Benign Vascular Tumors Research Articles

Çok Sayıda Flebolitle İzlenen Oral Hemanjiyom

Hemangioma is a rare, non-reactive, benign vascular tumor, characterized by endothelial cell proliferations and results from vascular malformation. Hemangioma mostly occurs on head and neck skin and regresses spontaneously within 5-10 years in 50-90% of cases. However, oral lesions show less regression than skin lesions. The most commonly affected area is tongue and palatal mucosa, and rarely observed in jaw bones. Diagnosis is based on anamnesis and clinical features. Blanching of the hemangioma under pressure is characteristic clinical finding. Phlebolith is calcified thrombus in veins, venules and sinusoidal walls of hemangiomas. Head and neck phleboliths almost always indicate the soft tissue hemangioma. Phleboliths observed with hemangioma in head and neck region have distinctive appearance on panoramic radiographs. Cone-beam computed tomography provides useful information about location and distribution of phleboliths. In this case report, clinical and radiological features of oral hemangioma and many associated phleboliths are presented.

Pressure Therapy for Pyogenic Granuloma.

Pyogenic granuloma is a benign vascular tumor, with a tendency to bleed on manipulation. A young female presented to us with a disfiguring facial pyogenic granuloma. We adopted a novel approach using pressure therapy to treat the same. The use of an elastic adhesive bandage reduced the size and vascularity of the lesion, following which laser ablation was done with minimal bleeding and scarring. This is a simple, inexpensive method to approach large and disfiguring pyogenic granulomas.

Oralni topikalni timolol maleat ili oralni propranolol u lečenju infantilnih hemangioma: klinička analiza 403 pacijenta

Objective: Infantile hemangiomas (IH) are the most common benign vascular tumors of infancy. Propranolol (P), a nonselective beta-blocker, has been successfully used in managing IHs. Ongoing studies investigate the efficacy of the topical b-antagonist timolol maleate (TM) in IHs. The aim of this study is to assess the effects of interventions for managing infantile hemangiomas in children. Material and Methods: We retrospectively reviewed a total of 403 IH patients from March 2021 to March 2022. The patients were stratified into three groups. Patients in Group 1 were given TM at a dose of one drop topically twice a day, 0.5%. Patients in Group 2 were given P at a dose of 1 mg/kg twice a day. The patients in Group 3 did not receive any treatment, and observation was conducted solely by contacting the controls. Results: The median age of diagnosis was 5 months (range 0-60), with 57.1% of the cases being male. While TM treatment was applied to 32% of the children and P treatment was applied to 46.9% of the children, no treatment was administered in 21.1%. The most common location of hemangiomas was the face, accounting for 39.2%. Hemangiomas were observed in more than one location in 48 (12%) children. The median follow-up period for the patients was 4 months (range 0-28). Hemangiomas remained unchanged in 28.3% of all cases, shrank in 60.3%, and continued to grow in 11.4%. The primary indication for initiating TM was superficial hemangiomas and infants younger than 6 months. The leading reason for starting P significantly higher than in the other groups (p : 0.001). No statistically significant differences were observed between the groups regarding bleeding and ulceration rates (p > 0.05). Conclusion: The efficacy of propranolol in treating IH was higher than that of TM.

Overview of the Head and Neck Hemangiomas: a 5-year Retrospective Study.

Infantile hemangiomas (IHs) are benign vascular tumors commonly observed in children. The pathogenesis of hemangiomas is complex and poorly understood. IH occur most commonly on the head and neck. There are different classification of them according to the depth, number, distribution and locations. A multidisciplinary approach is needed for the diagnosis and treatment of hemangiomas because it is easy to misdiagnose or decide on a wrong treatment in the existing single-treatment system. In this retrospective study between 2018 and 2022 we provided an overview of the hemangiomas located in the head and neck in 232 patients, and the different treatment approaches used. Of the 232 patients 60.3 % were females and 38.7% males. The youngest age was 10 weeks old and the oldest age who underwent treatment was 79 years old. The most common lesion sites were the mid-cheek, the upper lip and the upper eyelid. 104 patients (53.4 %) underwent surgical intervention due to the location of the lesion, size and functional reasons. Meanwhile 128 patients (46.6 %) were observed and treated with propranolol and pulsed dye laser. Hemangiomas are generally benign tumors. Hemangiomas present a number of diagnostic and therapeutic challenges; thus, early diagnosis by a specialist clinic is key in preventing associated morbidity with these vascular tumors.

Primary intraosseous cavernous hemangioma of the cranium: a case report

Primary intraosseous cavernous hemangioma (PICH) is a rare benign vascular tumor. This neoplasm is common in the spine and less common in skull. Toynbee J. first described this tumor in 1845. PICH of the cranium does not always have typical X-ray features and should be always differentiated with other more common skull lesions. Surgical resection is preferable since total resection is followed by favorable prognosis. We present a 65-year-old patient with asymptomatic tumor of the right parietal bone. CT revealed osteolytic lesion that required total resection and skull repair. Histopathological analysis revealed intraosseous cavernous hemangioma.

Unusual representation of oral pyogenic granuloma in mandible mimicking malignancy: Report of two cases

Pyogenic granuloma is a common benign vascular tumour found to occur in all ages. Both skin and mucous membranes can be affected. Its most common aetiology is trauma, local irritants, microorganisms, plaque and calculus, etc. Histologically, the surface epithelium may be intact or may show foci of ulcerations or even exhibit hyperkeratosis. Gingiva is the commonly affected site in the oral cavity followed by buccal mucosa, tongue, etc. We are reporting two cases of pyogenic granuloma in young adults one in an 18 years old female and the other one in a 21 years old Male, they have an unusual presentation in the right posterior side of the jaw that resembled a malignant lesion.

Pyogenic Granuloma Treated with Topical Timolol: A Case Series

Pyogenic Granulomas (PGs) are benign vascular tumours primarily treated with surgical procedures. Recently, topical Timolol, a beta-adrenergic receptor antagonist, has been used for the treatment of PG due to its vasoconstrictive, anti-angiogenic, and wound healing properties. Herein, the authors presented a case series of 12 patients (10 males and two females) with red papules and nodules that spontaneously bleed. The age of the patients ranged from 7-51 years, and the duration of lesions ranged from one week to nine months. The lesions were located on the face, neck, hand, and mucosa. All patients were treated with topical Timolol maleate 0.5% drops twice daily for four weeks and followed-up weekly for four weeks. The treatment efficacy was evaluated based on complete response, partial response, or no response. Changes in colour, size, bleeding tendency, and adverse events were also assessed. Two patients showed complete resolution, while the bleeding tendency improved in the other patients. No side effects were encountered, except in one patient where the lesion increased in size and became secondarily infected. Thus, topical timolol appeared to provide symptomatic improvement by reducing bleeding and lesion size without any side effects. It can be considered as an alternative therapeutic option for small, uncomplicated classical PG.

Hemangioma–Benign Tumor in Childhood

Background: Hemangiomas are vascular tumors, i.e. neoplasms of the vascular network. These are the most common neoplasms in the age of infancy. They can be infantile and congenital. Objective: Present the case of a 7.5-year-old girl suffering from a benign vascular tumor–hemangiomatosis of the skin and liver, which is part of the autosomal recessive syndrome SDC (Spondylocostal dysostosis). Case presentation: This case shows that hemangiomas can be accompanied by other diseases as part of congenital syndromes or metabolopathies that are often genetically inherited. In the present case, it is an autosomal recessive form of SCD syndrome or spondylocostal dysostosis. Conclusion: It is important to consider SCD, i.e., spondylocostal dysostosis, as a rare autosomal recessive disease that can occur as part of hemangiomatosis. Recent studies from 2020 and 2013 have shown the efficacy of topical timolol as well as atenolol which can replace oral propranolol as the first-line agent in the treatment of hemangiomas. In randomized clinical trial (2020), when compared with propranolol, atenolol had similar efficacy and fewer adverse events in the treatment of infants with problematic infantile hemangiomas.

Extradigital glomus tumor – A rare case report

Glomus tumor is benign vascular tumors arising from modified smooth muscle cells of the glomus bodies and accounting for 1.6% of all soft-tissue tumors. The presence of glomus tumors at sites other than fingertips is a very rare occurrence. We present a rare case of a 68-year-old male with a history of painful nodules over the interscapular region for the last 10 years which was excised and sent to our department of pathology. On gross examination, the lesion was 1 × 1 cm, nodular. Cut section was gray and brown with areas of hemorrhage seen. Histopathological examination revealed a circumscribed lesion in the dermis comprising small dilated vascular spaces surrounded by sheets and clusters of glomus cells having round–oval, bland nucleus with moderate-abundant eosinophilic cytoplasm. No areas with increased mitosis, no atypia, and no necrotic areas were seen. There was no area with ductal/mucin differentiation. Glomus tumor is very rare at extradigital sites and may be often missed clinically. However, the presence of the characteristic microscopic picture of perivascular sheets of bland, uniform glomus cells should help us arrive at the correct diagnosis and provide appropriate management to the patient.

Computed Tomography and Magnetic Resonance Imaging Features of a Huge Cavernous Hemangioma in the Pleural Space: A Case Report

A 44-year-old male with a huge left pleural mass was admitted due to chest discomfort. Chest computed tomography showed a large pleural mass with punctate calcification and serpentine-shaped enhancement in the left pleural space. Magnetic resonance imaging showed markedly high signal intensity with septa on fat-suppressed T2-weighted imaging (WI) and gradual peripheral delayed enhancement on dynamic-enhancing T1-WI. With hemangioma as the suspected diagnosis, the entire mass was surgically removed carefully and the final histopathological diagnosis was confirmed to be a cavernous hemangioma. Cavernous hemangioma of the pleural space is a rare benign vascular tumor. Precise radiologic diagnosis is important before the surgical operation of hemangiomas because of risk of massive hemorrhage requiring meticulous bleeding control.

Nasal lobular capillary hemangioma: etiologic factors

<p class="abstract">Nasal lobular capillary hemangioma (LCH) is a rare and benign vascular tumor of unknown etiology, often associated with hormonal factors and a history of trauma. In this case series we present twelve cases of nasal LCH diagnosed on patients treated at the Hospital da Senhora da Oliveira from January 2010 and December 2019. Of the 12 patients, 66, 7% were males. The most common clinical presentation was epistaxis (75%) followed by nasal obstruction (50%). In 75% of patients the most commonly affected area was the nasal septum. Regarding proposed contributing factors, nasal trauma was the most prevalent (33%), followed by the use of oral contraceptives (25%) and pregnancy (8.3%). Endoscopic sinus surgery was performed in all patients, with complete excision of the lesion, and no post-operative complications were observed. Nasal LCH should be considered in the differential diagnosis of nasal vascular lesions associated with unilateral epistaxis and nasal obstruction. Complete surgical resection should be the treatment of choice, since it’s associated with lower risk of recurrence.</p>

Pyogenic Granuloma of the Oral Cavity: Clinical and Histopathological Features, Etiopathogenesis, and Management

Pyogenic granuloma (PG) is a benign vascular tumor that usually occurs on the skin and mucous membranes, mostly of the oral cavity. The most common site for oral PG is the gingiva. The lesion arises in response to various stimuli, such as low-grade local irritation, traumatic injury, or hormonal changes. It may occur at any age, with the highest incidence in the 2nd and 5th decades of life. Women are more frequently affected due to the increased levels of circulating hormones like estrogen and progesterone. This article reviews the clinical and histopathological features of oral PG, as well as its etiopathogenesis, differential diagnosis, and treatment.

Symptoms: Purple Ear Drum and Hearing Loss

Symptoms: Purple Ear Drum and Hearing Loss

HEMANGIOMA TONGUE: AN UNUSUAL PRESENTATION

Hemangiomas are benign vascular tumours that arise from vascular tissue cell types. Hemangiomas generally appear on Face, Lips, Tongue, Scalp, skin of Cheeks, Neck and Head-Neck region and they may occur throughout the body. They generally appear in rst year of life and generally present as a Red mark anywhere on the body. They have a tendency of growth for about one year and then they regress as the child gets older. A Hemangioma generally required treatment when they obscure Airway and inict mass effect on other tissues. There are several types of Hemangiomas viz., Capillary, Cavernous, Mixed, Racemose, Strawberry, Sponge. The diagnosis of hemangiomas is largely clinical where a clinician can diagnose hemangioma in clinical examination and no further investigations are required. The Hemangiomas occurring in Liver and other body organs warrant a full workup and investigations including Skiagrams, USG, Computed tomography scanning and Contrast Enhanced MRI. The contrast accumulation in the hemangiomas themselves excellently demonstrates the Size, Location and extend of the Hemangiomas. The Hemangiomas are generally never subjected to biopsy due to the risk of bleeding. Generally the management involves the use of topical Beta-blocker solution and Propranolol oral suspension in children having Strawberry birthmarks, These supercial hemangioms disappear after about 1 year of continued treatment. The adverse effects of Beta blockers are high blood sugar, low blood pressure and wheezing. In those patients where beta blockers are not effective the topical solution of corticosteroids may be an option. In some cases LASER surgery has been tried to ablate and remove small hemangiomas. In cases where the hemangoima is present in an internal organ then removing the entire organ is also an option to be considered in treatment.

Prenatal ultrasound evaluation of fetal cutaneous hemangioma and related complications

Objectives Congenital hemangiomas are rare benign vascular tumors but can lead to serious adverse pregnancy outcomes. Its prenatal diagnosis is a challenge. We explored the clinical applications of prenatal ultrasound for evaluating fetal cutaneous hemangioma and associated complications. Methods A retrospective observational study was conducted comprising a population of pregnant women with fetal cutaneous hemangioma, the latter diagnosed by prenatal ultrasound, between January 2016 and December 2020. The clinical characteristics, sonographic images, complications, and pregnancy outcomes were documented and analyzed. Results We identified 20 cases of fetal cutaneous hemangioma diagnosed by prenatal ultrasound and confirmed by postpartum examinations. Most hemangiomas were in the head and neck (55%), with either solid isoechoicity (25%) or solid mildly hyperechoic (25%), and well-circumscribed (80%) mass. Eight (40%) fetuses experienced complications, which often occurred in fetuses with large hemangiomas (67% with maximum diameter ≥5 cm; 100% with a volume ≥40 cm3). The most common complications were cardiac-related (88%), including elevated cardiothoracic area ratio, atrioventricular valve regurgitation, and fetal hydrops. A large hemangioma was usually associated with advanced gestational age and a fast hemangioma growth rate. In five (25%) cases, the pregnancy was terminated; these involved hemangioma of the head or neck. One newborn developed Kasabach–Merritt phenomenon, pulmonary hemorrhage and respiratory distress, and died 3 days after birth. Among the 14 (70%) fetuses that survived birth, all hemangiomas disappeared or regressed after treatments with propranolol, interventional surgery, or observed routinely. Conclusions Prenatal ultrasound examination can accurately diagnose fetal cutaneous hemangioma and related complications to facilitate appropriate management during the pregnancy. Rationale Prenatal diagnosis of cutaneous hemangiomas is a clinical challenge. Prenatal ultrasound examination could be a method to accurately diagnose and monitor these hemangiomas.

Chinese expert consensus on the use of oral propranolol for treatment of infantile hemangiomas (version 2022)

: Infantile hemangioma (IH) is the most common benign vascular neoplasm in children. Although the probability of spontaneous regression is very high, large and rapidly growing hemangioma may result in various sequela after spontaneous involution. Therefore, except for hemangiomas that grow in concealed sites, are small in size, or are in a stable state that can undergo “watchful waiting”, aggressive treatment is often required. Since 2008, propranolol has gradually replaced glucocorticoids and become recognized worldwide as first-line treatment for IH. Many studies have reported on its treatment mechanism, both domestically and internationally, resulting in expert consensus and clinical practice guidelines. In recent years, with the continuous accumulation of clinical experience and growing number of studies, there has been a deepening understanding of the pathogenesis of hemangiomas and mechanism of action of propranolol. Thus, it is necessary to update the expert consensus to be more consistent with clinical practice in order to guide medication management and provide scientific norms for the clinical use of propranolol in the treatment of IH. This updated version simplifies the clinical examination, medication, and monitoring process for the use of propranolol in the treatment of IH, making it easier to use.

Choroidal haemangioma and its multimodal diagnosis: A case report

AbstractPurpose: To describe the clinical manifestations and diagnosis of choroidal haemangioma with the aid of different multimodal images, as well as its usefulness for making a differential diagnosis.Methods: A case of a patient who comes due to blurred vision is described, who underwent different complementary tests of multimodal images: optical coherence tomography (OCT), fluorescein angiography (FA), indocyanine green angiography (ICGA), autofluorescence (AF), ultrasound eye exam and retinography to achieve the accurate diagnosis.Results: We present the case of a 50‐year‐old patient who debuted with recently‐onset blurred vision in the left eye (LE). In the eye fundus of LE, a yellow‐orange temporal‐inferior lesion of 3 disc diameter (DD) with neurosensory detachment of 4 DD that affects the fovea is observed. An OCT is performed that shows a choroidal mass associated with subretinal and intraretinal fluid with hyperrefringent points, the B‐scan ultrasound shows a hyperechoic lesion in the posterior pole, and both ICGA and FA reveal a hyperfluorescent pattern in all its phases, being the choroidal vessels of better visualization in the latter phase (without double vascularization pattern). AF shows hyperautofluorescence. After the definitive diagnosis of choroidal haemangioma, he was referred for treatment with Argon laser with favourable results.Conclusions: Choroidal haemangioma is a rare benign vascular tumour that occurs in middle‐aged adults and can be circumscribed (CCH) or diffuse depending on its extension. For the diagnosis of intraocular tumours it is very important to make a good differential diagnosis with the help of multimodal images: OCT, FA, ICGA, AF, Ultrasound and retinography; in order to differentiate it from similar posterior pole lesions with worse prognosis. CCH itself is benign and asymptomatic, and its treatment consists of observation; but it can present inflammatory signs with subretinal fluid and affect the macular area and therefore a more invasive treatment is indicated.References.1. Singh AD, Kaiser PK, Sears JE. Choroidal hemangioma. Ophthalmol Clin North Am. 2005;18(1):151–61, ix.2. Berry M, Lucas LJH. Circumscribed choroidal hemangioma: A case report and literature review. J Optom. 2017;10(2):79–83.

Identification of Diagnostic Markers in Infantile Hemangiomas.

Infantile Hemangiomas (IHs) are common benign vascular tumors of infancy that may have serious consequences. The research on diagnostic markers for IHs is scarce. The "limma" R package was applied to identify differentially expressed genes (DEGs) in developing IHs. Plugin ClueGO in Cytoscape software performed functional enrichment of DEGs. The Search Tool for Retrieving Interacting Genes (STRING) database was utilized to construct the PPI network. The least absolute shrinkage and selection operator (LASSO) regression model and support vector machine recursive feature elimination (SVM-RFE) analysis were used to identify diagnostic genes for IHs. The receiver operating characteristic (ROC) curve evaluated diagnostic genes' discriminatory ability. Single-gene based on Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) was conducted by Gene Set Enrichment Analysis (GSEA). The chemicals related to the diagnostic genes were excavated by the Comparative Toxicogenomics Database (CTD). Finally, the online website Network Analyst was used to predict the transcription factors targeting the diagnostic genes. A total of 205 DEGs were singled out from IHs samples of 6-, 12-, and 24-month-old infants. These genes principally participated in vasculogenesis and development-related, endothelial cell-related biological processes. Then we mined 127 interacting proteins and created a network with 127 nodes and 251 edges. Furthermore, LASSO and SVM-RRF algorithms identified five diagnostic genes, namely, TMEM2, GUCY1A2, ISL1, WARS, and STEAP4. ROC curve analysis results indicated that the diagnostic genes had a powerful ability to distinguish IHs samples from normal samples. Next, the results of GSEA for a single gene illustrated that all five diagnostic genes inhibited the "valine, leucine, and isoleucine degradation" pathway in the development of IHs. WARS, TMEM2, and STEAP4 activated the "blood vessel development" and "vasculature development" in IHs. Subsequently, inhibitors targeting TMEM2, GUCY1A2, ISL1, and STEAP4 were mined. Finally, 14 transcription factors regulating GUCY1A2, 14 transcription factors regulating STEAP4, and 26 transcription factors regulating ISL1 were predicted. This study identified five diagnostic markers for IHs and further explored the mechanisms and targeting drugs, providing a basis for diagnosing and treating IHs.

Glomus jugulare tumors treatment by gamma knife radiosurgery: A single center study.

Glomus jugulare tumor are benign vascular tumors and surgical resection is almost impossible. We have treated these tumors by Gamma knife radiosurgery and share our experience. This study was conducted at the Neurospinal and Cancer Care Institute, Karachi from January 2010 to May 2020. Thirty-four patients with glomus jugulare tumors treated with gamma knife radiosurgery were included in the study. The comprehensive clinical and demographic characteristics of all patients were collected through a manually designed questionnaire. Computed tomography, digital subtraction angiography and magnetic resonance imaging were used to make the diagnosis. Data was incorporated and analyzed by SPSS version 26. A total of 34 patients were included in the study of which 16(47%) were males and 18(53%) were females with first follow up after 6-month up to two year clinical and radiological follow-up. The mean age of the patients was 42.5±13.5 with a minimum age of 20 years and maximum age of 65 years. The KPS scale was 2.09±0.45 and the volume of the tumor was 33.8±22.5 cm3. The improvement was shown in 27 patients of which 14 were males and 13 were females showing insignificance post radiation change. Of all 34 patients, the outcome was recorded as 3(9%) for excellent, 22(64%) for good, 6(17%) for fair and 3(9%) were poor results. Gamma Knife radiosurgery is a safe and effective primary therapy and salvage therapy for residual and recurrent cases of glomus jugulare and tympanicum tumors.

Management of infantile hemangiomas: Recent advances.

Infantile hemangiomas (IHs) are benign vascular tumors commonly observed in children. A small number of cases can manifest as organ or system dysfunction, permanent scarring, or even disfigurement. Currently, diagnosis is mainly based on clinical history, physical examination, and auxiliary inspection. In the treatment of a hemangioma, the functional damage caused by the lesion and complications that may endanger the patient's life should be given priority. This suggests that identification, diagnosis, and referral to specialists during the early stages of IHs are important factors in preventing related complications and obtaining a better prognosis. During the past few decades, researchers have explored different treatments according to the condition, including oral or topical drugs, topical drug injections, laser surgery, and surgical treatment. However, oral propranolol remains a well-accepted first-line treatment. This article will primarily focus on the recent advances in the clinical diagnosis and treatment of hemangiomas, along with a literature review on the subject.