Figure 6 - uploaded by Anita Gupta
Content may be subject to copyright.
Nasal pyogenic granuloma in a 12-year-old girl. Axial postcontrast fat-suppressed T1-weighted MR image shows a well-circumscribed ovoid nodule (arrow) in the right nostril that largely enhances.
Source publication
Since the publication of the seminal work on the histology-based classification of vascular anomalies by Mulliken and Glowacki in 1982 and the subsequent adoption of an expanded and modified version in 1996 by the International Society for the Study of Vascular Anomalies, an increasing number of vascular lesions have been recognized as histological...
Similar publications
Sinus pericranii is a rare vascular anomaly characterized by abnormal venous communication between the inner and outer regions of the cranial cavity. Here, we report a case of sinus pericranii and venous malformations in the right periorbital region of a 2-year-old girl. Radiologic findings showed venous malformations in the right parietal region c...
Citations
... Type II combined vascular malformations consist of two or more distinct vascular malformations within a single lesion (e.g., capillary-venous malformation and venolymphantic malformations). [2] Vascular malformations arise due to an error in individual or combination morphogenesis of any arterial, venous, or lymphatic vascular networks. These VAs are present from birth, grow proportionally with the growth of the body, and do not exhibit any tendency to involute spontaneously. ...
Vascular lesions are the most common congenital and neonatal abnormalities. About 60% of anomalies occur in the head‑and‑neck region due
to its complex vascular anatomy. There is confusion in the descriptive terminology for the vascular entity and eponyms. Thus, appropriate
classification based on clinical examination and imaging is essential for proper diagnosis and treatment. Thus, the aim of this article is to
report a case of venolymphatic malformation with comprehensive knowledge about classifications, pathogenesis, clinical presentation, and
its management
... A previous study of the imaging patterns of STVTs demonstrated the use of inappropriate terminology [6,19,20]. As a result, the ISSVA classification was developed to promote the use of standard terminology [2,5,21]. There was fair to moderate concordance between the on-site and off-site imaging analyses. ...
... Imaging is usually reserved for treatment planning as well as for lesions with an unclear diagnosis or deep tissue involvement [21]. MRI using a standardized protocol is the imaging technique of choice to demonstrate the extension and anatomical relationship of the lesion with adjacent structures [22]. ...
Objectives
To compare the magnetic resonance imaging (MRI) and Doppler ultrasound (DUS) findings with the pathological findings of soft tissue vascular tumors (STVTs) according to the 2018 ISSVA (International Society for the Study of Vascular Anomalies) classification to differentiate vascular tumors from vascular malformations.
Methods
This retrospective study included patients with STVTs who underwent contrast-enhanced MRI and pathological analysis at our hospital between 2010 and 2020. The presumptive diagnosis based on the on-site imaging and histological analysis was compared with imaging and histological analysis conducted off-site utilizing the ISSVA criteria.
Results
This study included 31 patients with 31 vascular tumors located in the head and neck ( n = 3), trunk ( n = 2), and extremities ( n = 26). The off-site pathological analysis confirmed benign vascular tumors in 54.8% of cases (non-involuting congenital hemangioma: 35.5%; epithelioid hemangioma: 13%; pyogenic granuloma: 3%; and spindle cell hemangioma: 3%). Based on the off-site histological analysis, 25.8% were reclassified as having a vascular malformation whereas three had other benign lesions. Only phleboliths were associated with a vascular malformation ( p = 0.03). The concordance between off-site MRI and pathological findings was fair ( k = 0.3902 (0.0531–0.7274)), whereas that between on-site and off-site pathological analyses was poor ( k = −0.0949 (−0.4661 to 0.2763)).
Conclusion
Benign vascular tumors have non-specific imaging features on imaging with some overlap with atypical vascular malformations. Therefore, histological analysis is recommended. Imaging and pathological analyses should be performed in accordance with the ISSVA classification to minimize inter-observer discrepancies.
Critical relevance statement
Imaging features of benign vascular tumors on MRI are non-specific, leading to discrepancies with pathological findings and potential overlap with atypical vascular malformations. Imaging and histological analyses should be performed in accordance with ISSVA guidelines to improve patient management.
Key Points
The imaging features of benign vascular tumors are non-specific.
Histological analysis is recommended for soft tissue vascular tumors in adults.
Analyses of soft tissue vascular tumors should be performed in accordance with ISSVA guidelines.
Graphical Abstract
... However, the final diagnosis was hemangioma, notable for the absence of tumor cells. Hemangiomas in the head and neck are defined as benign vascular neoplasms in the WHO classification [2], but they are categorized as a vascular malformation according to the latest International Society for the Study of Vascular Anomalies (ISSVA) classification published in 2018, due to the absence of atypical cells, and the term "-oma" is not preferred for non-neoplastic lesions [8,9]. Nevertheless, the mass lesions, so-called hemangioma, may be acceptable in imaging. ...
Sphenoid sinus hemangiomas are uncommon and pose significant diagnostic challenges due to their rarity and the complex symptoms associated with their critical anatomical location. This report discusses a woman in her 40s who presented with worsening headaches, diplopia, and a sensation of pressure behind her eyes. Diagnostic imaging revealed a lobulated mass in the sphenoid sinus extending into the cavernous sinus and sella, initially mimicking an aggressive neoplastic pathology. However, histopathological examination following endovascular embolization and partial surgical resection confirmed the diagnosis of a cavernous hemangioma. This case highlights the importance of considering hemangiomas in the differential diagnosis of sphenoid sinus masses, especially when patients present with atypical symptoms and imaging shows features such as high vascularity and bone remodeling. The findings emphasize the need for careful diagnostic and therapeutic approaches to effectively manage such cases and differentiate them from more aggressive pathologies.
... Built upon this fundamental principle, the International Society for the Study of Vascular Anomalies (ISSVA) classification system is the most recent and the most comprehensive [13] (Table 1). The last update, published in 2018, reported the known molecular and genetic markers to identify each entity for the first time. ...
... VeMs can present as either small, well-circumscribed lesions or large, infiltrative ones [13,23]. They can be observed in any anatomical location, with a preference for the limbs, and can either be superficial or deep, intramuscular and even intraosseous. ...
This narrative review aims to summarise the classification of vascular anomalies, their clinical presentation, and their radiological features to propose a diagnostic algorithm to approach patients with suspected soft tissue vascular anomalies of the extremities. The management of vascular anomalies necessitates a multidisciplinary approach. Clinical presentation and physical examination are sufficient in most cases to achieve a correct diagnosis. This is especially true for small congenital lesions of the skin and subcutaneous tissue. Imaging is used for accurate characterization of these lesions, especially in cases of atypical or vague clinical presentation, and to assess extension in cases of lesions that are larger and localized in deeper tissues.
... In addition to malignant tumors, borderline and benign neoplasms in FT can sometimes be revealed. They are worth considering, as many of them may be the first signals of malignancy or several complications 3,5,7,8 . ...
... It is commonly believed that FT hemangioma is associated with the effect of estrogens, which stimulate the growth of blood vessels. This has been confirmed in some cases in which estrogen receptors were found in the endothelial cells of hemangiomas during immunohistochemical studies [1][2][3]6,8,10 . This case's postoperative material study demonstrated the absence of estrogen receptors in the endothelial tumor cells, which indicates that the occurrence and growth of the FT hemangioma did not depend on the effect of estrogen. ...
... Histologically, it is not difficult to distinguish hemangiomas from the above-mentioned neoplasms and FT cancer. However, for reliable confirmation of the diagnosis, an immunohistochemical study is recommended 3,8,11,12 . ...
Hemangioma in female reproductive organs, particularly in the fallopian tube (FT), is a sporadic disease. In this report, we describe a case of hidden capillary hemangioma in FT in a 39-year-old woman who suffered from uterine leiomyoma. During the preoperative stage, pelvic sonography, computed tomography, and diagnostic laparoscopy revealed a subserous leiomyomatous nodule located along the posterior wall of the uterus. Despite this, intraoperatively, a benign vascular neoplasm was diagnosed. Histologically, it is characterized by multiple thin-walled vascular spaces lined with a single layer of endothelial cells, in which single mitoses were observed. The diagnosis was then confirmed immunohistochemically by CD31 and CD34 expression in the endothelial cells lining the inner surface of the spaces and the low mitotic activity of the tumor cells. It is virtually impossible to diagnose this asymptomatic neoplasm before and during surgery, which can result in an inadequate number of surgeries. Incorrect interpretation of a benign tumor at a young age can lead to unnecessary radical surgery with a resulting loss of fertility, and an unrevealed malignant process can threaten life.
... There have been a few isolated studies or reports published in the literature since the identification of fibro-adipose vascular anomaly (FAVA) as a distinct clinical, radiological, and pathological soft tissue lesion in 2014. This condition is characterized by intramuscular replacement with fibrofatty tissue, complex vascular malformation, phelbectesia, venous thrombosis, and lymphatic involvement [1,2]. This lesion was evaluated for a possible FAVA, given the higher predisposition of young females with painful swelling and contractures due to intramuscular mass lesions (Figs. 1, 2 and 3) [3]. ...
... There have been a few isolated studies or reports published in the literature since the identification of fibro-adipose vascular anomaly (FAVA) as a distinct clinical, radiological, and pathological soft tissue lesion in 2014. This condition is characterized by intramuscular replacement with fibrofatty tissue, complex vascular malformation, phelbectesia, venous thrombosis, and lymphatic involvement [1,2]. This lesion was evaluated for a possible FAVA, given the higher predisposition of young females with painful swelling and contractures due to intramuscular mass lesions (Figs. 1, 2 and 3) [3]. ...
... Complete surgical excision of vascular lesions is not always possible and carries a high risk of complications. Indeed, the complete surgical excision of lip, cheek, and tongue LMs may lead to various cosmetic and functional complications, including facial nerve damage, heavy arterial bleeding, Horner's syndrome, post-operative lymphatic leakage, seroma, poor wound healing, and infection [27]. ...
Purpose
To evaluate the clinical and aesthetic outcome of percutaneous injection of sclerosant agents to treat head and neck cystic malformations (HNCM) and to assess their recurrence rate based on histology and site.
Methods
Fifty-four subjects (mean age 46 years) with HNCM treated by percutaneous injection of sclerosant agents between January and December 2017 were included. Imaging and clinical data before and after the procedure were collected. Quality of Life Index, Pain Visual Analogue Scale, and Aesthetic Scale scores were measured to assess clinical and aesthetic outcomes. A size reduction of ≥ 70% assessed through the visual scale was considered significant.
Results
Of the 54 HNCM, there were 26 (48%) lymphatic malformations (LM), 13 (24%) salivary epithelial duct cysts of the parotid gland, 12 (22%) salivary mucoceles, and 3 (5%) branchial cysts. A significant size reduction and a satisfactory clinical-aesthetic outcome were observed in all types of LM. The number of reinterventions was significantly associated with the number of lesions (p < 0.001). The lowest number of interventions was observed in macrocystic lymphatic malformations (average of 1.2 interventions). All salivary epithelial duct cysts showed a significant reduction in size, a satisfactory clinical-aesthetic outcome, and an average of 1.16 interventions per patient. Mucoceles had a worse response, with only 3/14 patients showing a satisfactory and long-lasting clinical outcome (average of 1.16 interventions). Treatment of branchial cysts showed the worst outcome with a limited clinical response (3/3).
Conclusion
Percutaneous injection of sclerosant agents may be considered as a first-line treatment for LM and salivary epithelial duct cysts.
... Percutaneous sclerotherapy (PS) has been studied for treating hepatic hemangioma (7,11). Hepatic hemangiomas are classified as low-flow venous anomalies by the International Society for the Study of Vascular Anomalies (12), and PS is considered to be the preferred therapy for subcutaneous low-flow vascular abnormalities (7). In a preliminary study, patients with giant liver hemangioma received percutaneous sclerotherapy with a mixture of bleomycin and ethiodized oil. ...
Background: hepatic hemangiomas, primarily affecting adults in their fourth and fifth decades, are common benign mesenchymal hepatic tumors. The management of giant hepatic hemangiomas, defined variably as greater than 4 cm to 10 cm in diameter, is a clinical challenge due to their potential size and associated symptoms. This study compares two minimally invasive treatment methods: trans-catheter arterial bleomycin chemoembolization (TACE) and ultrasound and fluoroscopy-guided transhepatic bleomycin sclerotherapy (PLIB), in the treatment of giant hepatic hemangiomas. Methods: this prospective cohort study was conducted in Baghdad, Iraq, involved 20 patients with giant hepatic hemangioma. The study assessed the efficacy of TACE and PLIB by comparing tumor size reduction, symptom improvement, changes in radiological features, laboratory parameters, and treatment-related complications. Results: the study observed no significant age difference between the two groups. Post-treatment CT scans revealed different enhancement patterns between TACE and PLIB, with TACE showing more uniform ischemic effects and PLIB demonstrating a variety of enhancement patterns. Both treatments effectively reduced the size of the hemangiomas, with PLIB showing a greater reduction in mass volume than TACE. Conclusion: both TACE and PLIB are effective in reducing the size of giant hepatic heman-giomas, with initial results favoring PLIB for greater volume reduction. Further studies with larger samples and longer follow-up are needed to confirm these findings and establish long-term safety and efficacy profiles for these treatments.
... Several closely associated vascular anomalies should be distinguished from each other first. A recent case series indicated a female predilection and an age range of 1-30 years, with the thigh being the second most common site after the calf [3,5,6]. There is a distinction between FAVA and congenital vascular malformations (CVM), which are classified under separate vascular anomalies. ...
