Vascular Tumors Slides
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Transcript of Vascular Tumors Slides
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Vascular Tumors of theHead and Neck
Russell D. Briggs, M.D.
Faculty Advisor: Anna M. Pou, M.D.
The University of Texas Medical Branch
Department of Otolaryngology
Grand Rounds Presentation
April 2001
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Introduction Many different types of neoplasms
Share common etiology with vascularsystem
Benign, malignant, others
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Benign TumorsVascular Birthmarks
Hemangiomas
Vascular Malformations
Nasopharyngeal angiofibromas
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Vascular Birthmarks History
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Vascular Birthmarks Classification system
Hemangioma vs. malformation
Based on clinical, cellular, biologic factors
Older termscapillary, juvenile,strawberry, cavernous
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Vascular Birthmarks Classification system
Superficial vs. Deep Hemangiomas
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Hemangiomas Most common tumor of infancy (10%)
Slight female predominance
60% arise in head and neckcosmeticconcerns
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Hemangiomas Clinical presentation for diagnosis
Not seen at birth
Precursor lesion
Proliferative phase
Involution phase
Superficial vs. deep
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Complications from Hemangiomas Occur in 20%
Ulceration
Compression of vital structures
High-output cardiac failure
Bleeding
Kasabach-Merritt syndrome
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Laryngeal Hemangiomas Usually in the
subglottis
Healthy infant withbiphasic stridor(croup)
Behave similarly
50% with cutaneouscounterpart
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Diagnosis of Hemangiomas History and physical examination
Certain casesradiology
Ultrasound, MRI
Large facial hemangiomasDandy-Walker
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Treatment of Hemangiomas Why and when to treat?
Normal skin in 50% that involute within 5 years
Other 50%-- 80% substantial deformity Pros and Cons
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Treatment of Hemangiomas Observation
Serial photography important to document
involution Regular visits with reassurance
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Treatment of Hemangiomas Systemic steroids
Careful selection criteria
Prednisone 2-4mg/kg for up to 6 weeks
Varied results (30%)
Side effects
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Treatment of Hemangiomas Intralesional steroids
Usually for vision
threatening lesions Combination of beta-
methasone andtriamcinolone
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Treatment of Hemangiomas Pulse-dye lasers
Useful for superficial variety
Good for ulcerations/residual cosmesis
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Treatment for Hemangiomas Surgery
Eyelid lesions, bulky
lesions, vermillionborder, nasal tip,eyebrow
CO2 laser forsubglottis
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Treatment of HemangiomasArterial embolization
Radiation therapy
Alpha-2b interferon
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Vascular malformations Capillary, venous, arterial, lymphatic, mixed
By definitionpresent at birth
No proliferative or involution phase
Commensurate growth
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Capillary malformations Older termport-wine stain
Usually in trigeminal distribution
Most isolated anomalies
Sturge-Weber syndrome
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Treatment of Capillary Malformations Cosmetic concealing makeup
Tattooing
Surgical excision (tissue expanders) Pulse dye-laser
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Venous Malformations Diagnosis is clinicalpalpation
Treatment dependent on location
(surgery and sclerotherapy)
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Lymphatic malformations Older termscystic hygroma,lymphangioma
Can expand with URI
Surgical treatment is mainstay
Picibanil (OK-432)
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Arteriovenous malformations Usually clinically apparent
Embolization and surgical resection
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Nasopharyngeal Angiofibroma Most common benign tumor of nasopharynx
Older termjuvenile nasopharyngeal
angiofibroma, JNA Presentation: recurrent epistaxis/nasal
congestion, hearing loss, orbital, CN
Arise where sphenoidal process of palatinebone meets horizontal ala of vomer
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Nasopharyngeal Angiofibroma Diagnosis is made
by clinical and
radiographic findings CT/MRI
Biopsy- rarelyindicated
Angiography
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Nasopharyngeal Angiofibroma Angiography Histology
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Nasopharyngeal Angiofibroma Treatment
Embolization and surgery
Autologous blood/Cell SaverApproaches
Transnasal endoscopic, lateral rhinotomy/MFD withmedial maxillectomy or LeFort I, transpalatal, facialtranslocation/maxillary swing, infratemporal
approaches, craniotomy Radiation therapy
Chemotherapy
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Malignant Vascular Tumors Angiosarcoma
Extremely rare (50%in head and neck)
Prognosis on tumorsize, grade, margins
Radiation minimallyeffective
Sinonasal tract lessaggressive
Poor survival
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Malignant Vascular Tumors Hemangiopericytoma
Pericytes of Zimmerman
25% in head and neck
Surgical treatment
Grade important onprognosis
Radiation/chemotherapyfor selected cases
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Malignant Vascular Tumors Kaposis Sarcoma
Viral-induced
Four entities Classic
Endemic
Immunosuppressed
AIDS-related
Surgery, chemo,radiation, sclerotherapy
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Paragangliomas Named for anatomic location
Arise in paraganglionic tissue (neural crest)
Type I cells (chief)APUD cellscatecholamines
Type II cells (sustentacular)
Clusters togetherZellballen
Malignancy is clinical
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Carotid paragangliomas Most common of head and neck (60%)
Multicentric 10%, malignant 10%
Familial (AD) 20% -- more multicentric
Painless mass at SCM, immobilesuperior-inferior direction
May produce catecholamines
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Carotid paragangliomas
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Carotid paragangliomas Treatment
Surgery
Mortality 8%, >5cm tumors had morecomplications
Preop workup keyvascular surgeon,anesthesia
Embolizationcontroversial
Radiation
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Vagal paragangliomas Most commonly at nodose ganglion
Painless mass at angle of mandible
present for many yearsenlarging mayget Horners, CN XII, hoarseness
More multicentric (25%)
Malignancy (18%)
None produce catecholamines
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Vagal paragangliomas
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Laryngeal paragangliomas Usually from superior laryngeal
paraganglia from aryepiglottic fold
Hoarseness and dysphagia common
High rates of malignancy
Wide local excision or partiallaryngectomy