title: 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.
authors.affiliation: Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, USA. hmoss@unch.unc.edu
authors.forename: Hart B
authors.initials: HB
authors.lastname: Moss
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Sines
authors.forename: Julie
authors.initials: J
authors.lastname: Blatt
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Dutton
authors.forename: Alan D
authors.initials: AD
authors.lastname: Proia
mesh_terms: D000284:Administration, Oral; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D002648:Child; D005094:Exophthalmos / Q000175:diagnosis; D006391:Hemangioma / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009364:Neoplasm Recurrence, Local; D013508:Ophthalmologic Surgical Procedures; D009918:Orbital Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D011433:Propranolol / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed
chemical_list: D000319:Adrenergic beta-Antagonists; D011433:Propranolol