Epithelioid Hemangioma Responsive to Oral Propranolol

Abstract

An 11-year-old boy presented with progressive right-sided proptosis and an orbital mass on neuroimaging. Incisional biopsy revealed an epithelioid hemangioma. The patient underwent an orbitotomy with subtotal excision of the mass. However, the tumor recurred and progressed to the cavernous sinus, despite oral steroids, tacrolimus, and a second subtotal excision. Because of encouraging results reported with beta-blockers in the treatment of pediatric capillary hemangiomas, the patient was subsequently started on oral propranolol, 2 mg/kg/day, with discontinuation of steroids and tacrolimus. A rapid and impressive interval decrease in tumor size was observed, with improvement in proptosis and exposure keratopathy. The patient remains without recurrence approximately 9 months after initiation of propranolol. Our results suggest that oral propranolol may be a potential alternative therapy when complete excision of an epithelioid hemangioma is not practical.

Propranolol: a novel treatment for angiolymphoid hyperplasia with eosinophilia

“…There is only one previous report of the use of oral propranolol for ALHE, but the lesions in that patient presented as a superotemporal orbital mass affecting his vision, instead of the more typical, subcutaneous periauricular lesions. 8 As reported above, the use of propranolol in this patient, with a typical presentation of ALHE, was successful in reducing the growth rate of several lesions and reducing the size of several more lesions. We believe that the success of both monoclonal antibody therapy and propranolol is due to them targeting the vascular proliferative element of ALHE.…”

“…These latter approaches have been reported as successful, but given the cost of biological therapies, may be untenable as a treatment in many clinical situations. There is only one previous report of the use of oral propranolol for ALHE, but the lesions in that patient presented as a superotemporal orbital mass affecting his vision, instead of the more typical, subcutaneous periauricular lesions . As reported above, the use of propranolol in this patient, with a typical presentation of ALHE, was successful in reducing the growth rate of several lesions and reducing the size of several more lesions.…”

The effectiveness of propranolol in treating infantile haemangiomas: a meta‐analysis including 35 studies

“…Subsequently, seven studies were excluded because of initial treatment with a combination of propranolol and other treatment modalities (Figure ). Data from the 35 reports consisting of 324 IH patients and 248 controls matching the inclusion and exclusion criteria were included in current meta‐analysis . Of these, 34 studies with 323 IH patients and 247 controls compared the efficacy of propranolol and steroids in treating IHs, 10 studies with 10 IH patients and 10 controls compared the propranolol vs. a vincristine subgroup and six studies with six IH patients and six controls compared propranolol vs. a laser subgroup.…”

β-Adrenergic receptor expression in vascular tumors

“…In addition, propranolol has recently been reported to induce resolution of an aggressive, recurring orbital epithelioid hemangioma. 28 These examples illustrates that propranolol may be an important single or adjunctive therapy in many vascular lesions.…”