Vascular tumors

I spent the weekend at a professional otolaryngology meeting. I find these meetings interesting largely because I seldom learn what the speakers think they are going to to teach me. Rather, the I typically learn tidbits in the hallways during casual conversation. This time, two independent talks seem to run on parallel tracks.

I don't encounter vascular tumors very often, but on the first day, the meeting concentrated on hemangiomas in children. Several years ago some otolaryngologists in France (Christine Léauté-Labrèze, Eric Dumas de la Roque, Thomas Hubiche & Franck Boralevi. Propranolol for Severe Hemangiomas of Infancy) serendipitously discovered that children with hemangiomas, who took propranolol for their heart conditions, had their hemangiomas disappear surprisingly quickly. In fact, the character of the hemangioma changed within a day. Pretty quickly, over the past several years, medical treatment with propranolol has largely replaced what were some rather large and morbid surgeries at times. It seems that the propranolol starts to constrict the blood vessels even within hours of taking it.

During the second day of the conference, on different topics, a physician presenter demonstrated his surgical technique on juvenile nasopharyngeal angiofibromas and commented about how much blood loss there typically was during surgery and how difficult some of them are to get out. He largely seemed to be trying to demonstrate a technique for peeling these tumors out of nooks and crevices at the base of the brain. The striking analogy to me, was not the technique, but rather that these complaints or complications of surgical treatment of a vascular lesion were the same problems that were noted about the surgical management of hemangioma's of infancy in the past.

I wonder if propranolol would have a beneficial effect on juvenile nasopharyngeal angiofibromas. They are vascular tumors. They bleed easily with surgical removal. Medical treatments, such as hormone therapy with testosterone doesn't necessarily work very well. Radiation therapy doesn't work well. While it is possible that propranolol would not work at all, it seems at least possible that it would constrict the blood vessels and reduce blood loss during surgery. Perhaps if given for a longer period of time, it might even shrink the tumor to some degree. It would seem worth a try.

Sometimes it seems that it's the transfer of ideas from one area to the other, rather than a completely new idea,