scholarly journals Vascular Tumors of the Neck in Adults: 10-Year Experience in a Tertiary Center

2020 ◽  
Vol 23 (4) ◽  
pp. E493-E497
Author(s):  
ONUR SELÇUK GÖKSEL ◽  
Emre Gok ◽  
Celalettin Karatepe ◽  
Çağla Canbay Sarılar ◽  
Mehmet Akif Önalan ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Multidisciplinary Approach ◽  
Preoperative Evaluation ◽  
Surgical Excision ◽  
Vascular Lesions ◽  
Vascular Tumors ◽  
Preoperative Embolization ◽  
Glomus Caroticum ◽  
Estimated Blood Loss ◽  
Tertiary Center

Introduction: The diagnosis and management of vascular lesions of the neck is a challenging task that requires a multidisciplinary approach. This retrospective study assesses the single center experience of vascular tumors of the neck. Materials and methods: Patients diagnosed with a vascular tumor and/or a mass in close proximity to the carotid artery were identified from our records over a 10-year period. The demographic characteristics, clinical features, surgical approach, and outcomes were reviewed. Results: Surgical excision of 17 vascular lesions were performed in 16 patients with a mean age of 51.56 ± 17.35 years at the time of operation. Intra- and/or postoperative clinical and histological assessment revealed unilateral glomus caroticum (N = 11), glomus vagale (N = 2), bilateral glomus caroticum (N = 1), cavernous hemangioma (N = 1), and carotid sheath tumor (N = 1). In three patients, internal carotid artery, common carotid artery and vagal nerve were sacrificed to facilitate complete tumor excision. During the follow-up period, no tumor recurrences were observed, and the morbidity and mortality were minimal. Conclusion: Preoperative evaluation concerning the size, extent, and anatomical relationships of the tumor thoroughly should be investigated. Multidisciplinary approach involving vascular surgery, otolaryngology, and radiology is preferred to treat these patients for better outcomes. Preoperative embolization in selected cases may decrease estimated blood loss and operative time.

Adult Invasive Subcutaneous Hemangioma

1978 ◽  
Vol 86 (5) ◽  
pp. ORL-750-ORL-754
Author(s):  
Thomas C. Calcaterra ◽  
Arthur J. Weiss
Keyword(s):  
Adult Patient ◽  
Rare Variant ◽  
Growth Pattern ◽  
Surgical Excision ◽  
Vascular Tumors ◽  
Preoperative Embolization ◽  
Clinical Behavior ◽  
Microscopic Morphology

Hemangiomas consist of a spectrum of benign vascular tumors with variable clinical behavior and microscopic morphology, which usually occur in infancy. A rare variant of these tumors is the invasive subcutaneous hemangioma, which shows an aggressive growth pattern by invading subcutaneous structures and recurring after apparent excision. The authors describe an adult patient with a large submandibular invasive hemangioma who was treated by preoperative embolization and surgical excision.

scholarly journals DIAGNOSIS OF CAROTID PARAGANGLIOMA: MULTIDISCIPLINARY ASPECTS

2018 ◽  
Vol 99 (3) ◽  
pp. 125-131
Author(s):  
I. V. Stepanov ◽  
M. S. Ol’shanskiy ◽  
D. Yu. Kharitonov ◽  
V. V. Dmitriev ◽  
A. V. Podoprigora ◽  
...  
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Flow Velocity ◽  
Blood Flow Velocity ◽  
Multidisciplinary Approach ◽  
Diagnosis And Treatment ◽  
External Carotid ◽  
Vascular Tumors ◽  
X Ray ◽  
Carotid Paragangliomas

Objective: to enhance the efficiency of diagnosis and treatment of  carotid paragangliomas, by introducing of a multidisciplinary approach into clinical practice.Material and methods. A total of 15 cases of paragangliomas have been followed up for 10 years. The age of the patients was 18 to 58  years (mean age 38±12 years). Primary multiple sites of chemodectomas were noted in 2 cases. Bilateral involvement was observed in one case. In the other, two unilateral vascular  tumors successively developed with an interval of almost 6 years. A  set of studies was conducted, which embraced ultrasound duplex  scanning (USDS) of the neck vessels, computed tomography (CT), and selective carotid angiography (SCAG) in various  combinations. The investigators made a successive examination of  the symmetrical areas of the face and neck and polypositional  scanning of the zone of interest and studied quantitative parameters, including linear blood flow velocity (LBFV) and  volumetric blood flow velocity. Native and contrast-enhanced X-ray  CT and magnetic resonance imaging (MRI) were carried out. SCAG  was performed as digital subtraction angiography.Results.USDS can confirm the hypervascular nature of the tumor  and its close relationship with the carotid artery branches and  measure blood flow velocity (LBFVmean, 0.46 m/sec). X-ray CT and  MRI examinations in combination with vessel contrasting make it  possible to accurately determine the localization and topography of  the tumor, its association with the carotid artery system and to type  afferent vessels. SCAG is a highly informative technique that can  identify the afferent vessels of the tumor and its relationship with  the great vessels and, if technically possible, perform selective  microembolization of the afferent tumor vessels, which will further facilitate surgical treatment, reducing the risk of intraoperative bleeding. Conclusion.The multidisciplinary approach to diagnosing carotid  paragangliomas in the maxillofacial area and neck makes it possible  to determine the type, size, and velocity characteristics, to verify the  diagnosis, and to work out optimal treatment policy. Among the  non-invasive techniques, CT angiography and MR angiography are  most valuable for final diagnosis. Selective angiography of the  branches of the external carotid arteries remains the gold standard  and is the final and most important stage of the study, which make it possible to detail angioarchitectonics, to determine afferent vessels,  and to plan further treatment, including endovascular embolization.  The diagnosis of carotid paragangliomas requires a multidisciplinary  approach with the equal attraction of endovascular diagnosis and  treatment specialists, maxillofacial surgeons, angiologists,  ultrasound and radiology diagnosticians, and pathologists both at the  stages of diagnosis and subsequent treatment. This problem can be effectively solved in a multidisciplinary hospital that has skilled  staff with sufficient clinical experience in diagnosing vascular masses and is equipped with modern equipment, which allows  optimization of further treatment.

scholarly journals The value of preoperative embolization in large and giant solid cerebellar hemangioblastomas

2016 ◽  
Vol 22 (4) ◽  
pp. 482-488 ◽  
Author(s):  
Ahmed Sultan ◽  
Tamer Hassan ◽  
Hisham Aboul-Enein ◽  
Osama Mansour ◽  
Tamer Ibrahim
Keyword(s):  
Tumor Resection ◽  
Vascular Lesions ◽  
Vascular Tumors ◽  
Preoperative Embolization ◽  
Total Occlusion ◽  
Von Hippel Lindau ◽  
Presenting Symptoms ◽  
Primary Surgery ◽  
Maximal Diameter ◽  
Basic Features

Background Solid cerebellar hemangioblastomas are highly vascular lesions and may cause catastrophic hemorrhage during excision. Methods This retrospective study enrolled 10 patients (7 men and 3 women, with a mean age of 38.2 ± 12.5 years) with solid cerebellar hemangioblastomas. All patients had a solitary tumor and underwent surgical resection of the lesion through a suboccipital approach. The basic features, serial radiographic examinations, and operative records were analyzed. Results The most common presenting symptoms were headache (100%), ataxia (100%), and long tract manifestations (60%). Three patients had experienced failed surgery previously due to massive intraoperative bleeding. Three patients were confirmed as having Von Hippel–Lindau disease. The average size of the tumor was 40.7 ± 8.7 mm in its maximal diameter (range 25–58 mm). Total endovascular occlusion obtained in six patients, near total occlusion in three patients, and incomplete occlusion in one patient. Nine (90.0%) patients underwent gross total resection and one (10.0%) underwent partial resection. After the primary surgery, eight (80.0%) patients experienced improvement in their symptoms, two (20.0%) maintained their pre-treatment status, and none showed neurological deterioration following tumor resection. Blood loss during surgery after embolization was minimal and controllable. Conclusion Preoperative embolization improves safety and efficacy of the microsurgical excision of such tightly located very vascular tumors. Embolization changes the concept of this lesion surgery into piecemeal removal rather than a total mass extraction technique. Liquid agents are superior to particles in obliteration of such lesions.

scholarly journals A rare case of pediatric intranasal lobular capillary hemangioma

2020 ◽  
Vol 6 (11) ◽  
pp. 2115
Author(s):  
Sam D. Schild ◽  
Rachel Irizarry ◽  
Ann Plum
Keyword(s):  
Nasal Cavity ◽  
Surgical Excision ◽  
Vascular Lesion ◽  
Capillary Hemangioma ◽  
Vascular Tumors ◽  
Preoperative Embolization ◽  
Mri Imaging ◽  
En Bloc ◽  
Lobular Capillary Hemangioma ◽  
The Right

<p class="abstract">Pediatric nasal cavity vascular tumors express a wide variety of pathologies. Lobular capillary hemangioma (LCH) is an acquired benign vascular growth of skin and mucosa whose etiology remains unknown, though trauma and hormonal influences are implicated. Although well documented in the head and neck literature for children age five or less, it is a rarity within the nasal cavity and has yet to be documented in the mid-septum. We describe a unique case of intranasal LCH and review the current literature. A nine-year-old male presented with one week of profuse intermittent unilateral epistaxis and no history of nasal trauma. Rhinoscopy revealed a pink, pedunculated mass of the right mid-nasal septum at the bony-cartilaginous junction. CT and MRI imaging were consistent with an expansile vascular lesion receiving prominent bilateral sphenopalatine artery supply. Following embolization, en bloc endoscopic surgical excision of the lesion using cold dissection was performed with no bony or cartilaginous involvement noted. The epistaxis resolved following resection. Final histology confirmed the mass as a lobular capillary hemangioma. Paediatric intranasal LCH is a rare entity, yet warrants consideration in our differential diagnosis of pediatric vascular tumors. Our study indicates these lesions can develop in the mid-septum despite the absence of a vascular plexus. Preoperative embolization should be considered for pediatric nasal cavity tumors due to concern for hemorrhage. Endoscopic wide local excision is an appropriate and effective treatment.  </p>

Multidisciplinary Approach of a Very Rare Infected Verrucous Carcinoma of the Scrotum

2019 ◽  
Vol 70 (4) ◽  
pp. 1476-1478
Author(s):  
Laura Raducu ◽  
Adelaida Avino ◽  
Cristina-Nicoleta Cozma ◽  
Sorin Nedelea ◽  
Andra-Elena Balcangiu-Stroescu ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Rare Disease ◽  
Chronic Inflammation ◽  
Male Patient ◽  
Multidisciplinary Approach ◽  
Verrucous Carcinoma ◽  
Surgical Excision ◽  
Diagnosis And Treatment ◽  
Wide Surgical Excision ◽  
The Right

Verrucous carcinoma of the scrotum is an extremely rare disease and most cases are thought to result from poor hygiene and chronic inflammation. Currently, it has not been well characterized, the etiology, diagnosis and treatment remaining poorly understood. We present the case of a 50-year-old male patient diagnosed with verrucous carcinoma of the right hemiscrotum. Wide surgical excision was performed. Favorable outcomes can be achieved by surgery, even without any adjuvant therapy, but patients should be carefully followed up.

scholarly journals Multimodal management of pediatric carotid body tumors: a systematic review and case illustrations

2019 ◽  
Vol 23 (3) ◽  
pp. 325-332
Author(s):  
Manish Kuchakulla ◽  
Ashish H. Shah ◽  
Valerie Armstrong ◽  
Sarah Jernigan ◽  
Sanjiv Bhatia ◽  
...  
Keyword(s):  
Systematic Review ◽  
Carotid Artery ◽  
Cranial Nerve ◽  
External Carotid Artery ◽  
External Carotid ◽  
Preoperative Embolization ◽  
Surgical Morbidity ◽  
Balloon Test Occlusion ◽  
Cranial Nerve Palsies ◽  
Carotid Body Tumors

OBJECTIVECarotid body tumors (CBTs), extraadrenal paragangliomas, are extremely rare neoplasms in children that often require multimodal surgical treatment, including preoperative anesthesia workup, embolization, and resection. With only a few cases reported in the pediatric literature, treatment paradigms and surgical morbidity are loosely defined, especially when carotid artery infiltration is noted. Here, the authors report two cases of pediatric CBT and provide the results of a systematic review of the literature.METHODSThe study was divided into two sections. First, the authors conducted a retrospective review of our series of pediatric CBT patients and screened for patients with evidence of a CBT over the last 10 years (2007–2017) at a single tertiary referral pediatric hospital. Second, they conducted a systematic review, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, of all reported cases of pediatric CBTs to determine the characteristics (tumor size, vascularity, symptomatology), treatment paradigms, and complications.RESULTSIn the systematic review (n = 21 patients [includes 19 cases found in the literature and 2 from the authors’ series]), the mean age at diagnosis was 11.8 years. The most common presenting symptoms were palpable neck mass (62%), cranial nerve palsies (33%), cough or dysphagia (14%), and neck pain (19%). Metastasis occurred only in 5% of patients, and 19% of cases were recurrent lesions. Only 10% of patients presented with elevated catecholamines and associated sympathetic involvement. Preoperative embolization was utilized in 24% of patients (external carotid artery in 4 and external carotid artery and vertebral artery in 1). Cranial nerve palsies (cranial nerve VII [n = 1], IX [n = 1], X [n = 4], XI [n = 1], and XII [n = 3]) were the most common cause of surgical morbidity (33% of cases). The patients in the authors’ illustrative cases underwent preoperative embolization and balloon test occlusion followed by resection, and both patients suffered from transient Horner’s syndrome after embolization.CONCLUSIONSSurgical management of CBTs requires an extensive preoperative workup, anesthesia, and multimodal surgical management. Due to a potentially high rate of surgical morbidity and vascularity, balloon test occlusion with embolization may be necessary in select patients prior to resection. Careful thorough preoperative counseling is vital to preparing families for the intensive management of these children.

scholarly journals Colocalization of Erythrocytes and Vascular Calcification in Human Atherosclerosis: A Systematic Histomorphometric Analysis

TH Open ◽  
2021 ◽  
Vol 05 (02) ◽  
pp. e113-e124
Author(s):  
Elsa Wilma Böhm ◽  
Maria Pavlaki ◽  
Georgios Chalikias ◽  
Dimitrios Mikroulis ◽  
George S. Georgiadis ◽  
...  
Keyword(s):  
Calcium Phosphate ◽  
Aortic Valve ◽  
Carotid Artery ◽  
Vascular Tissue ◽  
Osteoblastic Differentiation ◽  
Aortic Aneurysms ◽  
Vascular Lesions ◽  
Erythrocyte Membranes ◽  
Intraplaque Hemorrhage ◽  
Alizarin Red

Abstract Background Intimal calcification typically develops in advanced atherosclerosis, and microcalcification may promote plaque progression and instability. Conversely, intraplaque hemorrhage and erythrocyte extravasation may stimulate osteoblastic differentiation and intralesional calcium phosphate deposition. The presence of erythrocytes and their main cellular components (membranes, hemoglobin, and iron) and colocalization with calcification has never been systematically studied. Methods and Results We examined three types of diseased vascular tissue specimens, namely, degenerative aortic valve stenosis (n = 46), atherosclerotic carotid artery plaques (n = 9), and abdominal aortic aneurysms (n = 14). Biomaterial was obtained from symptomatic patients undergoing elective aortic valve replacement, carotid artery endatherectomy, or aortic aneurysm repair, respectively. Serial sections were stained using Masson–Goldner trichrome, Alizarin red S, and Perl's iron stain to visualize erythrocytes, extracelluar matrix and osteoid, calcium phosphate deposition, or the presence of iron and hemosiderin, respectively. Immunohistochemistry was employed to detect erythrocyte membranes (CD235a), hemoglobin or the hemoglobin scavenger receptor (CD163), endothelial cells (CD31), myofibroblasts (SMA), mesenchymal cells (osteopontin), or osteoblasts (periostin). Our analyses revealed a varying degree of intraplaque hemorrhage and that the majority of extravasated erythrocytes were lysed. Osteoid and calcifications also were frequently present, and erythrocyte membranes were significantly more prevalent in areas with calcification. Areas with extravasated erythrocytes frequently contained CD163-positive cells, although calcification also occurred in areas without CD163 immunosignals. Conclusion Our findings underline the presence of extravasated erythrocytes and their membranes in different types of vascular lesions, and their association with areas of calcification suggests an active role of erythrocytes in vascular disease processes.

Contemporary Surgical Management of Juvenile Nasopharyngeal Angiofibroma

2021 ◽  
Author(s):  
Salomon Cohen-Cohen ◽  
Kristen M. Scheitler ◽  
Garret Choby ◽  
Jeffrey Janus ◽  
Eric J. Moore ◽  
...  
Keyword(s):  
Surgical Management ◽  
Intracranial Extension ◽  
Preoperative Embolization ◽  
Tumor Diameter ◽  
Historical Cohort ◽  
Nasopharyngeal Angiofibroma ◽  
Estimated Blood Loss ◽  
The Impact ◽  
Previous Series

Abstract Objectives Juvenile nasopharyngeal angiofibromas (JNAs) are uncommon tumors with an evolving treatment paradigm. The objective of this study was to compare our prior experience reported in 2005 with our most contemporary series to compare practice improvements and the impact of expanded endonasal procedures. Design Retrospective review comparing a contemporary 22 patients with JNA who underwent surgical management between 2005 and 2019, compared with a historical cohort of 65 patients from the same center. Results The most common presenting symptom was epistaxis (68%). The median maximum tumor diameter was 4.4 cm. All patients underwent preoperative embolization. An endoscopic endonasal approach (EEA) was used in 18 patients (82%), compared with 9% in the series prior to 2005. Gross total resection was achieved in all patients. The median estimated blood loss was 175 and 350 mL for EEA and open (transfacial) cases, respectively. Only two patients (9%) required a blood transfusion compared with 52% on the previous series. The median follow-up was 19 months. The overall recurrence rate was 9% in this series and 24% in the previous series. No patient required radiation therapy in follow-up compared with 3% in our historical cohort. Conclusion There have been significant changes regarding the management of patients with JNA compared with the previous Mayo Clinic experience. The EEA has become the preferred route over the transfacial approaches to treat JNA in selected patients who do not have intracranial extension. Preoperative embolization has aided in reducing the postoperative transfusion rates.

scholarly journals Osteochondroma of the pubic symphysis causing hematuria: a case report and literature review

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Li-cheng Song ◽  
Qian Xu ◽  
Hui Li ◽  
Zhi-jun Li ◽  
Ya Li ◽  
...  
Keyword(s):  
Bladder Tumor ◽  
Multidisciplinary Approach ◽  
Bladder Tumour ◽  
Surgical Excision ◽  
Pubic Symphysis ◽  
Careful Analysis ◽  
Bone Neoplasm ◽  
Imaging Data ◽  
Case Presentation

Abstract Background Osteochondroma is the most common benign bone neoplasm and is sometimes referred to as osteocartilaginous exostosis. The symptoms caused by osteochondroma are rare, especially the urogenital complications. Therefore, this tumour is sometimes misdiagnosed. Case presentation This report described a 70-year-old woman with hematuria who was initially misdiagnosed with a bladder tumour in the outpatient department by a urologist. However, during cystoscopy, we found that the mass did not resemble a bladder tumor. Multidisciplinary approach with careful analysis of the imaging data suggested the diagnosis of osteochondroma. Open surgical excision of the mass was done and histology confirmed the diagnosis of benign osteochondroma. After 6 months of follow-up, the patient was still asymptomatic. Conclusions This case illustrates that hematuria is caused by not only urogenital disease but also osteochondroma. We present this case to draw the attention of clinicians to osteochondroma of the pubic symphysis.

scholarly journals Multidisciplinary Approach for the Management of Complex Hepatic Injuries AAST-OIS Grades IV—V: A Prospective Study

2007 ◽  
Vol 96 (3) ◽  
pp. 214-220 ◽  
Author(s):  
J. A. Asensio ◽  
P. Petrone ◽  
L. Garcí-Núñez ◽  
B. Kimbrell ◽  
E. Kuncir
Keyword(s):  
Emergency Department ◽  
Logistic Regression ◽  
Blood Loss ◽  
Blood Cells ◽  
Multidisciplinary Approach ◽  
Stepwise Logistic Regression ◽  
Packed Red Blood Cells ◽  
Emergency Department Thoracotomy ◽  
Estimated Blood Loss ◽  
Hepatic Injuries

Background: Complex hepatic injuries grades IV—V are highly lethal. The objective of this study is to assess the multidisciplinary approach for their management and to evaluate if survival could be improved with this approach. Study Design: Prospective 54-month study of all patients sustaining hepatic injuries grades IV—V managed operatively at a Level I Trauma Center. Main outcome measure: survival. Statistical analysis: univariate and stepwise logistic regression. Results: Seventy-five patients sustained penetrating (47/63%) and blunt (28/37%) injuries. Seven (9%) patients underwent emergency department thoracotomy with a mortality of 100%. Out of the 75 patients, 52 (69%) sustained grade IV, and 23 (31%) grade V. The estimated blood loss was 3,539±-3,040 ml. The overall survival was 69%, adjusted survival excluding patients requiring emergency department thoracotomy was 76%. Survival stratified to injury grade: grade IV 42/52–81%, grade V 10/23–43%. Mortality grade IV versus V injuries (p <0.002; RR 2.94; 95% CI 1.52–5.70). Risk factors for mortality: packed red blood cells transfused in operating room (p=0.024), estimated blood loss (p<0.001), dysryhthmia (p<0.0001), acidosis (p=0.051), hypothermia (p=0.04). The benefit of angiography and angioembolization indicated: 12% mortality (2/17) among those that received it versus a 36% mortality (21/58) among those that did not (p=0.074; RR 0.32; 95% CI 0.08–1.25). Stepwise logistic regression identified as significant independent predictors of outcome: estimated blood loss (p=0.0017; RR 1.24; 95% CI 1.08–1.41) and number of packed red blood cells transfused in the operating room (p=0.0358; RR 1.16; 95% CI 1.01–1.34). Conclusions: The multidisciplinary approach to the management of these severe grades of injuries appears to improve survival in these highly lethal injuries. A prospective multi-institutional study is needed to validate this approach.

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