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Pozo-Kreilinger JJ, Pena-Burgos EM, Ortiz-Cruz EJ, Cordero-García JM, Barrientos Ruiz I, Tapia-Viñe M, Peleteiro-Pensado M, Bernabéu-Taboada D. Primary intraosseous papillary intralymphatic angioendothelioma of the distal femoral epiphysis: a case report with literature review. Skeletal Radiol 2024:10.1007/s00256-024-04674-8. [PMID: 38619614 DOI: 10.1007/s00256-024-04674-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/29/2024] [Accepted: 04/01/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Papillary intralymphatic angioendothelioma (PILA) is an exceptionally rare metastasizing soft tissue tumor. It tends to arise in the subcutaneous tissues of distal extremities in children. Only four intraosseous PILA cases have been reported until now in English language literature. CASE REPORT We present a case of PILA arising in the distal femoral epiphysis of a 50-year-old female patient. It started as a relentless pain in her left knee. A plain radiography revealed a radiolucent area in the left internal femoral condyle. Computerized tomography revealed a 1-cm lytic lesion with a sclerotic rim. Magnetic resonance images showed a significant bone marrow edema signal focused on a 1-cm subchondral lesion suggestive of an intraarticular osteoid osteoma. Histologically, the tumor contained vascular channels covered by a single endothelial layer with intraluminal papillary endothelial structures lined with hobnail cells. Immunohistochemically, the cells were positive for ERG, CD31, and D2-40. The tumor underwent cryoablation and 6 months later, after local recurrence or tumor persistence, a wide tumor resection was referred. After 7 years of follow-up, the patient displayed neither local recurrence nor distant metastases. CONCLUSION Primary intraosseous PILAs are exceedingly rare tumors that should be considered in the differential diagnosis of vascular bone tumors.
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Affiliation(s)
| | - E M Pena-Burgos
- Pathology Department, Gregorio Marañón General University Hospital, Madrid, Spain.
| | - E J Ortiz-Cruz
- Orthopaedic Surgery and Traumatology Department, La Paz University Hospital, Madrid, Spain
| | | | - I Barrientos Ruiz
- Orthopaedic Surgery and Traumatology Department, La Paz University Hospital, Madrid, Spain
| | - M Tapia-Viñe
- Radiology Department, La Paz University Hospital, Madrid, Spain
| | - M Peleteiro-Pensado
- Orthopaedic Surgery and Traumatology Department, La Paz University Hospital, Madrid, Spain
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Intravascular papillary hemangioendothelioma disguised as a peripheral sheath tumor of median nerve at the wrist: a case report and literature review. Skeletal Radiol 2022; 52:1421-1426. [PMID: 36513787 DOI: 10.1007/s00256-022-04250-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 11/23/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Intravascular papillary hemangioendothelioma (IVPH) is a benign lesion previously reported in the nasal cavity, neck, upper extremities, and breast. Diagnosis with cross-sectional imaging can prove difficult, with histopathological examination necessary for diagnosis. IVPH resulting in carpal tunnel symptoms is quite rare. CASE PRESENTATION We report the case of a 37-year-old woman who presented with a radial, volar right wrist mass enlarging over the span of 5 years. She noted numbness and tingling in her wrist and thumb, exacerbated by minor accidental collisions and wrist hyperextension. There was no antecedent trauma. On examination, a mildly tender, mobile mass was evident at the volar aspect of the right wrist. Magnetic resonance imaging (MRI) with contrast demonstrated a lobulated, predominantly T2 hyperintense, heterogeneously enhancing mass thought to be a peripheral nerve sheath tumor. The patient elected for surgical excision of the mass, and the histopathological examination showed organizing thrombi with prominent papillary endothelial hyperplasia. At the 2-month follow-up, the patient had full range of motion of her fingers and wrist, with subjectively normal sensation in the distribution of the median nerve. CONCLUSION Carpal tunnel syndrome, in exceedingly rare occasions, can result from an IVPH. MRI findings may be confused with more common entities. Histopathological confirmation remains necessary for conclusive diagnosis.
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Ye P, Wei T, Cai YJ, Lu ZY. Oral papillary intralymphatic angioendothelioma: A case report and literature review. OTOLARYNGOLOGY CASE REPORTS 2022. [DOI: 10.1016/j.xocr.2022.100483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Pillai P, Gajanan Hegde S, Mahadevaiah Shubha A, Crasta J. Dabska Tumor – Out of site. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2022. [DOI: 10.1016/j.phoj.2022.03.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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5
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Papillary intralymphatic angioendothelioma: An extremely rare tumor. Jt Dis Relat Surg 2021; 32:245-248. [PMID: 33463445 PMCID: PMC8073449 DOI: 10.5606/ehc.2021.78112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/21/2020] [Indexed: 11/21/2022] Open
Abstract
Papillary intralymphatic angioendothelioma (PILA), an intralymphatic lesion of vascular ducts, is an extremely rare tumor. It is generally encountered as an unexpected pathology following excision of a vascular skin lesion. Re-excision is the commonly preferred treatment option once the pathological diagnosis is established. In this article, we present a 12-year-old male patient with a PILA treated with re-excision, skin grafting, and sentinel lymph node biopsy. The patient was symptom-free at annual follow-up. A sentinel lymph node biopsy during re-excision might be a good option in the surgical management of PILA. Frequent examination of lymph nodes and skin lesion also might be beneficial during the follow-ups.
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Gambarotti M, Righi A, Sbaraglia M, Bianchi G, Picci P, Vanel D, Tos APD. Intraosseous papillary intralymphatic angioendothelioma (PILA): one new case and review of the literature. Clin Sarcoma Res 2018; 8:1. [PMID: 29423171 PMCID: PMC5789605 DOI: 10.1186/s13569-018-0087-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 01/15/2018] [Indexed: 11/10/2022] Open
Abstract
Background Papillary intralymphatic angioendothelioma (PILA) is a locally aggressive, rarely metastasizing vascular tumor, generally occurring in the soft tissues, with less than 40 cases described in the literature and only three cases reported in bone. Case presentation We describe the case of a 51-year-old male with an intraosseous PILA of the proximal edge of his left clavicle and two other lesions evident on imaging. The patient was treated with marginal resection of the clavicle lesion but was lost to follow-up 1 month after surgery. Conclusions PILA can also occur in bone, albeit very rarely, and has to be considered in the differential diagnosis of vascular bone tumors.
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Affiliation(s)
| | - Alberto Righi
- 1Department of Pathology, Rizzoli Institute, Bologna, Italy.,5Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Marta Sbaraglia
- 2Department of Pathology, Treviso Regional Hospital, Treviso, Italy
| | - Giuseppe Bianchi
- 3Orthopaedic Oncology Department, Rizzoli Institute, Bologna, Italy
| | - Piero Picci
- 1Department of Pathology, Rizzoli Institute, Bologna, Italy
| | - Daniel Vanel
- 1Department of Pathology, Rizzoli Institute, Bologna, Italy
| | - Angelo Paolo Dei Tos
- 1Department of Pathology, Rizzoli Institute, Bologna, Italy.,2Department of Pathology, Treviso Regional Hospital, Treviso, Italy.,4University of Padua School of Medicine, Padua, Italy
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8
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Colmenero I, Hoeger P. Vascular tumours in infants. Part
II
: vascular tumours of intermediate dignity and malignant tumours. Br J Dermatol 2014; 171:474-84. [DOI: 10.1111/bjd.12835] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2013] [Indexed: 02/06/2023]
Affiliation(s)
- I. Colmenero
- Histopathology Department Birmingham Children's Hospital Birmingham U.K
| | - P.H. Hoeger
- Paediatric Dermatology Department Catholic Children's Hospital Wilhelmstift Hamburg Germany
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9
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Li B, Li Y, Tian XY, Li Z. Unusual multifocal intraosseous papillary intralymphatic angioendothelioma (Dabska tumor) of facial bones: a case report and review of literature. Diagn Pathol 2013; 8:160. [PMID: 24063649 PMCID: PMC3852300 DOI: 10.1186/1746-1596-8-160] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 09/17/2013] [Indexed: 11/10/2022] Open
Abstract
Abstract Papillary intralymphatic angioendothelioma (PILA) or Dabska tumor is extremely rare, and often affects the skin and subcutaneous tissues of children. Since its first description by Dabska, only a few intraosseous cases have been described in the literature and none of them presents with multifocal osteolytic lesion of bones. We present a case of unusual multifocal intraosseous PILA in facial bones occurring in a 1 year 3 month old male child. Computed tomography (CT) scan revealed multifocal osteolytic lesions were located at the left zygoma, left orbital bone and right maxillary. Histologically, the lesions were ill-defined and composed of multiple delicate interconnecting vascular channels with papillae formation which projected into the lumen lined by atypical plumped endothelial cells. The vascular channels were also lined by plump cuboidal endothelial cells with focal hobnailed or “match-head” appearance. In some areas, endothelial cells formed solid-appearing aggregates with vessel lumens. By immunohistochemistry, the tumor cells were positive for CD31, CD34 and D2-40 at varying intensity. A final diagnosis of intraosseous PILA was made. To the best of our knowledge, this case is the first case of primary multifocal osseous PILA. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1919488629100787
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Affiliation(s)
- Bin Li
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen university, 58, Zhongshan Road II, Guangzhou 510080, China.
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10
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Abstract
Hemangioendothelioma is the term used to name those vascular neoplasms that show a borderline biological behavior, intermediate between entirely benign hemangiomas and highly malignant angiosarcomas. Although originally spindle cell hemangioendothelioma was proposed as a specific clinicopathologic variant of hemangioendothelioma, currently, it is considered as an entirely benign lesion, and thus, the name spindle cell hemangioma seems to be the most accurate for this lesion. Authentic hemangioendotheliomas involving the skin and soft tissues include papillary intralymphatic angioendothelioma (also known as Dabska tumor), retiform hemangioendothelioma, kaposiform hemangioendothelioma, epithelioid hemangioendothelioma, pseudomyogenic hemangioendothelioma (also known as epithelioid sarcoma-like hemangioendothelioma), and composite hemangioendothelioma. Each of these neoplasms exhibit characteristic histopathologic features. The most characteristic finding of papillary intralymphatic hemangioendothelioma consists of papillary tufts, with a central hyaline core lined by hobnail-like endothelial cells protruding into the lumina. Retiform hemangioendothelioma is an infiltrative neoplasm composed of elongated arborizing vessels, arranged in an anastomosing pattern that resembles that of the rete testis, and lined by a single layer of hobnail-like endothelial cells that protrude within the narrow lumina. Kaposiform hemangioendothelioma is composed of several solid poorly circumscribed nodules, and each nodule is composed of a mixture of small capillaries and solid lobules of endothelial cells arranged in a glomeruloid pattern. A frequent finding consists of the presence of areas of lymphangiomatosis adjacent to the solid nodules. Epithelioid hemangioendothelioma is composed of cords, strands, and solid aggregates of round, oval, and polygonal cells, with abundant pale eosinophilic cytoplasm, vesicular nuclei, and inconspicuous nucleoli, embedded in a fibromyxoid or sclerotic stroma. Many neoplastic cells exhibit prominent cytoplasmic vacuolization as an expression of primitive vascular differentiation. Pseudomyogenic hemangioendothelioma is a poorly circumscribed, fascicular lesion with infiltrative borders composed of round or oval neoplastic cells, with vesicular nuclei and inconspicuous nucleoli, and ample homogeneous eosinophilic cytoplasm, giving them a rhabdomyoblastic appearance. Finally, composite hemangioendothelioma is the term used to name locally aggressive vascular neoplasms of low-grade malignancy showing varying combinations of benign, low-grade malignant, and high-grade malignant vascular components. From the immunohistochemical point of view, proliferating cells of all hemangioendotheliomas express a lymphatic endothelial cell immunophenotype. Most hemangioendotheliomas are low-grade vascular neoplasms, with a tendency to recur locally and a low metastatic potential, mostly to regional lymph nodes. Epithelioid hemangioendothelioma, especially large lesions and those located in deep soft tissues, seems to have a more aggressive biological behavior.
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Affiliation(s)
- Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain.
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Kitagawa Y, Tamai K, Kim Y, Hayashi M, Makino A, Takai S. Intravascular papillary endothelial hyperplasia of the digit: MRI features with histological correlation. J Hand Surg Eur Vol 2013; 38:306-12. [PMID: 22759484 DOI: 10.1177/1753193412453541] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
To clarify the magnetic resonance (MR) features of the pure form of intravascular papillary endothelial hyperplasia, MR images (MRIs) from five patients were retrospectively reviewed and compared with histological findings. The images showed a heterogeneous, iso- to slightly high signal intensity mass on T1-weighted images and a mass with a central heterogeneous, iso- to slightly high signal intensity area completely or incompletely surrounded by peripheral high signal intensity areas on T2-weighted images. Heterogeneous enhancement was observed after gadolinium administration. Histological studies indicated that the central heterogeneous area on T2-weighted images corresponded to thrombi (organized and/or hyalinized) and/or papillary endothelial proliferation, and also that the peripheral high signal intensity area corresponded to vascular blood space and/or papillary endothelial proliferation. The pure form of intravascular papillary endothelial hyperplasia showed relatively characteristic features on MRIs.
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Affiliation(s)
- Y Kitagawa
- Department of Orthopaedic Surgery, Tamanagayama Hospital, Nippon Medical School, Tokyo, Japan.
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Banik T, Sinha AK, Rai MK, Prasad J. Fine needle aspiration cytology of malignant endovascular papillary angioendothelioma. Diagn Cytopathol 2011; 39:514-6. [PMID: 21695802 DOI: 10.1002/dc.21475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2010] [Accepted: 05/28/2010] [Indexed: 11/10/2022]
Abstract
Here we described a rare case of malignant endovascular papillary angioendothelioma (Dabska tumor) in an adult female. On fine needle aspiration, the smear showed many small clusters of tumor cells with rosettoid arrangement along with papillary fragments with fibrovascular core and hobnail like arrangement of the cells. Histopathological examination revealed a vascular tumor in the form of papillary projection into the vascular lumina, lined by atypical endothelial cells.
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Affiliation(s)
- Tarak Banik
- Department of Pathology, Rajendra Institute of Medical Sciences, Ranchi, India.
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Abstract
We describe a pediatric case of primary angiosarcoma of the brain displaying striking intravascular papillary pattern, consistent with the "Dabska tumor," often in continuity with a massive, multifocal intravascular papillary endothelial hyperplasia. The tumor contained small hemangioma and obliterated dysplastic arteries as well as very large thin-walled veins. The surrounding brain tissue showed scattered telangiectasias, conglomerates of calcified dysplastic arteries, old hemorrhages and gliosis. Colocalization of these lesions suggests the development of a papillary angiosarcoma in the pre-existing vascular malformation. Although never reported, the possibility of a malignant transformation of endothelial papillary hyperplasia also should be considered in this case.
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Affiliation(s)
- Boleslaw Lach
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
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Maclean FM, Schatz J, McCarthy SW, Scolyer RA, Stalley P, Bonar SF. Epithelioid and spindle cell haemangioma of bone. Skeletal Radiol 2007; 36 Suppl 1:S50-7. [PMID: 16688448 DOI: 10.1007/s00256-006-0135-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2005] [Revised: 03/10/2006] [Accepted: 03/28/2006] [Indexed: 02/02/2023]
Abstract
A case of epithelioid and spindle cell haemangioma of bone occurring in the proximal femur is presented. The tumour had typical microscopic features with a striking lobular pattern comprising spindled and epithelioid areas with admixed inflammatory cells. The case represents only the eighth reported example of this rare tumour, which appears to fit in the spectrum of epithelioid haemangioma. This is the first case to involve the proximal portion of a long bone. A review of the classification and features of similar vascular tumours of bone is presented.
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Affiliation(s)
- Fiona M Maclean
- Douglass Hanly Moir Pathology, 95 Epping Road, Macquarie Park 2113, Australia.
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Bhatia A, Nada R, Kumar Y, Menon P. Dabska tumor (endovascular papillary angioendothelioma) of testis: a case report with brief review of literature. Diagn Pathol 2006; 1:12. [PMID: 16859564 PMCID: PMC1555613 DOI: 10.1186/1746-1596-1-12] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2006] [Accepted: 07/22/2006] [Indexed: 11/13/2022] Open
Abstract
The Dabska tumor also known as Endovascular papillary angioendothelioma is a rare type of hemangioendothelioma characterized by intraluminal papillary endothelial structures. Most of these are superficial in location but occurrence in deeper tissues is also known. We describe case report of testicular Dabska tumor in a child presenting as inguinal hernia. To the best of our knowledge this is the first case report describing the occurrence of this rare entity in testis.
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Affiliation(s)
- Alka Bhatia
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritambra Nada
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Yashwant Kumar
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Prema Menon
- Department of Pediatric surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Nakayama T, Nishino M, Takasu K, Hayakawa K, Toguchida J, Tanaka C. Endovascular papillary angioendothelioma (Dabska tumor) of bone. Orthopedics 2004; 27:327-8. [PMID: 15058457 DOI: 10.3928/0147-7447-20040301-19] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Takaoka K, Sakurai K, Noguchi K, Hashitani S, Urade M. Endovascular papillary angioendothelioma (Dabska tumor) of the tongue: report of a case. J Oral Pathol Med 2003; 32:492-5. [PMID: 12901732 DOI: 10.1034/j.1600-0714.2003.00120.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Endovascular papillary angioendothelioma (EPA), known as Dabska tumor, is a very rare vascular neoplasm that usually occurs in the skin or subcutis of infants and young children. There is no previous report of EPA appearing in the oral cavity. Here, we present an exceptionally rare case of EPA of the tongue in a 67-year-old man. A well-defined, reddish tumor measuring 11 mm x 8 mm x 7 mm existed at the submucosal area of the left tongue margin. Microscopic examination of an excisional biopsy specimen revealed the endothelioid tumor cells showing a papillary growth pattern, such as blood vessel-like structures. Immunohistochemical studies showed positive reactivities for CD31, CD34, alpha-smooth muscle actin, and factor VIII-related antigen in most of the tumor cells and CD68 in some tumor cells. Based on these observations, the tumor was diagnosed as an EPA.
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Affiliation(s)
- Kazuki Takaoka
- Department of Oral and Maxillofacial Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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