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Tufted angiomas in childhood: A series of 9 cases and a literature review
Angiomas en penacho en la infancia. Serie de 9 casos yrevisión de la literatura
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Victoria Martínez, L. Cubells Sánchez, A. Esteve Martínez, J.R. Estela Cubells, I. Febrer Bosch, V. Alegre de Miquel, V. Oliver Martínez" "autores" => array:7 [ 0 => array:4 [ "nombre" => "A.M." "apellidos" => "Victoria Martínez" "email" => array:1 [ 0 => "anamercevictoria@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "L." "apellidos" => "Cubells Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Esteve Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "J.R." "apellidos" => "Estela Cubells" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "I." "apellidos" => "Febrer Bosch" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "V." "apellidos" => "Alegre de Miquel" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 6 => array:3 [ "nombre" => "V." "apellidos" => "Oliver Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universidad de Valencia, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Angiomas en penacho en la infancia. Serie de 9 casos yrevisión de la literatura" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 532 "Ancho" => 1301 "Tamanyo" => 79748 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">(A) Tufted angioma in right inner thigh measuring 10<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>cm, present since birth, previous to treatment with 2<span class="elsevierStyleHsp" style=""></span>mg/kg/day of propanolol for 3 months. (B) Four-year followup: the lesion had regressed, leaving behind subcutaneous atrophic tissue.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Tufted angioma (TA) is a rare benign vascular tumour. It was first described by Nakagawa as angioblastoma in 1949.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">1</span></a> Later on, in 1971, Jones and Orkin<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">1</span></a> presented a series of cases with similar histological characteristics and coined the term “tufted angioma”. This term derives from its histological appearance, consisting of small “tufts” of capillaries and angiomatous lobules in the dermis associated with dilated lymphatic channels and with characteristic “cannonball” distribution.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">2</span></a> Tufted angioma may be congenital or acquired, and the incidence of congenital cases is greater than initially believed, rising to 50% in recent series. Acquired cases generally appear in the early years of life, although the literature has described cases with onset in adulthood.<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3,4</span></a> Although there are cases of disseminated TA,<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">5</span></a> most present with a solitary lesion, an erythematous, purplish, infiltrated and usually poorly demarcated plaque.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">6</span></a> Most patients are asymptomatic, although they can experience local discomfort in the form of warmth, tenderness or swelling, and the most severe potential complication is Kasabach–Merritt syndrome.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0010" class="elsevierStylePara elsevierViewall">We conducted an observational and descriptive retrospective study by reviewing the cases of TA diagnosed by biopsy in the past 20 years in the Hospital General Universitario of Valencia in children less than 15 years of age. Patients were selected by reviewing the paper medical records and the electronic records in our hospital's intranet. We excluded patients that were more than 15 years of age at the onset and patients without a histological diagnosis.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We included a total of nine patients for whom we collected epidemiological data such as sex, age at onset and ethnicity; clinical data such as localisation, appearance, and clinical diagnosis; data on diagnostic testing, such as imaging studies, coagulation tests, or complete blood counts (whenever they were performed); results from the histological examination; treatment received and outcomes during followup. We defined spontaneous regression as the absence of superficial or deep infiltration, even in the presence of residual skin changes, such as hyperpigmentation or telangiectasias.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0020" class="elsevierStylePara elsevierViewall">We included a total of nine cases, six in females and three in males, with a mean followup duration of 8 years (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). We classified the cases of TA as congenital or acquired based on the age at onset. We further divided acquired TAs into early-onset (onset of symptoms at age <1 year) and late-onset (at age >1 year).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">We found seven patients with congenital TA, one patient with early-onset TA that developed the lesion at 10 months of age, and one patient with late onset at 9 years of age. The lesions most frequently localised to the upper extremities (five patients), followed by the torso and thighs. The clinical manifestations were heterogeneous, with a predominance of hard, poorly demarcated and infiltrated purplish erythematous plaques or nodules.</p><p id="par0030" class="elsevierStylePara elsevierViewall">A soft-tissue ultrasound was performed in five patients, revealing an arteriovenous malformation in only one patient. A vascular MRI scan was performed in this patient, confirming the presence of hypervascularization and micronodules in the subcutaneous tissue associated with arteriovenous microfistulas.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In every patient, the definitive diagnosis was made based on biopsy results. The histopathological examination of haematoxylin and eosin (HE) stained sections showed multiple lobules of small capillaries that were distributed through the reticular dermis in every patient, with involvement of the subcutaneous fat layer in six. The presence of dilated thin-wall vessels that gave rise to crescent-shaped vascular channels was observed in the periphery as well as inside the vascular lobules (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). There was no evidence of atypia or inflammatory infiltrate in the stroma. Immunohistochemical staining was performed in the biopsies of two patients; the GLUT-1 stain was negative, unlike what happens in childhood haemangiomas, while the podoplanin stain (D2-40) was positive in the lymphatic channels of the stroma and in parts of the capillaries contained in the lobules, which demonstrated the partial lymphatic differentiation found in TA.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">As for the outcome of TA, it is known that congenital and early-onset cases are more likely to regress than cases that appear later in life.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">7</span></a> In our series, we observed regression of the lesions in six patients, which was spontaneous in five and resulted from treatment in one other. In one patient, the lesion stabilised after initiating treatment, and the angioma was surgically resected in another patient, in whom it did not recur.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Of the five cases in which it was decided not to treat the patient and that showed spontaneous regression, four were congenital and one had early onset. All these patients were followed up in regular clinical checkups, and the observed mean time to the start of spontaneous regression was 3.5 months since diagnosis, with a progressive reduction of the deep component and of induration over time; in some of these patients, mild subcutaneous tissue atrophy, superficial telangiectasias or purplish colouration remained (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">In one patient that had congenital TA in the inner left thigh and was starting to show some signs of regression, the decision was made to initiate compassionate treatment with oral propranolol at doses of 2<span class="elsevierStyleHsp" style=""></span>mg/kg/day. After 5 months, treatment was suspended after finding that the deep component had regressed. There was also evidence of marked atrophy in the subcutaneous tissue and prominent blood vessels, with no functional compromise in the limb (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). We cannot attribute the clinical improvement of the patient nor the secondary atrophy to the oral treatment with propranolol, as spontaneous involution had already started in the patient before treatment was initiated; furthermore, there are published cases in the literature of patients with similar sequelae following spontaneous regression under watchful waiting.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">7</span></a></p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The patient in whom the lesion stabilised with treatment had a hard purplish lesion in the inner arm since birth and had experienced episodes of local pain and swelling during the followup. Imaging tests showed the presence of an arteriovenous malformation, and laboratory tests ruled out Kasabach–Merritt syndrome. The patient was treated with prednisone at a dose of 3<span class="elsevierStyleHsp" style=""></span>mg/kg/day for several months, with improvement of the clinical manifestations and the swelling. At 9 years of age, treatment with oral propranolol at 2<span class="elsevierStyleHsp" style=""></span>mg/kg/day was initiated, which the patient stopped taking after 6 months due to severe asthenia in the absence of clinical improvement. The lesion has remained stable to the present day (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">None of our patients had Kasabach–Merritt syndrome, thrombocytopaenia, haemolytic anaemia or disseminated intravascular coagulation, which have been described in 10% of patients with TA and can be life-threatening.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">Tufted angioma is a rare vascular tumour. It has a heterogeneous clinical presentation. This entity should be suspected in patients presenting with an indurated, erythematous or purplish lesion with poorly defined borders, although in some cases the lesion is well demarcated. They usually have a deep nodular component (they may extend into the subcutaneous tissues, fascia and muscle). The lesion can sometimes cause mild pain. Some patients have hyperhidrosis and hypertrichosis, or port-wine stains on the surface of the skin.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The pathogenesis of TA remains unclear. It has been associated to increased local secretion of growth factors with a significant role in angiogenesis, such as interleukin 8, which would stimulate angiogenesis and promote the development of vascular lobules.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">8</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The diagnosis of TA is made by clinical assessment, histopathological examination and imaging tests, although the definitive diagnosis is given by the histopathological examination.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The differential diagnosis must include childhood haemangiomas, congenital haemangiomas, childhood haemangiopericytoma, childhood fibroxanthoma, venous malformations, Kaposi's sarcoma and kaposiform haemangioendothelioma (KHE).</p><p id="par0085" class="elsevierStylePara elsevierViewall">Kaposiform haemangioendothelioma has a characteristic purpura-like appearance; it is a locally aggressive tumour that may affect deep tissues, even the retroperitoneum, mediastinum or internal organs. There is consensus that TA and KHE represent the two extremes of a single spectrum of histopathological findings. While TA tends to be more superficial and KHE to localise to deep tissues, the histological patterns of both entities may be found in a single mass. Furthermore, both have an association with coagulopathy and Kasabach–Merritt syndrome, which may be found in up to 70% of KHE cases and 10% of TA cases. All of the above support the notion that both entities are part of a single neoplastic spectrum.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">9,10</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Imaging studies such as ultrasonography or magnetic resonance imaging can help distinguish TA from other tumours, although their main contribution is determining the extension of the lesion. They can also be used to assess response to treatment.</p><p id="par0095" class="elsevierStylePara elsevierViewall">If a patient has a large lesion that has increased in size rapidly, is painful, or is associated with other warning signs, laboratory tests such as a complete blood count and coagulations tests should be done to rule out Kasabach–Merritt syndrome.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">11</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The histological appearance of TA consists of multiple cellular lobules scattered through the entire thickness of the dermis and that frequently extend to the hypodermis. Each lobule is composed of several aggregates of endothelial cells arranged concentrically around the vessels of the vascular plexus of the skin. These lobules are separated by normal dermis, with no evidence of inflammatory infiltrate. Some of these lobules push against the walls of surrounding vessels, producing the characteristic crescent-shaped morphology. Small vascular spaces with a capillary appearance can also be observed within the endothelial cell lobules.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Immunohistochemical tests show that the cells contained in the neoplastic lobules are positive for endothelial cell markers such as CD31, CD34, WT1 and alpha-smooth muscle actin. The crescent-shaped dilated vascular channels in the periphery are stained to different degrees by podoplanin (D2-40), which evinces their lymphatic nature. Historically it was believed that the vascular lobules were D2-40-negative, but a more recent study has shown that they test positive for this marker and for PROX 1, which is evidence of the partial lymphatic nature of TA. All of these findings support the notion of an overlap between TA and KHE, the latter of which is known to test positive for D2-40.<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">12,13</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Although TA can develop in adults, most cases manifest in childhood. A review of 41 cases conducted in 2000 showed that onset occurred before age 1 year in 50% of patients.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">14</span></a> The reported prevalence of congenital TA varies in different publications; a study conducted in the 1990s estimated a 10% prevalence;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">15</span></a> a case review from 2000 found a prevalence of 20%, and the prevalence of congenital TA in a 2010 series of 16 patients was 54%.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">16</span></a> The frequency of congenital TA in our nine-patient series was 77.7%, which is significantly higher than the prevalences previously reported in the literature. When we compared our patients to the rest of the published series (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>)<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">6,7,17,18</span></a> we observed a high rate of spontaneous regression, which could probably be attributed to the high percentage of congenital cases. Other factors worth noting in our series were the higher prevalence in the female sex and the predominant localisation in the upper extremities (55.5%), compared to other series in which thigh and neck involvement are more common.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">We found differences in the disease course. Tufted angiomas frequently show a slow growth phase that lasts a few months, followed by a stabilisation phase.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">19</span></a> As for spontaneous regression, a review of 27 cases of congenital TA<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">20</span></a> found that in 95% spontaneous regression occurred less than 2 years since the onset of symptoms. Meanwhile, acquired TAs tend to have a longer slow-growth phase and are not likely to spontaneously regress, which happens in only 15.9% of cases.<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">21</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">When it comes to the management of TA, it has not been standardised, and most publications that refer to its treatment consist of single-case reports or small case series. The management should be determined on a case-to-case basis, taking into account localisation, size, presence or absence of functional compromise, and comorbidity with Kasabach–Merritt syndrome. Watchful waiting without treatment may be a good strategy in patients with TA that do not have Kasabach–Merritt syndrome and have uncomplicated and asymptomatic lesions that do not involve a vital organ, as there is a high probability of spontaneous regression.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">20</span></a> Surgical resection should be considered if the lesion is small, however, complete resection may prove challenging given that the lesions are usually not well-demarcated.<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">22,23</span></a> Other treatments have been reported in the literature with varying degrees of success, such as high-dose systemic corticosteroids,<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">24</span></a> interferon alpha, and chemotherapy medications such as vincristine.<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">25,26</span></a> In recent years, good outcomes have resulted from treatment with low-dose aspirin<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">27</span></a> alone or in combination with ticlopidine, so many authors now propose doses of 5<span class="elsevierStyleHsp" style=""></span>mg/kg/day of aspirin for the first-line treatment of uncomplicated TA. Given the success rate of treatment of childhood haemangiomas with oral propranolol, this agent has been used in some cases of TA. A series of 11 patients with KHE and TA treated with oral propranolol showed improvement in only 36% of the patients,<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">28</span></a> and there was a high rate of spontaneous regression, so this treatment cannot be considered effective for TA. Last of all, there are treatments that aim to improve the aesthetic appearance of the lesions, such as laser treatment with PDL or IPL, which are useful for the superficial port-wine stains found in some TAs.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0125" class="elsevierStylePara elsevierViewall">We present a series of nine patients diagnosed with TA in childhood, in which 77.7% of the cases were congenital and subject to a long followup period. Our series is one of the longest described in the literature to date. All our patients were diagnosed by biopsy, since the clinical heterogeneity of this entity requires that the diagnosis be made by histopathological examination. We observed spontaneous regression in 55.5% of patients, most of whom had congenital TAs. This percentage of spontaneous involution was higher than percentages previously reported in other case series. In conclusion, given the high rate of spontaneous regression in congenital and early-onset cases, in the absence of other complications watchful waiting is an appropriate strategy in the management of patients with TA as long as they are monitored closely.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres576256" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec592904" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres576257" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec592903" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-08-07" "fechaAceptado" => "2014-10-20" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec592904" "palabras" => array:4 [ 0 => "Tufted angioma" 1 => "Benign vascular tumour" 2 => "Congenital" 3 => "Cannon ball" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec592903" "palabras" => array:4 [ 0 => "Angioma en penacho" 1 => "Tumoración vascular benigna" 2 => "Congénito" 3 => "Lóbulos angiomatosos" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tufted angioma (TA) is a rare benign vascular tumour that mostly appears during infancy or early childhood, although there are cases reported in adults. Clinical presentation and evolution of TA can vary. Histologically, it takes on a classic appearance of vascular tufts (“cannon ball” like appearance).</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A retrospective observational study was conducted that included all patients diagnosed with TA at our centre in the last 20 years.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A series of 9 cases of tufted angioma in childhood are presented, 77.7% of which were congenital. This represents a frequency higher than previously described. Spontaneous regression was observed in 55.5% of the cases, and was more frequent in the congenital TA group. Unlike other TA series reported in the literature, a higher proportion of patients with spontaneous regression was observed in this series, with a higher prevalence in females (6 out of 9 children) and predominantly located in the upper limbs. None of our patients had Kasabach–Merritt phenomenon.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">There are many ways of treating TA, but none are uniformly effective. Given the high rate of spontaneous regression in congenital or early TA, we suggest that, in the absence of other complications, monitoring would be a good option for management.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El angioma en penacho o tufted angioma (TA) es una tumoración vascular benigna poco frecuente, que suele aparecer en la infancia, aunque existen casos de aparición en la edad adulta. Su presentación clínica es muy variable. Se manifiesta típicamente como una mácula, pápula o nódulo eritematovioláceo en el tronco o el cuello. Histológicamente, se caracteriza por agregados de lóbulos angiomatosos en la dermis formando pequeños penachos de capilares.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo observacional de los casos diagnosticados de TA en los últimos 20 años en nuestro centro.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Presentamos un total de 9 casos de angiomas en penacho en la infancia. El 77,7% de los casos fueron congénitos, lo que representa una frecuencia superior a la descrita previamente. Nuestros pacientes presentaron regresión espontánea en el 55,5% de los casos, siendo más frecuente en el grupo de TA congénitos. A diferencia de las otras series descritas en la literatura, observamos un mayor porcentaje de pacientes con regresión espontánea, un predominio femenino (6 de los 9 niños) y una localización más frecuente en miembros los superiores. Ninguno de nuestros pacientes presentó fenómeno de Kasabach-Merritt.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Dada la alta tasa de involución espontánea en TA congénitos o tempranos, en ausencia de otras complicaciones, la vigilancia sería una buena opción de manejo, monitorizando estrechamente al paciente.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Victoria Martínez AM, Cubells Sánchez L, Esteve Martínez A, Estela Cubells JR, Febrer Bosch I, Alegre de Miquel V, et al. Angiomas en penacho en la infancia. Serie de 9 casos yrevisión de la literatura. An Pediatr (Barc). 2015;83:201–208.</p>" ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1024 "Ancho" => 1300 "Tamanyo" => 369822 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">(A) Skin biopsy (HE, 40×): proliferation of round lobules in middle and deep dermis. (B) Capillary lobules reaching the hypodermis (HE, 100×). (C) Typical appearance of angiomatous aggregates showing compact bundles of capillaries and thin-walled crescent-shaped vessels both in and out of the lobules (HE, 200×). (D) Podoplanin staining (D2-40, 200×) shows partial lymphatic differentiation within the capillary lobules.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 488 "Ancho" => 1300 "Tamanyo" => 100940 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">(A) Congenital tufted angioma in the lumbar region of a child. (B) After 6 months of followup with no treatment, the lesion shows involution with a reduction in its deep component and in the intensity of the surface colouration.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 532 "Ancho" => 1301 "Tamanyo" => 79748 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">(A) Tufted angioma in right inner thigh measuring 10<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>cm, present since birth, previous to treatment with 2<span class="elsevierStyleHsp" style=""></span>mg/kg/day of propanolol for 3 months. (B) Four-year followup: the lesion had regressed, leaving behind subcutaneous atrophic tissue.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1039 "Ancho" => 1401 "Tamanyo" => 110998 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">(A) Tufted angioma associated with arteriovenous malformation. (B) After a 5-month course of 2<span class="elsevierStyleHsp" style=""></span>mg/kg/day of propanolol, the lesion remained unchanged, with no improvement. (C) Parameters after three PDL sessions: spot 7<span class="elsevierStyleHsp" style=""></span>mm, 0.5<span class="elsevierStyleHsp" style=""></span>ms and 9, 10 and 10.5<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span>, with clinical improvement and no scars.</p>" ] ] 4 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age at onset \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Localisation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Clinical features \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Arteriovenous malformation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Management \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Spontaneous regression \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sequelae \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Complications \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">1/F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">At birth \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Upper extremity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Indurated purplish erythematous plaque \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Watchful waiting \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Atrophic skin tissue and hyperpigmentation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">2/M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">At birth \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Upper extremity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Port-wine stain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oral steroids. Oral and topical propranolol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Persistence of lesion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pain, swelling, local warmth, hypertrichosis, paraesthesias \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">3/F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">At birth \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Dorsum of foot \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hard erythematous mass \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lost to followup \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lost to followup \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">4/F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bridge of the nose \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Indurated erythematous nodule \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Surgical resection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bleeding \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">5/F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lumbar \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Soft mass with angiomatous appearance \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Watchful waiting \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Residual fibroadipose tissue \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ulceration \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">6/F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">At birth \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Upper limb \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Elastic bilobulated erythematous mass \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Watchful waiting \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">7/F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">At birth \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ingle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Indurated, infiltrated purplish mass \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Propranolol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">8/M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">At birth \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Thigh \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Red-wine lesion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Propranolol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes, prior to initiation of propranolol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Atrophic subcutaneous tissue and prominent vessels \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">9/M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">At birth \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Flank \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Semisoft purplish lesion, painless, with superficial haematoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Watchful waiting \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab940509.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Tufted angiomas diagnosed by biopsy in patients younger than 15 years at our hospital.</p>" ] ] 5 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Source \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>15 years \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Female to male ratio \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean age at onset \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Congenital \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Localisation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Outcome \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Jones and Orkin, 1989 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7:9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Neck 6, torso 5, thigh 3, face 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 stabilised or recurred after treatment \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Herron et al., 2002 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1:4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Thigh 3, face 1, torso 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 regression, 4 without recurrence after treatment \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Wong and Tay, 2002 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2:3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Thigh 5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 stabilised, 2 no data available \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Browning et al., 2006 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2:3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">At birth \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Face 2, thigh 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 regression \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Osio and Fraitag, 2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4:9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 month \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Thigh 7, Genitalia 4, torso 2, face 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 regression, 5 KMS, 2 chronic coagulopathy, 1 stabilised \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Hospital General Valencia, 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6: 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 month \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Arm 5, thigh 2, torso 2, foot 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 spontaneous regression, 1 stabilised after several courses of medication, 1 regression after propranolol, 1 resected, 1 lost to followup \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab940508.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Comparison of our series with previously published case series of childhood tufted angioma.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => 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|---|---|---|---|
| 2024 November | 17 | 7 | 24 |
| 2024 October | 92 | 43 | 135 |
| 2024 September | 92 | 50 | 142 |
| 2024 August | 106 | 67 | 173 |
| 2024 July | 78 | 29 | 107 |
| 2024 June | 68 | 40 | 108 |
| 2024 May | 69 | 42 | 111 |
| 2024 April | 66 | 37 | 103 |
| 2024 March | 76 | 20 | 96 |
| 2024 February | 69 | 34 | 103 |
| 2024 January | 91 | 33 | 124 |
| 2023 December | 79 | 33 | 112 |
| 2023 November | 91 | 25 | 116 |
| 2023 October | 85 | 34 | 119 |
| 2023 September | 65 | 19 | 84 |
| 2023 August | 60 | 21 | 81 |
| 2023 July | 84 | 43 | 127 |
| 2023 June | 66 | 26 | 92 |
| 2023 May | 98 | 25 | 123 |
| 2023 April | 61 | 16 | 77 |
| 2023 March | 90 | 28 | 118 |
| 2023 February | 80 | 30 | 110 |
| 2023 January | 62 | 27 | 89 |
| 2022 December | 116 | 39 | 155 |
| 2022 November | 106 | 57 | 163 |
| 2022 October | 93 | 43 | 136 |
| 2022 September | 86 | 40 | 126 |
| 2022 August | 110 | 50 | 160 |
| 2022 July | 96 | 46 | 142 |
| 2022 June | 75 | 35 | 110 |
| 2022 May | 57 | 39 | 96 |
| 2022 April | 65 | 43 | 108 |
| 2022 March | 76 | 62 | 138 |
| 2022 February | 82 | 35 | 117 |
| 2022 January | 118 | 37 | 155 |
| 2021 December | 97 | 39 | 136 |
| 2021 November | 96 | 41 | 137 |
| 2021 October | 94 | 64 | 158 |
| 2021 September | 84 | 57 | 141 |
| 2021 August | 66 | 43 | 109 |
| 2021 July | 66 | 31 | 97 |
| 2021 June | 68 | 45 | 113 |
| 2021 May | 70 | 43 | 113 |
| 2021 April | 125 | 92 | 217 |
| 2021 March | 90 | 35 | 125 |
| 2021 February | 63 | 17 | 80 |
| 2021 January | 72 | 16 | 88 |
| 2020 December | 63 | 23 | 86 |
| 2020 November | 62 | 17 | 79 |
| 2020 October | 60 | 15 | 75 |
| 2020 September | 66 | 24 | 90 |
| 2020 August | 63 | 23 | 86 |
| 2020 July | 75 | 28 | 103 |
| 2020 June | 75 | 15 | 90 |
| 2020 May | 56 | 17 | 73 |
| 2020 April | 49 | 18 | 67 |
| 2020 March | 58 | 17 | 75 |
| 2020 February | 48 | 21 | 69 |
| 2020 January | 57 | 12 | 69 |
| 2019 December | 68 | 21 | 89 |
| 2019 November | 70 | 14 | 84 |
| 2019 October | 88 | 18 | 106 |
| 2019 September | 90 | 9 | 99 |
| 2019 August | 81 | 24 | 105 |
| 2019 July | 57 | 19 | 76 |
| 2019 June | 85 | 17 | 102 |
| 2019 May | 66 | 26 | 92 |
| 2019 April | 81 | 40 | 121 |
| 2019 March | 59 | 22 | 81 |
| 2019 February | 40 | 18 | 58 |
| 2019 January | 53 | 29 | 82 |
| 2018 December | 63 | 32 | 95 |
| 2018 November | 105 | 32 | 137 |
| 2018 October | 201 | 25 | 226 |
| 2018 September | 121 | 16 | 137 |
| 2018 June | 4 | 0 | 4 |
| 2018 May | 11 | 0 | 11 |
| 2018 April | 51 | 0 | 51 |
| 2018 March | 39 | 0 | 39 |
| 2018 February | 32 | 0 | 32 |
| 2018 January | 26 | 0 | 26 |
| 2017 December | 33 | 0 | 33 |
| 2017 November | 33 | 0 | 33 |
| 2017 October | 20 | 0 | 20 |
| 2017 September | 23 | 0 | 23 |
| 2017 August | 25 | 0 | 25 |
| 2017 July | 24 | 0 | 24 |
| 2017 June | 50 | 13 | 63 |
| 2017 May | 51 | 9 | 60 |
| 2017 April | 29 | 5 | 34 |
| 2017 March | 24 | 1 | 25 |
| 2017 February | 132 | 6 | 138 |
| 2017 January | 23 | 3 | 26 |
| 2016 December | 36 | 9 | 45 |
| 2016 November | 62 | 23 | 85 |
| 2016 October | 91 | 12 | 103 |
| 2016 September | 147 | 2 | 149 |
| 2016 August | 75 | 6 | 81 |
| 2016 July | 23 | 0 | 23 |
Show all
