Skin Hemangiomas Research Articles

Is the identification of multiple infantile cutaneous haemangiomas always a definitive diagnosis? A case report of an infant with multifocal hepatic haemangioma

Multifocal hepatic haemangiomas are the most common benign vascular tumours of the liver that are detected in children with concomitant multiple infantile haemangiomas. Reported lesions are usually undetectable at birth, which presents a diagnostic problem for general practitioners. Ultrasound should be the imaging examination performed in the first instance in search for vascular anomalies in children. In pharmacotherapy, the first-choice treatment is propranolol, administered orally. In the described case, a boy with multiple hepatic and skin haemangiomas, after treatment with propranolol, achieved a significant improvement in the ultrasound image of the liver. Skin lesions were also reduced. The importance of the physical examination should be emphasised in the context of detecting cutaneous haemangiomas, which usually accompany multifocal hepatic haemangiomas and should prompt the physician to regularly observe and repeat abdominal ultrasound examinations of the diagnosed and/or treated child.

POEMS syndrome with undetectable M-protein: a case report and literature review

BackgroundPolyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes (POEMS) syndrome is a rare plasma cell (PC) neoplasm with associated paraneoplastic syndrome. According to the current diagnostic criteria, peripheral polyneuropathy and monoclonal PC proliferative disorder represent two mandatory criteria.Case presentationWe report a 54-year-old male with peripheral neuropathy of bilateral lower limbs, sclerotic bone lesions, elevated vascular endothelial growth factor (VEGF) levels, splenomegaly, extravascular volume overload, endocrinopathy, and skin hemangiomas. Of note, serum and urine protein electrophoresis (PEP) and immunofixation electrophoresis (IFE) of this patient indicated undetectable M-protein and the normal ratio of free light chains κ and λ (FLC-R (κ/λ)). No monoclonal PCs were found in bone marrow examinations or biopsy of diseased bones. However, his clinical manifestations matched most of the diagnostic criteria. After excluding other diseases that are easily confused with POEMS syndrome, the diagnosis of variant POEMS syndrome with undetectable M-protein was proposed. The patient obtained clinically significant improvement and elevated VEGF returned to normal after 6 months of treatment with lenalidomide plus dexamethasone.ConclusionsMonoclonal PC dyscrasia (M-protein) while being a mandatory criterion for POEMS syndrome is undetectable in a considerable amount of patients that otherwise demonstrate typical symptoms. Here, we reported a case of variant POEMS syndrome with featured clinical manifestations, elevated VEGF levels, and good response to therapies targeting PCs but no evidence of M-protein. Therefore, negative results in M-protein and monoclonal PCs aren’t enough to reject the diagnosis of POEMS syndrome. It is imperative to recognize the variant form of POEMS syndrome.

Analysis of a Case of Airway Hemangioma in a 1-Month-Old Infant with Dyspnea – A Secondary Publication

Infantile hemangiomas are the most common benign tumors of infancy. However, hemangiomas located in the respiratory tract are rare and could cause life-threatening events due to airway obstruction. To date, the best recommended treatment for infantile hemangioma is oral propranolol as it exhibits faster effects with fewer adverse effects as compared to systemic corticosteroid therapy. In this study, we reported a case of a 1-month-old girl who was presented with respiratory symptoms and hemangioma on the scalp. The hemangioma extended from the right base of the skull to the thoracic inlet, causing inspiratory stridor and dyspnea. Treatment with oral propranolol was initiated and her symptoms regressed. Imaging showed regression of the hemangioma. This was a rare case of skin hemangioma found on the scalp, in which the hemangioma extended from the base of the skull to the subglottis, precipitating respiratory symptoms from airway obstruction. Based on this encounter, the presentation of skin hemangioma on the head, coupled with respiratory symptoms, necessitates the use of imaging studies, such as computed tomography, ultrasound, and magnetic resonance imaging to ascertain the extent of hemangioma.

MAIN METHODS OF QUALITY CONTROL OF BЕТА-BLOCKER DRUGS AND APPLICATION OF SPECTROPHOTOMETRY IN THE ANALYSIS OF ANTIANGIOGENIC OINTMENTS ON TIZOL GEL (REVIEW)

Over th past decade, beta-blockers have shown their promise in the therapy of skin hemangiomas. Infantile hemangiomas are the most common soft tissue tumors occurring in 4-10% of children under the age of 1 year. Various methods are used to treat the disease: laser therapy, surgical exci-sion, cryodestruction, sclerosing, as well as conservative treatment with systemic glucocorticosteroids and beta-blockers administered enterally, topi-cally, and externally. Pharmacotherapy with the use of application dosage forms of beta-receptor antagonists is considered to be the most effective and safe method. This approach to treatment has several advantages over the oral method of administration: first, the convenience and painlessness of use, and secondly, the local effect on the pathological process, hence reducing the risk of systemic side effects (bradycardia, hypotension, bron-chospasm, insomnia). All these advantages emphasize the relevance of the development of soft dosage forms of beta-blockers. The patent RU 2471500 C2 “Use of beta-blocker for preparing drug for treating hemangiomas” proposes atenolol, betaxolol, bisoprolol, carvediol, metoprolol, nebivolol, propranolol and sotalol as antiangiogenic agents. The creation of soft dosage forms of beta-blockers with domestic transcutaneous enhancer Tizol gel is a solution to the problem of targeted delivery of active substances to the lesion site. For the development of new drugs, one of the most fundamen-tal areas of pharmaceutical science, pharmaceutical analysis, is of fundamental importance. The main objectives of pharmaceutical analysis are to determine the qualitative and quantitative characteristics of medicines. This article provides a review of the main methods for the analysis of beta-blockers used for the effective quality control of medicines, as well as methods for identifying, quantifying, and biopharmaceutically analyzing new ointments based on Tizol gel.

Онлайн-обучение врачей неонкологических специальностей по профилактике и ранней диагностике злокачественных новообразований кожи.

One of the reasons for the late diagnosis of malignant skin neoplasms (hereinafter referred to as MNS) is the insufficient knowledge of doctors in non-oncology specialties [1], [2]. The sensitivity for recognizing cutaneous melanoma (hereinafter referred to as MNS) during a visual examination by primary care physicians is 40,2% [3]. The sensitivity of recognizing MNS for an inexperienced dermatologist is 69%, compared to the sensitivity of diagnosing MNS by an experienced dermatologist is 92% [4]. Also, the reason for the late diagnosis of MNS is an insufficiently complete examination of patients. Evidence suggests that doctors do not routinely offer full body mole screening. Up to 63% of patients diagnosed with MK visited their GP in the year before diagnosis. Only 30% of dermatologists perform a full body skin examination on all of their patients [5]. Thus, an important method is the education of doctors of non-oncology specialties in the form of training programs in the principles of early diagnosis of cancer, which in turn can help improve the oncological epidemiological situation [9]. The purpose of this study is to study the effectiveness of organizing an 8-hour online training aimed at raising the awareness of nononcology doctors on the prevention and early diagnosis of cancer. Material and methods. An 8-hour online course «Early diagnosis of skin tumors» was conducted for doctors, created by a group of authors on the platform «Personal Account of a Doctor at the Volga Research Medical University.» The training course included the following issues: risk factors for MK and other cancers, a description of the diagnostic algorithm using the ABCDE method with an illustration of each sign on photographic images, differential diagnosis of skin tumors, prevention with an emphasis on protection from ultraviolet radiation. The course used 82 photographs of MNS. The illustrated material consisted of 30 images of MK, 25 images of basal cell skin cancer (BCSC), 15 images of seborrheic keratoma of the skin, 12 images of skin hemangiomas. Conclusion. As a result of online training, one can note an improvement in the level of knowledge of doctors after completing an online course aimed at the prevention and early diagnosis of cervical cancer. Increasing the specificity of diagnosing nevi (0,846, 0,953) before and after, respectively, can help reduce costs in the “secondary level” of healthcare. The topic of prevention presented in the course also contributes to conducting preventive conversations with patients and correct patient routing. Thus, conducting online training has a number of advantages and shows good learning results. The diagnostic methods discussed in the course, aimed at clarifying the diagnosis of cancer, especially in the early stages of the disease, predetermine the choice of optimal treatment tactics and are the key to ensuring the best prognosis of the disease.

Clinical features and endoscopic images of hemoptysis and subglottic mass in children at Vietnam National Children’s Hospital

Objectives: To describe clinical characteristics and endoscopic image of patients with subglottic hemangioma. Subjects: 25 patients were diagnosed subglottic hemangioma at Vietnam National Children’s Hospital from 1st June, 2018 to 30th May, 2023. Methods: Retrospective and prospective cross-sectional studies. Results: median age was 2.7 months, ranged from 20 days to 20 months, female/male ratio: 2.1/1, mean age of stridor breathing onset was 30.7±20.6 days. The mean of prolonged and recurred stridor breathing was 51.3±47.5 days. Clinical features: stridor breathing (80%), suprasternal depression (76%), respiratory failure (72%), cough (36%), skin hemangioma (8%), choking (8%). Bronchoscopy results: The most common characteristic of the subglottic hemangioma was red with smooth wall (92%). The location of subglottic hemangioma included the following: circumferential lesion (36%), the right wall (32%), the left wall (28%), posterior wall (4%), and 8% of those spread to 1 cm below the trachea. The range of subglottic narrowing tumour was grade III (60%) and grade II (32%). Conclusions: Subglottic hemangioma is one of the rare diseases, causing early onset stridor breathing in children under 6 months. The most outstanding presentation is prolonged, recurrent stridor, which can cause laryngeal dyspnea. Diagnosis is mainly based on bronchoscopy to evaluate the colour, morphology, and tumour size.

Association between Blood Donation and Malignant and Benign Tumour Risk: A Population-Based Study of 3.4 Million Participants in China.

This study aims to identify the relationship between blood donation and malignant and benign tumour hospitalization risk. The cohort study was constructed in Shaanxi, China, to include blood donors and match nonblood donors one-to-one by gender, age, and county of residence. The study compared the hospitalization records of two groups from 2012 to 2018. A log-binomial regression model was used to estimate the relative risk (RR) of tumour risk between donors and nonblood donors among different age groups. A total of 1,625,599 donors were recruited (including 968,823 males) and compared with the matched nonblood donor group. Significantly lower risk of malignancy in males was found among donors (adjusted RR: 0.82, 95% CI: 0.75–0.92). Lower risks for specific types of tumours among donors were observed, including liver (0.42, [0.28–0.67]), lung (0.74, [0.59–0.87]), lymphoma (0.75, [0.62–0.85]), and oesophagus (0.55, [0.41–0.72]). However, the risk of brain cancer was higher among male donors (RR 1.19 [1.06–1.29]). Among female donors, lower risk of liver (0.57, [0.42–0.79]) and oesophagus malignancy (0.73, [0.62–0.88]) was observed. For benign tumours, male donors have a lower risk of benign skin tumour (0.79, [0.62–0.94]) and hemangioma and lymphangioma (0.75, [0.51–0.89]), while female donors have a lower risk in hemangioma and lymphangioma (0.65, [0.44–0.83]). We also found that the risk decreased with age among donors in the prevalence of tumours compared to that in nonblood donors (p < 0.05). Blood donation appears to be significantly associated with various tumour risks among both males and females. Overall, the risk of tumours decreased more substantially with age in blood donors compared with nonblood donors. Further research is warranted to investigate the impact of ‘health donor effects' on these findings.

Multifocal Infantile Hemangiomas Treated by Oral Itraconazole: A Case Report

We describe a case of a 2-month-old girl presented with more than 60 papules and nodules of hemangiomas involving the skin of the sclera, endocanthion, lower lip, and labium majus pudenda without visceral hemangiomas and laboratory abnormality. A skin biopsy showed numerous scattered, clearly limited, irregular cellular lobules in the dermis circumvoluted into capillaries comprising incomplete vessel walls, which was consistent with a diagnosis of multifocal cutaneous infantile hemangioma. Oral treatment with itraconazole (5mg/kg/day) for 26 weeks resulted in predominantly involution of the skin hemangiomas. We would like to report a rare case of multifocal cutaneous infantile hemangioma, successfully treated with oral itraconazole.

A rare case of Diastematomyelia with syrinx and tethered cord in a newborn

Diastematomyelia or Split cord syndrome is a rare form of spinal dysraphism characterized by longitudinal splitting of spinal cord, conus medullaris or filum terminale to a variable extent. Presence of SCM is suggested by certain superficial markers like skin pigmentation, hemangioma, lipoma, dermal sinus and hypertrichosis. Meningocele or myelomenigocele may also be present. Affected children usually present with progressive sensorimotor symptoms and bowel and bladder dysfunction. Development of sensorimotor symptoms and progressive loss of function emphasis the need for antenatal diagnosis of the spinal deformities which paves way for early intervention and management thus minimizing the morbidity.

087 Expression of opsin 3 in skin tissues and hemangioma vessels and may be involved in vascular development

087 Expression of opsin 3 in skin tissues and hemangioma vessels and may be involved in vascular development

Miliary red papules in a newborn: a rare neonatal hemangiomatosis.

Hemangiomatosis is the efflorescence of 5 or 6, and up to several hundred, infantile hemangiomas.Several predisposing factors have been isolated: female gender, Caucasian origin, low birth weight and prematurity (these two factors are closely linked and it is above all the birth weight which seems to be the most significant factor). We describe the case of a 15 days old newborn, from a followed up full term pregnancy with a low birth weight at 2200g; admitted for respiratory distress. The examination found more than a hundred angiomas scattered all over the body (A), the head and the mucous membranes (B) whose diameter was less than one centimeter. The examination also showed respiratory distress without hepatomegaly or heart murmur. These cutaneous hemangiomas are often associated with visceral hemangiomas, the most frequent localization of which is the liver. The natural course of these hepatic hemangiomas is parallel to that of skin hemangiomas. They will evolve, like skin forms, towards spontaneous regression, without any treatment. However, they can also; because of intense vascularity, lead to heart failure due to high flow, sometimes severe. A complete clinical examination of the child for signs of heart failure, hepatomegaly, hepatic murmur and the practice of an abdominal ultrasound and doppler. There is no consensus on the number of lesions required to speak of multiple hemangiomas, as well as to provide the indication for a liver ultrasound. Regular monitoring every 2-3 weeks is necessary.

Differential Diagnosis of Malignant Melanoma and Benign Cutaneous Lesions by Ultrasound Analysis

Background: The purpose of the study is to evaluate the assessment of ultrasound analysis in the differential diagnosis of skin melanoma and benign cutaneous lesions. Objective: 61 patients (23 men and 38 women) between 17 and 87 years of age, with melanomas, atheromas, hemangiomas, keratoses, and naevi were studied. Methods: High-frequency gray-scale ultrasound analysis, color Doppler, power Doppler, advanced dynamic flow, strain Elastography, digital Dermoscopy were performed in all cases. Results: In malignant melanoma cases we have mainly: sharp margins, hypoechoic, homogenous structure, absent of posterior shadowing, central and disorganized circulatory pattern with multiple peduncles. In some benign pathology, several ultrasound criteria were exclusive: microcalcifications are only in atheroma, posterior shadowing, and circular rim - in keratosis. The incidence of other ultrasound criteria can vary in atheroma, hemangioma, keratosis, and nevus. Tumor longitudinal and thickness relation were higher (7.9±1.96) than in all benign pathologies (2.1-4.8). The Elastography stiffness of the 26 skin melanomas was 2.95±0.18 and was higher than the group of 35 patients with all benign skin pathology (0.96±0.59), including atheroma (2.0±0.78), hemangioma (0.55±0.21), keratosis (1.21±0.21) and nevus (0.78±0.45). Conclusion: Multimodal approaches to exploring high-frequency ultrasound analytic criteria can be helpful in the differential diagnosis of malignant melanoma and benign cutaneous lesions.

联合普萘洛尔治疗高风险婴幼儿皮肤血管瘤并溃疡临床疗效观察

联合普萘洛尔治疗高风险婴幼儿皮肤血管瘤并溃疡临床疗效观察

Successful treatment of cardiac haemangiomas with oral propranolol: a case series of two patients.

BackgroundCardiac haemangiomas are extremely rare tumours with equivocal surgical outcomes. Haemangiomas appearing on other sites of the body have been successfully treated with oral propranolol. To the best of our knowledge, such treatment has not been tried to date for cardiac location of haemangiomas.Case summaryWe report two cases of neonatal cardiac haemangiomas, and we describe their presentation and characteristics, as well as how these were successfully treated with oral propranolol, with complete regression of the tumours within the 1st year of life.DiscussionDespite the rarity of cardiac haemangiomas, their presentation and complications could be dramatic with side-effects spanning from intracardiac space occupying phenomena to Kasabach–Merritt syndrome. Propranolol therapy, having been established for long now in the treatment of skin haemangiomas, should also be considered in cases of cardiac haemangiomas, particularly in the neonatal and infantile population.

Activation of Hedgehog Signaling in Aggressive Hepatic Hemangioma in Newborns and Infants.

Hepatic hemangiomas (HH) can show an aggressive course with significant complications. Prognostic markers that identify an aggressive course are entirely absent. Since we have showed that Hedgehog signaling is overexpressed in aggressive hemangiomas of the skin. Here, we hypothesize that it is also altered in aggressive HH. Immunohistological staining for GLUT1 and quantitative PCR was performed in seven specimens with aggressive HH. For comparison, we included specimens of kaposiform hemangioendothelioma (KHE), skin hemangioma and normal liver tissue. Overexpression of the Hedgehog signaling components SHH and GLI2 and its target gene FOXA2 in HH were similar to those found in aggressive skin hemangioma and KHE, their expression being significantly higher than in mild skin hemangioma. High expression levels of SHH and FOXA2 positively correlated with HH, but not with normal liver tissue. Hedgehog signaling is up-regulated in aggressive HH. This finding may lead to a biomarker allowing early intervention.

Radiation-induced genomic instability in breast carcinomas of the Swedish hemangioma cohort.

Radiation-induced genomic instability (GI) is hypothesized to persist after exposure and ultimately promote carcinogenesis. Based on the absorbed dose to the breast, an increased risk of developing breast cancer was shown in the Swedish hemangioma cohort that was treated with radium-226 for skin hemangioma as infants. Here, we screened 31 primary breast carcinomas for genetic alterations using the OncoScan CNV Plus Assay to assess GI and chromothripsis-like patterns associated with the absorbed dose to the breast. Higher absorbed doses were associated with increased numbers of copy number alterations in the tumor genome and thus a more unstable genome. Hence, the observed dose-dependent GI in the tumor genome is a measurable manifestation of the long-term effects of irradiation. We developed a highly predictive Cox regression model for overall survival based on the interaction between absorbed dose and GI. The Swedish hemangioma cohort is a valuable cohort to investigate the biological relationship between absorbed dose and GI in irradiated humans. This work gives a biological basis for improved risk assessment to minimize carcinogenesis as a secondary disease after radiation therapy.

Skin Hemangiomas with Limb Hypertrophy

Skin Hemangiomas with Limb Hypertrophy

Numerical Modeling and Clinical Evaluation of Pulsed Dye Laser and Copper Vapor Laser in Skin Vascular Lesions Treatment.

Introduction: Different yellow lasers have been successfully used for the treatment of vascular lesions. This study is aimed to ascertain the role and efficiency of copper vapor lasers (CVLs) and pulsed dye lasers (PDLs) for the treatment of vascular lesions using numerical modeling and to compare results with our clinical experience. In this study we aimed to develop criteria for the choice of more efficient laser exposure mode, investigate more relevant modes of laser irradiation to ensure selective photothermolysis of target vessels, and compare the CVL and PDL efficiency in the course of patients with skin vascular lesions (SVL) treatment. Methods: We performed numerical simulation of the processes of heating a vessel with CVL and PDL to temperatures at which its coagulation could occur. Calculated fluencies were compared with clinical results of laser therapy performed on 1242 patients with skin hemangiomas and vascular malformations (SHVM), including 635 patients treated with CVL and 607 patients treated with PDL. PDL and CVL provided excellent results in 40 and ten days after treatment. The treatment was not painful. Patients did not need anesthesia. Postoperative crusts were greater with PDL than with CVL. Results: Results of computer simulation of a selective vessel heating using PDL and CVL radiation are presented. By results obtained, depth of the location and sizes of vessels that could be selectively heated to more than 75°C are determined. Conclusion: Based on calculated and clinical data, the heating mode for dysplastic vessels using a series of CVL micropulses could be regarded to be safer and more efficient than the mode of a PDL short, powerful pulse.

Angiographic optical coherence tomography imaging of hemangiomas and port wine birthmarks.

A current therapeutic challenge of vascular lesions is that they do not always respond effectively to laser treatment. Information on targeted vessels could potentially be used to guide laser treatments. Optical coherence tomography (OCT) is a useful tool for the non-invasive imaging of tissues, including skin hemangiomas and port wine birthmarks. Dynamic OCT is able to rapidly characterize cutaneous blood vessels. The primary goal of this study was to demonstrate the ability of bedside OCT to image (i) overall vessel pattern; (ii) individual vessel morphology, diameter and depth; and (iii) total vessel density as a function of depth in infantile hemangiomas and port wine birthmarks (PWB). This IRB approved, observational clinical trial was performed among healthy volunteers ages 3 months-73 years old. All patients presented for laser treatment of either infantile hemangiomas or PWB with skin types ranging from Fitzpatrick I-V. OCT imaging of 49 hemangioma and PWB scans were performed pre- and post-treatment. The diameter and depth of the blood vessels making up the vascular lesions were measured. In addition, normal skin was scanned for comparison. Five datasets for infantile hemangiomas and five for PWB that were without motion artifacts were analyzed. Scanned lesions exhibited variable and highly heterogeneous blood vessel patterns with vessel diameters ranging from 20 to 160 μm, suggesting that the laser treatment with single pulse durations may not be optimal. The largest blood vessel diameter observed (160 μm) may not be adequately treated by commonly used pulsed dye laser pulse durations. OCT allowed rapid, non-invasive characterization of the diameter and depth of blood vessels in individual vascular lesions. Imaged lesions consisted of a heterogeneous population of vessel sizes, morphologies, and depth. Future studies could utilize this information to assist development of individualized treatment protocols in an effort to improve vascular birthmark removal. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.

The expression and function of miR-424 in infantile skin hemangioma and its mechanism

Infantile hemangioma is the most common benign tumor in infants. Many studies have confirmed that basic fibroblast growth factor (bFGF) and its key receptor FGFR1 are highly expressed in hemangioma. Moreover, several miRNAs can regulate angiogenesis. In this regard, miR-424 often plays a role as tumor suppressor gene. This study was designed to investigate the mechanism of miR-424 in infantile skin hemangioma. Our results showed low expression of miR-424 in infantile skin hemangioma tissues, and that miR-424 overexpression downregulated FGFR1 expression in hemangioma-derived endothelial cells, while miR-424 inhibition upregulated FGFR1 expression. Luciferase reporter analysis confirmed that FGFR1 was a target gene of miR-424. CCK-8, flow cytometry, transwell migration and tube formation assays demonstrated that miR-424 overexpression inhibited cell proliferation, migration and tube formation, at least in part by blocking the bFGF/FGFR1 pathway. In contrast, miR-424 inhibition significantly enhanced these functions. Furthermore, miR-424 overexpression significantly inhibited ERK1/2 phosphorylation, whereas miR-424 inhibition enhanced ERK1/2 phosphorylation. In conclusion, miR-424 could suppress the bFGF/FGFR1 pathway, thereby inhibit ERK1/2 phosphorylation, and thus inhibit cell proliferation, migration and tube formation capabilities and the development of infantile skin hemangioma.