Hemangioma Research Articles

Congenital Neonatal scalp Arteriovenous Malformation, a very rare lesion.

Introduction: Congenital arteriovenous malformation (AVM) of scalp are rare congenital lesions to be reported. To date there is very scant data available on symptomatic congenital Scalp AVM in the neonatal population. They appear as red or purple birthmarks and are often mistaken as capillary hemangioma. We describe a case of symptomatic congenital arteriovenous malformation of scalp. Case-Report: A 10 days old baby boy was presented with an episode of profuse bleeding from a swelling at left temporal region of the scalp. Antenatal and birth history was …

Prescribing Propranolol for Hemangioma of Infancy: Assessment of Dosing Errors

In 2008, oral propranolol was serendipitously discovered to be an effective treatment for Infantile hemangiomas (IH). Since then, this medication has gained widespread popular acceptance as a treatment for IH. Generic propranolol oral solution has been commercially available for decades in two different concentrations: 20 mg/5 mL and 40 mg/5 mL. These formulations have been widely used off-label since 2008, to treat IH, initially empirically dosed by weight, in gradually escalating amounts given every 8-12 hours, up to a total of 3 mg/kg/day. In 2014, a unique oral …

Application of the cold cutting technique in transumbilical single-incision laparoscopic liver resection

Objective To study the application of the cold cutting technique in transumbilical single-incision laparoscopic liver resection (TUSI-LLR), and to evaluate its feasibility and treatment results. Methods The clinical data of 35 patients with liver lesions treated by transumbilical single-incision laparoscopic liver resection from 2013 to 2017 were retrospectively analyzed in Shengjing Hospital of China Medical University. In all these patients, the liver parenchyma was transected with the cold cutting technique. The operation time, intraoperative blood loss, postoperative complications, time to remove abdominal drain, and total hospital stay in the patients were analyzed. Results 11 of the 35 patients were male. The average age was (49.9±10.8) years. The average body weight was (63.2±11.1) kg. The diagnoses were hemangiomas in 18 patients, hepatolithiasis in 5 patients, malignant hepatocellular tumors in 5 patients, focal nodular hyperplasia in 3 patients, and others in 4 patients. There were 22 left lateral sectionectomies, 2 left hemihepatectomies, 11 wedge resections (8 in the left and 3 in the right). The operations were all successfully performed, with no conversion to conventional laparoscopic hepatectomy or open surgery. The average operation time was (112.2±51.0) minutes, and the intraoperative blood loss was (105.4±70.1) ml. No patients required intraoperative blood transfusion. The average surgery cost was (36 336.7±5 938.2) yuan. All patients recovered well, with no postoperative hemorrhage, bile leakage, or incisional wound infection. The average time periods for removal of the abdominal drain, and hospital stay were (4.5±1.2) days and (5.2±1.4) days, respectively. All the 35 patients were followed up (1~3 months), with no patients complaining of abdominal distension or abdominal pain. Conclusions The cold cutting technique in transumbi-lical single-incision laparoscopic liver resection was safe and feasible. Its benefits included the operative speed, the small amount of intraoperative blood loss and the rapid postoperative recovery of the patients. Key words: Cold cutting technique; Liver resection, laparoscopic, single incision; Stapling devices

Upregulated GP73 expression and downregulated NLRP3 expression in liver cancer tissues correlate with patient’s survival

Background: To investigate the correlation between Golgi protein 73 (GP73) and NLRP3 expression and the clinicopathologic features and prognosis in patients with hepatocellular carcinoma (HCC). Methods: A total of 54 HCC tumor tissues and matched paracarcinomatous liver (PCL) tissues from patients who received liver resection in our hospital were collected. The expression of GP73 and NLRP3 were tested by using Western blotting method. Eleven healthy liver (HL) tissues from patients with hepatic hemangioma were tested at the same time. Correlations between GP73/NLRP3 protein expression levels and clinicopathologic features were evaluated by Chi-square test. Survival analysis was conducted by Kaplan-Meier method, and overall survival (OS) and disease-free survival (DFS) were calculated, meanwhile the log-rank test was used to compare the survival differences between different groups. Results: The median GP73 protein level in HL, PCL and HCC tissues were 1.6 (1.4–1.9) RU, 2.7 (1.6–3.4) RU and 4.5 (2.8–5.5) RU, respectively. The median NLRP3 protein level in HL, PCL and HCC tissues were 1.1 (0.9–1.3) RU, 1.9 (1.4–2.6) RU and 1.2 (0.4–1.3) RU, respectively. They were both with significant difference (P Conclusions: GP73 and NLRP3 may play the role of different level in tumor development in patients with HCC. NLRP3 could have more effect on DFS.

Anesthetic management of pediatric patients with Kasabach-Merritt phenomenon undergoing radical resection for huge hemangioma of head and neck

Nine pediatric patients (4 females, 5 males) with huge hemangioma of head and neck complicated with Kasabach-Merritt phenomenon, aged 15-135 days, undergoing elective radical resection for huge hemangioma of head and neck, were selected from June 2012 to June 2016 in our hospital.Two pediatric patients were sensitive to preoperative hormone treatment, the platelet count almost increased to the normal value, 7 pediatric patients were not sensitive to preoperative hormone treatment, and the increase in platelet count was not obvious.When the platelet count 100×109/L.Two pediatric patients with larger haemangioma in maxillofacial region kept spontaneous breathing, and anesthesia was induced by inhaling high-concentration of sevoflurane.Anesthesia was induced with intravenous midazolam, sufentanil and cisatracurium in the other seven pediatric patients.Pediatric patients were mechanically ventilated in pressure-controlled mode after endotracheal intubation with airway pressure of 9-12 cmH2O.All pediatric patients inhaled sevoflurane, and anesthesia was maintained by infusing remifentanil.Heart rate and systolic blood pressure were maintained within the normal range during operation.Fluid and blood products were infused according to the blood loss, urine volume, physiological requirement and central venous pressure, etc.Pediatric patients were transferred to pediatric intensive care unit (PICU) at the end of operation, and the endotracheal tube was removed after the patients were completely awake.One pediatric patient developed pulmonary infection after operation, was discharged from PICU on day 7 after operation, then cured and discharged from hospital after healing on day 20 after operation.The other eight pediatric patients were discharged from PICU on day 2 after operation, then cured and discharged from hospital on days 5-10 after operation.After a follow-up period of 1 yr, the pediatric patients recovered well, the platelet count was normal, and the tumor recurrence was not found. Key words: Hemangioma; Head and neck neoplasms; Anesthesia; Kasabach-Merritt syndrome

Application value of secondary splenic pedicle separation technology through superior posterior approach of the pancreatic tail in laparoscopic partial splenectomy

Objective To investigate the application value of secondary splenic pedicle separation technology through superior posterior approach of the pancreatic tail in laparoscopic partial splenectomy. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 13 patients who underwent laparoscopic partial splenectomy in the Ningbo First Hospital from March 2016 to October 2017 were collected. After preoperative assessment using computed tomography(CT) angiography, 13 patients underwent laparoscopic partial splenectomy using secondary splenic pedicle separation technology through superior posterior approach of the pancreatic tail. Observation indicators: (1) intra- and post-operative recovery situations; (2) follow-up situations. Follow-up using outpatient examination was performed to detect postoperative changes of peripheral blood platelet (PLT), thrombosis of splenic vein, lesions residual or recurrence up to November 2017. Measurement data were represented as average (range). Results (1) Intra- and post-operative recovery situations: 13 patients underwent successful laparoscopic partial splenectomy using secondary splenic pedicle separation technology through superior posterior approach of the pancreatic tail, without conversion to open surgery, including 6 with laparoscopic partial splenectomy of inferior pole of the spleen and 7 with laparoscopic partial splenectomy of upper pole of the spleen. Operation time was 42-93 minutes, with an average of 61 minutes; volume of intraoperative blood loss was 30-260 mL, with an average of 92 mL; postoperative gastrointestinal function recovery time was 22-47 hours, with an average of 34 hours; postoperative drainage tube removal time was 3.0-6.0 days, with an average of 4.2 days. The postoperative pathological examination of 13 patients: 7, 2, 2, 1 and 1 patients were respectively confirmed with splenic cysts, splenic hemangiomas, vascular hemangiomas, splenic hamartoma and splenic lymphangioma. Of 13 patients, 1 was complicated with splenic recess effusion and fever, and was improved with B ultrasound-guided percutaneous catheter drainage. Duration of hospital stay of 13 patients was 7.0-16.0 days, with an average of 9.6 days. (2) Follow-up situations: 13 patients were followed up for 1.0-19.5 months, with a median time of 8.5 months. During the follow-up, PLT level of 13 patients was normal. Color Doppler ultrasound examination showed no venous embolism, and CT angiography showed good vascular perfusion. There was no recurrence of splenic cysts in 7 patients and no tumor residual or recurrence in 6 patients. Conclusion Laparoscopic partial splenectomy using secondary splenic pedicle separation technology through superior posterior approach of the pancreatic tail is safe and effective, and it can precisely dissect splenic hilum, preserve blood supply and function of the remnant spleen, and reduce surgical injury. Key words: Splenic neoplasms, benign; Partial splenectomy; Secondary splenic pedicle separation; Superior posterior approach of the pancreatic tail; Laparoscopy

Curcumin-induced apoptosis of hemangioma endothelial cells by downregulating expression of vascular endothelial growth factor and angiogenin 2

Objective To investigate the effect of curcumin on vascular endothelial growth factor (VEGF) and angiogenin (Ang)-2 in hemangioma endothelial cells (HemECs) and the apoptosis mechanism. Methods HemECs were separated and cultured by enzyme digestion, and were treated with 0, 6.25, 12.50, 25.00, 50.00 and 100.00 μmol/L of curcumin. Cell counting kit-8 (CCK-8) was used to detect the cell proliferation toxicity of HemECs. TdT-mediated dUTP nick end labeling (TUNEL) method was used to detect the apoptosis of HemECs. Real-time reverse transcriptase-polymerase chain reaction(RT-qPCR) was used to detect the mRNA expression of VEGF, Ang-1, and Ang-2. The cell immunofluorescence was used to detect the protein expression of vascular endothelial growth factor receptor (VEGFR)1, VEGFR2, endothelium-specific tyrosine kinase receptor (Tie)1 and Tie2. Results The survival rate of cells treated with 25.00 or 50.00 μmol/L curcumin for 48 h was significantly lower than that of cells treated with 25.00 or 50.00 μmol/L curcumin for 24 h [(62.34±10.08)% vs. (79.25±8.17)% and (15.23±4.01)% vs. (26.10±6.05)%; t=3.192, P=0.010 and t=3.668, P=0.004]. The number of TUNEL positive cells treated with 25.00 μmol/L curcumin for 48 h (16.00±2.80) was significantly greater than that after treatment with 0 μmol/L curcumin (5.00±1.40; t=8.607, P=0.000). The VEGF mRNA relative expression in HemECs treated with 25.00 μmol/L curcumin for 24 h (0.34±0.09) was significantly lower than that after treatment with 0 μmol/L curcumin (1.00±0.12; t=8.193, P=0.001). The Ang-2 mRNA relative expression in HemECs treated with 25.00 μmol/L curcumin for 24 h (0.45±0.07) was significantly lower than that after treatment with 0 μmol/L curcumin (0.99±0.12; t=8.193, P=0.001). The absorbance values of VEGFR2 and Tie2 protein expression in HemECs treated with 25 μmol/L curcumin for 24 h (0.30±0.05 and 0.30±0.04) were significantly lower than those after treatment with 0 μmol/L curcumin (0.48±0.09, 0.52±0.07; t=4.300, P=0.002; t=6.602, P=0.000). Conclusion Curcumin can inhibit the growth of HemECs by inducing apoptosis. The underlying mechanism may be closely related with down-regulations of VEGF and Ang-2. Key words: Hemangioma endothelial cells; Apoptosis; Vascular endothelial growth factor; Angiogenin 2

Application value of laparoscopic right-posterior lobe hepatectomy using the technique of regional blood flow occlusion

Objective To explore the application value of laparoscopic right-posterior lobe hepatectomy using the technique of regional blood flow occlusion. Methods The retrospectively cross-sectional study was conducted. The clinicopathological data of 27 patients who received laparoscopic right-posterior lobe hepatectomy in the Sir Run Run Shaw Hospital of Zhejiang University from May 2007 to June 2017 were collected. The hepatocellular carcinoma, intrahepatic bile duct stone, hepatic hemangioma, focal nodular hyperplasia, cholangiocarcinoma and metastatic hepatic carcinoma were respectively detected in 13, 4, 4, 4, 1 and 1 patients. The laparoscopic right-posterior lobe hepatectomy were performed after regional blood flow occlusion. Observation indicators: (1) intra- and post-operative recovery situations; (2) follow-up situations. Follow-up using outpatient examination and telephone interview was performed to detect the postoperative recurrence of patients with benign liver diseases and survival of patients with malignant liver tumors up to August 2017. Measurement data with skewed distribution were described as M (range). Results (1) Intra- and post-operative recovery situations: 27 patients underwent successful laparoscopic right-posterior lobe hepatectomy after regional blood flow occlusion, including 24 undergoing laparoscopic surgery and 3 undergoing conversion to open surgery due to difficult exposure under laparoscopy. Operation time, volume of intraoperative blood loss, recovery time of postoperative gastrointestinal function and time of postoperative abdominal drainage-tube removal were respectively 205 minutes (range, 125-455 minutes), 400 mL (range, 50-2 000 mL), 1 day (range, 1-3 days) and 3 days (range, 2-24 days). There was no postoperative hepatic failure, bile leakage and bleeding-induced reoperation. Of 4 patients with postoperative complications, 1 with wound infection was improved by regular dressing, 1 with deep venous thrombosis of the lower extremity was improved by anticoagulant therapy and 2 with pulmonary infection were improved by anti-infective supporting treatment. The duration of postoperative hospital stay in 27 patients was 9 days (range, 5-26 days). (2) Follow-up situations: 26 of 27 patients were followed up for 2-121 months, with a median time of 17 months, and 1 patient with benign liver disease lost to follow-up. During the follow-up, 11 patients with benign liver disease had no recurrence, the tumor-free and overall survival times of 15 patients with malignant liver tumors were respectively 13 months (range, 5-57 months) and 14 months (range, 5-57 months). Conclusion Laparoscopic right-posterior lobe hepatectomy using the technique of regional blood flow occlusion is safe and feasible, with a lower risk of liver failure and better clinical efficacies. Key words: Liver neoplasms; Carcinoma hepatocellular; Hepatolithiasis; Right-posterior lobe hepatectomy; Regional blood flow occlusion; Laparoscopy

Management of an elevated soft-tissue lesion with diagnosis of capillary hemangioma

Capillary hemangiomas are considered one of the rare benign oral tumors. Hemangioma of oral cavity is rare; accordingly, the present study aims to report a rare case of hemangioma that it is clinical sign representing mucocele and irritation fibroma, but the histologic results obtained from excisional biopsy led to the diagnosis of capillary hemangioma happening in the lower lip, in which the benign endothelial cell neoplasms are typically absent at birth but have a drastic development in childhood years with a natural involution in the later years of human life. In contrast to other human vascular malformations, related clinical reports have rarely mentioned its occurrence in the lower lip.

Von Hipple-Lindau: Unusual case presentation with peripheral and juxtapapillary retinal hemangioma.

Von Hipple-Lindua (VHL) syndrome is an autosomal dominant neoplastic disorder in which multiple benign or malignant tumours and cysts develop in central nervous system and visceral organs. Retinal capillary hemangioma is the most frequent and often the earliest manifestation of VHL syndrome. We report a case with multisystemic involvement diagnosed as a case of multiple endocrine neoplasia (MEN) syndrome but the presence of multiple, unilateral peripheral and juxtapapillary retinal capillary hemangioma was able to clinche the definative diagnosis of VHL and thus helped in appropriate management of the patient.

Virome Analysis Reveals No Association of Head and Neck Vascular Anomalies with an Active Viral Infection.

Vascular anomalies encompass different vascular malformations [arteriovenous (AVM), lymphatic (LM), venous lymphatic (VLM), venous (VM)] and vascular tumors such as hemangiomas (HA). The pathogenesis of vascular anomalies is still poorly understood. Viral infection was speculated as a possible underlying cause. A total of 13 human vascular anomalies and three human skin control tissues were used for viral analysis. RNA derived from AVM (n=4) and normal skin control (n=3) tissues was evaluated by RNA sequencing. The Virome Capture Sequencing Platform for Vertebrate Viruses (VirCapSeq-VERT) was deployed on 10 tissues with vascular anomalies (2×AVM, 1×HA, 1×LM, 2×VLM, 4×VM). RNA sequencing did not show any correlation of AVM with viral infection. By deploying VirCapSeq-VERT, no consistent viral association was seen in the tested tissues. The analysis does not point to the presence of an active viral infection in vascular anomalies. However, transient earlier viral infections, e.g. during pregnancy, cannot be excluded with this approach.

Classic computed tomography features of hepatic hemangioma

Classic computed tomography features of hepatic hemangioma

Excision of Masson’s Haemangioma Following Suspected Liposarcoma on Imaging

Excision of Masson’s Haemangioma Following Suspected Liposarcoma on Imaging

MiR-199a-5p inhibits proliferation and induces apoptosis in hemangioma cells through targeting HIF1A.

MicroRNAs (miRNAs) exhibit a crucial role in the regulation of angiogenesis and tumor progression, of which miR-199a-5p (miR-199a) has been reported to function as a tumor suppressor in multiple malignancies. However, the precise mechanisms underlying miR-199a in hemangiomas (HAs) remain elusive. In this study, we found that miR-199a had low expression level, while proliferating cell nuclear antigen (PCNA) had high expression level in proliferating-phase HAs compared with the involuting-phase HAs and normal tissues. Spearman correlation analysis revealed the negative correlation of miR-199a with PCNA expression in proliferating-phase HAs. In vitro experiments showed that restoration of miR-199a suppressed cell proliferation capability and induced cell apoptosis in HA-derived endothelial cells (HDEC) and CRL-2586 EOMA cells, followed with decreased PCNA expression and increased cleaved caspase-3 expression, but miR-199a inhibitor reversed these effects. Furthermore, HIF1A was identified as a target of miR-199a and had negative correlation with miR-199a expression in proliferating-phase HAs. Overexpression of HIF1A attenuated the anti-proliferation effect of miR-199a mimic in HAs cells. Taken together, our findings demonstrate that miR-199a may inhibit proliferation and induce apoptosis in HAs cells via targeting HIF1A and provide a potential therapeutic target for HAs.

Serum cytokeratin-18 is a non-invasive biomarker for evaluating disease severity in patients with liver cirrhosis and hepatocellular carcinoma

Background: To investigate the dynamic changes in cytokeratin-18 (CK18) levels in patients with liver cirrhosis and hepatocellular carcinoma (HCC) undergoing surgery, and to evaluate its diagnostic value for HCC and acute liver injury. Methods: Serum levels of total CK18 and CK18 fragments were measured using specific enzyme-linked immunosorbent assays in patients with liver cirrhosis and HCC, and control patients with liver cavernous hemangioma. Clinical parameters were measured 1 day before and 1, 3, and 5 days after surgery. Results: CK18 levels were markedly elevated in patients with liver cirrhosis and HCC compared with control patients with non-cirrhotic liver disease (total CK18: 262.9±130.0 U/L, control 158.7±44.5 U/L, P=0.038; CK18 fragments: 145.1±69.6 U/L, control 81.6±15.2 U/L, P=0.005), but fell to near preoperative levels at postoperative day (POD) 5. CK18 levels paralleled perioperative changes in alanine transaminase (ALT), reaching peak values on POD 1, and then decreasing gradually to near preoperative levels by POD 5. The correlation coefficients for the relationships between serum CK18 released by hepatocyte necrosis and ALT levels were 0.659 in the cancer group and 0.922 in the control group. Serum ALT levels remained above preoperative levels at POD 5. The levels of total CK18 and CK18 fragment released by hepatocyte necrosis were remarkably higher on POD 1 than the levels before operation. Conclusions: Serum levels of total CK18 and CK18 fragments were higher in HCC patients with chronic hepatitis B-related liver cirrhosis compared with levels in patients with liver cavernous hemangioma. Liver cancer may have a greater impact on serum CK18 levels than cirrhosis. Surgical injury can increase serum CK18 levels, and CK18 may be a more sensitive marker of liver injury than ALT.

The clinical application of the telovelar approach in tumor resection of the fourth ventricle

Objective To investigate the safety of telovelar approach for removing the fourth ventricle tumors. Methods The clinical data of 30 patients with fourth ventricle tumors was analyzed from July, 2012 to July, 2017 in our hospital. All patients were treated through telovelar approach. Results 25 cases had total tumor resection and 5 cases had subtotal resection. 24 cases recovered well after operation [Glasgow treatment outcome classification (GOS): 5 points]. 4 cases suffered from facial numbness and deviated mouth (GOS: 4 points), limb hemiparesis occurred in one case (GOS: 3 points). One patient died from pulmonary infection (GOS: 1 points). None of the survived patients underwent reticence, and the follow-up duration was 2 to 40 months. No obvious tumor recurrence occurred. Pathology results confirmed: 12 cases of ependymoma, 5 cases of astrocytoma, 2 cases of arachnoid cyst, 2 cases of medulloblastoma, 2 cases of choroid plexus papilloma, 2 cases of metastatic carcinoma, 2 cases of central neurocytoma, 2 cases of hemangioblastoma and 1 case of cavernous hemangioma. Conclusion Resection of the fourth ventricle tumors is very difficult. The tumors can fully be exposed through telovelar approach which avoiding the incision of the vermis and reducing the complications. Key words: Telovelar approach; Fourth ventricle tumors; Total tumor resection; Safety

Case report of intramuscular ossified haemangioma of shoulder in a child

Case report of intramuscular ossified haemangioma of shoulder in a child

Effects of propranolol on in vitro cultured hemangioma endothelial cells and their mechanisms

Objective To evaluate effects of propranolol on the proliferation and apoptosis of in vitro cultured hemangioma endothelial cells (HemEC) , and to explore their molecular mechanisms. Methods Hemangioma tissues were resected from 7 children with proliferative hemangioma, and used for in vitro culture of HemEC. Meanwhile, cultured human umbilical vein endothelial cells (HUVEC) served as controls. The 2 kinds of cells were treated with propranolol at different concentrations of 0, 25, 50, 75, 100, 125 and 150 μmol/L for 24, 48 and 72 hours separately. Methyl thiazolyl tetrazolium (MTT) assay was performed to evaluate cellular proliferative activity, and flow cytometry to determine the apoptosis rate. Some cultured HemEC were divided into 2 groups to be treated with 100 μmol/L propranolol-containing culture medium (propranolol group) and culture medium alone (blank control group) , respectively, for 18 hours. Total RNA in the 2 groups was extracted separately. Differentially expressed genes in HemEC between the above 2 groups were identified by DNA microarray technology, and verified by real-time quantitative PCR. Results The treatment with 25 μmol/L propranolol for 24 and 48 hours caused a slight proliferation of HemEC (P 1.5-fold changes) were screened out by DNA microarray technology, including 128 up-regulated genes and 58 down-regulated genes. Real-time quantitative PCR showed that the mRNA expression of proprotein convertase subtilisin/kexin type 9 (PCSK9) and fatty acid binding protein 3 (FABP3) in the propranolol group were (9.88 ± 2.19) and (21.90 ± 8.18) times that in the blank control group respectively (t = 7.028, 4.427 respectively, P < 0.05) . Conclusions Propranolol at high concentrations can inhibit the proliferation of HemEC and HUVEC, and its inhibitory effect on HemEC is stronger than that on HUVEC. The inhibitory effect of propranolol on HemEC may be related to the inhibition of HemEC proliferation and promotion of HemEC apoptosis. Key words: Hemangioma; Propranolol; Cell proliferation; Apoptosis; Gene expression profiling; Oligonucleotide array sequence analysis

Magnetic resonance imaging manifestations of deep vascular diseases in children with superficial vascular diseases

Objective To assess the clinical value of magnetic resonance imaging (MRI) in the diagnosis of deep vascular diseases in children with superficial vascular diseases. Methods From January 2012 to December 2016, 105 children with superficial vascular diseases in the Department of Dermatology of Shanghai Children′s Hospital underwent MRI examination, and the clinical and imaging data were analyzed. Results Of the 105 children, 42 were male and 63 were female. Their ages ranged from 0.5 to 168 months with an average age of 21.6 months. As MRI showed, 25 (23.8%) children had deep vascular diseases, which could not be seen with naked eyes. These deep vascular diseases included multisite deep capillary hemangiomas in 15 cases, cranial-facial hemangioma syndrome in 4, arteriovenous malformation in 3, persistent intracranial artery sinus in 2, and varicosity and bone hypertrophy syndrome in 1. Conclusion MRI is of great value to the diagnosis of deep vascular diseases in children with superficial vascular diseases. Key words: Hemangioma; Magnetic resonance imaging; Vascular malformations

The angiographic characteristics and transcatheter arterial embolization therapy of Kasabach-Merritt syndrome

Objective To analyze the angiographic characteristics of Kasabach-Merritt syndrome (KMS) and study the value of transcatheter arterial embolization (TAE) in KMS therapy. Methods The clinical data of 36 infants with KMS treated between June 2010 and June 2016 in our hospital were reviewed retrospectively. All infants performed angiography and TAE therapy. These angiographic characteristics were analyzed by comparing with infantile hemangioma (IH). The times of TAE and the level of platelet after TAE therapy were observed. Results The angiographic characteristics of KMS were as follows: The capillary blush of KMS were ill defined with no-uniform distribution. There were a lot of very fine feeding arteries. The diameter of feeding artery was disproportionate to the volume of tumor blush because the feeding arteries were too small or fine. Normal artery was usually embedded in tumor blush. However, the angiographic characteristics of IH were different as follows: the capillary blush of IH were well defined with uniform distribution. There were about 1-4 feeding arteries. The diameter of feeding artery was proportional to the volume of tumor blush. Normal artery was not embedded in tumor blush. Tumor blush was usually located beside the normal artery. In 36 patients, 107 embolization treatments were performed. The platelet declined for 11 times and increased for 96 times after TAE therapy. The platelet count for these 96 cases increased to ≥100×109/L at (7.1±2.4) days following therapy. However, the platelet level fluctuated thereafter and the average relapse time was (45.9±21.8) days. All cases were followed-up ranging from 6 months to 2 years and finally received other therapies. Eight cases were cured and the other 28 cases were improved. Conclusions The angiographic characteristics of KMS are different from common infantile hemangioma. It is difficult to embolize the feeding arteries of KMS because there are a lot of very fine feeding arteries. TAE may rapidly improve the level of platelets while the long term effect was poor. It might be better to combine TAE with other medical therapies to treat KMS. Key words: Hemangioma; Embolization, therapeutic; Angiography; Kasabach-Merritt syndrome; Infantile hemangioma