Kumar Bitesh, Kulkarni Kaushal, Kumar Dhua Anjan, Prabudh Goel, Kumar Yadav Devendra, Vishesh Jain, Sandeep Agarwala, Kavneet Kaur, Devasenathipathy Kandasamy
Department of Pediatric Surgery, AIIMS, Delhi, India.
Department of Pathology, AIIMS, Delhi, India.
J Indian Assoc Pediatr Surg. 2024 Nov-Dec;29(6):589-595. doi: 10.4103/jiaps.jiaps_111_24. Epub 2024 Nov 5.
Intranodal hemangiomas are rare benign vascular tumors of the lymph nodes, often misdiagnosed as malignant lymphadenopathies due to their clinical and radiological features. This case report and systematic review aim to elucidate the epidemiology, clinical profile, and therapeutic interventions for intranodal hemangioma, enhancing diagnostic accuracy and management.
A systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches were conducted in PubMed, Scopus, Web of Science, and Google Scholar up to March 15, 2024, using keywords like "intranodal hemangioma," "primary intranodal hemangioma," "nodal hemangioma," "vascular tumor," and "lymph node hemangioma." Inclusion criteria included studies on clinical presentation, diagnostic strategies, and therapeutic interventions for intranodal hemangioma in patients of all ages. Excluded were reviews, opinion pieces, non-English studies, cases of hemangioendothelioma, sclerosing hemangioma, and animal studies. Key aspects analyzed included demographics, clinical presentation, management strategies, and histopathological findings.
Our case involves a 3-year-old female with a submandibular mass, initially diagnosed with hemangioma. After no response to beta-blocker therapy and conflicting imaging results, surgical excision was performed. Histopathology confirmed intranodal hemangioma. From 233 records, 19 publications (36 patients, including our case) met the inclusion criteria. The review shows common clinical presentations as painless, slowly enlarging lymph nodes, primarily in the cervical and axillary regions. Diagnostic challenges often require imaging and biopsy to differentiate from malignancies.
Recognizing intranodal hemangiomas, particularly in childhood, is crucial to prevent misdiagnosis and inappropriate treatment. The rarity of these tumors in childhood and their clinical presentation similar to malignancies in older patients make diagnosis challenging without widespread awareness. Surgical excision remains the mainstay of both diagnosis and treatment, often leading to favorable outcomes.
结内血管瘤是一种罕见的淋巴结良性血管肿瘤，由于其临床和放射学特征，常被误诊为恶性淋巴结病。本病例报告和系统评价旨在阐明结内血管瘤的流行病学、临床特征和治疗干预措施，提高诊断准确性和管理水平。
系统评价遵循系统评价和Meta分析的首选报告项目指南。截至2024年3月15日，在PubMed、Scopus、科学网和谷歌学术上进行检索，使用“结内血管瘤”、“原发性结内血管瘤”、“淋巴结血管瘤”、“血管肿瘤”和“淋巴结血管瘤”等关键词。纳入标准包括对各年龄段患者结内血管瘤的临床表现、诊断策略和治疗干预的研究。排除综述、观点文章、非英语研究、血管内皮瘤、硬化性血管瘤病例和动物研究。分析的关键方面包括人口统计学、临床表现、管理策略和组织病理学发现。
我们的病例是一名3岁女性，下颌下有肿块，最初诊断为血管瘤。在β受体阻滞剂治疗无效且影像学结果相互矛盾后，进行了手术切除。组织病理学证实为结内血管瘤。从233条记录中，19篇出版物（36例患者，包括我们的病例）符合纳入标准。综述显示，常见的临床表现为无痛、缓慢增大的淋巴结，主要位于颈部和腋窝区域。诊断挑战通常需要影像学和活检来与恶性肿瘤相鉴别。
认识结内血管瘤，尤其是在儿童期，对于防止误诊和不适当治疗至关重要。这些肿瘤在儿童期罕见，且其临床表现与老年患者的恶性肿瘤相似，在缺乏广泛认识的情况下，诊断具有挑战性。手术切除仍然是诊断和治疗的主要方法，通常会带来良好的结果。
