Letter - Dermatopathology
Blue rubber bleb nevus syndrome and multiple glomangiomas: report of two cases highlighting the importance of the histological analysis
Elsa Stella Mosquera-Belalcazara, Aline Alves Dominguesa, Alessandra Coppinia, Laura Luzzattob, Ana Elisa Kiszewskia,c,d,
Corresponding author
a Service of Dermatology, Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
b Department of Pathology, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
c Department of Internal Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
d Pediatric Dermatology Unit, Dermatology Service, Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
Read
4035
Timeswas read the article
1343
Total PDF
2692
Total HTML
Share statistics
array:22 [ "pii" => "S036505962300017X" "issn" => "03650596" "doi" => "10.1016/j.abd.2022.04.013" "estado" => "S300" "fechaPublicacion" => "2023-05-01" "aid" => "714" "copyrightAnyo" => "2023" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "pt" => array:17 [ "pii" => "S2666275223000401" "issn" => "26662752" "doi" => "10.1016/j.abdp.2023.02.013" "estado" => "S300" "fechaPublicacion" => "2023-05-01" "aid" => "714" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "pt" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta ‐ Dermatopatologia</span>" "titulo" => "Síndrome de <span class="elsevierStyleItalic">Blue Rubber Bleb Nevus</span> e glomangioma múltiplo: relato de dois casos destacando a importância da histopatologia" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "410" "paginaFinal" => "414" ] ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2057 "Ancho" => 2925 "Tamanyo" => 314661 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Glomangiomas. Múltiplas lesões vasculares na região cervical e uma única lesão palpável na coxa direita.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Elsa Stella Mosquera‐Belalcazar, Aline Alves Domingues, Alessandra Coppini, Laura Luzzatto, Ana Elisa Kiszewski" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Elsa Stella" "apellidos" => "Mosquera‐Belalcazar" ] 1 => array:2 [ "nombre" => "Aline Alves" "apellidos" => "Domingues" ] 2 => array:2 [ "nombre" => "Alessandra" "apellidos" => "Coppini" ] 3 => array:2 [ "nombre" => "Laura" "apellidos" => "Luzzatto" ] 4 => array:2 [ "nombre" => "Ana Elisa" "apellidos" => "Kiszewski" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S036505962300017X" "doi" => "10.1016/j.abd.2022.04.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S036505962300017X?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223000401?idApp=UINPBA00008Z" "url" => "/26662752/0000009800000003/v3_202305121556/S2666275223000401/v3_202305121556/pt/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S0365059623000132" "issn" => "03650596" "doi" => "10.1016/j.abd.2022.04.012" "estado" => "S300" "fechaPublicacion" => "2023-05-01" "aid" => "712" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - Dermatopathology</span>" "titulo" => "Invasive extramammary Paget's disease with lymph node metastases and high-grade B-cell lymphoma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "414" "paginaFinal" => "418" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 891 "Ancho" => 2508 "Tamanyo" => 519953 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Clinical findings. A subcutaneous mass in the right inguinal area is observed. (A) Atypical cells with a pale cytoplasm proliferated rapidly, and the findings are similar to those of previous invasive Paget’s disease (Hematoxylin & eosin, ×400).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Misato Ueda, Makoto Omori, Ayumi Sakai" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Misato" "apellidos" => "Ueda" ] 1 => array:2 [ "nombre" => "Makoto" "apellidos" => "Omori" ] 2 => array:2 [ "nombre" => "Ayumi" "apellidos" => "Sakai" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275223000383" "doi" => "10.1016/j.abdp.2023.02.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223000383?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623000132?idApp=UINPBA00008Z" "url" => "/03650596/0000009800000003/v3_202305121633/S0365059623000132/v3_202305121633/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0365059622003154" "issn" => "03650596" "doi" => "10.1016/j.abd.2021.11.011" "estado" => "S300" "fechaPublicacion" => "2023-05-01" "aid" => "694" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "article" "crossmark" => 1 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - Clinical</span>" "titulo" => "Syringocystadenoma papilliferum in the scalp, with a linear presentation" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "406" "paginaFinal" => "409" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2020 "Ancho" => 3008 "Tamanyo" => 529333 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0130" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Red papillomatous projection with central ulceration in an erythematous background and polymorphic vessels in the periphery of the lesion (asterisk) (B) Another lesion with multiple ulcerations, whitish-yellow crusts (asterisk), and small white circles (arrow) on the periphery.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marina Monaco, Virginia Mariana González, Felix Alberto Vigovich, Margarita Larralde" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Marina" "apellidos" => "Monaco" ] 1 => array:2 [ "nombre" => "Virginia Mariana" "apellidos" => "González" ] 2 => array:2 [ "nombre" => "Felix Alberto" "apellidos" => "Vigovich" ] 3 => array:2 [ "nombre" => "Margarita" "apellidos" => "Larralde" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S266627522300019X" "doi" => "10.1016/j.abdp.2023.01.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S266627522300019X?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059622003154?idApp=UINPBA00008Z" "url" => "/03650596/0000009800000003/v3_202305121633/S0365059622003154/v3_202305121633/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - Dermatopathology</span>" "titulo" => "Blue rubber bleb nevus syndrome and multiple glomangiomas: report of two cases highlighting the importance of the histological analysis" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "410" "paginaFinal" => "414" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Elsa Stella Mosquera-Belalcazar, Aline Alves Domingues, Alessandra Coppini, Laura Luzzatto, Ana Elisa Kiszewski" "autores" => array:5 [ 0 => array:3 [ "nombre" => "Elsa Stella" "apellidos" => "Mosquera-Belalcazar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Aline Alves" "apellidos" => "Domingues" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Alessandra" "apellidos" => "Coppini" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Laura" "apellidos" => "Luzzatto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:4 [ "nombre" => "Ana Elisa" "apellidos" => "Kiszewski" "email" => array:1 [ 0 => "kiszewski@gmail.com" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Service of Dermatology, Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Pathology, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Internal Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Pediatric Dermatology Unit, Dermatology Service, Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 2195 "Ancho" => 2925 "Tamanyo" => 1125723 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Glomangioma. Dilated vascular spaces lined by glomus cells. (A) Hematoxylin & eosin (×100). (B) Hematoxylin & eosin (×400); (C) Immunohistochemistry positive for smooth muscle actin (×400). (D) Immunohistochemistry positive for caldesmon ×400).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Blue rubber bleb nevus syndrome (BRBNS) is characterized by multiple venous malformations that often affect the skin and gastrointestinal tract, in some cases causing intestinal bleeding and iron-deficiency anemia.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> BRBNS is associated with an autosomal dominant inheritance and equally affects males and females.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Glomangiomas arise from modified perivascular muscle cells, more often affect the male sex, and have an autosomal dominant inheritance pattern.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case reports</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case 1</span><p id="par0010" class="elsevierStylePara elsevierViewall">An 11-year-old female had a history of bluish lesions on the right earlobe and left thigh since birth. The parents reported progressive increase in lesion size over the years and the appearance of new similar lesions. The clinical examination showed a violaceous lesion on the left thigh with slight swelling on palpation, measuring 4×1<span class="elsevierStyleHsp" style=""></span>cm, a violaceous papule on the right earlobe measuring 1.5×1<span class="elsevierStyleHsp" style=""></span>cm, discrete violaceous spots on the lumbar region and a small violaceous spot on the right shoulder, measuring 0.5<span class="elsevierStyleHsp" style=""></span>cm (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The patient had been diagnosed with polycystic kidney disease and was being followed by a nephrologist. The Doppler echocardiogram of the left thigh showed a hypervascular lesion with predominantly venous flow and no signs of an arteriovenous fistula. The cranial angiotomography showed ectasia of cortical veins in both parietal regions. Histopathology of the lesion in the dorsal region showed dilated dermal capillaries positive for CD34 on immunohistochemistry. These findings were compatible with blue rubber bleb nevus syndrome (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Colonoscopy and endoscopy of the upper digestive tract showed no alterations.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Case 2</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 13-year-old healthy female was referred to the Dermatology Service for evaluation of a multifocal vascular lesion in the cervical region, present since birth. She reported the recent appearance of new lesions on her face and right thigh (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The Computed tomography angiography (CTA) of the cervical region showed the presence of a group of small vessels with subcutaneous, semilunar distribution in the lateral cervical region, in addition to large vessels with normal diameters and trajectories. The histological study of the lesion on the right thigh showed a poorly circumscribed vascular proliferation in the skin, dilated vascular spaces, and the presence of glomus cells lining the endothelium. Immunohistochemistry was positive for smooth muscle actin, caldesmon and negative for CD34, desmin and S100 (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). The histopathological and immunohistochemical findings were compatible with the diagnosis of glomangioma.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="par0020" class="elsevierStylePara elsevierViewall">BRBNS, also known as Bean syndrome, is a rare condition, in which multiple vascular malformations usually arise in the skin and digestive tract, and which can also affect other organs such as the heart, liver, spleen, eyes, central nervous system, lung, bladder, thyroid and parotids. The lesions appear more frequently in the skin and small intestine and may lead to digestive bleeding and iron deficiency anemia. The lesions may be present at birth but tend to increase in size and number throughout life.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4,5</span></a> Glomangiomas originate from the glomus bodies in the venous system. Glomus cells are modified smooth muscle cells that are important in regulating body temperature.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Glomangiomas usually present as multiple lesions that may be present at birth or appear later, during childhood. The lesions do not usually affect the subungual region and may affect systemic organs. Before the anatomopathological evaluation, BRBNS is usually the most frequently considered diagnosis.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In addition, it is important to consider other differential diagnoses for multiple glomangioma, such as hemangiomas, venous malformations, and Maffucci syndrome.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Both primary lesions are described as bluish papules with vascular appearance and varying sizes. Both types of lesions tend to be painless, but painful lesions are not uncommon. Glomangiomas can be painful during pregnancy and menstrual periods.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Moreover, both lesions show a wide cutaneous distribution, potentially affecting the face, trunk, or extremities.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,6,7</span></a> An important consideration is that multiple glomangiomas primarily affect the skin, whereas the involvement of the skin and the gastrointestinal tract is very common in BRBNS.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Autosomal dominant inheritance has also been demonstrated in both diseases.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,6</span></a> In BRDNS, it is linked to somatic mutations in the TEK gene encoding the TIE2 protein, a tyrosine kinase-like membrane receptor for angiopoietins (vascular growth factors) present in endothelial cells. Multifocal malformations such as BRBN are predominantly caused by two somatic mutations in the same TEK gene allele.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In glomangiomas, an autosomal dominant pattern with incomplete penetrance and variable expression caused by a mutation in the glomulin gene (GLMN) located on chromosome 1p21-p22 has been described.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">On histopathology, dilated vascular spaces and the presence of glomus cells lining the endothelium are unique to glomangiomas, together with positive immunohistochemistry for SMA (marker of actin-related protein present in smooth muscle), caldesmon (marker of actin- and calmodulin-related protein present in smooth muscle) and myosin (marker of protein present in muscles), which confirms the muscular nature of these cells. These immunohistochemical markers are negative in BRBNS. In the latter, irregular dilated capillary spaces surrounded by a thin layer of endothelial cells (which are CD34-positive) can be identified in the dermis or subcutaneous adipose tissue.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The diagnosis of BRBN is confirmed by histopathological and immunohistochemical examination and a wide range of therapies have been described, from watchful waiting to surgical excision, laser therapy, sclerotherapy of lesions and systemic sirolimus. Treatment will vary according to the symptoms, organ involvement, and development of complications over the course of the disease, taking into account that patients with mild gastrointestinal bleeding can be managed conservatively with iron supplements and transfusions. On the other hand, patients showing greater severity are advised to start systemic treatment with sirolimus. Sirolimus acts by inhibiting angiogenesis and has shown good results.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,7,10</span></a> Treatments described for glomangioma, on the other hand, involve surgical excision, laser therapy and sclerotherapy of the lesions or watchful waiting.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The clinical similarities between these two conditions in the absence of histological study can lead to an incorrect diagnosis and, therefore, to inadequate treatment.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> It should be noted that a multidisciplinary therapeutic approach is recommended in patients with both diagnoses.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Financial support</span><p id="par0050" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Authors’ contributions</span><p id="par0055" class="elsevierStylePara elsevierViewall">Elsa Stella Mosquera-Belalcazar: Drafting and editing of the manuscript.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Aline Alves Domingues: Review of the literature and drafting of the manuscript.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Alessandra Coppinni: Review of the literature and drafting of the manuscript.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Laura Luzzatto: Effective participation in data analysis; approval of the final version of the manuscript.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Ana Elisa Kiszewski: Design and planning of the study; critical review of the manuscript and approval of the final version of the manuscript.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Case reports" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Case 1" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Case 2" ] ] ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Financial support" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Authors’ contributions" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-02-14" "fechaAceptado" => "2022-04-27" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Pediatric Dermatology Unit, Dermatology Service, Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre, RS, Brazil.</p>" ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1854 "Ancho" => 2925 "Tamanyo" => 309526 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">BRBNS. Violaceous papule on the right earlobe and violaceous lesion on the left thigh, with slight swelling on palpation.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2195 "Ancho" => 2925 "Tamanyo" => 1098187 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">BRBNS. Dilated capillaries lined by a thin layer of endothelial cells. (A) Hematoxylin & eosin (×40). (B) Hematoxylin & eosin, (×100). (C) Hematoxylin & eosin (×400). (D) Immunohistochemistry positive for CD34, showing the vascular endothelium (×400).</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2057 "Ancho" => 2925 "Tamanyo" => 314661 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Glomangiomas. Multiple vascular lesions in the cervical region and a single palpable lesion on the right thigh.</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 2195 "Ancho" => 2925 "Tamanyo" => 1125723 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Glomangioma. Dilated vascular spaces lined by glomus cells. (A) Hematoxylin & eosin (×100). (B) Hematoxylin & eosin (×400); (C) Immunohistochemistry positive for smooth muscle actin (×400). (D) Immunohistochemistry positive for caldesmon ×400).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Blue Rubber Bleb Nevus Syndrome. 2022 jul 11" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Baigrie" 1 => "A.S. Rice" 2 => "I.C. An" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "titulo" => "StatPearls [Internet]" "fecha" => "2022" "editorial" => "StatPearls Publishing" "editorialLocalizacion" => "Treasure Island (FL)" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and management of children with Blue Rubber Bleb Nevus Syndrome: A multi-center case series" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Isoldi" 1 => "D. Belsha" 2 => "I. Yeop" 3 => "A. Uc" 4 => "N. Zevit" 5 => "P. Mamula" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Dig Liver Dis" "fecha" => "2019" "volumen" => "51" "paginaInicial" => "1537" "paginaFinal" => "1546" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multiple glomangiomas: Potential for confusion with blue rubber bleb nevus syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Lu" 1 => "R.A. Kratben" 2 => "R.L. Sanchez" 3 => "S. Hsu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2004.12.019" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2005" "volumen" => "52" "paginaInicial" => "731" "paginaFinal" => "732" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15793549" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hereditary multiple glomangiomas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Iqbal" 1 => "G.C. Cormack" 2 => "G. Scerri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1054/bjps.1997.0116" "Revista" => array:6 [ "tituloSerie" => "Br J Plast Surg" "fecha" => "1998" "volumen" => "51" "paginaInicial" => "32" "paginaFinal" => "37" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9577316" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Venous malformations in blue rubber bleb nevus syndrome: Variable onset of presentation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W.K. Nahm" 1 => "S. Moise" 2 => "L.F. Eichenfield" 3 => "A.S. Paller" 4 => "L. Nathanson" 5 => "D.M. Malicki" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0190-9622(03)02468-x" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2004" "volumen" => "50" "paginaInicial" => "S101" "paginaFinal" => "S106" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15097941" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multiple familial cutaneous glomangioma: A pedigree of 4 generations and critical analysis of histologic and genetic differences of glomus tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "U. Blume-Peytavi" 1 => "Y.D. Adler" 2 => "C.C. Geilen" 3 => "W. Ahmad" 4 => "A. Christiano" 5 => "S. Goerdt" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2000" "volumen" => "42" "paginaInicial" => "633" "paginaFinal" => "639" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Blue rubber bleb nevus syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.N. Mayba" 1 => "K. Cullingham" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "CMAJ" "fecha" => "2019" "volumen" => "191" "paginaInicial" => "E841" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Familial generalized multiple glomangiomyoma: report of a new family, with immunohistochemical and ultrastructural studies and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Calduch" 1 => "C. Monteagudo" 2 => "E. Martínez-Ruiz" 3 => "D. Ramón" 4 => "I. Pinazo" 5 => "C. Cardá" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1046/j.1525-1470.2002.00114.x" "Revista" => array:6 [ "tituloSerie" => "Pediatr Dermatol" "fecha" => "2002" "volumen" => "19" "paginaInicial" => "402" "paginaFinal" => "408" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12383095" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A novel mutation of the glomulin gene in an Italian family with autosomal dominant cutaneous glomuvenous malformations" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.G. Borroni" 1 => "N. Narula" 2 => "M. Diegoli" 3 => "M. Grasso" 4 => "M. Concardi" 5 => "R. Rosso" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Exp Dermatol" "fecha" => "2011" "volumen" => "20" "paginaInicial" => "1032" "paginaFinal" => "1034" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sirolimus in blue rubber bleb naevus syndrome: A systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "X.L. Wong" 1 => "K. Phan" 2 => "A.I. Rodríguez Bandera" 3 => "D.F. Sebaratnam" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jpc.14345" "Revista" => array:6 [ "tituloSerie" => "J Paediatr Child Health" "fecha" => "2019" "volumen" => "55" "paginaInicial" => "152" "paginaFinal" => "155" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30565378" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03650596/0000009800000003/v3_202305121633/S036505962300017X/v3_202305121633/en/main.assets" "Apartado" => array:4 [ "identificador" => "95152" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter - Dermatopathology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009800000003/v3_202305121633/S036505962300017X/v3_202305121633/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S036505962300017X?idApp=UINPBA00008Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 33 | 6 | 39 |
| 2024 October | 157 | 69 | 226 |
| 2024 September | 152 | 80 | 232 |
| 2024 August | 162 | 111 | 273 |
| 2024 July | 155 | 91 | 246 |
| 2024 June | 141 | 89 | 230 |
| 2024 May | 125 | 64 | 189 |
| 2024 April | 135 | 81 | 216 |
| 2024 March | 145 | 67 | 212 |
| 2024 February | 165 | 76 | 241 |
| 2024 January | 173 | 50 | 223 |
| 2023 December | 120 | 61 | 181 |
| 2023 November | 104 | 83 | 187 |
| 2023 October | 84 | 73 | 157 |
| 2023 September | 88 | 76 | 164 |
| 2023 August | 68 | 30 | 98 |
| 2023 July | 89 | 36 | 125 |
| 2023 June | 151 | 54 | 205 |
| 2023 May | 284 | 60 | 344 |
| 2023 April | 92 | 10 | 102 |
| 2023 March | 43 | 56 | 99 |
| 2023 February | 26 | 20 | 46 |
Show all
