Benign Vascular Tumors Research Articles

Hemangioma of The External Auditory Canal: A Case Report.

Hemangioma is a subtype of benign vascular tumors. Although they are commonly found in head and neck region, they are rare in the external auditory canal. Few cases reported capillary hemangioma in the external auditory canal with surgical excision is the mainstay of management and low recurrence rate. We present a 41-year-old woman with left external auditory canal capillary hemangioma and cartilage with its perichondrium graft was used for repairing the defect after surgical excision.

Revisiting imaging features of rectosigmoid vascular malformation with emphasis on multiparametric MRI: a case report

BackgroundGastrointestinal vascular malformations are rare benign vascular neoplasms of the gastrointestinal tract, with the rectosigmoid region being the most frequently involved site. Patients often manifest with recurrent, intermittent rectal bleeding, which might occasionally be life-threatening.Case presentationA 39-year-old man with a history of hemorrhoid operations twice was presented to our gastroenterology department with blood in the stool and abdominal pain. After the colonoscopy, multiparametric MRI, and CT examinations, robotic low anterior resection was performed with the diagnosis of rectosigmoid venous malformation. The histopathological examination confirmed the diagnosis.ConclusionColonoscopy is the preferred method in diagnosing rectosigmoid vascular malformation, but wrong and delayed diagnoses are common. Thus, imaging modalities might add to colonoscopy in equivocal cases.

Ovarian Hemangioma – A Rare Case Report

Ovarian hemangioma is a benign vascular tumor which is rare and often encountered as an incidental finding despite ovary being a vascular organ. Symptomatically, ovarian hemangiomas present when they are large and cause abdominal distension. Thorough pre-op clinical examination and post-op follow up is required. We present a case of a 65 year old post-menopausal woman with pain in abdomen with past history of LSCS and tubal ligation who was diagnosed histopathologically as ovarian hemangioma.

Ultrasound features of placental chorioangioma detected by SMI technology before and after thrombosis of feeding vessels: analysis of a clinical case

Objective: Placental chorioangioma is the most common non-trophoblastic vascular benign tumor of the placenta, with an estimated incidence of 1% of all pregnancies. Most chorioangiomas are small asymptomatic lesions that are found incidentally only postnatally during histologic examination of the placenta. Voluminous chorioangiomas (>4–5 cm), however, are less common and are more often diagnosed prenatally, through ultrasound imaging. Color Doppler demonstrates either a single blood vessel feeding the lesion or substantial vascularity within the mass. Large tumors have been associated with multiple adverse perinatal outcomes, including fetal growth restriction, preterm birth, polyhydramnios, fetal congestive heart failure, fetal anemia, fetal hydrops and intrauterine death. Case(s): A 35-years-old primigravida woman with uncomplicated pregnancy was referred to the Ultrasound Centre of Obstetric and Gynecologic of Sant’Anna Hospital, Turin, due to a suspect placental mass seen during the ultrasound performed at 32 weeks of gestation. In this case, detailed ultrasound scans with grey scale and Doppler examination were performed (using Aplio 550; Canon Medical Systems Europe BV, Zoetermeer, The Netherlands). We also decided to study the vascularization of the mass with SMI (superb microvascular imaging) technology. In particular, with the use of SMI, it was possible to visualize the vascularization of the mass more completely which was conspicuous at first but disappeared after thrombosis of feeding vessels with favorable pregnancy outcome. Conclusion: SMI is a new vascularity imaging method that can visualize vessels that exhibit slow flow rates. It uses a system to reduce artifacts by greatly reducing interference from tissue movement.

Management of Oral Pyogenic Granuloma: A Case Report

Granuloma pyogenicum, also referred to as a pyogenic granuloma, is a typical, acquired, benign vascular tumor that develops in tissues like the skin and mucous membranes. The correct term is lobular capillary hemangioma. Is typically brought on by a variety of stimuli, including mild local irritation, acute damage, hormonal variables, or specific types of medications. Pyogenic granuloma often do not develop when the base and the causes of it are removed. The case of pyogenic granulomas treated surgically as well as electro cautery are presented in this paper.

Multiple retroperitoneal cystic lymphangiomas in a pregnant woman: A case report

Cystic lymphangiomas are extremely rare benign vascular neoplasms generally found in childhood. Thought to arise from obstructed lymphatic channels during development, but may also arise secondary to trauma, inflammation, malignancy, and surgery or radiation exposure. They are usually seen in the head and neck or axillary region, and rarely in the abdominal cavity with only 1% occurring in the retroperitoneum. These are typically asymptomatic lesions incidentally identified by computer tomography, magnetic resonance imaging or ultrasound. Complete surgical resection with histologic confirmation of the diagnosis is the treatment of choice.We present a case of a 27-year-old woman with multiple cystic lymphangiomas in retroperitoneum, discovered incidentally by ultrasound during pregnancy.

Acral vasculitis and Chilblain-like lesions: is it COVID-19 infection?

The cutaneous manifestations associated with COVID-19 are increasingly reported, their exact incidence remains to be estimated, their pathophysiological mechanisms are largely unknown and the role, direct or indirect, of SARS-CoV-2 in their pathogenesis is still debated. We present a case of COVID-19 that manifested with a purpuric vasculitis pattern on the lower extremities and chilblain-like lesion in toe in a patient presented COVID-19 lungs involvement with polymerase chain reaction and serology are negatives. The reported presenting dermatological symptoms: associated chilblain-like lesions and vasculitis pattern of patient with negative COVID-19 RT-PCR and serology. The polymorphism of cutaneous lesions associated with the COVID-19 infection can mimic or appear similar to other well-known conditions. Even though, RT- PCR and serology are negatives, an infection of SARS-CoV-2 should be considerate.

Percutaneous Cryoablation for Symptomatic Peripheral Congenital Hemangioma

Congenital hemangiomas (CHs) are rare, benign vascular tumors that are present at birth. They are divided into 3 major subtypes: rapidly involuting CHs, partially involuting CHs, and noninvoluting CHs (NICHs). There is a paucity of data in the literature regarding NICH and its management. Most symptomatic patients with NICH are managed with surgery. However, endovascular embolization, direct percutaneous sclerotherapy, or laser treatment can be used on a case-by-case basis. In this report, 3 cases with peripheral symptomatic NICH treated with percutaneous cryoablation are presented.

Tracheal Hemangioma: A Rare Cause of Hemoptysis in Children.

Tracheal hemangioma is a very rare benign vascular tumor. Few cases of tracheal hemangioma in children are reported in the literature. Chronic cough is the main symptom of the disease; however, hemoptysis is rarely reported as a symptom of tracheal hemangioma in children. Here, we report a case of tracheal hemangioma in an eight-year-old girl admitted to our pediatric department for recurrent hemoptysis. Routine biological and radiological investigations were normal. Diagnosis was made using computed tomography and bronchoscopy. Beta-blocker therapy was not efficient. Bronchoscopic treatment by electrical excision enables complete recovery. Tracheal hemangioma should be considered a cause of recurrent hemoptysis when routine biological and radiological investigations are negative.

Atypical PIK3CA Positive Hemangioma Refractory to Propranolol

A newborn presented with a lateral right eye proliferating vascular tumor, with characteristics consistent with infantile hemangioma by examination and imaging. The lesion was refractory to therapeutic dosing of oral propranolol, with worsening mass effect in the upper eyelid threatening hemianopsia. A near total surgical resection was completed. Histologic findings were mostly consistent with infantile hemangioma with some atypical areas of larger serpiginous, ectatic vessels identified. Immunostaining demonstrated strong CD34+, CD31+, and glucose transporter type 1 immunoreactivity and D2-40 immuno-negativity. Genetic sequencing revealed a pathogenic somatic PIK3CA (phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha) variant (p.His1047Gln) at 8.3% allele frequency. Despite continued postoperative propranolol therapy, the lesion produced new mass effect over the right cheek. Alternative therapy with the mammalian target of rapamycin inhibitor, sirolimus, was initiated based on the novel genetic finding and lack of clinical response to standard therapy. The case demonstrates mosaic PIK3CA variant expression within a benign vascular tumor histologically and clinically sharing features of an infantile hemangioma.

Pulmonary Capillary Haemangiomatosis: A Rare Cause of Pulmonary Hypertension

Pulmonary capillary haemangiomatosis (PCH) is a rare disorder of unknown aetiology, characterised by proliferating capillaries that invade the pulmonary interstitium, alveolar septae and the pulmonary vasculature. It is often mis-diagnosed as primary pulmonary hypertension and pulmonary veno-occlusive disease. Pulmonary capillary haemangiomatosis is a locally aggressive benign vascular neoplasm of the lung. We report the case of a 19-year-old female who was referred to us in the early post-partum period with severe pulmonary artery hypertension, which was diagnosed as PCH by open lung biopsy.

Infantile hemangioma cured with homoeopathy - A case report

Introduction: Infantile hemangioma (IH) is the most common benign vascular neoplasm in infants. It is characterized by endothelial cell proliferation which usually develops shortly after birth and grows most rapidly over the first 6 months. It is self-limiting in nature. However, in a small percentage of patients, hemangioma does not disappear completely. It may result in serious ocular or systemic complications. These patients may require drug therapy, surgical intervention, and/or laser therapy often during childhood at the cost of certain adverse events. Case Summary: The case reported here is of IH affecting the right eye in a 5-month-old female child who was cured completely with the help of homoeopathic medicine within 4 months. Arnica montana was prescribed as a specific remedy based on its physiological action. Follow-up was done every 2 weeks for 4 months. Vancouver scar scale (VSS) score and photographs were considered every month to assess the involution of hemangioma. For confirming complete recovery and no recurrence, follow-up for another 3 months was done after involution. VSS score reduced from 9 to 0 in 4 months duration. Complete cure in this case of hemangioma with homoeopathy can be considered as a reference to explore the utility of alternative modes of treatment like Homoeopathy to give a better therapeutic option for such conditions and avoid any kind of surgical intervention.

Mediastinal Haemangioma with Pericardial Effusion: A Rare Entity

Mediastinal haemangioma is a rare benign vascular tumour. A young male presented with complaints of cough and dyspnoea. Serial chest radiographs were suggestive of progressive mediastinal widening and cardiomegaly. Pericardiocentesis revealed haemorrhagic fluid which was negative for microbiology and malignant cells. Patient was unresponsive to antituberculosis treatment and steroids. Computed tomography (CT) of thorax revealed an anterior mediastinal mass lesion with pericardial effusion which on biopsy was found to be a mediastinal haemangioma.

Anastomosing hemangioma: a current update on clinical, pathological and imaging features.

Anastomosing hemangioma (AH) is a rare, benign vascular neoplasm with distinctive histopathology and characteristic tumor distribution. AHs show marked proclivity to involve the kidneys, gonads and the retroperitoneal soft tissues; kidney is the most common target site often in the context of end stage renal disease. Recent studies have identified activating mutations of GNA genes that drive the molecular pathogenesis of AHs. AH appears as a solitary, well-circumscribed, hypervascular tumor that charters a benign course with an excellent prognosis. The purpose of this article is to provide a current update on clinical, pathological and imaging features of anastomotic hemangioma.

The Challenges of Upper Extremity Intramuscular Hemangioma: A Case Study and Systematic Review

Intramuscular hemangiomas are rare, benign vascular tumors, constituting 0.8 percent of all hemangiomas. Upper extremity intramuscular hemangiomas pose diagnostic and therapeutic challenges because of their rarity, invasive nature, and potential for neurovascular involvement. The authors report a comprehensive systematic review of upper extremity intramuscular hemangioma management and a challenging case report. A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Electronic databases were used to identify articles describing upper extremity intramuscular hemangiomas through 2019. Patient demographics, clinical presentation, management, complications, and outcomes were reviewed. Based on operative timing, cases were categorized as either "primary" (excision performed at initial diagnosis) or "secondary" (excision performed after failure of conservative treatment). Eighteen articles encompassing 25 patients were included in the authors' systematic review. Of those, 18 underwent primary excision and seven underwent secondary excision. The majority involved the forearm or antecubital region. Complete excision, evaluated by gross examination or pathology, was reported in all primary cases and 71 percent of secondary cases. Primary excisions demonstrated smaller size of mass (19.4 cm 2 versus 165.3 cm 2 ) and superior reported functional outcomes (100 percent versus 33 percent). Complications were reported in 5 percent of the primary excisions compared to 71 percent of the secondary excisions, where one complication was a fatal hematoma. The literature concerning upper extremity intramuscular hemangioma is limited to mostly case reports and several case series with the potential risk of bias. With careful dissection and microsurgical technique, wide local excision followed by complete reconstruction can be successfully performed at initial diagnosis for upper extremity intramuscular hemangiomas. At early stages, smaller lesion size significantly reduces the risk of functional impairment and complications.

Endoscopic Management of Sinonasal Vascular Tumors Without Embolization: Our Experience with Vessel Ligation

ABSTRACT Objective: To present our surgical experience and technique in performing endoscopic sinus surgery for vascular sinonasal tumors without pre-operative embolization using intraoperative ligation of the external carotid artery or its distal branches. Methods: Design: Retrospective Series Setting: Tertiary Private Teaching Hospital Participants: Seven Patients Results: Out of 7 patients (5 males, 2 females, aged 12 to 64 years old) with non-embolized vascular sinonasal tumors, 2 had juvenile angiofibroma, 3 had a benign vascular tumor (hemangiopericytoma, hemangioma and a vasoformative solitary fibrous tumor), and 2 had a malignancy (rhabdomyosarcoma, squamous cell carcinoma). Four (57.1%) had external carotid artery ligation, two (28.6%) had internal maxillary artery ligation and one (14.2%) had sphenopalatine artery ligation. The mean intraoperative blood loss was 2447.1 mL (range 900mL to 5,000mL) and average operation duration was 7.6 hours (range 2.9 hours to 14.5 hours). The average amount of transfused blood products was 1785.7mL (zero to 3,000mL). The average hospital stay was 7 days (range 2 to 13 days) with one post-operative complication (ICU admission for hypotension from intraoperative blood loss). Conclusion: Intraoperative ligation of the ECA or its distal branches to disrupt the vascular supply of sinonasal tumors may provide a viable means of preventing excessive intraoperative blood loss in patients with non-embolized vascular sinonasal tumors.

Engineered exosomes for targeted delivery of miR-187-3p suppress the viability of hemangioma stem cells by targeting Notch signaling.

BackgroundInfantile hemangioma (IH) is the most common benign vascular tumor of infancy and is proposed to arise from hemangioma stem cells (HemSCs). Therapies for IH include oral beta-blockers, surgery, and the delivery of novel therapeutic agents, such as bioactive microRNAs (miRNAs). However, in the extracellular environment, miRNA is easily hydrolyzed by RNase. miR-187-3p has previously been confirmed to promote or inhibit various malignancies, but its role in the development and progression of IH remains unclear.MethodsIn this study, engineered exosomes (E-exos) were exploited to deliver miR-187-3p into HemSCs. The E-exos were generated by introducing miR-187-3p mimics into human adipose mesenchymal stem cell-derived exosomes (hAMSC-exos) via electroporation. The expression and secretion of miR-187-3p were examined by quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Western blot analysis, transmission electron microscopy (TEM), and dynamic light scattering (DLS) were used to characterize the exosomes. The effects of the E-exos on HemSC viability were examined using the tube formation assay and the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide assay. Western blot analysis was used to evaluate the effects of E-exos on Notch-1, Notch-4, and Jagged-1 expression in HemSCs.ResultsE-exos did not differ significantly from hAMSC-exos in terms of morphology, particle size, or surface markers. E-exos could be internalized by HemSCs, and the course of cellular uptake of E-exos was time dependent. After 12 hours of treatment, E-exos significant inhibited tube formation. Notch signaling was also inhibited by miR-187-3p loading by E-exos. E-exos showed excellent inhibitory effects against HemSC proliferation via Notch signaling.ConclusionsThis study provides a foundation for using hAMSC-exos to optimize current clinical options to facilitate IH treatment and deliver therapeutic agents in the future.

Immunohistochemistry for FOSB and FOS is a Useful Ancillary Tool in the Diagnosis of Epithelioid Hemangioma but There are Pitfalls in Interpretation Including Expression in Other Vascular Lesions.

Introduction. Epithelioid hemangioma is a benign vascular neoplasm associated with FOS and/or FOSB protein overexpression detected by immunohistochemistry (IHC). Methods. The aim of our study was to determine the co-expression or independent IHC expression of FOS and FOSB in a cohort of epithelioid hemangiomas. We also included two cohorts of other vascular lesions: papillary endothelial hyperplasia and lobular capillary hemangioma / pyogenic granuloma. Results. We identified 50 cases of epithelioid hemangioma, 84% of which were cutaneous and the remaining involved other anatomic locations. Over two thirds of all cases expressed FOSB (68%; 34/50) while FOS immunoreactivity was identified in 46% of all cases. Co-expression of FOSB and FOS occurred in 37% of cases while 76% of all cases stained for at least one of the antibodies. Fifty-eight percent (n = 14/24) and 33% (8/24) of all cases of papillary endothelial hyperplasia expressed FOS and FOSB, respectively. Thirty-two per cent of lobular capillary hemangiomas (n = 8/25) were positive for either FOS or FOSB. Conclusion. In summary, we present the largest cohort of epithelioid hemangiomas assessed with both FOS and FOSB and demonstrated that the use of both antibodies increases the detection rate of these proliferations by 10%. Nonetheless, the use of thresholds may not be appropriate, as only a subset of lesional endothelial cells label with FOS/FOSB. Over half of all cases of papillary endothelial hyperplasia and a third of lobular capillary hemangiomas also displayed immunoreactivity with FOS and/or FOSB.

Update on Treatment of Infantile Hemangiomas: What's New in the Last Five Years?

Among benign vascular tumors of infancy, hemangiomas are the commonest, affecting approximately 5–10% of one-year-old children. They are derived from a benign proliferation of vascular endothelial cells (VECs) in the mesoderm and may arise anywhere on the body around 1–2 weeks after birth. Infantile hemangiomas (IHs) are characterized by an early proliferative phase in the first year followed by a spontaneous progressive regression within the following 5 years or longer. IH prevalence is estimated to be 5%–10% in one-year-old children and commonly affects female, Caucasian and low-birth weight infants. Although most of them spontaneously regress, approximately 10% requires treatment to prevent complications due to the site of occurrence such as bleeding, ulceration, cosmetically disfigurement, functional impairment, or life-threatening complications. For over 30 years, steroids have represented the first-line treatment for IHs, but recently topical or systemic β-blockers are increasingly being used and recognized as effective and safe. A search for “Cutaneous infantile hemangioma” [All Fields] AND “Treatment” [All Fields] was performed by using PubMed and EMBASE databases. Treatment of IHs with labeled drugs, such as oral propranolol, but also with off-label drugs, such as topical β-blockers, including topical timolol and carteolol, steroids, itraconazole or sirolimus, with a focus on formulations types and adverse events were described in our review. We also discussed the benefits of pulsed dye laser and the treatment of IHs with involvement of central nervous system, namely the PHACE and LUMBAR syndrome.

Intracranial extension of an intramuscular haemangioma of superior rectus: case report and literature review

BackgroundIntramuscular haemangiomas are rare, benign vascular tumours that represent < 1% of all haemangiomas. When involving the extraocular muscles, haemangiomas are extremely rare, with only nine cases reported in the literature; to date there are no reported cases of extraocular muscle haemangiomas extending into the brain.Case presentationA 6-year-old boy with a two-week history of a painless swelling and erythema on the upper eyelid. On examination, the patient had restricted extraocular motility in all directions of gaze. In addition, the eye appeared proptotic, with chemosis and hyperaemia of the conjunctiva. Visual acuity and intraocular pressure were normal. Orbital computed tomography imaging showed a mass in the left superior rectus, with heterogeneous enhancement following contrast administration. Incisional biopsy revealed an intramuscular haemangioma of the superior rectus muscle with capillary-type vessels. The patient received an intralesional steroid, which improved the condition for a few months; however, the lesion later recurred and included an intracranial extension.ConclusionThis case represents the first reported case of intracranial extension of intramuscular haemangioma of extraocular muscle.