RESUMO
Microcystic lymphatic malformations as described in the international literature form a subgroup of low-flow congenital vascular malformations (VM) resulting from irregular embryological development. Microcystic lesions normally manifest as an accumulation of lymph- and blood-filled vesicles that, when externalized, cause skin maceration with consequent pain and potential infection resulting in the impairment of the patient's quality of life. There is no consensus on a standardized algorithm nor clear guidelines for successful treatment of this type of lymphatic malformation, and treatment options employed often result in ambivalent and transient outcomes with a high rate of recurrence. The topical formulation of tacrolimus is a well-known FDAapproved anti-T cell agent that was recently identified as a potent activator of ALK1, which is involved in several processes and functions including angiogenesis. We investigated if topical administration of tacrolimus may be an effective therapy for directly targeting cutaneous microcystic lymphatic malformations as a complement to systemic treatment. The study enrolled four patients with cutaneous microcystic lymphatic malformations: three male (ages: 13,15,18) and one female (age: 30). Two of the patients presented lesions on their backs, one patient on the left hand and one on the left lower limb. All four patients received treatment with topical tacrolimus 0.1% twice a day for 10 weeks on a previously selected area for application. Weekly clinical follow-ups were conducted along with close physician-patient contact. All patients displayed a satisfactory response after treatment. Lymphorrhea and bleeding were stopped in all cases and the esthetic aspect of lesions improved in two patients. To date, all patients presented no clinically significant changes to the size or extension of the lesion. Topical tacrolimus treatment is a promising and reasonable option for microcystic lymphatic malformations. Our results encourage further exploration in larger populations with the consideration that it is a safe and effective alternative or complementary therapy to systemic treatment.
Assuntos
Cistos , Anormalidades Linfáticas , Adulto , Feminino , Hemorragia , Humanos , Anormalidades Linfáticas/diagnóstico , Anormalidades Linfáticas/tratamento farmacológico , Masculino , Qualidade de Vida , Tacrolimo/uso terapêutico , Resultado do TratamentoRESUMO
Lipoblastoma is a benign mesenchymal tumor of embryonic adipose tissue, uncommon in infancy. Multicentricity, absence of a capsule and histopathology best defines a lipoblastoma. Synonyms for this lesion are embryonic lipoma, fetal lipoma, lipoblastic tumor, and congenital lipomatoid tumor. Lipoblastoma is more common in males (approximately 80%), is usually located in the subcutaneous soft tissue (benign lipoblastoma) or in the deep interstitium (benign lipoblastomatosis), or sometimes in all corporeal segments. Primary treatment is complete excision. Relapse is between 14-25%, many of which are more "mature," and difficult to differentiate from lipoma. The differential diagnosis includes liposarcoma, which is rare under ten years. Radical excision in children is recommended with relapses, especially with lipoblastomatosis. Chromosomal markers help discriminate between liposarcoma and lipoblastoma.
Assuntos
Doenças do Pé/congênito , Perna (Membro)/patologia , Lipoma/congênito , Recidiva Local de Neoplasia/cirurgia , Neoplasias de Tecidos Moles/congênito , Feminino , Doenças do Pé/complicações , Doenças do Pé/cirurgia , Humanos , Hipertrofia , Recém-Nascido , Desigualdade de Membros Inferiores/etiologia , Lipoma/complicações , Lipoma/cirurgia , Imageamento por Ressonância Magnética , Reoperação , Neoplasias de Tecidos Moles/complicações , Neoplasias de Tecidos Moles/cirurgiaRESUMO
The aim of this report is to explain the historical differences between Klippel-Trenaunay (KT), Klippel-Trenaunay-Weber (KTW), and Klippel-Trenaunay-Servelle (KTS) syndromes. Furthermore, an attempt will be made to describe the different causes, symptoms, and consequences of the pathology, largely as a consequence of venous hypertension. The significance of these syndromes within the pediatric population is highlighted.
Assuntos
Síndrome de Klippel-Trenaunay-Weber/diagnóstico , Síndrome , Angiografia , Angiomatose/diagnóstico , Malformações Arteriovenosas/diagnóstico , Diagnóstico Diferencial , Extremidades , Feminino , Glaucoma/patologia , Hemangioma/diagnóstico , Hemangioma/patologia , Humanos , Lactente , Recém-Nascido , Perna (Membro) , Masculino , Doenças Vasculares/diagnósticoRESUMO
A classification of dysplasias of the lymphatic system is proposed on the basis of the anatomical structures involved: lymph vessel-angiodysplasia, lymphadeno(nodal)-dysplasia and the summary of both lymphangio-adeno(nodal)dysplasias. The suggested terminology is: LAD I (Lymphangiodysplasias), LAD II (Lymphadeno(nodal)dysplasia) and LAAD (lymphadeno(nodal)-dysplasia). With this classification we may coherently group the malformations we already know, relate them to the big syndromes and to all the other angiodysplasias and also create the reference background for another chapter of lymphology: primary or idiopathic lymphedema.