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Fulltext Novel usage of dexmedetomidine in a paediatric patient with giant tongue haemangioma

Mohd Zulfakar Mazlan, Shamsul Kamalrujan Hassan, Laila Abd Mukmin, Mohd Hasyizan Hassan, Huda Zainal Abiddin, Irfan Mohamad, et al.

Malaysian Journal of Medicine and Health Sciences, 2016;12(2):46-48.
MyJurnal

Giant haemangioma of the tongue is a disease which can
obstruct the oropharyngeal airway and is presented with
obstructive symptoms. Due to its vascularity, inserting
laryngoscope for intubation can cause high risks, such as
inducing bleeding. Hypoxia and excessive bleeding must be
anticipated while securing the airway. We present a case of
novel usage of dexmedetomidine as a conscious sedation agent
for awake fibre optic intubation in a 9-year-old child with
obstructive symptoms secondary to a huge tongue
haemangioma, who was presented for interventional
sclerotherapy of the lesion.

Matched MeSH terms: Hemangioma
Fulltext Intramuscular haemangioma of the masseter muscle: a case report

Ahmad Sahril Hussin, Nik Azrizie Muhamed, Haryati Husin, Irfan Mohamad

Archives of Orofacial Sciences, 2018;13(1):41-44.
MyJurnal

Intramuscular haemangioma is relatively rare and accounts for less than 1% of all haemangioma.
Most of these tumours occur in the trunk, arms and legs. Only 14% of all intramuscular haemangioma arise
from the head and neck region, with masseter muscle representing the most common site of involvement,
followed by the trapezius and sternocleidomastoid muscles. We present a case of a 60-year-old man with a
soft lump in the left cheek. Imaging of the neck showed irregular, dilated enhancing vessels seen in the left
masseter muscle suggestive of intramuscular haemangioma. Excisional biopsy was performed, and
histopathological findings confirmed the diagnosis.

Matched MeSH terms: Hemangioma
Development of the international orbital Cavernous Hemangioma Exclusively Endonasal Resection (CHEER) staging system

El Rassi E, Adappa ND, Battaglia P, Castelnuovo P, Dallan I, Freitag SK, et al.

Int Forum Allergy Rhinol, 2019 07;9(7):804-812.
PMID: 30809970 DOI: 10.1002/alr.22316

BACKGROUND: Orbital cavernous hemangiomas (OCH) are the most common adult orbital tumor and represent an ideal index lesion for endonasal orbital tumor surgery. In order to standardize outcomes reporting, an anatomic-based staging system was developed.
METHODS: An international, multidisciplinary panel of 23 experts in orbital tumor surgery was formed. A modified Delphi method was used to develop the cavernous hemangioma exclusively endonasal resection (CHEER) staging system with a total of 2 rounds being completed.
RESULTS: Tumors medial to a plane along the long axis of the optic nerve may be considered amenable for an exclusively endonasal resection. In select cases, tumors may extend inferolaterally if the tumor remains below a plane from the contralateral naris through the long axis of the optic nerve (ie, plane of resectability [POR]). This definition reached consensus with 91.3% of panelists in agreement. Five stages were designed based on increasing technical resection difficulty and potential for morbidity. Stages were based on the relationship of the tumor to the extraocular muscles, the inferomedial muscular trunk of the ophthalmic artery (IMT), and orbital foramina. Staging by anatomic location also reached consensus with 87.0% of panelists in agreement. Size was not included in the staging system due to the lack of agreement on the contribution of size to resection difficulty.
CONCLUSION: Endoscopic orbital tumor surgery is a nascent field with a growing, yet heterogeneous, body of literature. The CHEER staging system is designed to facilitate international, high-quality, standardized studies establishing the safety, efficacy, and outcomes of endonasal resection of OCH.

Matched MeSH terms: Hemangioma, Cavernous
Fulltext Intra-articular haemangioma of the knee in the skeletally immature

Wong KA, Singh VA, Pailoor J

Singapore Med J, 2013 Nov;54(11):e228-9.
PMID: 24276110

Intra-articular haemangioma is a rare and uncommon condition that sometimes presents in infants. The lesion can be a diagnostic challenge, with misdiagnosis often leading to delayed diagnosis and treatment. It is essential to establish and treat the condition early, as intra-articular haemangioma can lead to destruction of the joint and secondary arthrosis. Herein, we report the case of a five-year-old boy who presented with intra-articular haemangioma and discuss the management of his condition.

Matched MeSH terms: Hemangioma/diagnosis; Hemangioma/pathology*; Hemangioma/surgery
Hepatic resections 1964-1979: vignettes drawn from the Malaysian experience

Balasegaram M, Joishy SK

Jpn J Surg, 1980 Jun;10(2):94-9.
PMID: 6253701

We present a study of 288 hepatic resections carried out in Malaysia for the past fifteen years. First, we describe our indications for hepatic resectins which are not limited to hepatic trauma and hepatomas, but also include hepatic abscesses, cysts, intrahepatic calculi and hemangiomas. Second, we give a simplified classification of hepatic resections using accurate terminology. Third, we describe the safety of hepatic resections in our hands which we believe is due to specially designed surgical instruments and the accurate decision making process at surgery. We have had minimum postoperative mortality and no intraoperative deaths so far. Finally, while analysing each indication we have drawn vignettes from our experience for the past fifteen years.

Matched MeSH terms: Hemangioma/surgery
Combined low-dose oral propranolol and oral prednisolone as first-line treatment in periocular infantile hemangiomas

Koay AC, Choo MM, Nathan AM, Omar A, Lim CT

J Ocul Pharmacol Ther, 2011 Jun;27(3):309-11.
PMID: 21542771 DOI: 10.1089/jop.2011.0013

The purpose of this report was to describe 2 cases of periocular infantile hemangiomas (IHs) that were successfully treated with low-dose oral propranolol alone and in combination with oral prednisolone.

Matched MeSH terms: Hemangioma, Capillary/congenital*; Hemangioma, Capillary/drug therapy
Fulltext Diffuse neonatal haemangiomatosis: a rare cause of haemorrhagic shock and refractory coagulopathy in the newborn

Rohana J, Boo NY, Hayati AR, Baizura J

Med J Malaysia, 2002 Sep;57(3):364-7.
PMID: 12440278

A term newborn infant developed hypovolaemic shock shortly after birth. She was pale with gross hepatomegaly. She required multiple boluses of intravenous fluids, blood products as well as inotropic support. Blood investigations showed persistent thrombocytopenia, anaemia and disseminated intravascular coagulopathy (DIC). She also developed heart failure. She finally succumbed on the eleventh day of life. Autopsy revealed haemangiomatosis involving the liver, lungs, gastrointestinal tract, kidneys and adrenals.

Matched MeSH terms: Hemangioma/complications*; Hemangioma/congenital*
Growing dural sinus malformation with associated developmental venous anomaly, multiple cavernomas and facial venous malformation in an infant. An associated disease or a disease spectrum?

Mohamed Z, Batista LL, Sachet M, Mahadevan J, Alvarez H, Lasjaunias P

Interv Neuroradiol, 2002 Dec 22;8(4):421-30.
PMID: 20594504

This is an unusual case report of an infant, who initially presented with a facial haemangioma and was later diagnosed to have a dural sinus malformation (DSM) involving the torcula. The DSM increased in size lateralising to the right transverse sinus at three months of age. Postnatal enlargement of the dural sinus has not been described before suggesting a delay in the maturation of the dural sinus which normally would occur antenatally. There was a further association with a complex developmental venous anomaly (DVA) draining the right cerebral hemisphere into the deep cerebral vein and multiple cavernous malformations. The DVA was not clearly demonstrated at age one month but was more obvious at age three months. This would be the first reported case of DSM associated with a DVA. Increasing venous hypertension probably contributed to the poor opacification of the DVA on follow-up angiography at age six months and to the haemorrhagic changes within the cavernomas on magnetic resonance imaging (MRI). The therapeutic goal was to correct venous hypertension by partially embolising the dural shunts to remodel the cerebral vasculature and preserve the patent sinus. The treatment strategy and possible link between the complex disease entities presented in this infant are discussed. Despite these attemps, the lesion continued to grow compressing the posterior fossa structures. The infant died at nine months of age.

Matched MeSH terms: Hemangioma, Cavernous
Fulltext Adult Intramuscular Shoulder Angiomyolipoma: a rare case

Kadhim Jawad Obaid, Yahya Mohammad Arpine, Nor Salmah Bakar, Marlina Tanty Ramli Hamid, Ahmed Ramzi Yusof

Journal of Clinical and Health Sciences, 2016;1:37-39.

Intramuscular shoulder angiomyolipomas are very rare. We report a case in a 22-year-old male with a well circumscribed lesion located on the back of the shoulder. This lesion, differs from renal angiomyolipoma in terms of non-association with tuberous sclerosis, circumscription and male predominance. Another characteristic feature is the absence of epithelioid cells. Differential diagnosis includes lipoma, angiolipoma, angioleiomyoma, hemangioma, myolipoma and liposarcoma. It is distinguished from the above mentioned entities by the presence of a combination of thick-walled blood vessels, smooth muscle and fat.

Matched MeSH terms: Hemangioma
Fulltext Cavernous sinus hemangioma presenting with binocular diplopia

Lathalakshmi, T., Tai, Evelyn L.M., Qi, Zhe Ngoo, See, Khim Sim, Wan-Hazabbah Wan Hitam, Liza-Sharmini A.T.

Journal of Biomedical and Clinical Sciences, 2017;2(2):32-34.
MyJurnal

A hemangioma is a benign vascular tumor of the brain, which rarely occurs in the cavernous sinus. We report a rare case of cavernous sinus hemangioma presenting with binocular diplopia. A 23-year-old lady presented with binocular diplopia associated with restricted left lateral gaze for 3 months. Visual acuity of both eyes was 6/6 with normal pupillary reaction. Both anterior and posterior segment were unremarkable. Contrasted computed tomography of brain showed an irregular mass within the left cavernous sinus causing pressure effect on the adjacent bone. Cerebral magnetic resonance imaging (MRI) showed a convexity in the left cavernous sinus, with a well-defined heterogeneous lesion with mixed hypo and hyperintensity in T1WI and T2WI; post gadolinium contrast, it was minimally enhanced. The patient was managed conservatively and at one-year post presentation, her symptoms improved but the lesion morphology and size remained static. We highlight the classic radiological presentation of a hemangioma and discuss the features differentiating it from the more commonly observed meningioma seen in the cavernous sinus.

Matched MeSH terms: Hemangioma, Cavernous
Fulltext Adult Intramuscular Shoulder Angiomyolipoma: a rare case

Kadhim Jawad Obaid, Yahya Mohammad Arpine, Nor Salmah Bakar, Marlina Tanty Ramli Hamid, Ahmed Ramzi Yusof

Journal of Clinical and Health Sciences, 2016;1(2):37-39.
MyJurnal

Intramuscular shoulder angiomyolipomas are very rare. We report a case in a 22-year-old male with a well circumscribed lesion located on the back of the shoulder. This lesion, differs from renal angiomyolipoma in terms of non-association with tuberous sclerosis, circumscription and male predominance. Another characteristic feature is the absence of epithelioid cells. Differential diagnosis includes lipoma, angiolipoma, angioleiomyoma, hemangioma, myolipoma and liposarcoma. It is distinguished from the above mentioned entities by the presence of a combination of thick-walled blood vessels, smooth muscle and fat.

Matched MeSH terms: Hemangioma
Fulltext Neuropsychological assessment in epilepsy surgery - preliminary experience in a rural tertiary care hospital in north East malaysia

Sayuthi S, Tharakan J, Pieter MS, Salmah WM, Madhavan M, Tahir A, et al.

Malays J Med Sci, 2009 Jan;16(1):39-43.
PMID: 22589647 MyJurnal

We present our preliminary experience in neuropsychological testing in epilepsy surgery patients to demonstrate how these tests contributed to decide the laterality of epileptic focus, and to assess the effect of surgery on patient's cognitive function and quality of life. Preoperative neuropsychological tests consisting of Wechsler Adult Intelligence Scale-III (WAIS) for IQ, Wechsler Memory Scale-III (WMS) for memory and patients' quality of life (QOLIE 31) were administered to refractory epilepsy patients under evaluation for surgical treatment. These tests were repeated one year after surgery and we studied any changes in trends. A total of seven patients were recruited in this study between July 2004 and July 2006. The aetiologies of refractory epilepsy were pure mesial temporal sclerosis (MTS) in five patients, dysembryogenic neuroepithelial tumour (DNET) in one and dual lesion of cavernous angioma with ipsilateral MTS in one. The preoperative neuropsychological tests were all in concordance to MRI finding, and showed good contralateral function; five lateralises to the right and two to the left. The post-operative Engel seizure count (median 8.00, IQR 7.00-8.75), general IQ (88 vs. 79), performance IQ (94 vs. 79), verbal memory (89 vs. 71), non-verbal memory (88 vs. 75) and QOLIE (53.14 vs. 44.71) were better compared to preoperative values. The verbal IQ (84 vs. 84) was unchanged. Neuropsychological tests are useful as ancillary investigations to determine the laterality of seizure focus and integrity of function in the contralateral temporal lobe. Following successful surgical treatment, there is a trend towards improvement in memory, IQ and quality of life scores in this small group of patients.

Matched MeSH terms: Hemangioma, Cavernous
Fulltext Early presentation of right adrenal mass, hepatoblastoma and hepatic cavernous haemangioma in Beckwith-Wiedemann Syndrome

Teh SH, Ong GB

Med J Malaysia, 2007 Oct;62(4):345-6.
PMID: 18551945 MyJurnal

Beckwith-Wiedemann Syndrome (BWS) is associated with early development of embryonal tumours usually in the first four years of life. We describe a patient who presented with a right adrenal cyst in the first month of life and hepatoblastoma in the third month of life. A cavernous haemangioma was subsequently found in the resected tumour.

Matched MeSH terms: Hemangioma, Cavernous/diagnosis
Ultrasonographic Measurements of the Liver, Gallbladder Wall Thickness, Inferior Vena Cava, Portal Vein and Pancreas in an Urban Region, Malaysia

Khammas ASA, Mahmud R

J Med Ultrasound, 2020 10 01;29(1):26-31.
PMID: 34084713 DOI: 10.4103/JMU.JMU_53_20

Background: Ultrasonographic (USG) measurements of the liver length, gallbladder wall thickness (GBWT), diameters of the inferior vena cava (IVC), portal vein (PV), and pancreas are valuable and reliable in diagnosis hepatobiliary and pancreas conditions. This study is aimed to determine the normal values of liver length, GBWT, AP diameters of the IVC and PV, AP diameter of the head and body of the pancreas.
Methods: A prospective cross-sectional study was carried out in this study. A total of the 408 participants were randomly recruited using a systematic method. According to the USG reports, the subjects who had normal USG report for liver, biliary system, and pancreas were described as normals, whereas the subjects who had hepatobiliary diseases such as fatty liver, liver cysts, hemangioma, cirrhosis, gallbladder wall thickening, acute cholecystitis, gallstones, and polyps were recorded as abnormal subjects.
Results: Of the 408 participants with a mean of 52.6 ± 8.4 years old. Of those, 294 (72.1%) participants were normal and 114 (27.9%) subjects were reported as abnormal. More than half of the study population was males, 52.9% versus 47.1% of females. There was a significant difference of liver length, head, and body of the pancreas between genders (P = 0.004, 0.002, and P < 0.001, respectively). Moreover, the pancreatic body only was significantly correlated with age (P = 0.026). There also was a significant difference of the liver length, head, and body of the pancreas between normal and abnormal subjects (P < 0.001, P = 0.007, and P < 0.001).
Conclusion: Liver length, diameter of the head, and body of the pancreas were significantly associated with gender and hepatobiliary diseases. In addition, only the diameter of the body of the pancreas was significantly correlated with age.

Matched MeSH terms: Hemangioma
Fulltext Intra-articular Localized Haemangioma of the Knee Mimicking Localized Pigmented Villonodular Synovitis: A Case Report

Goki-Kamei GK, Norimasa-Matsubara NM, Teruyasu-Tanaka TT, Koji-Natsu KN, Toshihiro-Sugioka TS

Malays Orthop J, 2017 Mar;11(1):60-63.
PMID: 28435577 DOI: 10.5704/MOJ.1703.004

Intra-articular synovial haemangioma of the knee is a benign tumour. However, diagnostic delay leads to degenerative changes in the cartilage and osteoarthritis due to recurrent haemarthrosis. Therefore, treatment should be performed immediately. We report the case of a localized synovial haemangioma arising from the medial plica in a 38-year old female presenting with pain and restricted range of motion in the right knee joint. Initially, we diagnosed this case as a localized pigmented villonodular synovitis (LPVS) based on MRI and arthroscopic findings and performed only arthroscopic en bloc excision of the mass and synovectomy around the mass for diagnostic confirmation. Fortunately, there was no difference in the treatment approaches for LPVS and localized haemangioma and the synovial haemangioma had not recurred at the 3-month postoperative follow-up with MRI. The patient's clinical symptoms resolved and had not relapsed two years after surgery.
Study site: Department of Orthopaedics, Miyoshi Central Hospital, Miyoshi, Japan

Matched MeSH terms: Hemangioma
Fulltext Timing of Surgery and Surgical Strategies in Symptomatic Brainstem Cavernomas: Review of the Literature

Rajagopal N, Kawase T, Mohammad AA, Seng LB, Yamada Y, Kato Y

Asian J Neurosurg, 2019 4 3;14(1):15-27.
PMID: 30937003 DOI: 10.4103/ajns.AJNS_158_18

Brainstem cavernomas (BSCs) are angiographically occult, benign low flow vascular malformations that pose a significant surgical challenge due to their eloquent location. The present study includes an extensive review of the literature and three illustrative cases of BSC with emphasis on the timing of surgery: surgical approaches, usage of intraoperative monitoring, and complication avoidance. A systematic search was performed using the PubMed database was from January 1, 1999, to June 2018. The relevant articles were reviewed with particular attention to hemorrhage rates, timing of surgery, indications for surgery, surgical approaches, and outcome. Along with this, a retrospective analysis of three cases of symptomatic BSC, who were operated for the same, during the year 2018 in our institute was conducted. All the three patients presented with at least 1 episode of hemorrhage before surgery. Of these, one patient was operated immediately due to altered sensorium whereas the other two were operated after at least 4 weeks of the hemorrhagic episode. The patients who were operated in the subacute phase of bleed were seen to have liquefaction of hematoma, thus providing a good surgical demarcation and thereby reduced surgery-related trauma to the surrounding eloquent structures. Two patients improved neurologically during the immediate postoperative period, whereas one had transient worsening of neurological deficits during the immediate postoperative period in the form of additional cranial nerve palsies which completely improved on follow-up after 2 months. Radical resection is recommended in all patients with symptomatic BSCs. Surgery should be considered after the first or the second episode of hemorrhage as multiple rebleeds can cause exacerbation of deficits and sometimes mortality as well. Considering surgical timing, anywhere between 4 and 6 weeks or the subacute phase of the hemorrhage is considered appropriate. The aims of surgical intervention must be to improve preoperative function, minimize surgical morbidity and to reduce hemorrhagic rates. In spite of the significant surgical morbidity associated with BSCs, appropriate patient selection, meticulous surgical planning with adjuncts such as intraoperative monitoring and neuronavigation will go a long way in avoidance of major postoperative complications.

Matched MeSH terms: Hemangioma, Cavernous
The Nasal Hemangioma

Tan SN, Gendeh HS, Gendeh BS, Ramzisham AR

Indian J Otolaryngol Head Neck Surg, 2019 Nov;71(Suppl 3):1683-1686.
PMID: 31763224 DOI: 10.1007/s12070-015-0918-4

Hemangioma is a disease of head and neck commonly, but its presence in the nasal cavity or sinus is rare. It is a form of benign tumour of vascular origin consisting of predominantly blood vessels. It can be categorized into capillary, cavernous and mixed type in accordance to its histopathology features. Retrospectively, we reviewed five cases of nasal hemangioma presenting at University Kebangsaan Malaysia Medical Center (UKMMC) between September 2007 and May 2015. Information on the patients age, gender, ethnicity, clinical symptoms, imaging findings (if available), treatment modalities were collected retrospectively for analysis. Five patients were analysed. Females were more affected than male with ratio of 4:1. All patients presented with unilateral lobular capillary hemangioma of the nasal cavity with 60 % (3/5) of the lesions on the right side and 40 % (2/5) on the left side. The common symptoms at presentation were epitaxis and nasal obstruction (5/5, 100 %), followed by rhinorrhea (3/5, 60 %) and facial pain (1/5, 20 %). All the patients underwent a surgical excision of the hemangioma. The five patients had no recurrence on subsequent follow ups. Computed tomography of paranasal sinuses can be performed to exclude bony erosions. Endoscopic sinus haemangioma excision provide good visualisation and better outcomes. In conclusion, nasal hemangioma should always be differential diagnosis for nasal lesions and surgical excision is still the preferred first line treatment.

Matched MeSH terms: Hemangioma

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