranged from 0.5% to 5%. Treatment duration ranged from two weeks to 16.5 months. Overall, 90% of lesions improved following the initiation of topical propranolol. A good or excellent response, defined as a reduction in size of at least 50%, was seen in 59% of lesions. Earlier initiation of treatment (less than 3 months of age) was associated with improved outcomes. No systemic adverse effects were reported. Minor local reactions were seen in 1.3% of patients. Topical propranolol is safer than oral propranolol, though may be less effective. Topical propranolol may be more suitable for patients with small, superficial haemangiomas at risk of cosmetic sequelae, where the cosmetic or symptomatic impact does not warrant oral propranolol treatment. This article is protected by copyright. All rights reserved.

Concepts: Medical terms, Adverse drug reaction, Initiation, All rights reserved, Copyright, Hemangioma, Ointment, Ointments

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The purpose of this study was to evaluate the safety and efficacy of intravitreal propranolol for the management of retinal capillary hemangioma in a patient with Von Hippel-Lindau.

Concepts: Hemangioma

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Spinal hemangiomas are common, benign vascular lesions that involve the bony portion of vertebral bodies and are generally asymptomatic. Rarely, they can become aggressive and present with predominantly epidural extension, mimicking other neoplasms. We present the case of a fifty-one year old woman who presented with myelopathy and was discovered to have a large mass causing epidural spinal cord compression, thought to be due to a peripheral nerve sheath tumor. She underwent surgery for tumor debulking. Intraoperatively, the mass was found to be mostly epidural with minimal bone involvement. Final pathology demonstrated a cavernous hemangioma. The patient did well post-operatively, with resolution of symptoms and stable size of residual tumor on eighteen month follow-up imaging.

Concepts: Spinal cord, Cancer, Oncology, Anatomical pathology, Benign tumor, Vertebra, Nerve sheath tumor, Hemangioma

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This single-center prospective trial evaluated the safety and efficacy of percutaneous sclerotherapy for liver hemangiomas in 5 patients (1 man, 4 women; mean age 41.2 y) between 2016 and 2017. All patients were symptomatic (4 abdominal pain; 1 early satiety) and refused surgery. A single session of sclerotherapy with 20 cc mixture of 45 IU. Bleomycin in 10 cc distilled water and 10 cc Lipiodol (Ultra Fluide, Guerbet, France) was performed in all patients, achieving a 45.6%-71.1% lesion volume reduction and a 12.9%-41% reduction in the largest diameter of the lesion. Symptoms subsided in all patients during the 5-month follow-up period. Adverse events included a self-limited intraperitoneal hemorrhage in 1 patient.

Concepts: Patient, Hospital, Hemangioma, Distilled water

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Hemangiomas of the head and neck are common benign tumors usually in childhood. They are rarely seen in hard palate. The authors present a geriatric patient with abundant hemorrhage due to a capillary hemangioma of the hard palate. Management and treatment approaches of this rare, urgent, and life-threatening situation is discussed.

Concepts: Head and neck anatomy, Head and neck, Hospital, Benign tumor, Amblyopia, Hemangioma