•  
  •  
 

Publication Date

7-7-2016

Article Type

Original Research

Abstract

Purpose: To report the therapeutic outcome of ultrasound-guided intralesional injection of bleomycin in the treatment of cutaneous hemangiomas and vascular malformations.

Material & Methods: The medical records of patients with cutaneous hemangiomas and vascular malformations treated with the intralesional injection of bleomycin under ultrasound guidance between August 2009 and June 2013 at the Indus Hospital, Karachi were reviewed retrospectively using a computerized medical record information management system. Data were extracted using a pre-coded performa that included patient demographics, type and location of lesion, number of treatments, presenting/pre- and post-treatment clinical symptoms (pain, swelling, heaviness, size, discoloration), ultrasound appearance and vascularity, and post-treatment side effects. The dose range of bleomycin was 0.5-1.0 mg/kg, but not exceeding 15 mg in a single session. A maximum of four treatments were given in any given patient except for one, who presented with recurrence after a year of complete resolution. Therapeutic outcome was determined using review of ultrasound images and recorded clinical assessment. Treatment response was categorized as: (i) complete resolution [more than 90% reduction]; (ii) substantial reduction [more than 50% reduction]; (iii) mild reduction [25% reduction]; or, (iv) no improvement [ < 10% reduction].

Results: A total of 30 patients (16 female, 14 male), ranging in age from 8 months to 48 years (mean age 10.2 years), were treated from 2009 to 2013. There were 23 hemangiomas. Seven were vascular malformations, of which five were lymphatic malformations and two were venous malformations. Twenty-eight lesions were located in the head and neck region, and two were peripheral.. In 24 of the 30 patients (76%), treatment had been completed. In six patients (21%) treatment was ongoing at the time of this report. Seventeen of the 23 hemangiomas (74%) were completely resolved clinically and on ultrasound, five (22%) showed substantial improvement and one (4%) showed mild improvement. In five of the seven vascular malformations (71%) lymphatic malformations resolved completely, and two (29%) venous malformations showed substantial improvement. Of the 13 patients presenting with discoloration, there was complete resolution in one (7.7%), marked reduction in 11 (84.6%) and mild reduction in one (7.7%). Of seven patients presenting with pain, there was complete resolution in two (28.6%), marked reduction in two (28.6%), mild reduction in two (28.6%), and no improvement in one (14.3%). There were no pulmonary complications.

Conclusion: Ultrasound-guided intralesional injection of bleomycin is an option to consider for the treatment of certain types of cutaneous hemangiomas and vascular malformations. Prospective studies should be undertaken to understand the various factors contributing to therapeutic success.

Keywords

cutaneous hemangioma, vascular malformation, bleomycin

Creative Commons License


This work is licensed under a Creative Commons Attribution 4.0 License.

Corresponding Author(s)

Nuzhat Irfan Malik, The Indus Hospital, Landhi Local Road, Karachi, Pakistan; nuzhat.irfan24@gmail.com

M1022_Fig1.tiff (241 kB)
8 year-old female presenting with left cheek hemangioma.

M1022_Fig2.tiff (264 kB)
Same patient as in Fig. 1 after two treatment sessions of intralesional bleomycin, at an interval of one session per month.

M1022_Fig3.tiff (254 kB)
Part of large macrocystic lymphatic malformation on neck present since birth in 2 year-old female.

M1022_Fig4.tiff (197 kB)
Greater than 50% reduction on ultrasound after first session of U/S guided IBI.

M1022_Fig5.tiff (362 kB)
Swelling in left mandible in female age 3 years 11 months, present since 18 months of age. On ultrasound mixed lymphatic malformation.

M1022_Fig6.tiff (338 kB)
Complete resolution with no cystic spaces and only residual fibrotic tissue after three treatment sessions.

M1022_Fig7a.tiff (289 kB)
Hemangioma in right cheek of 22 year-old male, measuring 5.7 cm x 2.7 cm and presenting as hypervascular on color Doppler.

M1022_Fig7b.tiff (279 kB)
Hemangioma in right cheek of 22 year-old male, measuring 5.7 cm x 2.7 cm and presenting as hypervascular on color Doppler.

M1022_Fig8a.tiff (299 kB)
Same patient as in Fig. 7a/7b after first injection; substantial reduction apparent with blood flow reduced more than 90%.

M1022_Fig8b.tiff (345 kB)
Same patient as in Fig. 7a/7b after first injection; substantial reduction apparent with blood flow reduced more than 90%.

Share

COinS
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.