Inconsistent immunohistochemical expression of lymphatic and blood endothelial cell markers in cutaneous lymphangiomas

Diagnostic Values of Dermatoscopy and CD31 Expression in Cutaneous Lymphangioma Circumscriptum

Background: Cutaneous lymphangioma circumscriptum is characterized by clusters of deep-seated, vesicle-like papules. Cutaneous lymphangioma circumscriptum (CLC) is not a tumor but rather a congenital malformation of superficial lymphatics.

Objectives: The study aimed to describe the dermoscopic features of CLC and investigate the reason why marked blood components in CLC. Moreover, this study sought to increase awareness of the clinical characteristics of CLC and provide insights into CLC diagnosis.

Methods: A representative sample of patients with CLC with demographic information and pathological and dermoscopical results was analyzed. The immunohistochemistry of lymphangioma specimens with CD31 and D2-40 was performed. The clinical manifestations of CLC, demographic information, and the results of immunohistochemistry were statistically analyzed to validate the correlation.

Results: Besides the pattern of frog spawn-like blisters, lymphangioma also presented as either transparent or pigmented with dark-red to whitish/yellowish shades. Moreover, lymphangioma manifested as a pattern of dermatofibroma. Furthermore, CD31 was detected in the flattened endothelium and only present in dilated spaces containing enough blood or lymph components.

Limitations: This study is limited by its retrospective nature and statistical power.

Conclusion: Dermoscopy is useful for the diagnosis of CLC. CD31 positive staining and cystic-dilated spaces showed flattened inner and outer endothelia are the diagnostic features in hypopyon-like shape and blisters resembling frog spawn patterns in CLC. These features can assist in the diagnosis of CLC.

Clinicopathological and Immunohistochemical Study of 14 Cases of Morbihan Disease: An Insight Into Its Pathogenesis

INTRODUCTION

Morbihan disease (MORD) is rare with only 45 clear-cut cases previously reported. Histopathologic findings are supposed to be nonspecific. We report 14 patients and review the previous cases.

OBJECTIVES

To characterize the clinicopathologic findings, outcomes, and immunophenotype of MORD.

MATERIAL AND METHODS

Inclusion criteria were a clinical picture of persistent, nonpitting edema affecting the mid and or upper third of the face and histopathological findings fitting previous reports and exclusion of other entities.

RESULTS

The majority of our patients were males (71.5%) with a male/female ratio of 10/4. The mean age when diagnosed was 58.8 years. Eyelids and forehead were the most frequently involved areas. Two of the patients presented previous rosacea. Most constant histopathological findings were lymphatic vessel dilatations in the upper dermis and the presence of mast cells (7.5 in 10 high-power field as a mean). Mild edema was also present in most of the cases. Granulomas were found in 7 of the cases, and immunostaining with CD68 and CD14 only revealed an additional case.

CONCLUSIONS

MORD occurs more in middle-aged males, not associated with rosacea and mostly affects eyelids and forehead. Granulomas are not mandatory for the diagnosis. Histopathology of MORD fits within the spectrum of localized lymphedema.

Rapid growing pulmonary cavernous lymphangioma after chronic process for ten years

•

Pulmonary cavernous lymphangioma very rarely appears as a solid tumour.

•

We encountered a case of pulmonary lymphangioma mimicking a malignant disease.

•

Surgical resection of lymphangiomas is recommended for both diagnosis and treatment.

Introduction

Solitary cavernous lymphangioma is very rare disease characterized by abnormally proliferating lymphatic vessels. We report a 49-year-old woman with a cavernous pulmonary lymphangioma showing rapid growth after remaining indolent for 10 years.

Presentation of case

Chest computed tomography revealed a solitary, poorly demarcated mass in the left lower lobe; however, the tumour grew in size over the next 6 months. A left lower lobectomy was performed following suspected lung cancer. Histopathological and immunohistochemical analysis of the resected specimens revealed a pulmonary cavernous lymphangioma.

Discussion

It is difficult to make an accurate diagnosis of solitary cavernous lymphangioma by imaging findings, therefore a surgical resection is recommended as the diagnostic and therapeutic modality.

Conclusion

A pulmonary lymphangioma should be included in the differential diagnosis of a rapidly growing tumour.

Disorders of the lymphatic system of the abdomen

The lymphatic system of the abdomen comprises of the cisterna chyli, its major and minor lymphatic tributaries, and lymph nodes. Disorders of the lymphatic system of the abdomen are rarely encountered and consist of primary and secondary types. Abdominal lymphangiomas constitute the majority and have characteristic imaging features. Complicated lymphangiomas may pose a diagnostic dilemma. Generalised systemic lymphangiomatosis is a rare condition and affects major organs with a poor prognosis. Retroperitoneal lymphangiectasia in the appropriate setting might predict underlying infection, such as filariasis. Other acquired conditions include iatrogenic or treatment-induced chylocoele. Chylous ascites can be secondary to multiple causes and can be confirmed by biochemical testing and lymphangiogram in appropriate settings.

An Unusual Etiology for Hematospermia and Treatments That Were Successful

OBJECTIVE

To describe the unusual etiology and effective treatments of intractable hematospermia from posterior urethral hemangioma.

METHODS

The ages, disease duration, syndromes, urinary routine, pathologic findings, immunohistochemical staining results, and postoperative complications of 5 patients were recorded. Four patients had a transurethral resection for total removal of lesions, and 1 patient was treated with transurethral fulguration.

RESULTS

The 5 patients involved were middle aged with an average age of 46.2 years and average disease duration of 8.8 years. The clinical features of their hematospermia were as follows: break outs repeatedly after ejaculation in large quantities, no obvious mixing with the seminal plasma, urine after the first ejaculation or second in the morning is hematuria and is even accompanied by blood clots, and urethrorrhagia after sexual excitation, and there is no significant effect of various positive anti-inflammatory treatments. Cystourethroscopy found that the solitary varicosities were located between the distal end of the verumontanum and the external urethral sphincter. The varicose lesion was removed by transurethral resection for posterior urethral lesions, and the surrounding tissue was removed with fulguration. Vessel formation was confirmed by CD31 and CD34 immunohistochemical staining. Finally, the presence of posterior urethral hemangioma was verified in 4 patients by pathologic examination combined with immunohistochemistry, but 1 patient did not have any specimens available.

CONCLUSION

The possibility of posterior urethral hemangioma should be considered for patients with repeated intractable hematospermia. Cystourethroscopy is recommended for examination throughout patient services, and transurethral resection, fulguration, or laser cutting methods can also be performed.

Incidental simultaneous finding of intravascular histiocytosis and reactive angioendotheliomatosis: a case report

Reactive angioendotheliomatosis (RAE) is a rare cutaneous vascular disorder characterized by intravascular hyperplasia of endothelial cells, sometimes with a vascular proliferation. Intravascular histiocytosis (IH) is a similar vascular disorder characterized by the presence of dilated vessels containing aggregates of mononuclear histiocytes (macrophages) within their lumina. Although their pathogenesis remains uncertain, there has been speculation about the possible relationship between IH and RAE. We report a case of coexistence of RAE and IH in a patient who underwent a wide reexcision of a metastatic malignant melanoma. The excision specimen did not show any residual melanoma but exhibited an intravascular collection of CD-68-positive histiocytes admixed with CD-31-positive endothelial cells and fibrin surrounded by D2-40-positive vascular wall. The presence of intravascular cells initially raised concern of intravascular invasion by melanoma. As there was no clinical lesion and immunohistochemical stains for melanocytic makers were negative, we interpret this as an incidental finding. Knowledge of this benign vascular disorder is important because the histologic changes may be mistaken for intravascular invasion of a malignant neoplasm.

Surgical resection of thoracic duct lymphangioma

A 67-year-old male patient came to the hospital due to lung cancer and mediastinal cystic mass which was suspected to be esophageal duplication cyst. Video-assisted thoracoscopic surgery (VATS) was performed and intra-operative finding suggested it as a cystic mass along the thoracic duct. Thoracic duct was ligated and the cyst was completely resected. A 48-year-old female patient visited the hospital for dysphagia. Mediastinal cystic mass was suspected to be an esophageal duplication cyst. Intraoperative finding suggest a thoracic duct lymphangioma. After thoracic duct ligation, the mass was completely resected with VATS. Postoperative chylothorax did not develop in both cases.

Expression of Prox1, D2-40, and WT1 in spindle cell hemangioma

BACKGROUND

Spindle cell hemangioma is a benign vascular proliferation that usually occurs on acral sites. A recent report showed focal positive staining of Prox1 in spindle cell hemangioma.

METHODS

We performed an immunohistochemical study of spindle cell hemangioma with antibodies to CD31, D2-40, Prox1, smooth muscle actin (SMA) and Wilms tumor-1 (WT-1).

RESULTS

The endothelial cells in spindle cell hemangioma were positive for CD31 and Prox1, focally positive for D2-40 and negative for WT-1, whereas the myoid spindle cells around the endothelial cells were weakly positive for WT-1.

CONCLUSION

Our results suggest that spindle cell hemangioma is a lymphatic malformation.