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multiple myofibromas&#44; or subcutaneous fat necrosis&#46; Histopathology showed an increased number of ectatic vessels in the dermis and was interpreted as a capillary malformation&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">At 6 months&#44; the plaques had acquired an annular pattern&#44; with an erythematous halo&#44; depressed blue-violaceous center&#44; ectatic vessels&#44; and flaccid skin &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A further biopsy&#44; performed because of the lack of clinical-pathological correlation&#44; revealed a dermis with vascular structures surrounded by several layers of monomorphic round cells with eosinophilic cytoplasm &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#46; Immunohistochemistry showed the perivascular glomus cells to be positive for vimentin and &#945;-actin and negative for desmin and S100 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46; Based on these findings&#44; we made a diagnosis of congenital plaque-type GVM&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Initially we took a wait-and-see approach&#46; Over the following years&#44; the plaques extended to the adjacent skin and took on a more atrophic appearance&#44; with very dilated vessels&#46; No new lesions appeared&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">At 7 years of age&#44; the lesions were still asymptomatic&#44; but their appearance &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41; negatively affected the patient&#39;s self-esteem&#44; leading us to evaluate the treatment options&#46; The size of the lesions limited a possible surgical intervention&#46; It was decided to start treatment with combined pulsed dye &#40;PDL&#41; &#40;595<span class="elsevierStyleHsp" style=""></span>nm&#41; and neodymium-doped yttrium aluminium garnet &#40;Nd&#58;YAG&#41; &#40;1064<span class="elsevierStyleHsp" style=""></span>nm&#41; lasers &#40;Cynergy Multiplex&#8482;&#44; Cynosure&#44; Westford&#44; Massachusetts&#44; United States&#41;&#44; with a spot size of 10<span class="elsevierStyleHsp" style=""></span>mm&#44; a PDL pulse duration of 0&#46;5<span class="elsevierStyleHsp" style=""></span>ms and fluence of 8&#46;5-9<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#44; followed by a pulse of Nd&#58;YAG with a duration of 15<span class="elsevierStyleHsp" style=""></span>ms and fluence of 50<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#46; A cooling system was used simultaneously to prevent epidermal damage&#46; The sessions were performed under general anesthesia every 2 or 3 months&#46; The post-treatment recommendations included oral analgesia and photoprotection&#46; At the time of writing&#44; the patient has received 10 sessions of laser therapy&#44; with lightening of the color of the lesions and a reduction in lesion volume and in the caliber of the vessels &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>D&#41;&#46; Treatment has been well tolerated and no complications have been detected&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">GVMs account for 5&#37; of venous malformations &#40;VM&#41; and are distinct from sporadic VMs and from hereditary mucocutaneous VMs&#46; A familial tendency is detected in 88&#37;&#44; with an autosomal dominant inheritance pattern and incomplete penetrance &#40;90&#37;&#41;&#46; Their etiology has been related to mutations in the glomulin gene &#40;<span class="elsevierStyleItalic">GLMN</span>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> GVMs are usually multiple and tend to appear at an early age&#46; They can present as papular-nodular lesions or as plaques&#44; and may be congenital<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> or acquired&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Congenital plaque-type GVMs present clinically as bluish plaques with a cobblestone surface&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> or as atrophic plaques with telangiectasias&#44;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;4&#8211;9</span></a> as in our patient&#46; A segmental distribution is often observed&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Histology is characterized by a nonencapsulated proliferation of ectatic vascular channels surrounded by 1 or several layers of polygonal glomus cells&#46; Immunohistochemistry is positive for &#945;-smooth muscle actin and vimentin and negative for desmin&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The clinical course of plaque-type GVMs varies&#46; Progressive thickening and darkening of the lesions has been reported&#44; as well as a tendency to spread into adjacent unaffected areas&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> as was seen in our patient&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The objectives of treatment of GVMs are to relieve pain and improve function and cosmetic appearance&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#44;7&#44;9</span></a> Surgery is an option for small localized lesions&#46; Treatments such as sclerotherapy and ablative therapy have been used in multiple or extensive GVMs&#44; but results have not been consistent&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> There are also descriptions of cases treated with Nd&#58;YAG laser with good results&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> and PDL lasers have been reported to be useful for the more superficial component of the lesions&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> The dual laser &#40;PDL&#47;Nd&#58;YAG&#41; allows us to treat different depths of the skin using lower fluences and thus minimize the risk of scars or necrosis&#46; There are 2 previous reports of congenital plaque-type GVM treated successfully with the combined PDL&#47;Nd&#58;YAG laser&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> using higher Nd&#58;YAG fluences than those employed in our patient&#44; with no complications &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">In conclusion&#44; we have presented a case of congenital plaque-type GVM that&#44; in its initial phases&#44; was included in the series by Mallory et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> We draw attention to its uncommon clinical presentation&#44; which was a diagnostic challenge and required histopathological confirmation&#44; the atypical clinical course over 11 years&#44; and the favorable response to combined laser treatment&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Vargas-Navia N&#44; Baselga E&#44; Mu&#241;oz-Garza FZ&#44; Puig L&#46; Malformaci&#243;n glomovenosa cong&#233;nita en placas&#58; 11 a&#241;os de seguimiento y respuesta al tratamiento con l&#225;ser combinado PDL&#47;Nd&#58; YAG&#46; Actas Dermosifiliogr&#46; 2017&#59;108&#58;72&#8211;74&#46;</p>"
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        "etiqueta" => "Figure 1"
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          0 => array:4 [
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical course of the lesions&#46; A&#44; Newborn&#58; erythematous-violaceous plaques on the back&#46; B&#44; At 6 months of age&#58; plaques with prominent vessels&#44; erythematous borders&#44; and a blue-violaceous center&#46; C&#44; Before laser treatment &#40;7 years of age&#41;&#46; D&#44; After 10 sessions of combined pulsed dye and neodymium-doped yttrium aluminium garnet laser treatment &#40;11 years of age&#41;&#46;</p>"
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      1 => array:7 [
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        "etiqueta" => "Figure 2"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histopathology&#46; A&#44; Blood vessels of different calibers surrounded by several layers of monomorphic round cells&#46; Hematoxylin and eosin&#44; original magnification<span class="elsevierStyleHsp" style=""></span>&#215;20&#41;&#46; B&#44; Positivity for &#945;-smooth muscle actin&#46; Immunohistochemistry&#44; original magnification<span class="elsevierStyleHsp" style=""></span>&#215;20&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reference&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age and Sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Site Affected&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Fluence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pulse Duration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Spot Size&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; of Sessions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Follow-up Period&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Response&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Complications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34 y<br>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Left arm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PDL 8<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span><br>Ns&#58;YAG 70<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PDL&#58; 0&#46;5<span class="elsevierStyleHsp" style=""></span>ms<br>Ns&#58;YAG&#58; 15<span class="elsevierStyleHsp" style=""></span>ms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><br>10<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Resolution of the pain&#44; lightening of color and volume reduction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 mo<br>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Scalp&#44; trunk&#44; abdomen&#44; back&#44; right inguinal region and thighs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PDL&#58; 6<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span><br>Ns&#58;YAG&#58; 110<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PDL&#58; 0&#46;5<span class="elsevierStyleHsp" style=""></span>ms<br>Ns&#58;YAG&#58; 20<span class="elsevierStyleHsp" style=""></span>ms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18 mo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lightening of color and size reduction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Our patient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 y<br>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Back&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PDL&#58; 8&#46;5<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">9</span><br>Ns&#58;YAG&#58; 50<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">9</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PDL&#58; 0&#46;5<span class="elsevierStyleHsp" style=""></span>ms<br>Ns&#58;YAG&#58; 15<span class="elsevierStyleHsp" style=""></span>ms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lightening of color and reduction of volume and of vessel caliber&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patients With Congenital Plaque-Type Glomuvenous Malformations Treated With Combined Pulsed Dye and Neodymium-Doped Yttrium Aluminium Garnet Laser&#46;</p>"
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    "bibliografia" => array:2 [
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Vol. 108. Núm. 1.
Páginas 72-74 (enero - febrero 2017)
Vol. 108. Núm. 1.
Páginas 72-74 (enero - febrero 2017)
Case and Research Letter
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Congenital Plaque-type Glomuvenous Malformation: 11 Years of Follow-up and Response to Treatment With the Combined Pulsed-Dye and Neodymium:Yttrium-Aluminum-Garnet Laser
Malformación glomovenosa congénita en placas: 11 años de seguimiento y respuesta al tratamiento con láser combinado PDL/Nd: YAG
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N. Vargas-Navia
Autor para correspondencia
navana2@hotmail.com

Corresponding author.
, E. Baselga, F.Z. Muñoz-Garza, L. Puig
Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Table 1. Patients With Congenital Plaque-Type Glomuvenous Malformations Treated With Combined Pulsed Dye and Neodymium-Doped Yttrium Aluminium Garnet Laser.
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To the Editor:

Glomuvenous malformations (GVM), previously known as glomangiomas, show a familial tendency and are characterized histologically by the presence of vascular channels surrounded by a variable number of glomus cells. There is a rare form that presents as plaques. The treatment of these lesions has still not been standardized.

Our patient was a newborn boy from a twin pregnancy, born preterm at 34 weeks, with erythematous plaques present on his back since birth. There was no family history of similar lesions. On physical examination, nonpulsatile, depressed erythematous-violaceous plaques were observed on the boy's back (Fig. 1A). We performed skin biopsy to clarify our differential diagnosis of capillary malformation, multiple myofibromas, or subcutaneous fat necrosis. Histopathology showed an increased number of ectatic vessels in the dermis and was interpreted as a capillary malformation.

Figure 1.

Clinical course of the lesions. A, Newborn: erythematous-violaceous plaques on the back. B, At 6 months of age: plaques with prominent vessels, erythematous borders, and a blue-violaceous center. C, Before laser treatment (7 years of age). D, After 10 sessions of combined pulsed dye and neodymium-doped yttrium aluminium garnet laser treatment (11 years of age).

(0.28MB).

At 6 months, the plaques had acquired an annular pattern, with an erythematous halo, depressed blue-violaceous center, ectatic vessels, and flaccid skin (Fig. 1B).

A further biopsy, performed because of the lack of clinical-pathological correlation, revealed a dermis with vascular structures surrounded by several layers of monomorphic round cells with eosinophilic cytoplasm (Fig. 2A). Immunohistochemistry showed the perivascular glomus cells to be positive for vimentin and α-actin and negative for desmin and S100 (Fig. 2B). Based on these findings, we made a diagnosis of congenital plaque-type GVM.

Figure 2.

Histopathology. A, Blood vessels of different calibers surrounded by several layers of monomorphic round cells. Hematoxylin and eosin, original magnification×20). B, Positivity for α-smooth muscle actin. Immunohistochemistry, original magnification×20.

(0.18MB).

Initially we took a wait-and-see approach. Over the following years, the plaques extended to the adjacent skin and took on a more atrophic appearance, with very dilated vessels. No new lesions appeared.

At 7 years of age, the lesions were still asymptomatic, but their appearance (Fig. 1C) negatively affected the patient's self-esteem, leading us to evaluate the treatment options. The size of the lesions limited a possible surgical intervention. It was decided to start treatment with combined pulsed dye (PDL) (595nm) and neodymium-doped yttrium aluminium garnet (Nd:YAG) (1064nm) lasers (Cynergy Multiplex™, Cynosure, Westford, Massachusetts, United States), with a spot size of 10mm, a PDL pulse duration of 0.5ms and fluence of 8.5-9J/cm2, followed by a pulse of Nd:YAG with a duration of 15ms and fluence of 50J/cm2. A cooling system was used simultaneously to prevent epidermal damage. The sessions were performed under general anesthesia every 2 or 3 months. The post-treatment recommendations included oral analgesia and photoprotection. At the time of writing, the patient has received 10 sessions of laser therapy, with lightening of the color of the lesions and a reduction in lesion volume and in the caliber of the vessels (Fig. 1D). Treatment has been well tolerated and no complications have been detected.

GVMs account for 5% of venous malformations (VM) and are distinct from sporadic VMs and from hereditary mucocutaneous VMs. A familial tendency is detected in 88%, with an autosomal dominant inheritance pattern and incomplete penetrance (90%). Their etiology has been related to mutations in the glomulin gene (GLMN).1 GVMs are usually multiple and tend to appear at an early age. They can present as papular-nodular lesions or as plaques, and may be congenital2 or acquired.3

Congenital plaque-type GVMs present clinically as bluish plaques with a cobblestone surface,1 or as atrophic plaques with telangiectasias,2,4–9 as in our patient. A segmental distribution is often observed.5

Histology is characterized by a nonencapsulated proliferation of ectatic vascular channels surrounded by 1 or several layers of polygonal glomus cells. Immunohistochemistry is positive for α-smooth muscle actin and vimentin and negative for desmin.1–3

The clinical course of plaque-type GVMs varies. Progressive thickening and darkening of the lesions has been reported, as well as a tendency to spread into adjacent unaffected areas,2 as was seen in our patient.

The objectives of treatment of GVMs are to relieve pain and improve function and cosmetic appearance.6,7,9 Surgery is an option for small localized lesions. Treatments such as sclerotherapy and ablative therapy have been used in multiple or extensive GVMs, but results have not been consistent.10 There are also descriptions of cases treated with Nd:YAG laser with good results,9 and PDL lasers have been reported to be useful for the more superficial component of the lesions.6 The dual laser (PDL/Nd:YAG) allows us to treat different depths of the skin using lower fluences and thus minimize the risk of scars or necrosis. There are 2 previous reports of congenital plaque-type GVM treated successfully with the combined PDL/Nd:YAG laser,10 using higher Nd:YAG fluences than those employed in our patient, with no complications (Table 1).

Table 1.

Patients With Congenital Plaque-Type Glomuvenous Malformations Treated With Combined Pulsed Dye and Neodymium-Doped Yttrium Aluminium Garnet Laser.

Reference  Age and Sex  Site Affected  Fluence  Pulse Duration  Spot Size  No. of Sessions  Follow-up Period  Response  Complications 
34 y
Male 
Left arm  PDL 8J/cm2
Ns:YAG 70J/cm2 
PDL: 0.5ms
Ns:YAG: 15ms 

10mm 
1 y  Resolution of the pain, lightening of color and volume reduction  None 
6 mo
Female 
Scalp, trunk, abdomen, back, right inguinal region and thighs  PDL: 6J/cm2
Ns:YAG: 110J/cm2 
PDL: 0.5ms
Ns:YAG: 20ms 
10mm  18 mo  Lightening of color and size reduction  None 
Our patient  11 y
Male 
Back  PDL: 8.5J/cm9
Ns:YAG: 50J/cm9 
PDL: 0.5ms
Ns:YAG: 15ms 
10mm  10  11 y  Lightening of color and reduction of volume and of vessel caliber  None 

In conclusion, we have presented a case of congenital plaque-type GVM that, in its initial phases, was included in the series by Mallory et al.2 We draw attention to its uncommon clinical presentation, which was a diagnostic challenge and required histopathological confirmation, the atypical clinical course over 11 years, and the favorable response to combined laser treatment.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

References
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Glomuvenous malformation (glomangioma) and venous malformation: Distinct clinicopathologic and genetic entities.
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Congenital plaque-type glomuvenous malformations presenting in childhood.
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Plaque-type glomuvenous malformations successfully treated using combined pulsed dye laser and neodymium-doped yttrium aluminum garnet laser.
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Nd:YAG laser treatment for multiple cutaneous glomangiomas: Report of 3 cases.
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Please cite this article as: Vargas-Navia N, Baselga E, Muñoz-Garza FZ, Puig L. Malformación glomovenosa congénita en placas: 11 años de seguimiento y respuesta al tratamiento con láser combinado PDL/Nd: YAG. Actas Dermosifiliogr. 2017;108:72–74.

Copyright © 2016. Elsevier España, S.L.U. and AEDV
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