Kaposiform Hemangioendothelioma Without Cutaneous Involvement

J Cancer Res Clin Oncol. 2018 Dec;144(12):2475-2484. doi: 10.1007/s00432-018-2759-5. Epub 2018 Oct 6.

Abstract

Purpose: We sought to characterize the clinical features and management of patients diagnosed as Kaposiform hemangioendothelioma (KHE) without cutaneous involvement.

Methods: The electronic patient chats at six Triple A hospitals in China were searched to find all patient diagnoses with KHE without cutaneous involvement.

Results: Of 30 patients (mean age at diagnosis, 55.6 months), 17 (56.7%) were male. Fourteen (46.7%) patients were associated with Kasabach-Merritt phenomenon (KMP). Patients with KMP were significantly more likely to have lesions involving truck compared to patients without KMP (odds ratio 10.000; 95% confidence interval 1.641-60.921; P = 0.011). Other common complication included severe anemia and decreased range of motion. In the majority of cases (93.3%), the lesions were highly infiltrative and locally invasive with ill-defined margins. Histological examination was required in all patients without KMP for precise diagnosis. In all, 16 (53.3%) patients received corticosteroid treatment, 19 (63.3%) received oral sirolimus treatment, 7 (23.3%) received intravenous vincristine, and 5 (16.7%) patients used propranolol. Patients had varied responses to conventional drugs, whereas all patients receiving sirolimus treatment had better response. In all, three patients (10%) died of disease, all presented with KMP. Feature of these recalcitrant cases (death) included young age, visceral location, extensive involvement, and lack of improvement with high-dose corticosteroids.

Conclusions: Our study clearly demonstrated that KHE without cutaneous involvement could be associated with important complication, which might result in death or severe morbidity. Increased awareness of KHE without cutaneous involvement is required for early diagnosis and aggressive therapy in an attempt to prevent complication.

Keywords: Cutaneous involvement; Kaposiform hemangioendothelioma; Kasabach–Merritt phenomenon; Morbidity; Mortality.

MeSH terms

  • Child
  • Child, Preschool
  • China
  • Disease Management
  • Female
  • Hemangioendothelioma / diagnosis*
  • Hemangioendothelioma / mortality
  • Hemangioendothelioma / therapy
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Infant
  • Kasabach-Merritt Syndrome / diagnosis*
  • Kasabach-Merritt Syndrome / mortality
  • Kasabach-Merritt Syndrome / therapy
  • Magnetic Resonance Imaging / methods
  • Male
  • Morbidity
  • Mortality
  • Retrospective Studies
  • Sarcoma, Kaposi / diagnosis*
  • Sarcoma, Kaposi / mortality
  • Sarcoma, Kaposi / therapy
  • Skin / pathology*
  • Symptom Assessment
  • Tomography, X-Ray Computed

Substances

  • Immunosuppressive Agents

Supplementary concepts

  • Kaposiform Hemangioendothelioma