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.

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.

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.

Infantile Hemangiomas: Epidemio-Clinical Profile and Therapeutic Difficulties in Côte d’Ivoire

Introduction :Infantile haemangiomas are the most common benign vascular tumours of infants. In Western countries, they have been the subject of several studies. However, in sub-Saharan Africa, few works are devoted to them. We initiated this work to contribute to a better knowledge of infantile haemangiomas in our work context. Material and Methods: This is a cross-sectional descriptive and analytical study carried out in the Dermatology Department of C.H.U. Treichville from November 2014 to December 2016;All children with infantile haemangiomas have been taken into account, in the study. Results: We counted 42 cases of haemangiomas on 4600 paediatric dermatoses, a prevalence of 0.9%. The sex ratio was 0.35. The age of our patients ranged from 2 days to 5 years. 76.2% of patients consulted after the age of 2 months. 26.9% of patients were born premature. 54% of the haemangiomas started with an erythematous macula. 52.4% had a size between 1 and 3 cm. Superficial haemangiomas (52.38%) and mixed haemangiomas (42.85%) were the most common clinical forms. The ulcerated forms represented 9.5%. The lesions were preferentially located in the cervico-facial region (71.4%) and resulted in aesthetic prejudice in 47% of cases. 3 patients (7.14%) were treated with propranolol. 37 patients (88.1%) used self-medication using poultice. Conclusion: Infantile haemangiomas are infrequent in Cote d’Ivoire. They sit mainly in the cervico-facial area. The ulcerated forms are not negligible and they sometimes cause a significant aesthetic prejudice. Their management is sometimes difficult because of the unavailability of propranolol.

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.

Non-bleeding technique in resection of hepatoma: report of 49cases

Objective: To investigate the experience and some re-lated problems of non-bleeding technique in partialhepatectomy.Methods: 49 cases of hepatic tumors were reviewed,including 41cases of hepatic carcinoma, 3 cases of sec-ondary hepatic carcinoma, 4 cases of haemangioma,and 1 case of hepatic adenoma. Three kinds of bleed-ing control technique including normothermic com-plete hepatic vascular exclusion (47/49), completevascular isolation with hypothermic perfusion (1/49),and partial extracorporeal hepatectomy (1/49) wereemployed.Results: The intraoperative volume of blood loss was1560±1252ml, and operative duration was 4.7±0.8h. One case died perioperatively because of severebleeding. 31 cases of primary hepatic carcinoma werefollowed up; the 0.5-, 1-, and 5-year survival rateswere 77% (24/31), 55% (17/31), and 36% (11/31)respectively.Conclusions: In liver surgery concerning hepatoma inthe segment of Couinaud Ⅰ, Ⅳ, Ⅴ or Ⅷ, Pringle'sprocedure is still the major method for bleeding con-trol. When the vena cava or/and venae hepaticaewas/were implicated, normothermic complete hepaticvascular exclusion is helpful. The partial extracorpo-real technique can provide a good exposure to the ca-va inferior, and is an alternative to the complete ex-tracorporeal method. Intraoperative B ultrasound de-tection plays an important role in choosing bleedingcontrol technique.

Primary vascular tumours of the kidney

Primary vascular tumours of the kidney are rare and may pose diagnostic difficulties because of their similar clinical,morphological,and immunohistochemical features.This article summarizes the clinical and pathological features of primary renal angiosarcoma and anastomosing haemangioma of the kidney including epidemiology,genetics,and prognosis.Renal anastomosing haemangiomas are benign neoplasms characterized by anastomosing capillary-sized vascular channels.These tumours are rare,with about 75 cases reported in the literature.Most anastomosing haemangiomas are found incidentally on ultrasound,computed tomography,or magnetic resonance imaging.Common symptoms include abdominal pain,haematuria,and abdominal mass.Renal anastomosing haemangiomas are characterized by recurrent mutations in GNAQ and GNA14 genes.The prognosis of anastomosing haemangioma is excellent.Primary renal angiosarcomas are malignant tumours showing endothelial differentiation.To date,76 cases have been described in the literature.Primary renal angiosarcomas are frequently symptomatic.The clinical features of renal angiosarcomas are similar to those of renal anastomosing haemangiomas,including abdominal pain,haematuria,and abdominal mass.Angiogenesis-related genes and vascular-specific receptor tyrosine kinases such as KDR,TIE1,SNRK,TEK,and FLT1 are upregulated in angiosarcomas.Primary renal angiosarcomas are highly aggressive neoplasms with a poor prognosis despite surgical treatment,chemotherapy,radiotherapy,or targeted therapy.

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.

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.

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.

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.

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.

Cavernous hemangioma of the cervix and pregnancy: a case report

Purpose: Cavernous haemangiomas of the uterine cervix are very rare and usually harmless. It is a benign tumor that may cause gynecological obstetrical complications. Although it is a benign condition but it can have serious consequences for the mother as well as for the baby. The treatment is often surgical and diagnosis is histological. Methods and Result: we reported a case of cavernous haemangioma of the cervix in a 25-year old multiparous patient, referred to our Centre in the 33 - 34 gestational weeks for premature labor with membranes rupture. A 3 cm × 6 cm soft regular purplish red mass is found in the uterine cervix. Tocolosys, prophylactic antibiotic therapy and corticotherapy for fetus pulmonary maturation were then decided after elimination of chorioamniotite signs. Caesarean has been made during labor, a week later, for tumor previa. The tumor excision has been made through the vagina after fetus extraction. The histological examination confirmed diagnosis of the cavernous haemangioma. Discussion: Further to this observation, the clinical, histological and therapeutic characteristics of the cavernous haemangioma unusual presentation were drawn up and literature enriched since this pathology is rare. Most previous reports in the literature consist of singlecase histories, and the experience of individual institutions is limited. The patients dramatically present dilemmas in the disease management. This can result in uncontrolled bleeding especially during operative delivery and may require hysterectomy. To avoid unexpected bleeding from haemangioma, patients should be repeatedly examined for haemangioma of the birth canal, and special care should be taken in choosing the delivery mode.

Type IV Aggressive and Symptomatic Vertebral Hemangioma

Vertebral hemangiomas (VHs) are benign tumours with rich vasculature. They are the most common tumours of the spine with an estimated incidence of 10% - 12% of the population. Despite its high incidence, they are often asymptomatic and only 0.9% - 1.2% are symptomatic. They may also be aggressive and are characterised by bone expansion, extra osseous extension of the tumour, disturbance of local blood flow and, in rare cases, compression fractures. We report a 59-year-old woman, presented with back pain after falling from standing height. Magnetic resonance imaging revealed lumbar spine vertebral fractures and T12 osteolytic lesion with spinal canal extension, concurring to VH type IV, according to Tomita’s surgical classification of spinal. Embolization, posterior decompression and fixation were performed followed by postoperative radiotherapy. Her symptoms were resolved immediately without recurrence after 6 mouths.

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.

Angiolymphoid Hyperplasia with Eosinophilia—A Case Report

Angiolymphoid hyperplasia with eosinophilia is a rare, benign vascular tumor affecting principally the head and neck region of young adult females. Microscopic analysis reveals hyperplastic blood vessels lined by a hypertrophic endothelium. An inflammatory infiltrate rich in eosinophils is also present. Etiology of the lesion is unknown. Various treatment modalities have been described. We present a case successfully treated by excision and local steroid infiltration.

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.