Overview the Causes of Early Deaths and Advance Supportive Care in Children with Acute Lymphoblastic Leukemia: A Systematic Review 2 2 Introduction: The objective of this study is to determine the major causes of early death in acute lymphoblastic leukemia (ALL). Methods: The following databases including PubMed, EMBASE, Science Direct and Google Scholar were searched for following terms: “acute lymphoblastic leukemia”, “early mortality”, “early death “ and “death in induction phase “. Inclusion criteria were all studies about the etiologies of early mortality in children with acute lymphoblastic leukemia. Early death means death occurs within 30 days of starting induction chemotherapy. Results: In total, 12 studies fulfilled inclusion criteria.7561 children under 18 years of age were studied in this review. Of these, 354 patients died during the induction phase of therapy. The early mortality rate was 4.6%±4.8. The most common cause of early death was an infection (52.5%), which was mainly bacterial. The second leading cause was bleeding (15%), and tumor lysis syndrome (4%) was the third most common cause. The other causes were septic shock (2%), hyperleukocytosis (2%), encephalopathy (1.7%), cardiomyopathy (1.7%), chemotherapy-related toxicity (1.2%), and thrombotic events (0.6%). Conclusion: It is needed to advance supportive care to prevent infection by starting Intravenous immunoglobulin for infant and prophylaxis against Pneumocystis jiroveci with trimethoprim/sulfamethoxazole in neutropenic patients during induction, and bleeding by transfusion support. 1 5 2020/07/24 1399/5/3 2022/03/21 1401/1/1 Nader Shakibazad Nader Shakibazad Bushehr University of Medical Sciences, Bushehr, Iran Iran nshakibazad@gmail.com Mohammadreza Bordbar Mohammadreza Bordbar Bushehr University of Medical Science, Shiraz, Iran Iran mbordbar53@gmail.com Early deaths Acute lymphoblastic leukemia Early mortality ## ##

Mir 143 rs353293 G>A Polymorphism is Not Associated with the Risk of Thyroid Cancer in the Iranian Population: A Case-Control Study 2 2 Background: Single nucleotide polymorphisms (SNPs) in the promoter region of miRNAs may disturb miRNAs processing, alter their expression, and ultimately affect an individual’s susceptibility to cancer. We conducted a case-control study to evaluate the association of rs353293 G>A with the risk of thyroid cancer in the Iranian population. Methods: 192 patients with thyroid cancer including (papillary, follicular, medullary, and undifferentiated) and 125 healthy subjects were enrolled in this case-control study. rs353293 G>A polymorphism in the promoter region of miR-143/145 were analyzed using polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP) to find the association of this SNP with thyroid cancer. Logistic regression analyses were conducted to evaluate adjusted odds ratios (ORs) for the potential confounding factors (age and sex), and 95% confidence intervals (95% CIs) between patients with thyroid cancer and controls. Results: We found no association between rs353293 G>A polymorphism and thyroid cancer. Conclusion: This study suggests that the functional polymorphism in rs353293 is not associated with development of thyroid cancer. Future investigations with larger sample size should be performed to confirm our observations. 6 11 2020/07/242020/06/16 1399/3/27 2022/03/212022/03/8 1400/12/17 Nima Montazeri-Najafabady Nima Montazeri-Najafabady Shiraz Endocrine and Metabolism Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran Iran montazerin@sums.ac.ir Mohammad Hossein Dabbaghmanesh Mohammad Hossein Dabbaghmanesh Shiraz Endocrine and Metabolism Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran Iran dabbaghm@sums.ac.ir Nazanin Chatrabnous Nazanin Chatrabnous Shiraz Endocrine and Metabolism Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran Iran chatrabnous2014@gmail.com Mohammad Reza Arabnezhad Mohammad Reza Arabnezhad Shiraz Endocrine and Metabolism Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran Iran mohammadarabnezhad1372@gmail.com Rajeeh Mohammadian Amiri Rajeeh Mohammadian Amiri Shiraz Endocrine and Metabolism Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran Iran Thyroid cancer rs353293 G>A polymorphism Mir 143 RFLP ## ##

Is Dietary Pattern Associated with Gastric Cancer Risk? A Case-control Study in Iran 2 2 Background: Diet is considered as an important contributor to the development of the cancers. In the present study, the association of dietary patterns with gastric cancer risk was studied. Methods: In the present case-control study, 192 newly diagnosed gastric cancer patients and 365 subjects as control group were included. The participants in each group underwent face-to-face interview. For food pattern determination, a 100-item qualitative food frequency questionnaire (FFQ) and exploratory factor analysis method were used. Logistic regression was used for determination of association between derived dietary patterns and gastric cancer risk. Results: Four major dietary patterns with 55.48% prediction rate, namely “tubers and spices”, “cereals and dairies”, “healthy” and “Western-style”, were identified. Tubers and spices [in males: 11.42 (4.17, 26.75); in females: 6.94 (2.24, 21.56)] and “Western-style” dietary patterns [ in males: 1.16 (1.00-4.35); in females: 2.25 (1.10, 6.49] significantly increased the odds of gastric cancer risk in both sex. However, “healthy” dietary pattern and “cereals and dairies” dietary pattern were not associated with gastric cancer risk (P>0.05). Conclusion: In Iranian population, consumption of diets high in tubers, spices and salts (labelled tubers and spices), processed meat, high energy drinks, snacks and desserts (labelled western-style) tended to increase the risk of gastric cancer. More longitudinal studies with large sample size and accurate estimate of dietary intake is suggested until more precise conclusion could be achieved. 12 17 2020/07/242020/06/162021/03/16 1399/12/26 2022/03/212022/03/82022/03/8 1400/12/17 Zeinab Nikniaz Zeinab Nikniaz Liver and gastrointestinal diseases research center, Tabriz University of medical sciences, Tabriz Iran Iran znikniaz@hotmail.com Mohammad Hossein Somi Mohammad Hossein Somi Liver and gastrointestinal diseases research center, Tabriz University of medical sciences, Tabriz Iran Iran mhosseinsina@yahoo.com Mohammad Asghati Jafarabadi Mohammad Asghati Jafarabadi Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Iran M.asghari862@gmail.com Shahnaz Naghashi Shahnaz Naghashi Liver and gastrointestinal diseases research center, Tabriz University of medical sciences, Tabriz Iran Iran Shahnaz.naghashi@gmail.com Elnaz Faramarzi Elnaz Faramarzi Liver and gastrointestinal diseases research center, Tabriz University of medical sciences, Tabriz Iran Iran Elnaz.faramarzi849@gmail.com Gastric cancer Dietary pattern Factor analysis Case-control study Iran ## ##

Clinical and Pathological Features of Iraqi Patients with Prostate Cancer 2 2 Background: The clinical pathological features were detected by measuring the prostatic acid phosphatase (PAP) activity according to the stages and grades of prostate cancer. We also explored the relationship between the disease and age with family history among the patients. Methods: Data were collected from direct interview and from the patient’s records. Blood samples that collected before the surgery from Baghdad hospitals. By using the ELISA device, PAP enzyme activity was determinred using Automated Chemiluminescent Immunometric Assay. Result: Older individuals were more likely to develop prostate cancer since out of the 50 samples collected, most (46%) were ≥60 years old. 23 (46%) cases were in stage II of PCa and 29 (58%) had grade-II as the most dominant stage and grade. Family history from parents to sons had a significant role in the possibility of being positive for prostate cancer. A positive family history was found in 72% of the cases of PCa, and it was found that the enzymatic activity of the PAP enzyme rises in the presence of prostate cancer. Conclusion: PAP enzyme is reliable in diagnosing the presence of prostate cancer, as the increase in the activity of the enzyme PAP coincides with the presence of prostate cancer. 18 22 2020/07/242020/06/162021/03/162022/04/30 1401/2/10 2022/03/212022/03/82022/03/82022/03/10 1400/12/19 Mohammed Mezher Hussein Mohammed Mezher Hussein Department of Optical Technology, College of Health and Medical Technique, Middle Technical University, Iraq Iraq Hind Sadeq Mohammed Hind Sadeq Mohammed Department of Medical Instrumentaion Engineering Techniques, Electrical Engineering Technical College, Middle Technical University, Iraq Iraq Prostate Phosphatase Cancer Immunometric assay Enzyme activity ## ##

Comparison Between Open and Ultrasonography Guided Venous Access Ports in Children with Malignancy 2 2 Background: Long-term central venous access is used in children for various reasons specially for delivering chemotherapy. Since vessels in children have smaller diameters, they are more prone to injury and complications such as thrombosis. Different methods are used for implantation of port-a-cath in children. We aimed to compare the complications of insertion of central venous access ports between two methods of open and ultrasound (US) guided. Methods: All children who were referred to pediatric surgery department of a children hospital from April 2018 to March 2020 for implantation of port-a-cath were included. Right jugular vein was the target vein and patients were randomly divided between two methods of insertion of open lateral neck exploration and ultrasound real-time guided percutaneous insertion and the reservoir was fixed in subpectoral fascia pouch. All open cases in which jugular vein was ligated proximally were excluded. Patients were followed up for early and late complications two days and one week later by the surgical team, then monthly by a trained nurse and were referred to the surgeon if any complication or malfunction had occurred for at least 6 months. Results: We included 76 patients (21 girls and 55 boys) less than 18 years of age: 24 patients with ultrasound guided method (1-13 years, median 3 years) and 52 patients with open exploration method (4 months-17 years, median 6 years). We observed no statistically significant difference between two groups with respect to sex, underlying disease, and complications. Most patients had hematological malignancies including ALL (52.9%), AML (19.1%) and the rest had solid organ malignancies. Early complications were observed in 2 (3.8%) in the open and 1 (4.2%) in the US- guided group (P=1). Late complications were observed in 9 (17.3%) patients in the open group and 1 (4.2%) in the US guided group. Infection was observed in 9.6% and malfunction in 5.8% of the open group leading to earlier removal of the catheter. There was not any complication indicative of infection in the US-guided group. Conclusion: US-guided method can be suggested for routine use as a safe method of insertion of port venous access in children. 23 28 2020/07/242020/06/162021/03/162022/04/302020/11/13 1399/8/23 2022/03/212022/03/82022/03/82022/03/102022/03/8 1400/12/17 Maryam Panahi Maryam Panahi Pediatric Surgery Research Center, Pediatric Institute for Children’s Health, Shahid Beheshti University of Medical Sciences,Tehran, Iran Iran maryam.neda.panahi@gmail.com Leyli Mohajerzadeh Leyli Mohajerzadeh Pediatric Surgery Research Center, Pediatric Institute for Children’s Health, Shahid Beheshti University of Medical Sciences,Tehran, Iran Iran mohajerzadehl@yahoo.com Mohsen Rouzrokh Mohsen Rouzrokh Pediatric Surgery Research Center, Pediatric Institute for Children’s Health, Shahid Beheshti University of Medical Sciences,Tehran, Iran Iran mohsen_rouzrokh@yahoo.com Parastou Molai Tavana Parastou Molai Tavana Pediatric Congenital Hematologic Disorder Research Center, Research Institute for Children’s health, Shahid Beheshti University of Medical Sciences, Tehran, Iran Iran dr_p1984@yahoo.com Fatemeh Abdollah Gorji Fatemeh Abdollah Gorji MSc.Mofid Clinical Research Development Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Iran fat_gorji@yahoo.com Javad Ghoroubi Javad Ghoroubi Pediatric Surgery Research Center, Pediatric Institute for Children’s Health, Shahid Beheshti University of Medical Sciences,Tehran, Iran Iran jghoroubi@yahoo.com Ahmad Khalegh Nejad Tabari Ahmad Khalegh Nejad Tabari Pediatric Surgery Research Center, Pediatric Institute for Children’s Health, Shahid Beheshti University of Medical Sciences,Tehran, Iran Iran khaleghnejad@gmail.com Children Central venous access Port-a-cath Ultrasound guided Open method Malignancy ## ##

Rare Absence of CD79alpha in B-ALLs is not Associated with Altered Prognosis 2 2 Background: The diagnosis of B-cell acute lymphoblastic leukemia (B-ALL) on the basis of the World Health Organization (WHO) recommendations in 2016 requires the expression of CD19 with CD79a (CD79a), cCD22 and CD10. CD79a is an integral B cell antigen expressed at all stages. Its absence in B-ALL has only been rarely reported. In this study, we described three cases of B-ALL showing complete loss or extremely weak expression of CD79a. Methods: Seventy-five patients with B-ALL diagnosed by flow cytometry over a period of 3.5 years were taken out from the records. Cases lacking for CD79a by flow cytometry were further analysed. Results: Out of 75 cases, CD 79a negativity was seen in 4% (3/75). However, every three cases expressed other B cell markers. No aberrant expression of myeloid and lymphoid antigens was seen in any of these three cases. The prognosis of these three cases was similar to CD79a positive cases. Conclusion: Rarely, B cell ALL may lack CD79a. Thus, to avoid the misdiagnosis, a comprehensive antibody panel should be used. There was no prognostic impact of CD79a negativity in this study, however larger studies are needed to confirm these results. 29 32 2020/07/242020/06/162021/03/162022/04/302020/11/132020/06/19 1399/3/30 2022/03/212022/03/82022/03/82022/03/102022/03/82022/03/11 1400/12/20 Neha Garg Neha Garg senior Resident, Department of Pathology, UCMS and GTBH India Malvika Shastri Malvika Shastri Junior Resident,Department of Pathology, UCMS and GTBH India Mrinalini kotru Mrinalini kotru Professor, Department of Pathology, UCMS and GTBH India Richa Gupta Richa Gupta Professor, Department of Pathology, UCMS and GTBH India richagupta0209@gmail.com B-cell acute lymphoblastic leukemia CD79a expression Flow cytometry Immunophenotyping Prognosis ## ##

Complex Arterial and Venous Thrombosis in Polycythemia Vera: what Does Leukocytosis Predict? 2 2 Thromboembolic events represent the main cause of morbidity and mortality in patients with polycythemia vera. Leukocytosis has been identified as an important risk factor for development of vascular thrombosis. A 47-year-old woman with polycythemia vera presented with pain and swelling in her right calf. She was scheduled to receive anagrelide which was effective on polycythemia and thrombocytosis, but leukocytosis persisted. She was diagnosed with thrombosis in right popliteal vein and left common femoral vein by duplex ultrasonography. We suggested a role for leukocytosis in inducing thrombotic phenomenon in our patient with polycythemia vera. 33 36 2020/07/242020/06/162021/03/162022/04/302020/11/132020/06/192021/01/3 1399/10/14 2022/03/212022/03/82022/03/82022/03/102022/03/82022/03/112022/02/16 1400/11/27 Denny Suwanto Denny Suwanto Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Hospital, Surabaya, Indonesia Indonesia suwantodenny88@gmail.com Muhammad Aminuddin Muhammad Aminuddin Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Hospital, Surabaya, Indonesia Indonesia maminuddincardio@gmail.com Eka Prasetya Budi Mulia Eka Prasetya Budi Mulia Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Hospital, Surabaya, Indonesia Indonesia eka.prasetya.budi-2017@fk.unair.ac.id Polycythemia vera Thrombotic event Leukocytosis Thrombocytosis Treatment ## ##

Erythrophagocytosis in Peripheral Blood Smear of a Patient with Urinary Tract Infection 2 2 Erythrophagocytosis refers to the removal of old and damaged red blood cells by leukocytes and macrophages. Observation of erythrophagocytosis in peripheral blood smear is a rare phenomenon that is mostly observed in paroxysmal cold hemoglobinuria and sporadically in some other pathological conditions. Here, we report a case of erythrophagocytosis by monocyte in peripheral blood of a patient with urinary tract infection. 37 39 2020/07/242020/06/162021/03/162022/04/302020/11/132020/06/192021/01/32020/10/29 1399/8/8 2022/03/212022/03/82022/03/82022/03/102022/03/82022/03/112022/02/162022/03/10 1400/12/19 Asra Amelirad Asra Amelirad Kowsar Medical laboratory, Kowsar Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran Iran asra.amelirad@gmail.com Parisa Modarresi Parisa Modarresi Department of Pathology, Kowsar Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran. Iran dr.parisapatho@gmail.com Farzad Abedi Farzad Abedi Department of Urology, Kowsar Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran. Iran dr.aabedi.urologist@gmail.com Hassan Soltani Hassan Soltani Vice Chancellor for Health Affairs, Kurdistan University of Medical Sciences, Sanandaj, Iran Iran soltanihasan64@gmail.com Erythrophagocytosis Peripheral blood smear Urinary tract infection ## ##

Recurrent Pneumothorax and Pneumomediastinum as a Complication of COVID-19 in a Young Athlete 2 2 A novel coronavirus, SARS-CoV-2 was identified as the cause of a cluster of pneumonia cases in Wuhan, China in December 2019. Coronavirus Disease 2019 (COVID-19) has rapidly spread worldwide. Numerous studies have shown diverse findings on chest CT scan of the patients with COVID-19. The established well-known features of COVID-19 on chest imaging include bilateral multilobar ground-glass opacification (GGO) predominantly with peripheral distribution, mainly in the lower lobes. Atypical presentation of consolidative opacities superimposed on GGO may be found in a smaller number of cases, mainly in the elderly populations. Pleural and pericardial effusion, lymphadenopathy, cavitation, halo sign on CT scan, and pneumothorax are uncommon but may be seen with disease progression. We report a case of severe COVID-19 in an athlete man with development of bilateral pneumothorax, pneumomediastinum and subcutaneous emphysema during progression of the disease. The only risk factor for severe COVID-19 in our patient was suggested to be chronic use of dexamethasone as anabolic steroids. Our patient also received three sessions of plasmapheresis. Unfortunately, the patient expired due to recurrence of bilateral pneumothorax and pneumomediastinum. 40 43 2020/07/242020/06/162021/03/162022/04/302020/11/132020/06/192021/01/32020/10/292022/04/30 1401/2/10 2022/03/212022/03/82022/03/82022/03/102022/03/82022/03/112022/02/162022/03/102022/03/10 1400/12/19 Soha Mohammadi Moghaddam Soha Mohammadi Moghaddam Pediatric Congenital Hematologic Disorders Research Center, Research Institute for Children’s health, Shahid Beheshti University of Medical Sciences, Tehran, Iran Iran Sina Maghsoudlou Sina Maghsoudlou Pediatric Congenital Hematologic Disorders Research Center, Research Institute for Children’s health, Shahid Beheshti University of Medical Sciences, Tehran, Iran Iran Hadi Choubdar Hadi Choubdar School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Iran Mahdi Mahdavi Mahdi Mahdavi School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Iran Mojtaba Nikoogadam Mojtaba Nikoogadam Department of Internal Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Iran Pneumothorax Pneumomediastinum COVID-19 ## ##

Discriminating Indices between Common Microcytic Anemias and Normal Population 2 2 Thalassemia minor (MT), either β or α, is the most frequent single gene mutation in human beings affecting 6% of population worldwide. It is more frequent in the Mediterranean region, Africa and South-East Asia. On the other hand Iron deficiency anemia (IDA), either nutritional or secondary to gastrointestinal or menstrual bleeding, is the most frequent cause of acquired anemia. Differentiation between these two types of anemia is important because both of them present themselves as microcytic anemia.2-6 However, in the thalassemia belt, some patients may have mixed IDA and TM.Therefore discrimination indexes should discriminate three categories from the normal population and each other. 44 45 2020/07/242020/06/162021/03/162022/04/302020/11/132020/06/192021/01/32020/10/292022/04/302022/04/30 1401/2/10 2022/03/212022/03/82022/03/82022/03/102022/03/82022/03/112022/02/162022/03/102022/03/102022/03/10 1400/12/19 Mahdi Shahriari Mahdi Shahriari Pediatric Hematologist-oncologist, Shiraz University of Medical Sciences, Shiraz, Iran Iran Discriminating Indices Microcytic Anemias Hematology ## ##

Kaposiform Hemangioendothelioma of Abdominal Wall Associated with Kasabach-Merritt in A Newborn with Dramatic Response to Sirolimus and Vincristine 2 2 Kaposiform Hemangioendotheliomawas (KHE) first described in 1993 by Zukerberg and colleagues as a distinctive lesion of infancy and early childhood with common features to both hemangiomas and Kaposi’s sarcoma. It is a rare vascular tumor typically seen as a cutaneous lesion with ill-defined borders. In this study we presented A 26-day-old male infant with KHE. 46 48 2020/07/242020/06/162021/03/162022/04/302020/11/132020/06/192021/01/32020/10/292022/04/302022/04/302022/04/30 1401/2/10 2022/03/212022/03/82022/03/82022/03/102022/03/82022/03/112022/02/162022/03/102022/03/102022/03/102022/03/10 1400/12/19 Samin Alavi Samin Alavi Pediatric Congenital Hematologic Disorders Research Center, Research Institute for Children’s health, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Iran Kaposiform Hemangioendothelioma Kasabach-Merritt Vincristine Sirolimus. Zukerberg, L.R., B.J. Nickoloff, and S.W. Weiss, Kaposiform hemangioendothelioma of infancy and childhood. An aggressive neoplasm associated with Kasabach-Merritt syndrome and lymphangiomatosis. The American journal of surgical pathology, 1993. 17(4): p. 321-328.##Fletcher, C., et al., WHO Classification of Tumours of Soft Tissue and Bone: WHO Classification of Tumours, vol. 5. 2013.##Croteau, S.E., et al., Kaposiform hemangioendothelioma: atypical features and risks of Kasabach-Merritt phenomenon in 107 referrals. The Journal of pediatrics, 2013. 162(1): p. 142-147.##Sarkar, M., et al., Thrombocytopenic coagulopathy (Kasabach-Merritt phenomenon) is associated with Kaposiform hemangioendothelioma and not with common infantile hemangioma. Plastic and reconstructive surgery, 1997. 100(6): p. 1377-1386.##Ji, Y., et al., Kaposiform haemangioendothelioma: clinical features, complications and risk factors for Kasabach-Merritt phenomenon. British Journal of Dermatology, 2018. 179(2): p. 457-463.##Adams, D.M., et al., Vascular anomaly cases for the pediatric hematologist oncologists-an interdisciplinary review. Pediatric Blood & Cancer, 2018. 65(1): p. e26716.##Mahajan, P., J. Margolin, and I. Iacobas, KasabachMerritt phenomenon: classic presentation and management options. Clinical Medicine Insights: Blood Disorders, 2017. 10: p. 1179545X17699849.##Rodriguez, V., et al., Kasabach-Merritt phenomenon: case series and retrospective review of the mayo clinic experience. Journal of pediatric hematology/ oncology, 2009. 31(7): p. 522-526.##Liu, Q., et al., Clinicopathological features of Kaposiform hemangioendothelioma. International journal of clinical and experimental pathology, 2015. 8(10): p. 13711.##Ryu, Y.J., et al., Imaging findings of kaposiform hemangioendothelioma in children. European Journal of Radiology, 2017. 86: p. 198-205.##Azma, R., et al., Multifocal kaposiform hemangioendothelioma of soft tissue with bilateral pulmonary involvement in an adolescent. Korean journal of pediatrics, 2014. 57(11): p. 500.##Ji, Y., et al., Sirolimus for the treatment of progressive kaposiform hemangioendothelioma: a multicenter retrospective study. International Journal of Cancer, 2017. 141(4): p. 848-855.##Cashell, J., et al., Kaposiform hemangioendothelioma with Kasabach-Merritt phenomenon in an infant: Successful treatment with prednisolone, vincristine, and addition of sirolimus. Pediatric Blood & Cancer, 2018. 65(12): p. e27305.##Wang, H., et al., Sirolimus as initial therapy for kaposiform hemangioendothelioma and tufted angioma. Pediatric dermatology, 2018. 35(5): p. 635-638.##Koury, J., et al., Use of Sirolimus in a Premature Neonate With Kaposiform Hemangioedema. The Journal of Pediatric Pharmacology and Therapeutics, 2021. 26(2): p. 205-209.## ##