Paradoxical capillary hemangioma during treatment with ramucirumab

Abstract Pyogenic granuloma also known as lobular capillary hemangioma occurs commonly in the skin and oral mucosa. This entity has been rarely reported in the gastrointestinal tract. We herein report three cases of pyogenic granuloma, located in the duodenum, ileum, and rectum, respectively. Case 1 is a 54-year-old female with a history of angioimmunoblastic T-cell lymphoma who underwent an esophagogastroduodenoscopy for severe heartburn. The endoscopy showed a 13-mm nonbleeding, pedunculated polyp in the second portion of duodenum, which was removed using a hot snare after injection of epinephrine. The patient had an episode of massive gastrointestinal bleeding postpolypectomy, with a significant drop of her hemoglobin, which was managed with blood transfusion. Case 2 is a 68-year-old male with a history of right hemicolectomy due to trauma who had a colonoscopy for chronic diarrhea. The colonoscopy revealed a 14-mm, nonbleeding, pedunculated polyp in the ileum, located 3 cm from the ileocolonic anastomosis. The polyp was removed with hot snare, without complications. Case 3 is a 44-year-old female with morbid obesity who underwent a colonoscopy for iron-deficiency anemia. The colonoscopy showed an 8-mm multilobulated sessile lesion in the distal rectum, which was completely removed using hot snare. No complications were seen postpolypectomy. Histological examination of all the three polyps showed a proliferation of capillary-sized blood vessels with a mixed inflammatory infiltrate, resembling granulation tissue. Additionally, the ileal polyp in our case had marked eosinophilic infiltrate, the etiology of which remains unknown. In conclusion, pyogenic granuloma, given its vascular nature, can be a cause of bleeding in the gastrointestinal tract. Awareness regarding this rare entity is important for its proper diagnosis and treatment.

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Simultaneous massive low gastrointestinal bleeding and hemoperitoneum caused by a capillary hemangioma in ileocecal valve

International Journal of Colorectal Disease ◽

10.1007/s00384-011-1142-7 ◽

2011 ◽

Vol 26 (10) ◽

pp. 1363-1364 ◽

Cited By ~ 4

Author(s):

Jair Santos ◽

Jaime Ruiz-Tovar ◽

Alberto López ◽

Antonio Arroyo ◽

Rafael Calpena

Keyword(s):

Gastrointestinal Bleeding ◽

Ileocecal Valve ◽

Capillary Hemangioma

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Testicular Juvenile Capillary Hemangioma

The Journal of Urology ◽

10.1016/s0022-5347(01)65513-7 ◽

1996 ◽

Vol 156 (5) ◽

pp. 1771-1771 ◽

Cited By ~ 9

Author(s):

Manuel Nistal ◽

Juan Vicente Garcia-Cardoso ◽

Ricardo Paniagua

Keyword(s):

Capillary Hemangioma

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Capillary Hemangioma of the Breast-a Rare Type of benign Breast Tumor

The Breast Journal ◽

10.1111/tbj.12539 ◽

2015 ◽

Vol 22 (3) ◽

pp. 355-356 ◽

Cited By ~ 1

Author(s):

Wei Ma ◽

Feng Jin ◽

Yunfei Wu

Keyword(s):

Breast Tumor ◽

Capillary Hemangioma ◽

Rare Type ◽

Benign Breast Tumor

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Intracranial capillary hemangioma: case report and review of the literature

Surgical Neurology ◽

10.1016/j.surneu.2004.10.025 ◽

2005 ◽

Vol 64 (2) ◽

pp. 154-159 ◽

Cited By ~ 27

Author(s):

Scott L. Simon ◽

Gul Moonis ◽

Alexander R. Judkins ◽

Janice Scobie ◽

Mark G. Burnett ◽

...

Keyword(s):

Case Report ◽

Capillary Hemangioma ◽

Review Of The Literature

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CT Features of Lobular Capillary Hemangioma of the Nasal Cavity

American Journal of Neuroradiology ◽

10.3174/ajnr.a1908 ◽

2009 ◽

Vol 31 (4) ◽

pp. 749-754 ◽

Cited By ~ 32

Author(s):

D.G. Lee ◽

S.K. Lee ◽

H.W. Chang ◽

J.Y. Kim ◽

H.J. Lee ◽

...

Keyword(s):

Nasal Cavity ◽

Capillary Hemangioma ◽

Lobular Capillary Hemangioma ◽

Ct Features

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Lobular Capillary Hemangioma of the Trachea

Journal of Bronchology & Interventional Pulmonology ◽

10.1097/lbr.0b013e3181e65117 ◽

2010 ◽

Vol 17 (3) ◽

pp. 238-240 ◽

Cited By ~ 10

Author(s):

Mohit Chawla ◽

Chad Stone ◽

Michael J. Simoff

Keyword(s):

Capillary Hemangioma ◽

Lobular Capillary Hemangioma

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Treatment of children and adolescents with hemangioma using propranolol: preliminary results from a retrospective study

Sao Paulo Medical Journal ◽

10.1590/1516-3180.2014.1321575 ◽

2014 ◽

Vol 132 (1) ◽

pp. 48-54 ◽

Cited By ~ 3

Author(s):

Juliana Costa Albuquerque ◽

Rosane Aline Magalhaes ◽

Jamille Araujo Felix ◽

Maria Vilani Rodrigues Bastos ◽

Juvenia Bezerra Fontenele ◽

...

Keyword(s):

Retrospective Study ◽

Children And Adolescents ◽

Previous Treatment ◽

Capillary Hemangioma ◽

Response To Treatment ◽

Vascular Tumors ◽

Lesion Volume ◽

Chi Square ◽

One Year ◽

Almost All

CONTEXT AND OBJECTIVE: Hemangiomas are the commonest vascular tumors during childhood. In 2008, the effect of propranolol for treating capillary hemangiomas was demonstrated. Other similar results followed, showing that it rapidly reduces lesion volume. The objective here was to evaluate children and adolescents with hemangiomas that were treated with propranolol. DESIGN AND SETTING: Retrospective study, conducted in a children's hospital. METHODS : Patients aged 0-19 years with or without previous treatment, who were treated between January 2009 and December 2010, were included. The response was assessed by comparing the lesion appearance between the start of treatment and the last consultation. We considered partial or complete responses as the response to treatment. RESULTS : Sixty-nine patients with a median follow-up of 11 months (mean age: 31 months) were included. Of these, 58 patients were recently diagnosed and 11 had had previous treatment. A response (partial or complete) was seen in 60 patients (87%). Among the capillary hemangioma cases, responses were seen in 50 out of 53 (94%), while in other lesion types, it was 10 out of 16 (63%) (P = 0.3; chi-square). Responses in patients less than one year of age were seen in 37 out of 38 (97%), whereas in those over one year of age, in 23 out of 31 (74%) (P = 0.4; chi-square). Side effects were uncommon and mild. CONCLUSIONS: Propranolol seemed to be effective for treatment of hemangiomas in children and adolescents, and not just in the proliferative stage, with responses in almost all the patients.

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