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Vol. 58. Núm. 4.
Páginas 339-349 (abril 2003)
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Vol. 58. Núm. 4.
Páginas 339-349 (abril 2003)
Acceso a texto completo
Hemangiomas y malformaciones vasculares cutáneas y patología asociada. Un nuevo síndrome neurocutáneo
Cutaneous hemangiomas, vascular malformations and associated disorders. a new neurocutaneous syndrome
Visitas
19692
I. Pascual-Castroviejoa,
Autor para correspondencia
pascas@inves.es

Correspondencia: Servicio de Neurología Pediátrica. Hospital Univesitario La Paz. P.° de la Castellana, 261. 28046 Madrid. España.
, J.C. López-Gutiérrezb, S.I. Pascual-Pascuala, S. Rafiaa, J. Alarcón-Palacioc
a Servicio de Neurología Pediátrica. Hospital Universitario La Paz
b Unidad de Cirugía Plástica Infantil. Hospital Universitario La Paz
c Unidad de Neurología. Hospital San Rafael. Madrid. España
Este artículo ha recibido
Información del artículo
Objetivo

Mostrar las características de este nuevo síndrome neurocutáneo, un trastorno sistémico que es el más frecuente de los síndromes neurocutáneos descritos hasta ahora y que se presenta con mayor frecuencia en mujeres.

Material y métodos

Lo constituyen el gran número de pacientes con alteraciones vasculares cutáneas en cualquier parte del cuerpo que son estudiados continuadamente por los autores desde los puntos de vista clínico y de imagen por sus problemas estéticos, funcionales y/o neurológicos.

Resultados

Los estudios clínicos han mostrado una amplia escala en la importancia de las lesiones vasculares cutáneas y su relación con diversas alteraciones internas, localizadas casi siempre en zonas subyacentes a las lesiones vasculares cutáneas, siendo las que afectan a la cabeza, cara, cuello y tórax la primera descrita y la mejor conocida. Como hallazgos más frecuentes se encuentran malformaciones del cerebelo, persistencia de la arteria trigeminal, ausencia de arteria carótida y/o vertebral, coartación aórtica y cardiopatía congénita. Una gran parte de los sujetos con este trastorno presentan retraso mental o nivel límite.

Conclusiones

Este trastorno se presenta con mayor frecuencia en mujeres y es el síndrome neurocutáneo más recientemente conocido y el de mayor prevalencia. Se asocia con una amplia patología que puede aparecer en zonas subyacentes a las alteraciones vasculares cutáneas de cualquier parte del cuerpo. Los hemangiomas cutáneos y los tumores hemangiomatosos subyacentes, al igual que otras alteraciones vasculares asociadas, pueden crecer e involucionar en paralelo de forma espontánea y natural, sin influencia terapéutica, hasta quedar los vasos completamente ocluidos mientras que las malformaciones vasculares no sufren ningún cambio evolutivo ni involutivo. Este nuevo trastorno neurocutáneo ya ha recibido diversas denominaciones, como síndrome de Pascual-Castroviejo tipo II y PHACE.

Palabras clave:
Síndrome neurocutáneo
Trastorno neurocutáneo
Hemangiomas
Malformaciones vasculares
Síndrome de Pascual-Castroviejo tipo II
PHACE
Malformaciones del cerebelo
Retraso mental
Objective

Cutaneous hemangiomas and vascular malformations constitute a systemic disease that is the most frequent of the neurocutaneous syndromes reported to date. It appears more frequently in women than in men. The aim of this study was to describe the characteristics of this new neurocutaneous syndrome.

Material and methods

We studied a large number of patients who presented cutaneous hemangiomas and/or vascular malformations located anywhere on the body. The patients underwent periodic clinical follow-up and imaging studies due to their aesthetic, functional and/or neurological problems.

Results

Clinical evaluation revealed a wide range in the size and severity of cutaneous vascular lesions and in their relationship with various internal anomalies, which were almost always located in the areas underlying the cutaneous vascular lesions. Those situated in the head, face, neck and chest were first discovered and are the best known. The most frequent findings were cerebellar malformations, persistence of the trigeminal artery, absence of the carotid or vertebral arteries and congenital heart disease. Many of the patients with this syndrome had mental retardation or borderline mental retardation.

Conclusions

This disorder appears more frequently in females than in males. It is the most recently described neurocutaneous syndrome and is also the most prevalent. This syndrome is associated with numerous disorders that can be located in the areas underlying the cutaneous vascular lesions anywhere on the body. Cutaneous hemangiomas and subjacent hemangiomatous tumors, like other associated vascular abnormalities, can show a parallel, spontaneous increase or decrease in size without treatment. Complete occlusion of the vessels can occur while vascular malformations show no progression or involution. This new neurocutaneous syndrome is also known as Pascual- Castroviejo type II syndrome and PHACE.

Key words:
Neurocutaneous syndrome
Neurocutaneous disease
Hemangiomas
Vascular malformations
Pascual-Castroviejo type II syndrome
PHACE
Cerebellar malformations
Mental retardation
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BibliografÍa
[1.]
I.J. Frieden, V. Reese, D. Cohen.
PHACE syndrome. The association of posterior fossa brain malformations, hemangiomas, arterial anomalies, coarctation of the aorta and cardiac defects, and eye abnormalities.
Arch Dermatol, 132 (1996), pp. 307-311
[2.]
N.B. Esterly.
Cutaneous hemangiomas, vascular stains and malformations and associated syndromes.
Current Probl Dermatol, 7 (1995), pp. 65-108
[3.]
W.L. Watson, W.D. McCarthy.
Blood and lymph vessel tumors. A report of 1056 cases.
Surg Gynecol Obstet, 71 (1940), pp. 569-588
[4.]
J. Folkman.
Toward a new understanding of vascular proliferation disease in children.
Pediatrics, 74 (1984), pp. 850-856
[5.]
J.B. Mulliken, J. Glowacki.
Hemangiomas and vascular malformations in infants and children: A classification based on endothelial characteristics.
Plast Reconstruct Surg, 69 (1982), pp. 412-422
[6.]
M.S. Persky.
Congenital vascular lesions of the head and neck.
Laryngoscope, 96 (1986), pp. 10002-10015
[7.]
R.J. Gorlin, P. Kantaputra, D.J. Aughton, J.B. Mullike.
Marked female predilection in some syndromes associated with facial hemangiomas.
Am J Med Genet, 52 (1994), pp. 130-135
[8.]
I. Pascual-Castroviejo, J. Viaño, F. Moreno, R. Palencia, V. Martínez-Fernández, S.I. Pascual-Pascual.
Hemangiomas of the head, neck, and chest with associated vascular and brain anomalies: A complex neurocutaneous syndrome.
Am J Neuroradiol, 17 (1996), pp. 461-471
[9.]
I. Pascual-Castroviejo.
Vascular and nonvascular intracranial malformations associated with external capillary hemangiomas.
Neuroradiology, 27 (1978), pp. 357-359
[10.]
I. Pascual-Castroviejo.
The association of extracranial and intracranial vascular malformations in children.
Can J Neurol Sci, 12 (1985), pp. 139-148
[11.]
O. Enjolras, M.C. Riche, J.J. Merland, J.P. Escaude.
Management of alarming hemangiomas in infancy: A review of 25 cases.
Pediatrics, 85 (1990), pp. 491-498
[12.]
R.W. Byard, P.E. Burrows, T. Isakawa, M.M. Silver.
Diffuse infantile hemangiomatosis. Clinicopathological features and management problems in five fatal cases.
Eur J Pediatr, 150 (1991), pp. 224-227
[13.]
I. Pascual-Castroviejo.
Introducción e historia. Epidemiología: Prevalencia.
Neurofibromatosis, pp. 13-23
[14.]
I. Pascual-Castroviejo, P. Cortés, J. Fernández-Cuadrado, M. De la, S.I. Pascual-Pascual.
Hemangioma cutáneo asociado a hemangioma hepático y a neurofibromatosis tipo 1 (NF 1).
Rev Neurol (Barcelona), 34 (2002), pp. 652-654
[15.]
I. Pascual-Castroviejo.
Neurología Pediátrica, (2000),
[16.]
I. Pascual-Castroviejo.
Estudio de patología asociada.
Neurofibromatosis, pp. 45-63
[17.]
J.H. Hersh, D. Waterfill, J. Rutledge, M.J.E. Harrod, S.F. O’Sheal, G. Verdi.
Sternal malformation/vascular dysplasia association.
Am J Med Genet, 21 (1985), pp. 177-186
[18.]
J.B. Boyd, J.B. Mulliken, LB. Kaban, J. Upton, J.E. Murray.
Skeletal changes associated with vascular malformations.
Plast Reconstr Surg, 74 (1984), pp. 789-795
[19.]
A. Schneeweis, L.C. Blieden, A. Shem-Tov, M. Motro, A. Feigel, H.N. Neufeld.
Coarctation of the aorta with congenital hemangioma of the face and neck and aneurysm or delitation of subclavian or innominate artery: A new syndromeα.
Chest, 82 (1982), pp. 186-187
[20.]
L. Vaillant, G. Lorette, A. Chantepie, M. Marchand, D. Alison, D. Vaillant.
Multiple cutaneous hemangiomas and coarctation of the aorta with right aortic arch.
Pediatrics, 81 (1988), pp. 707-710
[21.]
A.J. Burns, L.C. Kaplan, J.B. Mulliken.
Is there an association between hemangioma and syndromes with dysmorphic featuresα.
Pediatrics, 88 (1991), pp. 1257-1267
[22.]
L.L. Baker, W.P. Dillon, G.B. Hieshima, C.F. Dowd, I. Frieden.
Hemangiomas and vascular malformations of the head and neck: MR characterization.
Am J Neuroradiol, 14 (1993), pp. 307-314
[23.]
M. Igarashi, H. Uchida, T. Kajaii.
Supraumbilical midabdominal raphé and facial cavernous hemangiomas.
Clin Genet, 27 (1985), pp. 196-198
[24.]
N.S. Goldberg, A.A. Hebert, N.B. Esterly.
Sacral hemangiomas and múltiple congenital abnormalities.
Arch Dermatol, 122 (1986), pp. 684-687
[25.]
J.D. Geller, S.F. Topper, K. Hashimoto.
Difusse neonatal hemangiomatosis: A new constellation of findings.
J Am Acad Dermatol, 24 (1995), pp. 816-818
[26.]
V. Reese, I.J. Frieden, A.S. Paller, N.B. Esterly, D. Ferriero, M.L. Levy.
Association of facial hemangiomas with Dandy-Walker and other posterior fossa malformations.
J Pediatr, 122 (1993), pp. 379-384
[27.]
D.M. Capin, S. Gottlieb, N.P. Rosman.
Central nervous system hemangiomatosis in early childhood.
Pediatr Neurol, 17 (1997), pp. 365-370
[28.]
S. Cobb.
Haemangioma of the spinal cord associated with skin naevi of the same metamere.
Ann Surg, 62 (1915), pp. 641-649
[29.]
I. Pascual-Castroviejo, R. Frutos, J. Viaño, S.D. Pascual-Pascual, P. González.
. Cobb syndrome. A case report.
J Child Neurol, 17 (2002), pp. 847-849
[30.]
V. Tavafoghi, A. Ghandchi, G.W. Hambrick, G.B. Udverhelyi.
Cutaneous signs of spinal dysraphism.
Arch Dermatol, 114 (1978), pp. 573-577
[31.]
K.N. Haque.
Isolated asternia: An independent entity.
Clin Genet, 25 (1984), pp. 362-365
[32.]
W.H. Goh, R. Lo.
A new 3C syndrome: Cerebellar hypoplasia, cavernous hemangioma and coarctation of the aorta.
Dev Med Child Neurol, 35 (1993), pp. 637-641
[33.]
E.C. Burke, R.K. Winkelman, M.K. Strickland.
Disseminated hemangiomatosis. The newborn with central nervous system involvement.
Am J Dis Child, 108 (1964), pp. 418-424
[34.]
K.R. Holden, F. Alexander.
Diffuse neonatal hemangiomatosis.
Pediatrics, 46 (1970), pp. 411-421
[35.]
A.M. Margileth, M. Museles.
Cutaneous hemangiomas in children. Diagnosis and conservative management.
Jama, 194 (1965), pp. 135-138
[36.]
G. Stigmar, J.S. Crawford, C.M. Ward, H.G. Thomson.
Ophthalmic sequelae of infantile hemangiomas of the eyelids and orbit.
Am J Ophthalmol, 85 (1978), pp. 806-813
[37.]
I. Pascual-Castroviejo, J. Viaño, S.I. Pascual-Pascual, V. Martínez.
Facial hemangioma, agenesis of internal cartoid artery and cerebral cortex dysplasia.
Case report. Neuroradiology, 37 (1995), pp. 693-695
[38.]
P. Tortori-Donati, M.P. Fondelli, A. Rossi, G.L. Bava.
Intracranial contrast enhancing masses in infants with capillary hemangioma of the head and neck: Intracranial capillary hemangiomaα.
Neuroradiology, 41 (1999), pp. 369-375
[39.]
Y. Mizuno, T. Kurokawa, Y. Numaguchi, M. Goya.
Facial hemangioma with cerebro-vascular anomalies and cerebellar hypoplasia.
Brain Dev, 4 (1982), pp. 375-378
[40.]
K. Murotani, M. Hiramoto.
Agenesis of the internal carotid artery with a large hemangioma of the tongue.
Neuroradiology, 27 (1985), pp. 357-359
[41.]
T. Matsui, T. Ono, M. Kito, S. Yoshioka, T. Ikeda.
Extensive facial strawberry mark associated with cerebellar hypoplasia and vascular abnormalities.
J Dermatol, 24 (1997), pp. 113-116
[42.]
P.E. Burrows, R.L. Robertson, J.B. Mulliken, D.S. Beardsley, J.C. Chaloupka, R.A. Ezekowitz.
Cerebral vasculopathy and neurologic sequelae in infants with cervicofacial hemangioma:Report of eight patients.
Radiology, 207 (1998), pp. 601-607
[43.]
O. Enjolras, J.B. Mulliken.
Vascular tumors and vascular malformations.
Arch Dermatol, 13 (1997), pp. 375-423
[44.]
J. Dubois, L. Garel.
Imaging and therapeutic approach of hemangiomas and vascular malformations in the pediatric age group.
Pediat Radiol, 29 (1999), pp. 879-893
[45.]
C.C. Breugem, C.M.A.M. Van der Horst, R.C.M. Hennekam.
Progress toward understanding vascular malformations.
Plast Reconstr Surg, 107 (2001), pp. 1509-1523
[46.]
F.P. Mall.
Determination of the age of embryos and fetuses.
Manual of Human Embryology. Vol. 1, pp. 180-201
[47.]
G.L. Streeter.
The development alterations in the vascular system of the brain of human embryo.
Contrib Embryol, 8 (1918), pp. 5-38
[48.]
E.D. Congdon.
Transformation of aortic arch system during the development of the human embryo.
Contrib Embryol, 14 (1922), pp. 47-110
[49.]
D.H. Padget.
The development of the cranial arteries in the human embryo.
Contrib Embryol, 14 (1922), pp. 47-110
[50.]
J.B. Mulliken.
A biologic approach to cutaneous vascular anomalies.
Pediatr Dermatol, 9 (1992), pp. 356-357
[51.]
G. Tasnádi.
Epidemiology and etiology of congenital vascular malformations.
Sem Vasc Surg, 6 (1993), pp. 200-203
[52.]
E. Quecedo, M.P. Gil-Mateo, V. Pont, M.I. Febrer, A. Aliaga.
Giant hemifacial angioma and PHACE syndrome.
Br J Dermatol, 136 (1997), pp. 649-650
[53.]
D.K. Cotas, E.G. Paysse, M.L. Levy.
PHACE: A neurocutáneos syndrome with important ophthalmologic implications. Case report and literature review.
Ophthalmology, 106 (1999), pp. 1739-1741
[54.]
A. Rossi, G.L. Bava, R. Biancheri, P. Tortori-Donati.
Posterior fossa and arterial abnormalities in patients with facial capillary haemangioma: Presumed incomplete phenotypic expressions of PHACES syndrome.
Neuroradiology, 43 (2001), pp. 934-940
[55.]
J. Torres-Mohedas, A. Verdú, B. Vidal, R. Jadraque.
Presentación conjunta de hemangioma facial, malformación de fosa posterior e hipoplasia carótida vertebral (síndrome de Pascual-Castroviejo II): aportación de dos nuevos casos.
Rev Neurol (Barcelona), 32 (2001), pp. 50-54
[56.]
C.A. Dieterich-Miller, P.L. Safford.
Psychosocial development of children with hemangiomas: Home school, health care collaboration.
Children’s Health Care, 21 (1992), pp. 84-89
[57.]
L.E. Bartoshesky, M. Bull, M. Feingold.
Corticosteroid treatment of cutaneous hemangiomas: How effectiveα.
Clin Pediatr, 17 (1978), pp. 625-638
[58.]
L.M. Boon, D.M. McDonald, J.B. Mulliken.
Complications of systemic corticosteroids therapy for problematic hemangioma.
Plast Reconstr Surg, 104 (1999), pp. 1616-1623
[59.]
C.W. White.
Treatment of hemangiomatosis with recombinant interferon alfa-2a.
Sem Hematol, 27 (1990), pp. 15-22
[60.]
R.A.B. Ezekowitz, J.B. Mulliken, J. Folkman.
Interferon-alfa-2a therapy for life-threatening hemangiomas of infancy.
N Engl J Med, 326 (1992), pp. 1456-1463
[61.]
J. Folkman.
Successful treatment of an angiogenic disease.
N Engl J Med, 320 (1989), pp. 1211-1212
[62.]
C.F. Barlow, C.J. Priebe, J.B. Mulliken, P.D. Barnes, D. McDonald, J. Folkman.
Spastic diplegia as a complication on interferon alfa-2a treatment of hemangiomas of infancy.
J Pediatr, 132 (1998), pp. 527-530
[63.]
B.M. Achauer, C.J. Chang, V.M. Vanderkam, A. Boyko.
Intralesional photocoagulation of periorbital hemangiomas.
Plast Reconstr Surg, 103 (1999), pp. 11-16
[64.]
B.M. Achauer, B. Celikoz, V.M. Vanderkam.
Intralesional bare fiber laser treatment of hemangioma of infancy.
Plast Reconstr Surg, 101 (1998), pp. 1212-1217
[65.]
R.J.D. D’Amato, M.S. Loughnan, E. Flynn, J. Folkman.
Thalidomide is an inhibitor of angiogenesis.
Proc Natl Acad, 91 (1994), pp. 4082-4085
[66.]
Pascual-Castroviejo I, Pascual-Pascual SI, Moreno F, Viaño J, Martínez V. Anomalías vasculares extra e intracraneales y nevus de Ota en la misma familia. Neurología.
[67.]
J.M. Taveras.
Multiple progressive intracranial arterial occlusions: A syndrome of children and young adults.
Am J Roentgenol Rad Ther Nucl Med, 106 (1969), pp. 235-268
[68.]
T.L. Wright, M.J. Bresnan.
Radiation-induced cerebrovascular disase in children.
Neurology, 26 (1976), pp. 540-543
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