Comparison of the efficacy and safety of topical timolol and oral propranolol for the treatment of Superficial Infantile Haemangiomas

Background: Infantile haemangiomas (IHs) are the most common vascular tumours of infancy. In recenttime oral propranolol has achieved great success in treating IHs. To minimize the systemic side events caused by oral propranolol, topical timolol started to be applied in the treatment of IHs, especially for superficial lesions. Methods: We treated 50 children with superficial IHs using oral propranolol on 25 patients and, topical timolol on 25 patients and investigated the efficacy and safety of the two treatment patterns. Results: Both oral propranolol and topical timolol achieved a satisfactory therapeutic outcome, with an effective response rate of 96 and 95.4%, respectively. No significant differences in visual analogy scale (VAS) improvement between the two groups were observed. Systemic adverse events for patients treated with oral propranolol (3.9%) was significantly higher than that for patients treated with topical timolol. Clinical response was not associated with gender, duration of treatment, lesion location, lesion size, and gestational age but closely associated with age at treatment initiation, which indicated that younger age at treatment initiation predicted for a better regression rate. Conclusion: Topical timolol could be the first-line therapy for superficial IHs because of its good efficacy and improved safety profile.

Oral propranolol for the treatment of infantile haemangiomas in Singapore

INTRODUCTION@#Infantile haemangiomas (IH) are the most common vascular tumours in childhood. Over the past decade, treatment of IH has been revolutionised by the discovery of the effectiveness of beta-blockers in its treatment. We review our hospital's experience with oral propranolol in the treatment of IH in an Asian population.@*METHODS@#We performed a retrospective review of the medical records and clinical photos of paediatric patients with IH treated with propranolol in a tertiary paediatric hospital in Singapore from January 2010 to February 2015.@*RESULTS@#A total of 88 patients with IH treated with propranolol were identified over a five-year period, with 79 patients included in the final analysis. There was a predominance of female patients (75.9%) and preterm infants (41.8%) in our study population. The head and neck (65.8%), especially the orbital or preorbital region (45.6%), were the most common lesion sites in our cohort of patients. Mean age of onset was 2.3 ± 4.5 weeks of age, and mean age of starting propranolol treatment was 7.7 ± 10.5 weeks of age. 44.3% of patients experienced > 75% improvement, while 29.1% experienced improvement of 50%-75%. Response to treatment was influenced by the age of starting treatment.@*CONCLUSION@#Our study provides further evidence of the efficacy and safety of propranolol in the treatment of IH in an Asian population. Early treatment is recommended for optimal results.

Colloid cyst: unusual location of petrous temporal bone

Colloid cysts are benign, thin walled spherical neoplasms, composed of a collagenous capsule, underlying epithelium that arises from brain’s epidermal embryonic remnants and a viscous centre. They are shown to approximate 0.5% of all intracranial tumours with no recorded evidence of the petrous temporal bone involvement. Colloid cyst of the petrous temporal bone often presents with clinical symptoms of headache, hearing loss, facial palsy and imbalance/vertigo. Which is diagnosed on radiological and histological findings. Histologically, they are lined by ciliated cuboidal to pseudo stratified columnar epithelium resting on an eosinophilic basement membrane. Imaging Techniques are helpful in early diagnosis and preventing further complications. Here we will be discussing about a 24-year-old female, a known case of petrous apex osseous haemangioma presenting with unstable gait and tingling sensation on one side of face leading to an incidental finding of a colloid cyst on petrous temporal bone through histological examination.

One case of blue rubber bleb nevus syndrome with intestinal intussusception / 中华内分泌外科杂志

Blue rubber bleb nevus syndrome(BRBNS)is a rare disease, which is characterized by multiple hemangiomas of the skin and gastrointestinal tract. We once treated a case with intussusception requiring surgery. The purpose of this article is to improve our understanding of this disease.

One case of blue rubber bleb nevus syndrome with intestinal intussusception / 中华内分泌外科杂志

Blue rubber bleb nevus syndrome (BRBNS) is a rare disease, which is characterized by multiple hemangiomas of the skin and gastrointestinal tract. We once treated a case with intussusception requiring surgery. The purpose of this article is to improve our understanding of this disease.

Intramuscular haemangioma of the masseter muscle: a case report

@#Intramuscular haemangioma is relatively rare and accounts for less than 1% of all haemangioma. Most of these tumours occur in the trunk, arms and legs. Only 14% of all intramuscular haemangioma arise from the head and neck region, with masseter muscle representing the most common site of involvement, followed by the trapezius and sternocleidomastoid muscles. We present a case of a 60-year-old man with a soft lump in the left cheek. Imaging of the neck showed irregular, dilated enhancing vessels seen in the left masseter muscle suggestive of intramuscular haemangioma. Excisional biopsy was performed, and histopathological findings confirmed the diagnosis.

Analysis of MRI Diagnosis and Misdiagnosis of Parasellar Cavernous Haemangioma / 现代生物医学进展

Objective:To analyze the magnetic resonance imaging (MRI) features of parasellar cavernous haemangioma and improve the diagnosis and differential diagnosis accuracy.Methods:13 patients with parasellar cavernous haemangioma were collected.All the patients were diagnosed by MRI and confirmed by pathology.Based on the pathologic findings,the MRI features were discussed.Results:9 cases presented horizontal dumbbell.The lesions located in the parasellar were larger than the sella turcica.The main body position of the lesions were centered lateral to the parasellar and encasesed the intracavernous internal carotid artery (ICICA).While,1 cases were similar in size and shape.1 case was located in the sella turcica.2 cases was centered lateral to the ICICA.pituitary were detected obscurity in 7 cases and displaced in 6 cases,6 cases appeared extremely high homogeneous intensity on T2-weighted images:as bright as cerebrospinal fluid signal.Only 5 cases underwent three-dimensional arterial spin labelling perfusion imaging (3D-ASL).The lesions revealed marked hypoperfusion.The cases of misdiagnosis were 9,including 4 cpituitary adenomas and 5 meningiomas.Conclusions:The characteristics of MR images ofparasellar cavernous haemangioma were horizontal bottle gourd form,the main body position of the lesions were centered lateral to the parasellar and encasesed the (ICICA),and their extremely high homogeneous intensity on T2-weighted images:as bright as cerebrospinal fluid signal.In cases that are equivocal,3D-ASL were useful in differentiating cavernous haemangiomas from parasellar meningiomas,which could decrease mistaken diagnosis.Graspping the imaging feature and differential diagnosis were helpful for the diagnosis of this disease.

Intra-articular Localized Haemangioma of the Knee Mimicking Localized Pigmented Villonodular Synovitis: A Case Report

Intra-articular synovial haemangioma of the knee is a benign tumour. However, diagnostic delay leads to degenerative changes in the cartilage and osteoarthritis due to recurrent haemarthrosis. Therefore, treatment should be performed immediately. We report the case of a localized synovial haemangioma arising from the medial plica in a 38-year old female presenting with pain and restricted range of motion in the right knee joint. Initially, we diagnosed this case as a localized pigmented villonodular synovitis (LPVS) based on MRI and arthroscopic findings and performed only arthroscopic en bloc excision of the mass and synovectomy around the mass for diagnostic confirmation. Fortunately, there was no difference in the treatment approaches for LPVS and localized haemangioma and the synovial haemangioma had not recurred at the 3-month postoperative follow-up with MRI. The patient’s clinical symptoms resolved and had not relapsed two years after surgery.

Hemangioma hemosiderótico-targetoide: Presentación de un caso clínico / Targetoid hemosiderotic hemangioma: A case report

Las anomalías vasculares han sido clasificadas por primera vez en 1982, por Mulliken y Glowacki y recientemente, la Sociedad Internacional para el Estudio de las Anomalías Vasculares (ISSVA) modificó dicha clasificación, por la que hoy es aceptada mundialmente, que divide a las lesiones vasculares en tumorales y malformaciones. Dentro de la misma, encontramos una variedad de tumores, desde los más frecuentes como los hemangiomas infantiles, hasta los de menor frecuencia, integrando los síndromes clínicos y genéticos. El hemangioma hemosiderótico targetoide (HHT), también conocido como hemangioma hobnail, se encuentra dentro de dicha clasificación en el grupo de "otros" tumores vasculares, por su baja frecuencia. Fue descrito por primera vez por Santa Cruz y Aronberg en 1988, como una proliferación vascular benigna localizada con más frecuencia, en el tronco y las extremidades de los adultos jóvenes o de mediana edad. El objetivo es la presentación de un caso de hemangioma hobnail, patología vascular que se encuentra en constante revisión en la actualidad, profundizar en el conocimiento de los tumores vasculares, su clasificación y marcadores inmunohistoquímicos, revisar la bibliografía nacional e internacional y determinar bajo qué clasificación incluiríamos a esta entidad. La finalidad también es realizar un exhaustivo análisis de los diagnósticos diferenciales de esta patología, teniendo en cuenta la práctica clínica y demostrar como las nuevas tecnologías de diagnóstico, nos ayudan a aproximarnos al origen de la misma.

Vascular anomalies have been classified by Mulliken and Glowacki in 1982 and recently modified this classification by the International Society for the Study of Vascular Anomalies (ISSVA) today accepted worldwide, dividing vascular tumors and malformations. Within the same we find a variety of tumors from the more frequent as infantile hemangiomas, to the others with lower frequency, integrating clinical and genetic syndromes. Targetoid haemosiderotic haemangioma (THH), also known as hobnail haemangioma, is within that classification in the group of "other" vascular tumors due to their low frequency. It was described by Santa Cruz and Aronberg in 1988. It`s a benign vascular proliferation that arises most commonly on the trunk and limbs of young or middle-aged adults. The aim is to present a case of hobnail haemangioma, which is constantly being revised now a days, deepen of the knowledge of vascular tumors, their classification and immunohistochemical markers, review national and international literature and determine under what classification we would include this entity. The purpose is also to conduct a thorough analysis of the differential diagnosis of this disease, taking into account the clinical practice and demonstrate how new diagnostic technologies help us to approach it´s origin.

Infantile Hepatic Hemangioendothelioma (IHHE) – An Unusual Presentation.

Hepatic tumours are relatively rare in children, accounting for 1% - 4% of all paediatric solid tumors, commonest amongst them are hepatoblastoma, neuroblastoma, and vascular tumors (hemangioendothelioma/haemangiomas). Infantile Hepatic hemangioendothelioma (IHHE) is classically characterised by hepatomegaly, jaundice, congestive cardiac failure with high cardiac output, skin haemangiomas, haemolytic anemia, thrombocytopenia(kasabach – Merritt syndrome), normal Alfafeto protein (AFP) levels and hypothyroidism. We report a case of infantile hemangioendothelioma in a 5 day old female neonate with high output cardiac failure, unusually high alpha-fetoproteins, thrombocytosis and polycythaemia, which posed a diagnostic dilemma. Diffuse IHHE is a rapidly growing benign tumor which can lead to poor clinical outcome if not identified early. Serum AFP can’t be relied to exclude IHHE.

Giant Cranial Vault Frontal Haemangioma – A Case Report.

Cranial vault haemangiomas are benign vascular lesions having capillaries, venous and cavernous channels. Histopathologically, these are almost like soft tissue haemangiomas. These are slow growing tumors and very rarely bleed. Cranial vault is uncommon site for the occurrence as compared to the vertebral. Cross sectional imaging like Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) play an important role in delineation of the vault pathologies. We present a 38-years old male who presented with slow growing swelling over the frontal bone without any neurological symptoms. CT and MRI imaging clinched the diagnosis which was confirmed subsequently by histopathological examination.

A Rare Cause of Recurrent Epistaxis: Lobular Capillary Haemangioma.

Nasal lobular capillary haemangiomata are rare benign nasal tumours of vascular origin and unknown etiology. They tend to occur in both sexes depending on the age group. They usually present with unilateral nasal obstruction and recurrent epistaxis. They are usually treated by excision after having embolized the feeding vessel. We present a case of nasal lobular haemangioma we encountered and treated by pernasal excision biopsy without prior embolization since the initial consideration was fungal sinusitis.

Novel Usage of Dexmetomidine In A Paediatric Patient With Giant Tongue Haemangioma

Giant haemangioma of the tongue is a disease which can obstruct the oropharyngeal airway and is presented with obstructive symptoms. Due to its vascularity, inserting laryngoscope for intubation can cause high risks, such as inducing bleeding. Hypoxia and excessive bleeding must be anticipated while securing the airway. We present a case of novel usage of dexmetomidine as a conscious sedation agent for awake fibre optic intubation in a 9-year-old child with obstructive symptoms secondary to a huge tongue haemangioma, who was presented for interventional sclerotherapy of the lesion.

Propranolol en el tratamiento del hemangioma periocular: Presentación de un caso clínico / Propranolol in the treatment of periocular haemangioma: A clinical case

Los hemangiomas infantiles (HI) son los más comunes tumores vasculares benignos de la infancia. Más del 60% de HI ocurren en la cara, cabeza y cuello. Aunque son benignos, la localización en los párpados, punta nasal, labios y oídos pueden poner en peligro la respiración, la alimentación y la visión u ocasionar la desfiguración irreversible. El sangrado, la ulceración y la infección pueden ocurrir en hasta el 20% de los casos. Estudios anteriores han revelado que el propranolol, timolol y nadolol son eficaces en el tratamiento de los hemangiomas cutáneos, orbitales, hepáticos y subglóticos. La ambliopía es la preocupación principal por la deprivación del estímulo, produciendo anisometropía, estrabismo secundario o desplazamiento del globo ocular. Se presenta el caso de una paciente con diagnóstico de HI pericoular a quien se indicó tratamiento con Propranolol a 2mg/kg/día en los 6 primeros meses de vida.

Infantile haemangiomas (IH) are the most common benign vascular tumors of childhood. More than 60% of IH occur on the face, head and neck. Although they are benign, the location on the eyelids, tip of the nose, lips and ears can endanger breathing, feeding and vision or lead to irreversible disfigurement. Bleeding, ulceration and subsequent infection can occur in up to 20% of cases. Previous studies revealed that propranolol, nadolol and timolol are effective as treatment of cutaneous, orbital, subglottic and liver hemangiomas. Amblyopia is the primary concern due to the deprivation of the stimulus, producing anisometropia secondary strabismus or displacement of the eyeball. We present the case of a patient with the diagnosis of periocular IH, who was treated with propranolol, 2mg/kg/day during the 6 first months of life.

Cavernous haemangioma of spleen: a rare case report.

Tumours of the spleen are as such rare. Of these rare tumours, haemangioma is the most commonly encountered benign tumour with fewer than 100 cases reported. It is either an incidental finding or presents as splenic enlargement or with complications. Preoperative investigations are often inconclusive and may not distinguish between haemangioma and metastases. We report a case of 40 years female with cavernous haemangioma of spleen presenting as massive splenomegaly. Splenic haemangioma presenting as massive splenomegaly is extremely rare and deserves a mention.

Isolated Endobronchial Capillary Haemangioma: A Rare Cause of Haemoptysis in Adult.

Endobronchial capillary haemangioma is a very rare benign tumour in adults. The clinical presentation and management of adult capillary haemangiomas involving the tracheo-bronchial tree is not yet established. We present a case of an isolated capillary haemangioma of the left main bronchus detected during the evaluation of an adult male presented with haemoptysis. The lesion was managed successfully bronchoscopically.

Epithelioid Haemangioma – A Diagnostic Dilemma.

Epithelioid haemangioma (EH), synonymously termed as angiolymphoid hyperplasia with eosinophilia, is a rare lesion whose etiopathogenesis is unclear. Clinically it manifests as solitary or multiple nodules in the skin and subcutaneous tissues of the head and neck region. It can also arise in the deep tissues such as muscle, bone and lymphnode. Intra oral involvement is less common and very few cases have been reported in the literature. Common intra oral sites include lip followed by buccal mucosa and tongue. Epithelioid Haemangioma affecting alveolar mucosa is very rare. We report one such case of epithelioid hemangioma of size 4x4 cm on lower right alveolar mucosa in 38 year old female patient.

Hemangioma cavernoso mediastinal / Mediastinal cavernous hemangiomas

Hemangiomas mediastinais são raras lesões intratorácicas, correspondendo a aproximadamente 0,5% de todos os tumores mediastinais. Geralmente, apresentam-se nas primeiras quatro décadas de vida. O tumor descrito neste relato de caso foi diagnosticado em uma mulher de 30 anos assintomática, de forma incidental em um RX de tórax. É um tumor extremamente raro, que se enquadra no diagnóstico diferencial de tumores primários do mediastino, cujo tratamento é cirúrgico. Discutem-se a abordagem diagnóstica e a estratégia terapêutica (AU)

Mediastinal hemangiomas are rare intrathoracic lesions, representing approximately 0.5% of all mediastinal tumors. Generally, they present in the first four decades of life. The tumor described in this case report was diagnosed in an asymptomatic 30-year-old woman, incidentally on a chest x-ray. It is an extremely rare tumor, which falls in the differential diagnosis of primary mediastinal tumors, whose treatment is surgical. Diagnostic approach and therapeutic strategy are discussed (AU)

Cavernous haemangioma of cervix mimicking malignancy: a case report and review of the literature.

Haemangiomas are defined as benign neoplasm arising from blood vessels, either in internal organs or in the skin. There are two types of haemangioma: capillary and cavernous. Capillary haemangioma is usually seen at the top layer while cavernous is often found at deeper layer. These are characterized by abnormal accumulation or growth of blood vessels filled with blood. The cavernous haemangiomas occur less frequently than the capillary ones. These are usually soft to touch. Although some haemangiomas involve large portion of body, most are localized. The majority of lesions are superficial, often of head and neck, but can occur internally. The internal organs mostly affected are liver, spleen, pancreas, GIT, skin, uterus and sometimes the brain. The cervical localization is low. Most of cervical haemangiomas are incidental findings and show asymptomatic behaviour. They sometimes may cause abnormal vaginal bleeding as menorrhagia, metrorrhagia or post coital bleeding and dyspareunia. The most common differential diagnosis include cervical malignant tumor. The treatment is the surgical excision.

Cavernoma of the lateral ventricule presenting as speech arrests / Cavernoma do ventrículo lateral se apresentando como bloqueios da fala

Cavernous malformations (CM) are formed by dilated thin-walled vascular channels without intervening parenchyma and intraventricular lesions are rare. We report a case of an intraventricular cavernoma in a 54-year old female patient. She presented with speech arrests daily for 10 months. Neurological examination revealed no deficits. The brain MRI study revealed an intraventricular lesion at the level of the left atrium, heterogeneously hyperintense on both T1 and T2-weighted images. It was performed an interhemispheric transcallosal approach with gross-total resection of the lesion. The histological examination was compatible with the diagnosis of cavernous haemangioma. In the postoperative period the patient presented with transient right hemiparesis with recovery in two weeks. We briefly review the literature concerning intraventricular cavernomas...

Malformações cavenosas são formadas por canais vasculares dilatados e de paredes finas sem parênquima cerebral no interior. Lesões dessa natureza são raras nos ventrículos. Neste trabalho descrevemos um caso de cavernoma intraventricular em uma paciente feminina de 54 anos. Ela se apresentou clinicamente com bloqueios de fala diários nos últimos 10 meses. Nenhum déficit neurológico foi observado no exame. A ressonância magnética de encéfalo demonstrou lesão heterogênea na topografia do átrio ventricular esquerdo, hiperintensa em T1 e T2. Foi realizada abordagem interemisférica transcalosa com ressecção total da lesão. A análise histopatológica foi compatível com hemangioma cavernoso. No período pós-operatório a paciente apresentou hemiparesia direita, que melhorou em duas semanas. Revisa-se brevemente a literatura em relação a cavernomas intraventriculares...