Adult Hemangioma Research Articles

Combined Open Surgery and CO2 Laser for Giant Supraglottic Hemangioma in an Adult: A Case Report.

Laryngeal hemangiomas are rare vascular tumors, mainly in children, and less common in adults. Giant lesions typically require multiple endoscopic procedures and temporary tracheostomy. Open surgery allows single-procedure removal with fewer complications. CO2 laser excision controls bleeding and minimizes tissue damage. This study evaluates this hybrid approach to manage adult giant supraglottic hemangiomas. A 54-year-old woman with a giant supraglottic hemangioma was successfully treated using a combination of open surgery and CO2 laser. Limited data on adult laryngeal hemangiomas result in a lack of established treatment protocols. For giant supraglottic hemangiomas, combining open surgery with CO2 laser resection offers distinct advantages: enhanced lesion visibility, optimal airway control, effective hemostasis, reduced tissue damage, and lower recurrence rates. This hybrid approach also supports rapid recovery and favorable clinical outcomes. Combining open surgical excision with CO2 laser is effective for managing giant supraglottic hemangiomas in adults.

A 20 MHz Repetition Rate, Sub-Picosecond Ti-Sapphire Laser for Fiber Delivery in Nonlinear Microscopy of the Skin.

Nonlinear microscopy (NM) enables us to investigate the morphology or monitor the physiological processes of the skin through the use of ultrafast lasers. Fiber (or fiber-coupled) lasers are of great interest because they can easily be combined with a handheld, scanning nonlinear microscope. This latter feature greatly increases the utility of NM for pre-clinical applications and in vivo tissue imaging. Here, we present a fiber-coupled, sub-ps Ti-sapphire laser system being optimized for in vivo, stain-free, 3D imaging of skin alterations with a low thermal load of the skin. The laser is pumped by a low-cost, 2.1 W, 532 nm pump laser and delivers 0.5-1 ps, high-peak-power pulses at a ~20 MHz repetition rate. The spectral bandwidth of the laser is below 2 nm, which results in a low sensitivity for dispersion during fiber delivery. The reduction in the peak intensity due to the increased pulse duration is compensated by the lower repetition rate of our laser. In our proof-of-concept imaging experiments, a ~1.8 m long, commercial hollow-core photonic bandgap fiber was used for fiber delivery. Fresh and frozen skin biopsies of different skin alterations (e.g., adult hemangioma, basal cell cancer) and an unaffected control were used for high-quality, two-photon excitation fluorescence microscopy (2PEF) and second-harmonic generation (SHG) z-stack (3D) imaging.

Isolated bronchial hemangioma causing recurrent hemoptysis: A case report.

The development of bronchial hemangioma in adults is rare, and massive hemoptysis due to diffuse vascular proliferation of bronchial hemangioma is fatal. A case of a 29-year-old woman kept massive hemoptysis even after being underwent repeated interventional embolization for recurrent massive hemoptysis. Eventually, the patient was performed the operation of right upper lung lobectomy and bronchial hemangioma with extracorporeal membrane oxygenation support and was followed up for 4 years without recurrent hemoptysis. Bronchial hemangioma. For patients with bronchial angiomas bonded with bronchial artery-pulmonary arteriovenous fistulae, the early surgical resection is recommended if bronchial artery embolization (BAE) is considered ineffective.

Cavernous hemangioma in adult parotid gland encroaching on the parapharyngeal space: A case report

Hemangiomas account for 0.4-0.6% of all tumors of the parotid gland. With about 50 cases reported worldwide in adults, diagnosing a hemangioma in the parotid gland can be difficult. An accurate diagnosis of parotid hemangiomas in adults before excision is challenging. We report a case of a 54-year-old woman with a left parotid mass of five years duration, which was rapidly increasing in size over last one year. Magnetic resonance imaging (MRI) was suggestive of a left parotid pleomorphic adenoma invading the parapharyngeal space. Fine needle aspiration cytology was inconclusive. However, with a strong clinical suspicion of a pleomorphic adenoma, left total parotidectomy was performed. The histopathological findings were of a cavernous hemangioma. The rarity of such condition in head and neck region and misdiagnosis or failing to diagnose make this case more interesting to pathologists and clinicians alike. Nevertheless, hemangioma should be considered in the differential diagnosis of parotid tumors in adults.

A case of isolated bronchial hemangioma causing recurrent hemoptysis

The development of bronchial hemangioma in adults is rare, and massive hemoptysis due to diffuse vascular proliferation of bronchial hemangioma is fatal.

VASCULAR CAUSE OF VOICE CHANGE/HOARSENESS OF VOICE - A RARE UNLEASHING CASE REPORT

Hemangioma is the most common benign vascular lesion. Laryngeal hemangioma is a rare entity and it is divided into infantile and adult form. Of these two, infantile hemangioma is more common than adult which is most commonly present in the subglottic region which regress spontaneously. Whereas, adult hemangioma requires intervention if large and symptomatic and it is most commonly located in supraglottic and glottic region. This is one such rare presentation in the adult.

Three Cases of Parotid Hemangiomas in Adults.

Hemangiomas account for only 0.4% to 0.6% of all parotid tumors, making them extremely rare in adults. Unlike pediatric parotid hemangiomas, those in adults typically present as asymptomatic swellings of the parotid, have no skin discoloration, and usually do not regress spontaneously. Therefore, an accurate diagnosis of parotid hemangiomas in adults before surgical excision is generally challenging. Herein, we present 3 cases of adult parotid hemangiomas. The patients all received parotidectomies with tumor resection. Histopathological analysis of the resected specimens revealed numerous dilated, thin- or thick-walled (small, large, or variably sized) vessels lined with flattened endothelial cells. A diagnosis of cavernous hemangioma of the parotid gland was established only after the histopathological analysis. Parotid cavernous hemangiomas in adults are rare and often misdiagnosed before surgical resection. Clinical presentation and imaging features on ultrasonography, computed tomography, magnetic resonance imaging, and angiography may support an accurate preoperative diagnosis. Surgical resection proved a suitable treatment approach for our 3 cases.

Adult Laryngeal Hemangioma – A Rare Case Report

Laryngeal hemangiomas are classified into an adult and infantile forms. The incidence of laryngeal hemangioma in adults is rare. While infantile hemangiomas are more frequently found in subglottic regions and regress with age, adult hemangiomas occur commonly in supraglottic and glottic regions and they do not regress spontaneously. In this article, we report a case of laryngeal cavernous hemangioma in a 51-year-old male who was treated successfully with endolaryngeal microsurgical technique without any recurrence through one year follow up.

Cavernous hemangioma: A rare cause of hoarseness in adult

In contrary to the infantile hemangioma, adult hemangioma differs in terms of its rarity, gender prevalence, location and presenting symptoms. We report a case of a 61-year-old gentleman with right vocal cord cavernous hemangioma who presented to us with the complaint of hoarseness for 6 months duration. Endoscopic laryngeal microsurgery and excision biopsy was performed and the mass was completely excised. Post operatively, the voice improved with no evidence of recurrence.International Journal of Human and Health Sciences Vol. 04 No. 01 January’20 Page : 67-69

Periocular Lobular Capillary Hemangioma in Adults: A Clinicopathological Study.

PURPOSE:To describe a case series of periocular lobular capillary hemangiomas in adults, outlining characteristic clinical and histopathological patterns.MATERIALS AND METHODS:This was a retrospective case series of 16 patients with review of clinical and histopathological features.RESULTS:Eleven male and five female patients were diagnosed with periocular lobular capillary hemangioma at a median age of 38 years (mean, 41 years; range, 21–71 years). The median tumor basal diameter was 6 mm (mean, 7 mm; range, 3–14 mm) and all were well circumscribed. They arose over the course of weeks to months and developed most commonly in the eyelid region (n = 10), followed by the conjunctiva (n = 6). Excisional biopsy of the lesion was done in all cases. On histopathology, the tumors were composed of repeating units of capillary-sized lobules lined by plump endothelial cells. Lesion recurrence was noted in one case.CONCLUSION:Lobular capillary hemangiomas are common benign vascular tumors of periocular region in adults. Clinicohistopathological features and clinical presentation of these lesions are distinctive. Excisional biopsy was curative with recurrence noted rarely.

Campbell de Morgan Spots (Cherry Angiomas) Show Endothelial Proliferation.

Campbell de Morgan spots (also known as adult hemangiomas, cherry angiomas, or senile angiomas) show clinical and histopathological features that make them distinct. Despite this, they are not included as benign vascular tumors in the current classification by the International Society for Vascular Anomalies (ISSVA). In the current study, we investigated the proliferation rate (Ki67) of the endothelia of 23 cases of Campbell de Morgan spots, as well as the immunoexpression of Wilms tumor protein 1 (WT1) by these vascular anomalies. The youngest patient was 24 years old (range: 24-80; mean: 52.61). Ten patients were women (43.48%). All cases showed intense cytoplasmic expression of WT1 by the endothelia in 80%-100% of the endothelial cells. Ki67 demonstrated proliferation by the endothelia of all vascular lesions. A mean of 1077.6 nuclei were evaluated per case. Eight cases showed a very low proliferation (less than 0.5% of the nuclei). In the other 15 cases, the proliferation ranged from 0.59% to 3.59% (mean: 1.89%).

Adult Hemangioma of The Larynx in A Developing Community

Adult Hemangioma of The Larynx in A Developing Community

Management of Head and Neck Hemangiomas in Adults: Oral Propranolol Versus Oral Itraconazole in Conjugation with Injection Sodium Tetra Decyl Sulphate.

Management of head and neck hemangiomas with oral propranolol versus oral itraconazole in conjugation with injection sodium tetra decyl sulphate. This prospective parallel clinical trial was done to check for the effectiveness of oral propranolol and oral itraconazole when used in conjugation with inj. sodium tetra decyl sulphate in treatment of head and neck haemangiomas in adult patients visiting department of ENT and head and neck surgery, VIMSAR, Burla. All the patients visiting the department with hemangioma (diagnosed clinically and by FNAC) were considered and only those who gave written informed consent and were according to our inclusion and exclusion criteria were included into the study as subjects. Dimension (length, width and hemi-circumference) of the haemangiomas were measured using disposable paper taper measures. Depth of the hemangioma was calculated based on formula and using that volume was calculated both at baseline and after 8weeks of drug administration. Data so collected was entered into Microsoft Office Excel 2013 and statistical analysis was performed using SPSS Version 20.0. Descriptive statistics was calculated and student's t test (paired and unpaired) was used to compare within the group (before and after) and between the groups respectively. Statistical significance was set at p ≤ 0.05. Both the groups showed statistically significant volume reduction in the lesions [p < 0.018 (propranolo + sodium tetra decyl sulphate), p < 0.025 (itraconazole + sodium tetra decyl sulphate)]. The mean decrease in volume in propranolol group was 91.92% and that in itraconazole group was 88.97%. There was no statistical difference between the final outcome of both the groups (p < 0.766) but 3 patients on propranolol had complete resolution while 1 patient on itraconazole had complete resolution of the lesion. Oral propranolol and itraconazole are both effective and safe in hemangioma in adults. The combination with inj. sodium tetra decyl sulphate has a (1) favorable impact on decreasing the overall duration of treatment. (2) Aiding in complete resolution of lesions (especially < 3cm). Propranolol has an edge over itraconazole (more no of tumors had complete resolution).

An Unusual Cause of Chest Pain: Kasabach-Merritt Syndrome

Kasabach-Merritt syndrome (KMS) is a rare complication of hemangiomas that includes both thrombocytopenia and consumptive coagulopathy. Initial cases reported in the pediatric population in the 1940s predominantly involved tufted hemangiomas and kaposiform hemangioendotheliomas. However, this syndrome also includes visceral hemangiomas in adults and has been associated with a broad range of mortality. Abnormal platelet-endothelial interactions lead to platelet sequestration and coagulation factor consumption as a result of these large vascular lesions. Resultant bleeding and thrombosis presents as a localized mimicker of disseminated intravascular coagulopathy (DIC) and can progress to cause compression of nearby organs. Importantly, adults with visceral involvement are often unaware of the presence of these hemangiomas at time of diagnosis and management must be carefully selected with the patient. A multidisciplinary approach including corticosteroids, chemotherapeutics, interferon alpha, antiplatelet agents, embolization, and surgical excision have each been employed in efforts to treat KMS. We present a case of a 36 year-old male with past medical history of hypertension with new-onset chest pain and left arm numbness. He had no nausea, vomiting, melena, or hematochezia. He had no personal or family history of bleeding or clotting disorders. Vital signs were within normal limits and physical examination was unremarkable. After negative serial cardiac enzymes and stable electrocardiograms, Computed tomography (CT) evaluation of the chest was notable for multiple liver lesions. Further evaluation with magnetic resonance imaging (MRI) of the abdomen revealed multiple hepatic hemangiomas with the largest encompassing 15 cm in diameter. Laboratory studies were pertinent for thrombocytopenia, elevated fibrin split products, and a “clotted” PT, PTT, and fibrinogen study. Transaminases, bilirubin, viral hepatitis panel and urine drug screen were negative. The patient's atypical chest pain resolved and was likely attributed to the large liver hemangiomas. Surgery consultation recommended close outpatient follow up to further discuss elective surgical intervention. This case illustrates the importance of maintaining occult etiologies, such as KMS, in the differential of seemingly-routine chief complaints. Medical awareness of this rare syndrome is essential for follow-up, treatment, and prevention of potential life-threatening complications.Figure 1Figure 2Figure 3

A Critical Analysis of Eleven Periocular Lobular Capillary Hemangiomas in Adults

To provide a critical analysis of a series of periocular lobular capillary hemangiomas in adults, outlining characteristic clinical and histopathologic patterns in comparison with those of other vascular tumors of adults and children. Retrospective observational case series. Review of clinical data, hematoxylin-eosin-stained sections, and immunohistochemical studies of smooth muscle actin (SMA), D2-40, CD34, and glucose transporter 1 (GLUT-1). The 7 female and 4 male patients were diagnosed with periocular lobular capillary hemangioma at a median age of 39 years (range, 17-82 years). The tumors were small (3-14mm, median size 6mm) and well circumscribed, arose over the course of weeks to months, and developed most commonly in the canthal region, followed by the upper eyelid skin. The tumors were all composed microscopically of repeating units of various sizes (lobules) consisting of CD34-postive, GLUT-1-negative endothelial cells and SMA-positive pericytes arranged in macro- or microlobules. Some foci also exhibited ectatic vessels or diffuse, nonlobular capillary proliferations. Excision was curative without recurrence. Although capillary hemangiomas are more common in children, lobular capillary hemangiomas can also arise in the periocular region of adults. Some histopathologic features of these lesions are shared with those of infantile hemangioma and tufted angioma of children, but features of the clinical presentation and the results of immunohistochemical staining patterns are distinctive.

New recognition of the natural history and growth pattern of hepatic hemangioma in adults.

Surgical indications for hepatic hemangiomas are still not clearly defined due to limited data on their natural history. This study aimed to investigate the natural history and growth pattern of hepatic hemangiomas in adults. From April 2010 to March 2013, adult patients with hepatic hemangioma who had no prior treatment were enrolled. A routine follow up was performed to observe the natural history of the lesions and their tendency to cause complications. A total of 236 patients were enrolled in the study. The median size of hemangiomas was 4.5cm (range, 0.6-19.2). During a median follow-up period of 48months (range, 3-266), 61.0% patients had hemangiomas that increased in size, 23.7% patients had stable lesions and 8.5% patients had hemangiomas that decreased in size. The peak growth period of hemangiomas was in patients of less than 30years of age (0.46 ± 0.41cm/year) and the growth rate decreased significantly after 50years of age (0.21 ± 0.40cm/year). Hemangiomas of less than 2cm had the lowest growth rate (0.16 ± 0.42cm/year). The peak growth rate of hemangioma size was 8-10cm (0.80 ± 0.62cm/year), then decreased rapidly to 0.47 ± 0.91cm/year while the hemangiomas were of more than 10cm. Only nine patients had severe symptoms caused by hemangioma. No patients presented with hemangioma-related complications. The majority of hepatic hemangiomas have the tendency to increase in size but rarely cause complications. All the hemangiomas can be safely managed by observation, and surgery is only considered for patients with severe complications.

P0380 : New recognization of the natural history and growth pattern of hepatic hemangioma in adults

P0380 : New recognization of the natural history and growth pattern of hepatic hemangioma in adults

Cavernous Hemangioma of the Tongue

ABSTRACT Background Vascular anomalies are divided into vascular tumors, hemangiomas being the most common, and vascular malformations. Most vascular anomalies are noticed at birth or occur during infancy, and generally involve skin or subcutaneous soft tissues. Adult onset hemangiomas are rare, and intramuscular location is extremely rare. Surgical excision is recommended for hemangiomas in adults, if they are symptomatic, or manifest growth. Materials and methods We report a rare case of a 51-year-old woman, with an intramuscular hemangioma of the tongue, presenting as a submental mass. Preoperative imaging for assessment of tumor extent was followed by a successful surgical excision. Results Postoperative course was uneventful with primary healing of the wound, and with no functional deficit of tongue function. Conclusion Although a variety of treatment approaches are reported for childhood hemangiomas, surgical excision is the preferred treatment for adult onset symptomatic hemangiomas. Preoperative work up should include imaging preferably with contrast enhanced magnetic resonance imaging (MRI). Embolization may be considered for larger lesions. Intraoperative hypotension should be avoided to ensure identification of the entire lesion to ensure complete excision. How to cite this article Petrovic I, Roman B, Shah JP. Cavernous Hemangioma of the Tongue. Int J Head Neck Surg 2015;6(3):109-111.

Adult hemangioma of the pancreas: difficult diagnosis of a rare disease.

Adult pancreatic hemangiomas are rare. We report a new case and review the literature. Pancreatic hemangiomas do not produce specific symptoms, so diagnosis is not easy. Computed tomography is often misleading, since pancreatic hemangiomas behave differently from liver hemangiomas, which are more frequently seen. Instead of showing arterial peripheral nodular enhancement followed by centripetal filling they take up the contrast material more slowly and the filling is usually inhomogeneous, which may give the impression of a cystic tumor. The reason for this may be that the microscopic structure of the pancreatic hemangioma is different from that of the liver. It partly consists of thin-walled sinusoids which do not communicate with the circulation of the patient. Since no malignant cases have been published to date, surgical resection might be avoided if the diagnosis can be firmly established.

Spinal Cavernous and Capillary Hemangiomas in Adults

Retrospective cohort analysis. To evaluate the neurological outcomes after resection of intramedullary, intradural extramedullary, and extradural hemangiomas. Spinal hemangiomas most commonly arise in the vertebral bodies and are typically asymptomatic. Uncommonly, hemangiomas may cause significant neurological deficits via extraosseous extension. Intramedullary hemangiomas may also occur and account for approximately 5% of all spinal cord lesions, with those located intradural extramedullary occurring rarely. Although retrospective studies have primarily examined the neurological outcome of intramedullary and vertebral hemangiomas, there is little literature comparing outcomes after surgical treatment of hemangiomas of varying location. We performed a retrospective review of all patients treated for hemangiomas affecting the spinal cord at our institution between 1999 and 2012. Various patient, clinical, and tumor data were collected including patient demographics, neurological examinations, and procedure, clinic, and pathology notes. Imaging studies were evaluated to determine the extent of resection, presence of recurrence, and lesion volume. Functional status was defined using the Modified McCormick Scale (MMS). A total of 19 patients were evaluated, with our cohort consisting of 8 intramedullary, 5 intradural extramedullary, and 6 vertebral hemangiomas with extraosseous extension. Cavernous hemangiomas were most common (47.4%), followed by those of the capillary type. At long-term follow-up, 73.7% of patients had improved neurological outcome and 15.8% had worsened. However, only 50% of patients with intramedullary hemangiomas improved, compared with 80% and 100% for intradural extramedullary and vertebral hemangiomas, respectively. Also, those with intramedullary lesions more frequently had worse outcomes after surgery (25%) than those with intradural extramedullary (20%) and vertebral hemangiomas (0%). Although all patients typically present with a similar functional status, patients with intramedullary lesions are more unlikely to improve after surgical resection and derive less of a benefit compared with those with intradural extramedullary and vertebral hemangiomas.