Al-Haddab Mohammed, Almughera Tharaa N, Alsalhi Abdulaziz, Alfurayh Nuha
Division of Dermatology, King Saud University, Riyadh, Kingdom of Saudi Arabia.
Division of Dermatology, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.
AME Case Rep. 2024 Mar 22;8:44. doi: 10.21037/acr-23-159. eCollection 2024.
Lobular capillary hemangioma, also known as pyogenic granuloma (PG), is a relatively common benign rapidly growing friable vascular tumor of the skin and mucus membranes. Although the exact pathogenesis of PG is unknown, many theories discussed the potential of an angiogenic stimulus and an imbalance of inducers and inhibitors triggering the hyperplastic and neovascular response. The most frequently used modality for treatment of PG is surgical treatment. The proposed case represents an unexpected evolution to a possible therapeutic measure.
We represent a case of a 32-year-old male, known to have T-cell acute lymphoblastic leukemia treated successfully with chemotherapy, currently maintained on methotrexate (MTX) 40 mg and 6-mercaptopurine, 100 mg, presented with 1-month history of painful rapidly growing ulcerated nodules on his right-hand palm and middle finger. Both skin lesions developed approximately 3 months following patient initiation of maintenance treatment. Physical examination revealed two crusted nodules. A proximal lesion was observed over the palmar aspect between the second and third fingers, with the other one occurring alongside the distal phalanx of the third finger, measuring 2.5 cm × 1.5 cm, and 2.5 cm × 3.5 cm respectively. Skin biopsy was obtained from both lesions. The results of the histologic examination both revealed inflamed PG. Tissue cultures of both specimens tested positive for growth while no fungal and tuberculosis were cultured. Ciprofloxacin 500 mg twice daily, a 2-week course was started. Both lesions completely resolved at 10-day of antibiotic course with no recurrence.
This is a case of a patient with lobular capillary hemangioma of the hand treated successfully with no recurrence using an oral antibiotic. The proposed case represents an unexpected evolution to a possible therapeutic measure. The unexpected role of a conservative measure rather than the conventional surgical method in treating vascular tumors has been highlighted. Moreover, the contribution to an excellent cosmetic outcome has also been demonstrated.
小叶性毛细血管瘤，也称为化脓性肉芽肿（PG），是一种相对常见的良性、生长迅速、质地脆弱的皮肤和黏膜血管肿瘤。尽管PG的确切发病机制尚不清楚，但许多理论探讨了血管生成刺激以及诱导剂和抑制剂失衡引发增生和新生血管反应的可能性。治疗PG最常用的方法是手术治疗。本病例展示了一种意想不到的治疗措施演变。
我们报告一例32岁男性，已知患有T细胞急性淋巴细胞白血病，化疗成功，目前服用甲氨蝶呤（MTX）40毫克和6-巯基嘌呤100毫克维持治疗，右手掌和中指出现疼痛性迅速生长的溃疡结节1个月。这两个皮肤病变在患者开始维持治疗约3个月后出现。体格检查发现两个结痂结节。一个近端病变位于第二和第三指之间的手掌面，另一个位于第三指远节指骨旁，大小分别为2.5厘米×1.5厘米和2.5厘米×3.5厘米。从两个病变处获取皮肤活检样本。组织学检查结果均显示为炎症性PG。两个标本的组织培养均显示生长阳性，未培养出真菌和结核杆菌。开始每日两次服用500毫克环丙沙星，疗程为2周。抗生素疗程10天时，两个病变均完全消退，无复发。
这是一例手部小叶性毛细血管瘤患者，口服抗生素治疗成功且无复发。本病例展示了一种意想不到的治疗措施演变。突出了保守措施而非传统手术方法在治疗血管肿瘤中的意想不到的作用。此外，还证明了其对良好美容效果的贡献。
