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The COVID-19 pandemic has caused significant shifts in patient care including a steep decline in ambulatory visits and a marked increase in the use of telemedicine. Infantile hemangiomas (IH) can require urgent evaluation and risk stratification to determine which infants need treatment and which can be managed with continued observation. For those requiring treatment, prompt initiation decreases morbidity and improves long-term outcomes. The Hemangioma Investigator Group has created consensus recommendations for management of IH via telemedicine. FDA/EMA-approved monitoring guidelines, clinical practice guidelines, and relevant, up-to-date publications regarding initiation and monitoring of beta-blocker therapy were used to inform the recommendations. Clinical decision-making guidelines about when telehealth is an appropriate alternative to in-office visits, including medication initiation, dosage changes, and ongoing evaluation, are included. The importance of communication with caregivers in the context of telemedicine is discussed, and online resources for both hemangioma education and propranolol therapy are provided.

The COVID-19 pandemic has caused significant shifts in patient care including a steep decline in ambulatory visits and a marked increase in the use of telemedicine. Infantile hemangiomas (IH) can require urgent evaluation and risk stratification to determine which infants need treatment and which can be managed with continued observation. For those requiring treatment, prompt initiation decreases morbidity and improves long-term outcomes. The Hemangioma Investigator Group has created consensus recommendations for management of IH via telemedicine. FDA/EMA-approved monitoring guidelines, clinical practice guidelines, and relevant, up-to-date publications regarding initiation and monitoring of beta-blocker therapy were used to inform the recommendations. Clinical decision-making guidelines about when telehealth is an appropriate alternative to in-office visits, including medication initiation, dosage changes, and ongoing evaluation, are included. The importance of communication with caregivers in the context of telemedicine is discussed, and online resources for both hemangioma education and propranolol therapy are provided.

Background. The variety of the clinical features of vascular tumors in the maxillofacial area limits the choice of method and is able to make difficulties in the treatment. The combined method of treatment proposed by the authors (vascular sclerotherapy with concurrent propranolol intake) demonstrates high efficacy, lack of invasiveness, shortening the rehabilitation period and less side effects. Objective. The aim of the study was to increase the effectiveness of conservative treatment of vascular tumors of the maxillofacial area in young children by combining the method of sclerotherapy and taking proprono-lol. Methods. In a cohort study, the results of treatment of 80 children aged 2 months to 2 years with vascular tumors of the maxillofacial region (ICD-10: D18.0) were evaluated. A comparison was made of the results in 2 groups of children who were treated with different methods: combined (n =40; main group; sclerotherapy and taking propranolol) and propranolol monotherapy (n =40; comparison group). Analysis of the data obtained in the main group and the comparison group led to the development of the criteria for evaluating the treatment results: good (regression of vascular tumors and the absence of a cosmetic defect), satisfactory (reduction of vascular tumors by 2/3 or more with maintaining cosmetic defect) and unsatisfactory (gross cosmetic defect) in terms of changes in the volume of tumor, the diameter of the supply vessels and the values of the linear velocity of blood flow according to ultrasound data. Results. Subjects treated by the combined treatment had a significant regression of vascular tumors in the maxillofacial area compared with the comparison group: reduction of the tumor volume, diameter of the supply vessels and linear blood flow velocity according ultrasound data reached zero after 6 months from the start of combined treatment — 6 months earlier than in the comparison group (p <0.001). Conclusion. According to the results of the study, the

Background. Clinical diagnosis of vascular anomalies is often dif ficult. The informative of dif ferent instrumental evaluations isn’t the same in terms of visualization of vascular anomalies.Purpose: to establish the diagnostic value and informative of different visualization’s methods of vascular anomalies in children.Methods. The study included 194 patients with vascular anomalies in age from 1 month to 16 years. According to the updated ISSVA classification 2014, vascular anomalies divided into vascular tumors and vascular malformations (VMs). Vascular tumors are diagnosed in 95 patients, in particular, infantile hemangiomas (IHs) of soft tissues (80.0%), liver hemangiomas (5.3%), airways IHs (5.3%), IHs as a part of PHACE syndrome (2.1%). Rare vascular tumors were in 7 (7.3%) patients. In 99 patients VMs diagnosed: lymphatic malformations (LM) in 86.8%, venous malformations in 8.1%, and combined VMs in 5.1% of children.Results. Ultrasound examinations performed as a primary method and follow-up studies. The activity of His was determined by the ratio of small diameter vessels and solid tissue. CT with contrast enhanced and MRI performed in 5.3% patients with IHs of soft tissue with atypical clinical presentations and in patients with airway His (9.3%). To confirm the diagnosis of the liver hemangiomas the CT with contrast enhanced performed. In 4.4% patients with well localized cystic LM performed ultrasound only, all other patients underwent MRI. CT scans performed in 10.2% children with LM of head and neck and symptoms of airway compression as emergency diagnostic procedure.The peculiarity of VM is phleboliths formation. It can be detected as ultrasound, so X-ray examination but to determine the distribution of process is the most informative is MRI. Arteriovenous malformation in CDS scale has the same characteristic as the IHs in proliferative phase. So if these features are revealed in older children CT with contrast enhanced is necessary .Conclusions. For

Background: Epithelioid hemangioendothelioma is a malignant, often indolent vascular tumor which occurs at various anatomic sites. Based on a reciprocal translocation t (1;3)(p36;q25), a consistent WWTR1-CAMTA1 fusion gene has been found. An alternate YAP1-TFE3 fusion has been detected in a small and distinct subset of cases.Methods: Thirty-nine tumors, from 24 females and 15 males with an age range 9-85 years, were located in soft tissue (head and neck [8], trunk [5], upper extremities [3], lower extremities [2], mediastinal [1], and paratesticular [1]), lymph node (1), breast (1), skin (2), bone (6), lung (7), and liver (2). The cases were investigated using a panel of immunohistochemical markers. The aforementioned fusion-genes were examined using RT-PCR and/or FISH in order to validate their diagnostic value.Results: Follow-up available for 17 patients ranged from 3 months to 7 years (median interval 1.5 years). Eleven patients were alive without disease, 2 patients were alive with disease after 1.5 and 2 years, respectively. Four patients died of disease after 4 months (n = 1), 5 months (n = 2), and 1.5 years (n = 1).The size, known for 30 lesions, was >3 cm in 9 of them. Histologically, all lesions had classical features, at least focally. Four tumors counted >3 mitoses/50 HPF.Immunohistochemically, all cases tested stained positive for ERG (21), FLI1 (5) and CD31 (39). CD34 and D2-40 positivity was seen in 81% and 71% of the examined cases, respectively. 11/35 cases expressed pan-keratin and 6/20 cases CK8.18. TFE3 showed a nuclear reaction in 21/24 cases, irrespective of TFE3 rearrangement.Molecular genetically, 35/35 cases revealed one of the fusion genes by FISH and/or RT-PCR with WWTR1-CAMTA1 in 33 cases and YAP1-TFE3 in 2 cases.Conclusions: These results demonstrate the high diagnostic value of FISH and RT-PCR in detecting the fusion genes of EHE. The immunohistochemical utility of TFE3 appears questionable in this study.The virtual slide(s) for this art, SCOPUS: ar.j, info:eu-repo/semantics/published

Background: Epithelioid hemangioendothelioma is a malignant, often indolent vascular tumor which occurs at various anatomic sites. Based on a reciprocal translocation t (1;3)(p36;q25), a consistent WWTR1-CAMTA1 fusion gene has been found. An alternate YAP1-TFE3 fusion has been detected in a small and distinct subset of cases.Methods: Thirty-nine tumors, from 24 females and 15 males with an age range 9-85 years, were located in soft tissue (head and neck [8], trunk [5], upper extremities [3], lower extremities [2], mediastinal [1], and paratesticular [1]), lymph node (1), breast (1), skin (2), bone (6), lung (7), and liver (2). The cases were investigated using a panel of immunohistochemical markers. The aforementioned fusion-genes were examined using RT-PCR and/or FISH in order to validate their diagnostic value.Results: Follow-up available for 17 patients ranged from 3 months to 7 years (median interval 1.5 years). Eleven patients were alive without disease, 2 patients were alive with disease after 1.5 and 2 years, respectively. Four patients died of disease after 4 months (n = 1), 5 months (n = 2), and 1.5 years (n = 1).The size, known for 30 lesions, was >3 cm in 9 of them. Histologically, all lesions had classical features, at least focally. Four tumors counted >3 mitoses/50 HPF.Immunohistochemically, all cases tested stained positive for ERG (21), FLI1 (5) and CD31 (39). CD34 and D2-40 positivity was seen in 81% and 71% of the examined cases, respectively. 11/35 cases expressed pan-keratin and 6/20 cases CK8.18. TFE3 showed a nuclear reaction in 21/24 cases, irrespective of TFE3 rearrangement.Molecular genetically, 35/35 cases revealed one of the fusion genes by FISH and/or RT-PCR with WWTR1-CAMTA1 in 33 cases and YAP1-TFE3 in 2 cases.Conclusions: These results demonstrate the high diagnostic value of FISH and RT-PCR in detecting the fusion genes of EHE. The immunohistochemical utility of TFE3 appears questionable in this study.The virtual slide(s) for this art, SCOPUS: ar.j, info:eu-repo/semantics/published

Purpose of this retrospective study was (1) to evaluate overall survival and survival to local recurrence of patients with unifocal and multifocal tumor and (2) to evaluate survival to local recurrence after intralesional or wide surgery.We reviewed 62 patients with epithelioid hemangioendothelioma of bone, treated from 1985 to 2010. Histological sections and immunohistochemistry were evaluated. Tumor presented as unifocal in 49 patients and as multifocal in 13.Mean follow‐up was 9 years. Five patients (10%) with unifocal tumor progressed to multifocal. Overall survival was 92% at 10 years. Survival with unifocal tumor was significantly higher than survival with multifocal tumor. Survival to local recurrence was 76% at 10 years, significantly higher after wide resection than after intralesional surgery, while there was no statistical difference comparing unifocal and multifocal tumor. At multivariate analysis both variables showed no statistically significance.Wide surgical excision reduces the risk of local recurrence, but functional results and morbidity need to be considered individually when defining surgical indications. Due to the risk of radiation‐induced sarcomas, radiation therapy should be reserved to those cases not amenable to wide surgery or when lesions are seated locations difficult to treat.

Progressive development of a lobulated osteolytic lesion of the left calcaneus was observed in a 28-year-old woman. The bone tumor was associated with multiple lung nodules and later with a few small nodular liver lesions. A histological and immunochemical diagnosis of epithelioid hemangioendothelioma was obtained by bone tumor resection and thoracoscopic lung biopsy. Imaging aspects are reported with emphasis on its multifocality.

Object: The purpose of this study was to analyze patients diagnosed with symptomatic vascular tumors of spine and spinal cord treated at our department over a 20-year period to better define the course of those tumors, the results of treatment, and frequency.Methods: Eighty-one cases of symptomatic vascular tumors affecting the spine and spinal cord were retrospectively reviewed. This group included 31 patients with hemangiomas, 16 — hemangioblastomas, 5 — angiosarcomas, 9 — hemangiopericytomas, 5 — angiofibromas, 5 — angiolipomas, 9 — hemangioendotheliomas, 1— neoplastic angioendotheliomatosis. The pathology, neuroimaging findings, methods of treatment, results, similarities and differences between each tumor type at each location, are reviewed.The cases display a spectrum of different highly vascular pathological findings involving the vertebral body, epidural space, intradural extramedullary space, and intramedullary lesions. The primary therapeutic modality used in our series is a surgery, the second are embolization, radiation, observation.Conclusions: The vascular tumors are different in their origin, histologic appearances and behavior. The unification of this type of tumor as vascular is relative. For example hemangioma in the present time is considering as vascular malformation not a tumor. On the other hand, under no circumstances we can consider hemangioblastomas, hemangiopericitomas, hemangioendotheliomas, and angiosarcomas as the true group of vascular tumors. This is because of their similar origins, histological proximity and presence of the transitional types. The main differences of these tumors are the origin of their neoplastic component (endothelial or perivascular) and the degree of malignity.