IL13RA2 promotes progression of infantile haemangioma by activating glycolysis and the Wnt/β-catenin signaling pathway

Background:Interleukin 13 receptor subunit alpha 2(IL13RA2)plays an essential role in the progression of many cancers.However,the role of IL13RA2 in infantile haemangioma(IH)is still unknown.Materials and Methods:IL13RA2 expression in IH tissues was analyzed using western blot,qRT-PCR,and immunofluorescence.The role of IL13RA2 in haemangioma-derived endothelial cells(HemECs)was determined following knockdown or overexpression of IL13RA2 using CCK-8,colony formation,apoptosis,wound healing,tubule formation,Transwell,and western blot.Results:IL13RA2 expression was upregulated in IH tissues.IL13RA2 overexpression promoted proliferation,migration,and invasion of HemECs and induced glycolysis,which was confirmed with a glycolysis inhibitor.Specifically,IL13RA2 interacted withβ-catenin and activated the Wnt/β-catenin pathway in HemECs,which were involved in the above-mentioned effects of IL13RA2.Conclusions:These findings revealed that targeting IL13RA2 is a potential therapeutic approach for IH.

Expression of Matrix Metalloproteinase and Its Tissue Inhibitor in Haemangioma

The action mechanism of matrix metalloproteinases-2 （MMP-2） and tissue inhibitor of metalloproteinases-2 （TIMP-2） in the genesis, development and degeneration of haemangioma was investigated by detecting their expression in the tissue of haemangioma in different phases by using the immunohistochemistry. Fifty paraffin-embedded specimens of skin capillary haemangioma were collected, which were documented in the Department of Pathology, Renmin Hospital of Wuhan University from 2000 to 2006. All samples were stained by regular HE method, and proliferative cell nuclear antigen （PCNA） was tested by immunohistochemical S-P method. The samples were classified according to the Mulliken criteria and the expression pattern of PCNA. Immunohistochemical S-P method was ap- plied to detect the expression of MMP-2 and TIMP-2 in proliferative and degenerative phases of cutaneous capillary haemangioma, and in normal skin tissues. In combination with the detection of the expression of factor Ⅷ-related antigen, it was verified that in haemangioma tissues, the cells expressing MMP-2 and TIMP-2 were vascular endothelial cells. The MMP-2 and TIMP-2 expression was quantitatively analyzed by image analysis system （HPIAS-1000）, and one-way ANOVA（107） and SNK（q） test were done to analyze average absorbance （A） and positive area rate of immunohistochemically positive particles by using SPSS11.5. The results showed： （1） Among 50 samples of haemangioma, there were 26 proliferative haemangiomas, and 24 degenerative haemangiomas, respectively; （2） The expression of MMP-2 was weak in normal vascular endothelial cells, cytoplasm of connective tissues and extracellular matrix around blood vessels. The expression of MMP-2 in proliferative group was significantly higher than in degenerative group and control group （normal skin） （P〈0.05）, but there was no statistically significant difference between the latter two groups; （3） TIMP-2 was highly expressed in normal tissues, degenerative vascular endothelial cells, cytoplasm of connective tissues and extracellular matrix around blood vessels. The expression level of TIMP-2 in proliferative phase was significantly lower than in degenerative phase （P〈0.05）, and the expression of TIMP-2 in proliferative phase was significantly different from that in degenerative phase and normal tissues （P〈0.05）. It was concluded that in proliferative phase of haemangioma, MMP-2 may promote over-proliferation of endothelial cells of haemangioma, and in degenerative phase, TIMP-2 can inhibit the proliferation of endothelial cells of haemangioma. The two substances play important roles in the genesis, development and degeneration of haemangiomas.

Laparoscopic resection of a giant exophytic liver haemangioma with the laparoscopic Habib 4× radiofrequency device

Haemangiomas are the most common solitary benign neoplasm of the liver with an incidence ranging from 5% to 20%. Although usually small and asymptomatic, they may reach considerable proportions and rarely give rise to life-threatening complications. Surgical intervention is required for incapacitating symptoms, established complications, and diagnostic uncertainty. The resection of haemangiomas demands meticulous surgical technique, owing to their high vascularity and the concomitant risk of intra-operative haemorrhage. Laparoscopic resection of giant haemangiomas is even more challenging, and has only been reported twice. We here report the case of a giant 10 cm liver haemangioma which was successfully resected laparoscopically using the laparoscopic HabibTM 4×, a bipolar radiofrequency device, without clamping major vessels and with minimal blood loss. Transfusion of blood or blood products was not required. The patient had an uneventful recovery and was asymptomatic at 7-mo follow-up.

Treatment review of sight threatening circumscribed choroidal haemangioma

AIMTo describe our clinical experience in treating circumscribed choroidal haemangioma (CCH) in a tertiary referral centre over a fifteen year period prior to photodynamic therapy.

Haemangiomas in the urinary bladder:Two case reports

BACKGROUND Urinary bladder haemangioma is a benign nonurothelial tumour that rarely occurs in paediatric and adolescent patients.Clinical and radiological examinations are not adequate for an accurate diagnosis.The purpose of this serial case report is to raise awareness of urinary bladder haemangioma and appropriate management.CASE SUMMARY We described two rare cases of urinary bladder haemangioma that were confirmed by histopathology followed by immunohistochemistry and reviewed the literature on the diagnosis and treatment of patients with this disease.The radical cystectomy was performed with open method surgery associated with an abdominal wall ostomy of the ileal outlet tract for case 1.Case 2 underwent a laparoscopic partial cystectomy.Postoperative pathology confirmed the diagnosis of urinary bladder haemangioma.Haematuria resolved postoperatively,and there was no evidence of tumour recurrence in 3 years follow-up for case 1.Postoperative urinary and pelvic ultrasonography showed no signs of recurrence in 3 mo follow-up for case 2.CONCLUSION Careful histopathological and immunohistochemical studies are required to establish the correct diagnosis.There is no“gold standard”treatment for urinary bladder haemangioma,and treatment options are varied for individuals with favourable follow-ups.

Orthotopic liver transplantation for giant liver haemangioma: A case report

In liver haemangiomas, the risk of complication rises with increasing size, and treatment can be obligatory. Here we present a case of a 46-year-old female who suffered from a giant haemangioma causing severe portal hypertension and vena cava compression, leading to therapy refractory ascites, hyponatremia and venostasis-associated thrombosis with pulmonary embolism. The patients did not experience tumour rupture or consumptive coagulopathy. Surgical resection was impossible because of steatosis of the non-affected liver. Orthotopic liver transplantation was identified as the only treatment option. The patient's renal function remained stable even though progressive morbidity and organ allocation were improbable according to the patient's lab model for end-stage liver disease(lab MELD) score. Therefore, non-standard exception status was approved by the European organ allocation network "Eurotransplant". The patient underwent successful orthotopic liver transplantation 16 mo after admission to our centre. Our case report indicates the underrepresentation of morbidity associated with refractory ascites in the lab MELD-based transplant allocation system, and it indicates the necessity of promptly applying for non-standard exception status to enable transplantation in patients with a severe clinical condition but low lab MELD score. Our case highlights the fact that liver transplantation should be considered early in patients with non-resectable, symptomatic benign liver tumours.

Iris microhaemangioma: a management strategy

AIM: To analyse previous literature and to formulate a management strategy for iris microhaemangiomas (IMH).METHODS:Areview of the literature in English language articles on IMH.RESULTS: Thirty five English language articles fulfilled the criteria for inclusion to the study and based on the contents on these articles a management strategy was formulated. Age at presentation ranged from 42 to 80 years with no sex or racial predisposition. Most patients with IMH have no systemic disease but a higher incidence had been reported in patients with diabetes mellitus, myotonic dystrophy, chronic obstructive pulmonary disease (COPD) and several other systemic and ophthalmic co-morbidities. Most patients remained asymptomatic until they experienced a sudden blurring of vision due to a hyphaema. Some patients only develop a self-limiting single episode of hyphaema and therefore the laser or surgical photocoagulation of iris should be reserved for the cases complicated with recurrent hyphaema. In some patients, several laser photoco-agulation sessions may be needed and the recurrent iris vascular tufts may require more aggressive treatment. Iris fluorescein angiography (IFA) is useful in identifying the true extent of the disease and helps to improve the precision of the laser treatment. Surgical excision (iridectomy) should only be considered in patients who fail to respond to repeated laser treatment. In some cases IMHs has been initially misdiagnosed as amaurosis fugax, iritis and Posner-Schlossman syndrome.CONCLUSION: Owing to its scarcity, there is no good quality scientific evidence to support the management of IMH. The authors discuss the various treatment options and present a management strategy based on the previous literature for the management for this rare condition and its complications.

Surgical Treatment of Giant Cavernous Hepatic Haemangiomas

Background: Haemangiomas are the most common benign liver tumors. Treatment is indicated for symptomatic tumors, rapid increase in size, rupture or doubt in diagnosis. Objective: Evaluation the efficacy of surgical treatment of giant cavernous hepatic haemangioma in tertiary hepatobiliary center. Patients and Methods: Retrospective study of 34 patients with giant hepatic haemangioma operated upon. The diagnosis was proved preoperatively in 27 patients and confirmed by histopathology postoperatively in all patients. The indication of surgery was abdominal pain with large sizes tumors, rapid growth, and spontaneous rupture with haemoperitoneum. Surgical treatment either liver resection or living liver transplantation. Results: 23 cases (67.6%) were females & 11 cases (32.4%) were males, median age 38.8 years. Haemangiomas located in right lobe in 19 patients (55.9%), left lobe in 12 patients (35.4%) in both lobe in 2 patients (5.8%), scattered all over both lobe in one patient (2.9%), solitary in 27 cases (79.4%) and multiple in 7 patients (20.6%). The diameter was 8 - 27 cm, mean 18.6 cm in diameter. 33 patients had liver resection (29 elective resection and 4 emergent resection for rupture). One patient had haemangioma irresectable;the living liver transplant was performed. No mortality during 18 months follow up and complication occurred in 8 patients out of 34 patients. Conclusion: Hepatic resection is an effective treatment option for giant cavernous hepatic haemangioma, in selected patient living related liver transplantation may be the only therapeutic option.

Another Proliferative Diabetic Retinopathy? A Case Report of Retinal Cavernous Haemangioma Treated with Intravitreal Bevacizumab, Initially Labelled as Persistent Proliferative Diabetic Retinopathy

We present a case of Retinal Cavernous Haemangioma treated with Intravitreal Bevacizumab, which was initially labelled as persistent proliferative diabetic retinopathy with multiple episodes of vitreous haemorrhage. These lesions can be confused with new retinal vessels in diabetics and if correctly diagnosed unnecessary photocoagulation can be avoided. Our patient received a course of three intravitreal Bevacizumab injections (1.25 mg/0.05 ml) in order to stop the leakage from the retinal cavernous haemangioma lesions and prevent another episode of vitreous haemorrhage. No intraoperative or postoperative complications were seen. Twenty-two months following treatment there was no recurrence of vitreous haemorrhage.

Recurrence of Cortical Venous Haemangioma in the Tibia: Interest of Sclerotherapy

We report on a rare case of an intra-osseous haemangioma involving the medial portion of tibia in a 29-year-old man. The aim is to emphasize on diagnosis difficulties, possible recurrence and interest of sclerotherapy. In radiographs, the lesion was a well-defined osteolytic lesion having 3 mm of diameter with perimeter’s sclerosis. The computed tomography images demonstrated an intra-medullar gap’s image of the tibia with cortical participation. An osteoid osteoma was evocated but eliminated by the histhological examination. The osseous scintigraphy didn’t find any anomaly. The outcome was marked by the recurrence of pain. T1-weighted Magnetic resonance imaging showed a hypointense lesion, while T2-weighted images revealed hyperintense areas, with internal, hypointense septa. Gadolinium-enhanced T1-weighted images showed lattice-like enhancement of the lesion. These images signed a recurrence of the intra-osseous venous haemangioma. The sclerotherapy improved the pain in three days and prevented another recurrence.

Lateral Nasal Capillary Haemangioma a Rare Occurrence—Case Report and Literature Review

Nasal lobular capillary haemangioma (CH), also known as pyogenic granuloma, is a benign lesion of unknown etiology commonly associated with pregnancy, oral contraceptive pills, and trauma. Marked by epistaxis and nasal obstruction, the condition involves benign capillary proliferation with a microscopically distinctive lobular architecture, affecting the skin and mucous membranes of the oral cavity and nasal region. This aim of this article is to report a case of lateral nasal capillary haemangioma in a 39-year-old female, who presented in our facilities having experienced spontaneous epistaxis on the left side of the nose for the previous three months. Endoscopy revealed a protruding left intranasal mass arising from the lateral nasal wall in the region of the middle turbinate and osteo-meatal complex. The patient underwent endoscopic excision of the mass and did excellently well thereafter with no recurrence.

A New Modality of Treatment for Adult Laryngeal Haemangioma by Coblation: A Case Report

Few adult haemangiomas of larynx have been reported. Most common presentations are in infants where the incidence is about 4% - 5% [1]. In children they resolve by age of five whereas in adults they do not regress. In children the most common modality of treatment is by propranolol. In adults, there are various modalities of surgical excision by laser excision with Co2 or KTP and electrocautery assisted excision. We are presenting a case of adult laryngeal haemangioma that presented with blood-tinged sputum on coughing since 8 months and we managed with micro laryngeal surgical excision by coblation without any complications.

婴幼儿眼睑血管瘤内注射平阳霉素与皮质类固醇的比较

目的:分析平阳霉素局部血管瘤体内注射治疗婴幼儿眼睑血管瘤的疗效。方法:用平阳霉素治疗56例,另用皮质类固醇治疗52例婴幼儿眼睑血管瘤,对疗效进行对比分析。结果:用平阳霉素治疗56例有效56例(100%),完全治愈56例(100%);复发2例(4%),经再治疗后完全消退。用局部注射皮质类固醇方法治疗52例,其中39例(75%)在l～7次注射后肿瘤全部或接近全部退化;8例(15%)瘤体缩小50%以上;5例(10%)无效。结论:平阳霉素局部血管瘤体内注射疗效显著,治疗时间短,见效快,注射次数少,毒副作用小,复发率很低。与用局部注射皮质类固醇方法治疗血管瘤相比,有效率、治愈率显著提高。

某海兰褐鸡场祖代、父母代及商品代鸡血管瘤型ALV-J的分离与鉴定

从山东省某海兰褐鸡场祖代、父母代种鸡和商品代蛋鸡中获得疑似血管瘤型禽白血病(Avian leukosis,AL)病料。采用病理剖检、IFA、分子生物学检测,确定为J亚群禽白血病。从祖代、父母代病料中各分离到1株J亚群禽白血病病毒(J subgroup of avian leukosis virus,ALV-J),从商品代蛋鸡中分离到4株ALV-J。根据原型毒株HPRS103设计1对gp85基因引物,获得gp85基因序列。获得的gp85基因序列与各亚群参考毒株序列核苷酸同源性比对,结果显示:分离自商品代蛋鸡的Commercial03株、Commercial04株、Commercial06株和父母代分离株Parent02株位于同一分支,同源性在97.2%～97.9%,与HPRS103株同源性94.7%～95.2%;Commercial05株与祖代分离株Grandparent01株在同一分支,与HPRS103株同源性为98.3%,4株分离自商品代的ALV-J同源性为95.0%～99.9%。表明商品代蛋鸡中的ALV-J可能来自父母代或祖代种鸡的垂直传播,也可能来自于其他来源的水平传播。从同一鸡场祖代、父母代及商品代鸡中分离得到ALV-J,这在我国还是首次。对后续研究其基因突变、致瘤机制等奠定了良好的基础。

婴儿血管瘤的药物治疗

婴儿血管瘤是儿童最常见的一种肿瘤,发病率达10%。婴儿血管瘤具有一定自限性,通常在1岁内出现快速增殖期,部分血管瘤可自行消退。有些婴儿血管瘤在快速增殖期出现溃疡、出血、畸形或者感染时,需要及时予以干预治疗。血管瘤的治疗方法多种多样,常用的药物治疗方法包括:糖皮质激素、干扰素、平阳霉素等。普萘洛尔是一种治疗婴儿血管瘤的新方法,安全有效。特别是对于伴有一些严重并发症,能够在合适的时机选择恰当的药物治疗非常重要。

脉冲染料激光治疗婴幼儿体表溃烂型血管瘤疗效研究

目的：观察波长为585 nm脉冲染料激光治疗婴幼儿体表溃烂型血管瘤的临床疗效。方法：采用波长为585 nm的脉冲染料激光,对76例（男26例,女50例）体表溃烂型血管瘤（平均瘤体表面积22.1 cm^2）患者进行照射治疗,激光能量为5.8 J/cm^2~8 J/cm^2（平均6.6 J/cm^2）,间隔4周治疗一次,治疗二次后瘤体无消退者予口服类固醇辅助治疗,类固醇辅助治疗4周无效者再联合干扰素治疗,直至创面愈合和瘤体消失。结果：68例患儿在治疗二次后创面完全愈合,瘤体明显缩小,经一至八次（平均四次）激光治疗后瘤体完全消退,8例患儿辅以类固醇治疗,6例治愈,2例无效后予干扰素联合治疗后瘤体消退,总治愈率100%;经过平均12个月随访,所有患儿无溃疡复发和血管瘤再发。结论：脉冲染料激光治疗婴幼儿体表溃烂型血管瘤,具有良好疗效,是一种行之有效的治疗方法。

小肠血管瘤的诊断和治疗

目的探讨小肠血管瘤的有效诊断方法,减少误诊。方法回顾性分析该院1981年6月～2004年9月收治的小肠血管瘤患者20例。结果全组患者有轻重不等的贫血,临床主要表现为呕血、便血或黑便,部分患者有腹痛、腹胀,容易误诊。发病部位十二指肠、空肠各7例,回肠5例,空回肠交界1例。剖腹探查并手术治疗18例,单纯胃镜检查、血管造影检查确诊各1例。结论小肠血管瘤发病部位隐蔽,多种检查方法存在其局限性,手术探查并结合纤维内镜检查是一最有效的确诊手段。

口服普萘洛尔治疗40例面颈部婴幼儿血管瘤的临床观察

目的：评价普萘洛尔口服治疗婴幼儿血管瘤的临床疗效及不良反应.方法：对40例面颈部血管瘤患儿进行口服普萘洛尔治疗,并以32例强的松治疗的血管瘤患儿作对照.治疗组予口服普萘洛尔2mg/（kg·d）,分2次服用.住院治疗3-4天,为安全起见,第1天服全量的1/4,第2天服全量的1/2,第3天服全量.若无异常就可出院,且出院后继续按原剂量服药.每2-3周复诊1次,并观察瘤体的大小、质地、颜色,随访和同时针对药物的不良反应进行处置;对照组采用口服强的松3mg/（kg·d）,隔日1次,晨起时顿服,两组患者各自用药后,根据病变的生长、萎缩并稳定或服药时间满6个月为停药指征.按4级评分法（优、好、中、差）对近期疗效进行评价.结果：疗效统计,治疗组：优12例（30.00％）,好21例（52.50％）,中5例（12.50％）,差2例（5.00％）,有效率82.50％;对照组：优5例（15.62％）,好9例（28.12％）,中12例（37.50％）,差6例（1 8.75％）,有效率43.75％.治疗组与对照组的有效率比较差异有统计学意义（P＜0.05）.治疗组不良反应发生率7.5％,对照组为56.25％,两组比较差异有统计学意义（P＜0.05）.结论：普萘洛尔口服治疗婴幼儿血管瘤的方法有效,不良反应少,值得临床推广应用.

不常见肝血管瘤的影像学特征

目的探讨不常见肝血管瘤包括硬化性血管瘤和毛细血管瘤的影像学特征。方法对经病理证实的肝硬化性血管瘤和毛细血管瘤共7例影像学资料进行回顾性分析,分析总结其CT和MRI影像学特征。结果肝硬化性血管瘤5例,CT平扫呈不均匀稍低密度,2例病灶内见斑点状钙化,4例有包膜萎缩或病灶凹陷征象。增强CT动脉期病灶的边缘或内部出现斑点及结节状强化,3例病灶周围见斑片状灌注异常。门脉期除1例出现强化范围增大,3例在动脉期出现的强化灶未见增大或填充征象。延迟期5例病灶内部出现不同程度的不规则延迟强化。MRI表现:表现为边界不清的T1WI低信号,T2WI为不均匀高、低混杂信号,内部可见低信号区。2例为毛细血管瘤,表现为均匀的稍低密度或T2WI高信号,增强后强化均匀明显强化。结论肝硬化性血管瘤和毛细血管瘤罕见但具有一定特点,对其影像特征的认识可减少误诊率。

婴儿性血管瘤24例临床病理分析

目的探讨婴儿性血管瘤的临床病理、免疫组化特征以及鉴别诊断。方法采用HE及免疫组化技术对24例婴儿性血管瘤进行观察,并结合文献复习。结果17例呈增殖期图像:细胞丰富,增生的毛细血管排列成小叶状,血管内皮细胞肥胖,管腔不明显,内皮细胞周围为梭形的血管周细胞;7例呈消退期图像:皮下组织中纤维脂肪组织增生,血管减少,残留血管腔扩张,内皮细胞扁平,血管周细胞减少。血管内皮细胞GLUT1阳性,血管周细胞SMA阳性。结论婴儿性血管瘤是儿童期最常见的良性肿瘤,在年龄、性别、发病部位及病程上具有明显特点,组织学特点是肿瘤由血管内皮细胞及血管周细胞组成,内皮细胞特异性表达GLUT1。