Kaposiform hemangioendothelioma without cutaneous involvement
- 41 Downloads
We sought to characterize the clinical features and management of patients diagnosed as Kaposiform hemangioendothelioma (KHE) without cutaneous involvement.
The electronic patient chats at six Triple A hospitals in China were searched to find all patient diagnoses with KHE without cutaneous involvement.
Of 30 patients (mean age at diagnosis, 55.6 months), 17 (56.7%) were male. Fourteen (46.7%) patients were associated with Kasabach–Merritt phenomenon (KMP). Patients with KMP were significantly more likely to have lesions involving truck compared to patients without KMP (odds ratio 10.000; 95% confidence interval 1.641–60.921; P = 0.011). Other common complication included severe anemia and decreased range of motion. In the majority of cases (93.3%), the lesions were highly infiltrative and locally invasive with ill-defined margins. Histological examination was required in all patients without KMP for precise diagnosis. In all, 16 (53.3%) patients received corticosteroid treatment, 19 (63.3%) received oral sirolimus treatment, 7 (23.3%) received intravenous vincristine, and 5 (16.7%) patients used propranolol. Patients had varied responses to conventional drugs, whereas all patients receiving sirolimus treatment had better response. In all, three patients (10%) died of disease, all presented with KMP. Feature of these recalcitrant cases (death) included young age, visceral location, extensive involvement, and lack of improvement with high-dose corticosteroids.
Our study clearly demonstrated that KHE without cutaneous involvement could be associated with important complication, which might result in death or severe morbidity. Increased awareness of KHE without cutaneous involvement is required for early diagnosis and aggressive therapy in an attempt to prevent complication.
KeywordsKaposiform hemangioendothelioma Cutaneous involvement Kasabach–Merritt phenomenon Morbidity Mortality
This work was supported by Grants from the National Natural Science Foundation of China (Grant nos: 81401606 and 81400862) and the Science Foundation for Excellent Youth Scholars of Sichuan University (Grant no: 2015SU04A15).
Compliance with ethical standards
Conflict of interest
Author Yi Ji declares that they have no conflict of interest. Author Siyuan Chen declares that they have no conflict of interest. Author Lizhi Li declare that they have no conflict of interest. Author Kaiying Yang declares that they have no conflict of interest. Author Chunchao Xia declares that they have no conflict of interest. Author Li Li declares that they have no conflict of interest. Author Gang Yang declares that they have no conflict of interest. Author Feiteng Kong declares that they have no conflict of interest. Author Guoyan Lu declares that they have no conflict of interest. Author Xingtao Liu declares that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study. Written informed consent for publication of this study was obtained from all patients and patient’s parents.
- Adams DM, Trenor CR, Hammill AM, Vinks AA, Patel MN, Chaudry G, Wentzel MS, Mobberley-Schuman PS, Campbell LM, Brookbank C, Gupta A, Chute C, Eile J, McKenna J, Merrow AC, Fei L, Hornung L, Seid M, Dasgupta AR, Dickie BH, Elluru RG, Lucky AW, Weiss B, Azizkhan RG (2016) Efficacy and safety of sirolimus in the treatment of complicated vascular anomalies. Pediatrics 137(2):e20153257. https://doi.org/10.1542/peds.2015-3257 CrossRefPubMedPubMedCentralGoogle Scholar
- Drolet BA, Trenor CR, Brandao LR, Chiu YE, Chun RH, Dasgupta R, Garzon MC, Hammill AM, Johnson CM, Tlougan B, Blei F, David M, Elluru R, Frieden IJ, Friedlander SF, Iacobas I, Jensen JN, King DM, Lee MT, Nelson S, Patel M, Pope E, Powell J, Seefeldt M, Siegel DH, Kelly M, Adams DM (2013) Consensus-derived practice standards plan for complicated Kaposiform hemangioendothelioma. J Pediatr 163(1):285–291. https://doi.org/10.1016/j.jpeds.2013.03.080 CrossRefPubMedGoogle Scholar
- Fernandez-Pineda I, Lopez-Gutierrez JC, Ramirez G, Marquez C (2010) Vincristine-ticlopidine-aspirin: an effective therapy in children with Kasabach–Merritt phenomenon associated with vascular tumors. Pediatr Hematol Oncol 27(8):641–645. https://doi.org/10.3109/08880018.2010.508299 CrossRefPubMedGoogle Scholar
- Fernandez-Pineda I, Lopez-Gutierrez JC, Chocarro G, Bernabeu-Wittel J, Ramirez-Villar GL (2013) Long-term outcome of vincristine-aspirin-ticlopidine (VAT) therapy for vascular tumors associated with Kasabach–Merritt phenomenon. Pediatr Blood Cancer 60(9):1478–1481. https://doi.org/10.1002/pbc.24543 CrossRefPubMedGoogle Scholar
- Ji Y, Chen S, Xiang B, Li K, Xu Z, Yao W, Lu G, Liu X, Xia C, Wang Q, Li Y, Wang C, Yang K, Yang G, Tang X, Xu T, Wu H (2017) Sirolimus for the treatment of progressive kaposiform hemangioendothelioma: a multicenter retrospective study. Int J Cancer 141(4):848–855. https://doi.org/10.1002/ijc.30775 CrossRefPubMedGoogle Scholar
- Kasabach H, Merritt K (1940) Capillary hemangioma with extensive purpurareport of a case. Am J Dis Child 5(59):1070–1093. https://doi.org/10.1001/archpedi.1940.01990160135009 CrossRefGoogle Scholar