Intravascular Cutaneous Disorders. A Clinicopathologic Review

Cutaneous Intravascular Hematolymphoid Entities: A Review

Intravascular lymphomas are rare disease conditions that exhibit neoplastic lymphoid cells that are confined mainly to the lumens of small capillaries and medium-sized vessels. The majority of the intravascular lymphomas are of B-cell origin, but they can include NK/T-cell and CD30+ immunophenotypes. In the histologic differential diagnosis are benign proliferations such as intralymphatic histiocytosis and intravascular atypical CD30+ T-cell proliferation. In this review, we discuss the clinical, histopathologic, and molecular findings of intravascular B-cell lymphoma, intravascular NK/T-cell lymphoma, intralymphatic histiocytosis, and benign atypical intravascular CD30+ T-cell proliferation.

Giant papillary hemangioma-A rare tumor with an exceptional size

Papillary hemangioma (PH) is a recently described vascular tumor with a predilection for the skin of the head and neck. Histopathologically, it is characterized by a bland endothelial proliferation arranged in a papillary configuration, bearing resemblance to glomeruloid hemangioma seen in the context of polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes syndrome. The largest cutaneous PH reported to date measured 1.5 cm in greatest dimension. Here, we report a case of PH with an alarming size of 10 cm. We present this case to add to the limited literature on this rare tumor, highlight the histopathologic differences between PH and its mimics, and emphasize the variable nature of PH tumor size.

Lower Eyelid Complication After Blepharoplasty and COVID-19 Vaccination

BACKGROUND

Following COVID-19 mass vaccination campaign, new- and unknown-related reactions have emerged.

CASE REPORT

Four months after transcutaneous lower blepharoplasty and few days after the second dose of SARS-CoV-2 Pfizer mRNA vaccination, a 57-year-old man developed a bilateral palpebral ecchymosis. While the lesion healed spontaneously on the left side, the ecchymosis on the right lower lid did not regress. It presented swelling and hard consistency, clinically involving only skin layer. No alterations were revealed upon blood tests and instrumental evaluations. Histological examination showed lymphovascular hyperplasia on a probable reactive basis. The lesion was resistant to medical and surgical therapies. After 15 months, it regressed spontaneously.

CONCLUSIONS

In the reported case, an evident chronological relationship exists between surgical site and vaccine reaction, while other etiopathogenetic factors were excluded. This case represents a previously undescribed condition linking postvaccination reaction and long-term surgical outcome.

LEVEL OF EVIDENCE V

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Characterization of intravascular papillary endothelial hyperplasia: a multicenter cohort

Intravascular papillary endothelial hyperplasia (IPEH) is an uncommon benign malformation of the skin and subcutaneous tissue. In this retrospective multi-center study, we aimed to investigate the clinical and pathological features of 261 IPEH cases. We classified IPEH into three categories from most common to least common: pure (50%), mixed (46%), and extravascular types (4%). IPEH frequently stained positive for immunohistochemical markers such as CD31, SMA, ERG, CD34. Clinicians' initial impression of the lesion often included ambiguous terms such as "soft tissue mass." There is an opportunity for increased awareness of this lesion and its consideration within a differential diagnosis.

Intravascular histiocytosis: mimicker of cellulitis, angiosarcoma, inflammatory breast cancer, and others

BACKGROUND

Intravascular histiocytosis is an underrecognized reactive skin condition characterized by the clinical finding of poorly demarcated erythematous to violaceous patches and plaques. The diagnosis is confirmed by the histologic findings of intraluminal histiocytes on skin biopsy and exclusion of an alternative diagnosis.

METHODS

A review of patients with a histologic diagnosis of intravascular or intralymphatic histiocytosis and seen at Mayo Clinic, Rochester, Minnesota, from January 1, 2010, to October 10, 2020, was performed. Histologic and clinical information was collected from the medical records.

RESULTS

Nine patients were identified. Clinical impressions prior to biopsy varied widely, and no clinician included intravascular histiocytosis in the initial clinical differential diagnosis. Eight patients had preceding trauma to the affected area.

CONCLUSION

Intravascular histiocytosis remains a rare skin condition. Clinical identification remains low. Our cases add support to the hypothesis that intravascular histiocytosis is a reactive condition often preceded by trauma and/or surgery.