951/1154. hemangioma-associated rhinophyma. Report of a case with successful treatment using carbon dioxide laser surgery. BACKGROUND. rosacea is a disorder characterized by erythematous papules, pustules, and telangiectases involving the nose, chin, cheeks, and forehead that may progress to rhinophyma. Although the etiology of rosacea remains unclear, a common theme in pathogenesis is vasodilation. rosacea has been associated with both idiopathic flushing as well as that induced secondarily. OBJECTIVE. To report clinical and histologic features of rhinophyma that developed in association with a longstanding cavernous hemangioma. RESULT. The patient is a 57-year-old Hispanic man with a congenital port-wine stain that had developed into a nodular, cavernous hemangioma over the course of years. Clinically, in the site of the angioma there was marked soft-tissue overgrowth with sebaceous hyperplasia. These changes were confined to the angiomatosis areas and were sharply demarcated from the surrounding normal skin. Histologically, there was marked fibroplasia; numerous small cysts, some with focal rupture and inflammation; dilated follicular ostia; and prominent sebaceous gland hyperplasia in addition to numerous ectatic blood vessels, which were a component of the hemangioma. In contrast, normal-appearing skin adjacent to this site revealed only normal sebaceous glands and no fibroplasia. Treatment consisted of CO2 laser excision of the nodular components of the hemangioma with a tightly focused beam, followed by resculpting of the natural facial contour with laser abrasion of hypertrophic soft tissues with a broad, unfocused beam. The treated area healed well, with a skin tone of a more natural color than the original hemangioma. CONCLUSION. Our findings suggest that rhinophyma may develop secondary to the vasodilation seen in large hemangiomas and that the CO2 laser offers excellent treatment for both the vascular and stromal components of the lesion. ( info) |
952/1154. Multiple glomus tumours: a report of a family in denmark. In a family affected by multiple glomus tumours, one of the members had approximately 500 tumours spread over the entire skin. The histopathological similarity to cavernous haemangioma is emphasized. We consider that multiple glomus tumour is a more common skin disease than is assumed today. ( info) |
953/1154. Spinal intramedullary cavernous angioma in a patient with Down's syndrome. A rare case of cervical intramedullary cavernous angioma in a 30-year-old man with Down's syndrome is presented. A review of the literature showed this to be the first reported case. magnetic resonance imaging was diagnostic. A myelotomy was done and multiple biopsies were taken. The patient deteriorated neurologically and later died due to severe chest infection. The presentation, management and prognosis of this condition are discussed. ( info) |
954/1154. Posterior fossa surgery: an unusual cause of superficial siderosis. With the widespread use of magnetic resonance imaging, an increasing number of cases of superficial siderosis are being discovered. However, the cause remains uncertain in almost half the cases. We report a case where previous surgery for a pontine hematoma established a pathway for extravasation of blood into the 4th ventricle, resulting in superficial siderosis that was demonstrated on a follow-up magnetic resonance imaging scan 8 years later. This case presents an unusual iatrogenic cause of superficial siderosis that has not been reported previously. ( info) |
955/1154. Intraventricular cavernous malformation associated with medullary venous malformation. We reported a case of cavernous malformation (CM) associated with medullary venous malformation in the same area. The CM was located in the trigone of the lateral ventricle in the dominant hemisphere and drained into the longitudinal caudate vein of Schlesinger via deep medullary veins. By a transsylvian transventricular approach, the CM was totally removed with successful preservation of the medullary venous malformation. This approach is available for trigonal lesions, especially in cases with enlarged inferior horn. We stress that CM removal can be conducted with preservation of the adjacent medullary venous malformation. ( info) |
| An infant girl with aicardi syndrome, scalp lipomas, and angiosarcoma of a limb is reported. The cavernous hemangioma of the leg was benign when biopsied at age 5 months but became malignant at 11 months. Angiosarcoma caused multiple distant metastases which were evident at autopsy at age 19 months. This is the first case of aicardi syndrome associated with lipoma and metastatic angiosarcoma. ( info) |
957/1154. hemangioma of the upper arm associated with massive hemorrhage in a neonate. A rare case of an ulcerated hemangioma of the upper arm in a neonate is described herein. Resection of the huge hemangioma, which occupied the axilla and extended down the entire length of the upper arm, was necessary due to massive hemorrhage from the ulcer and progressive heart failure caused by the arteriovenous fistula in the hemangioma. After complete resection of the hemangioma, extensive defects of the skin and subcutaneous tissue were replaced by a skin flap closure technique which involved considerable difficulty. However, the arm gradually recovered its size and function with good wound healing. The present case illustrates that rapid surgical intervention may be required to prevent clinical deterioration in such cases. ( info) |
| BACKGROUND: Cavernous hemangiomas are the most common benign tumors of the liver and are found in about 2% of autopsy patients. The vast majority are small (less than 4 cm) and asymptomatic, but there have been a few reported cases of these lesions leading to severe pain and even spontaneous fatal hemorrhage. Estrogen may cause the growth of liver hemangiomas, but there is a paucity of information concerning the effect of pregnancy upon these lesions. CASE: A patient presented at 18 weeks' gestation with the acute onset of vomiting and epigastric pain. A right upper-quadrant ultrasound scan found a 9-cm hypodense lesion within the liver, and magnetic resonance imaging (MRI) suggested a hemangioma. The lesion was believed to be inoperable, and selective catheterization of the common hepatic artery was performed. An angiogram demonstrated a round vascular mass 12 cm in diameter occupying much of the left side of the liver, with the vascular supply from the middle hepatic artery and to a lesser extent from the left hepatic artery. Embolization was performed, and a post-embolization image demonstrated satisfactory occlusion of the vessels treated. The patient's epigastric pain resolved after the procedure. The lesion was observed with monthly ultrasound and regressed to about 50% of its original size. The patient was scheduled for an elective primary cesarean delivery at 39 weeks to avoid possible rupture of the hepatic hemangioma during the second stage of labor. Her cesarean and postpartum course were uncomplicated. CONCLUSION: A symptomatic liver hemangioma with intratumor hemorrhage can be successfully treated with embolization during pregnancy. Because of the paucity of reported cases, it is uncertain whether vaginal birth is contraindicated in these patients. ( info) |
959/1154. Cavernous hemangioma of the uterus in a pregnant woman. BACKGROUND: Cavernous hemangioma of the uterus is a rare but serious condition, especially during pregnancy. Most reported cases ended with hysterectomy in an attempt to control profuse bleeding, and only one of four resulted in a live birth. We describe the sonographic differential diagnosis of this condition and propose management of these patients. CASE: Cavernous hemangioma of the uterus was diagnosed sonographically at 33 weeks' gestation. Conservative management resulted in a favorable outcome for both mother and child. CONCLUSION: Ultrasound is helpful in the prenatal diagnosis of cavernous hemangioma of the uterus; however, other uterine or placental abnormalities with similar sonographic appearances should be considered in the differential diagnosis. ( info) |
960/1154. Nd:YAG laser surgery of venous malformations. Venous malformations are prevalent in the head and neck. These anomalies are difficult to eradicate by conventional methods due to excessive bleeding and imprecise excision. This article details how the success rate for treating low flow venous malformations was 100% in 24 patients who underwent Nd:YAG surgery. ( info) |