Elsevier

Auris Nasus Larynx

Volume 45, Issue 1, February 2018, Pages 190-193
Auris Nasus Larynx

A case of extensive pharyngeal vascular malformation successfully treated with Kampo medicine

https://doi.org/10.1016/j.anl.2017.03.008Get rights and content

Abstract

Objective

To present the efficacy of Japanese-traditional medicine (Kampo) for a case with vascular malformation.

Methods

A case study and literature review.

Patient

A 62-year-old female presented with dysphagia and spitting blood. Esophagogastroduodenoscopy showed a longitudinal lobulated and septated mass in the posterior pharynx. On MR imaging, the mass showed hyperintensity on T2-weighted images and heterogeneous enhancement on Gadlinium-enhanced T1-weighted images, suggestive of a low-flow vascular malformation.

Intervention

According to the Kampo diagnosis, kamisyouyousan and ninjinyoueito were prescribed to this patient. The effect of Kampo medicine was evaluated with improvement of her symptoms and volumetry of MRI findings.

Result

The longitudinal pharyngeal mass was markedly decreased and her symptoms disappeared after 2 years of Kampo administration.

Conclusions

Kampo medicine can be a novel alternative therapy for VM.

Introduction

Vascular malformations remain a therapeutic challenge. They are congenital lesions that never regress and grow with time, trauma, and/or hormonal changes. They are composed of abnormally formed vascular channels lined by endothelium that do not exhibit abnormal cellular turnover or mitosis. They may be of the low-flow variety, including capillary malformations (CM), venous malformations (VM), and lymphatic malformations (LM), or of the high-flow variety, including arteriovenous malformations (AVM). In the head and neck, venous malformations (VM) are the third most common vascular mass and may be seen within the muscles of mastication, lips, tongue, or elsewhere within the upper aerodigestive tract. The treatments of VM in the upper aerodigestive tract include laser treatment, resection, and sclerotherapy, but these therapeutic interventions are highly invasive and could cause a serious functional deterioration such as dyspnea or bleeding [1].

The confusion seen in Japan is that both vascular tumors and malformations are often called “hemangioma” in clinical practice. Indeed, VM has been often referred as “cavernous hemangioma”, “intramuscular hemangioma”, “venous hemangioma”, and so on. So, if the reviewer meant these types of “hemangioma”, VM could be the same as “hemangioma”.

The unique role played by traditional Japanese herbal (Kampo) medicine is gradually attracting worldwide attention. It is the most frequently used type of alternative and complementary medicine in Japan [2]. The aim of Kampo therapy is to improve patients’ condition regardless of their underlying diseases. Herein, we report on a patient suffering from an extensive pharyngeal low-flow vascular malformation causing chronic dysphagia which was successfully treated with Kampo medicine.

Section snippets

Case report

A 62-year-old woman with hemoptysis and dysphagia was referred to our Kampo clinic. She was diagnosed as having pharyngeal “hemangioma” at 50 years of age. She had difficulty in swallowing solid foods, difficulty in singing or talking loudly, and occasionally, was spitting blood. She had a history of endometriosis. Her social history included no drinking and no smoking. She had enjoyed singing karaoke, but she could not sing properly after exacerbation of the disease. Her symptoms exacerbated

Discussion

Venous malformations usually present lesion expansion, and spontaneous regression is rare. They may cause eventual alteration in function and/or esthetics. Therapeutic options include surgery, sclerotherapy, and laser treatment. Surgery is usually a second-line treatment option or is implemented in conjunction with sclerotherapy. The goals of therapy tends to revolve around controlling the disease with periodic interventions without harming preexisting form or function [3]. This patient

Conclusion

This is the first report of the marked efficacy of Kampo therapy on symptom improvement and volume reduction of a large oropharyngeal low-flow vascular malformation. In such an extensive case, in which the loco-regional treatments are invasive and limited in disease control, a systemic therapy vis-a-vis Kampo medicine can serve as a safe alternative option.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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