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Lu W, Cao Y, Zeng F, Chen C, Yang Z, Qi Z, Yang X. Surgical Treatment for Benign Lymphangioendothelioma After Two Incomplete Excisions: A Case Report and Literature Review. Clin Cosmet Investig Dermatol 2023; 16:2697-2719. [PMID: 37790904 PMCID: PMC10544170 DOI: 10.2147/ccid.s420019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/10/2023] [Indexed: 10/05/2023]
Abstract
Benign lymphangioendothelioma (BL) is a rare, poorly identified, slow-growing benign vascular lesion characterized by asymptomatic, solitary, well-demarcated macules, or by mildly infiltrated plaque. We report a case of an atypical BL that arose as a tender, protuberant, flesh-colored mass with cyanotic vesicles, and then progressed to a persistent exudative wound after two incomplete excisions. The patient was also diagnosed with thoracic duct narrowing. Although the stenosis was removed by surgery, the right lower extremity ulceration and exudation did not improve. Thus, we performed a thorough excision and split-thickness skin graft transplant following vacuum sealing drainage, and eventually the patient had a favorable functional and cosmetic outcome. A biopsy revealed irregular, dilated vascular spaces lined with a single layer of flat endothelial cells extending from the superficial dermis to the subcutis that did not reach the striated muscles. Additionally, by reviewing the literature on BL, in this paper we summarize the diverse pathogenic, morphological, and immunohistochemical presentations for this rare disease, as well as the histopathological differential diagnosis of lymphangiomatosis, Kaposi's sarcoma, and angiosarcoma.
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Affiliation(s)
- Wei Lu
- The Department of Hemangioma and Vascular Malformation, Plastic Surgery Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, People’s Republic of China
| | - Yan Cao
- The Department of Pathology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, People’s Republic of China
| | - Fanhua Zeng
- The Department of Hemangioma and Vascular Malformation, Plastic Surgery Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, People’s Republic of China
- The Department of Burn and Plastic Surgery, Hengyang No.1 People’s Hospital, Hunan, People’s Republic of China
| | - Chun Chen
- The Department of Hemangioma and Vascular Malformation, Plastic Surgery Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, People’s Republic of China
- E.N.T. Department, Shenzhen Longgang District Third People’s Hospital, Guangdong, People’s Republic of China
| | - Zhenyu Yang
- The Department of Hemangioma and Vascular Malformation, Plastic Surgery Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, People’s Republic of China
| | - Zuoliang Qi
- The Department of Hemangioma and Vascular Malformation, Plastic Surgery Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, People’s Republic of China
| | - Xiaonan Yang
- The Department of Hemangioma and Vascular Malformation, Plastic Surgery Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, People’s Republic of China
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Abstract
BACKGROUND Tufted angiomas (TAs) are uncommon benign vascular tumors mostly located cutaneously or subcutaneously in the skin of the neck and upper trunk, which appear during childhood and grow slowly. TAs are a variant of lobular capillary hemangiomas. This is the first study to provide an overview of the current literature in combination with the authors' own clinical experience on this rare entity in the head and neck area with non-dermatological localization. METHODS A selective Medline and Google Scholar database search was performed. Additionally, we conducted an ICD-10-based database search on hemangiomas (D18.0) in the Charité SAP patient records. RESULTS We identified 13 reports in the literature consisting of 16 cases of TA of the head and neck. Males were predominantly affected by TAs (70.6%). The mean age of the patients at the time of surgery was 31.5 years; the mean maximum diameter of the tumors was 16.3 mm. Additionally, we report on one case of TA in our Department of Head and Neck Surgery. A male patient presented with swelling and redness of the left upper eyelid. Radiological examination with computed tomography showed a suprabulbar tumor with a diameter of 13 mm. The tumor was surgically removed via a transcutaneous blepharoplasty approach with the patient under general anesthesia. DISCUSSION There is only one other case report on the surgical excision of an intra-orbital TA described to date. Here, we present an epidemiological overview, therapeutic considerations, and differential diagnoses.
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Affiliation(s)
- S M Häußler
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité - University Medical Center Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - F C Uecker
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité - University Medical Center Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - S Knopke
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité - University Medical Center Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - F Roßner
- Institute of Pathology, Charité - University Medical Center Berlin, Campus Charité Mitte, Berlin, Germany
| | - H Olze
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité - University Medical Center Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - A Böttcher
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Lei HZ, Sun B, Ma YC, Li MM, Wang LF, Jiang SW, Huo R, Dong CX. Retrospective study on the outcomes of infantile tufted angioma complicated by Kasabach-Merritt Phenomenon. Clin Chim Acta 2018; 486:199-204. [PMID: 30096317 DOI: 10.1016/j.cca.2018.07.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Hong-Zhao Lei
- Department of Aesthetic, Plastic, and Burn Surgery, Shandong Provincial Hospital, Shandong University, 324, Jingwu Road, Jinan, Shandong 250021, China; Department of Hemangioma and Vascular Malformation Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, 7 Weiwu Road, Zhengzhou 450003, China
| | - Bin Sun
- Department of Hemangioma and Vascular Malformation Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, 7 Weiwu Road, Zhengzhou 450003, China
| | - Yu-Chun Ma
- Department of Hemangioma and Vascular Malformation Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, 7 Weiwu Road, Zhengzhou 450003, China
| | - Miao-Miao Li
- Department of Hemangioma and Vascular Malformation Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, 7 Weiwu Road, Zhengzhou 450003, China
| | - Li-Fu Wang
- Departments of Pathology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, 7 Weiwu Road, Zhengzhou 450003, China
| | - Shi-Wen Jiang
- Center for Reproductive Medicine, Wuxi Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Wuxi 214002, China
| | - Ran Huo
- Department of Aesthetic, Plastic, and Burn Surgery, Shandong Provincial Hospital, Shandong University, 324, Jingwu Road, Jinan, Shandong 250021, China.
| | - Chang-Xian Dong
- Department of Hemangioma and Vascular Malformation Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, 7 Weiwu Road, Zhengzhou 450003, China.
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Prognostic Factors of Patients With Malignant Epithelioid Vascular Tumors in the Spine: Retrospective Analysis of 46 Patients in a Single Center. Spine (Phila Pa 1976) 2018; 43:E1218-E1224. [PMID: 29649089 DOI: 10.1097/brs.0000000000002670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study of 46 patients with malignant epithelioid vascular tumors (MEVT) in the spine was performed. OBJECTIVE The purpose of this study was to illustrate the clinic characteristics of MEVT in the spine and to discuss prognostic factors by survival analysis. SUMMARY OF BACKGROUND DATA MEVT in the spine is relatively uncommon, and there is little published information regarding this subject. Therefore, prognostic factors of this disease are still controversial. METHOD The univariate and multivariate analysis of various clinic characteristics were performed to identify the independent factor that affects prognosis for patients with MEVT in the spine who underwent surgical treatment in Changzheng Hospital Orthopedics Oncological Center (CHOOC) between 2005 and 2015. Disease-free survival (DFS) and overall survival (OS) were estimated by Kaplan-Meier method to identify potential prognostic factors. Factors with P values of 0.1 or less were subjected to multivariate analysis by Cox regression analysis. P values of 0.05 or less was considered statistically significant. RESULT A total of 46 patients with MEVT in the spine were included in the study. The mean follow-up period was 42.6 months (range, 5-143 mo). Recurrence was detected in 22 patients after initial surgery in our center, whereas death in 18 patients. The univariate analysis suggested that age (<30 yr/≥30 yr), metastasis, preoperative Frankel score, postoperative Frankel score, malignant grade and resection mode were potential prognostic factors for DFS and OS. However, as they were submitted to multivariate analyses, only malignant grade and resection mode were independent prognostic factors. CONCLUSION Total en bloc spondylectomy can significantly improve DFS for MEVT in the spine and low-grade malignancy was favorable factor for DFS. Total spondylectomy and low-grade malignancy considerably improve OS for patients with MEVT in the spine. LEVEL OF EVIDENCE 4.
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Patrushev AV, Belousova IE, Gorislavskaya TA, Suharev AV, Samtsov AV. BENIGN LYMPHANGIOENDOTHELIOMA. VESTNIK DERMATOLOGII I VENEROLOGII 2018. [DOI: 10.25208/0042-4609-2018-94-1-91-96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The authors describe modern data relating to the definition, clinical, pathological and immunohistochemical features of a rare vascular tumor — benign lymphangioendothelioma. The problems of differential diagnosis with Kaposi’s sarcoma and angiosarcoma are discussed. This is the first description of this tumorin domestic literature.
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Bisceglia M, Bosman C, Carlesimo OA, Innocenzi D, Quirke P. Kaposi's Sarcoma: A Clinico-Pathologic Overview. TUMORI JOURNAL 2018; 77:291-310. [PMID: 1746049 DOI: 10.1177/030089169107700402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A careful overview of the classical appearances of Kaposi's sarcoma (KS) as well as of its variants were reviewed from the clinical and pathological point of view. The growth phases (stages) and the cellular patterns were histopathologically compared with emphasis on the developmental progression of disease as well as mitotic activity. Other morphological aspects were also assessed such as the features of the early phases and the incidence of hyaline bodies. One hundred and forty-three lesions from 96 patients mostly of the Italian sporadic type were investigated. A complete list of those entities which should be considered in differential diagnosis is shown and the dilemma of whether KS is a neoplasia or a hyperplasia is discussed.
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Affiliation(s)
- M Bisceglia
- Anatomic Pathology Department, Casa Sollievo della Sofferenza Hospital, Istituto di Ricovero e Cure a Carattere Scientifico (I.R.C.C.S.), S. Giovanni Rotondo Foggia, Italy
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7
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Häußler SM, Uecker FC, Knopke S, Roßner F, Olze H, Böttcher A. [Tufted angiomas of the head and neck. German version]. HNO 2017; 65:981-986. [PMID: 28761971 DOI: 10.1007/s00106-017-0379-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Tufted angiomas (TAs) are uncommon benign vascular tumors mostly located cutaneously or subcutaneously in the skin of the neck and upper trunk, which appear during childhood and grow slowly. TAs are a variant of lobular capillary hemangiomas. This is the first study to provide an overview of the current literature in combination with the authors' own clinical experience on this rare entity in the head and neck area with non-dermatological localization. METHODS A selective Medline and Google Scholar database search was performed. Additionally, we conducted an ICD-10-based database search on hemangiomas (D18.0) in the Charité SAP patient records. RESULTS We identified 13 reports in the literature consisting of 16 cases of TA of the head and neck. Males were predominantly affected by TAs (70.6%). The mean age of the patients at the time of surgery was 31.5 years; the mean maximum diameter of the tumors was 16.3 mm. Additionally, we report on one case of TA in our Department of Head and Neck Surgery. A male patient presented with swelling and redness of the left upper eyelid. Radiological examination with computed tomography showed a suprabulbar tumor with a diameter of 13 mm. The tumor was surgically removed via a transcutaneous blepharoplasty approach with the patient under general anesthesia. DISCUSSION There is only one other case report on the surgical excision of an intra- orbital TA described to date. Here, we present an epidemiological overview, therapeutic considerations, and differential diagnoses.
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Affiliation(s)
- S M Häußler
- Klinik für Hals-Nasen-Ohrenheilkunde, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - F C Uecker
- Klinik für Hals-Nasen-Ohrenheilkunde, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - S Knopke
- Klinik für Hals-Nasen-Ohrenheilkunde, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - F Roßner
- Institut für Pathologie, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Deutschland
| | - H Olze
- Klinik für Hals-Nasen-Ohrenheilkunde, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - A Böttcher
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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8
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Abstract
Vascular tumors with a spindled morphology represent a diagnostic challenge in soft tissue pathology. It may be difficult to distinguish certain benign entities in this category from spindled vascular tumors of intermediate malignancy or even spindled variants of angiosarcoma. This article focuses on vascular tumors characterized by a predominantly spindled morphology, including spindle cell hemangioma, acquired tufted angioma (angioblastoma of Nakagawa), kaposiform hemangioendothelioma, Kaposi sarcoma, and spindle cell variants of angiosarcoma.
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Affiliation(s)
- Zlatko Marušić
- Department of Pathology, University Hospital Center Zagreb, Kišpatićeva 12, Zagreb 10 000, Croatia
| | - Steven D Billings
- Department of Pathology, Cleveland Clinic, 9500 Euclid Avenue, L25, Cleveland, OH 44195, USA.
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Katsoulas N, Nikitakis N, Theologie-Lygidakis N, Lianou V, Tsiklakis K, Iatrou I, Sklavounou-Andrikopoulou A. Tufted angioma of the maxilla: a rare case with unique clinical presentation. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122:e93-8. [PMID: 26896438 DOI: 10.1016/j.oooo.2015.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 11/26/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
Abstract
Tufted angioma is an uncommon benign vascular tumor usually presenting in early childhood and affecting mainly the skin. It has been associated with Kasabach-Merritt syndrome, a severe coagulopathy of poor prognosis. There have been very few published cases of oral tufted angiomas, and maxillary bone involvement has not been hitherto reported. We present a case of a 10-year-old Caucasian boy with an erythematous left maxillary gingival mass accompanied by subjacent hard tissue swelling. Radiologic evaluation revealed an irregular mixed radiolucent and radiopaque area in the left maxilla, accompanied by alveolar ridge erosion, cortical plate expansion, and displacement and divergence of the premolars. The histopathologic examination showed scattered irregular tufted lobules of variably sized vascular spaces inside the subepithelial connective tissue and among the underlying bone trabeculae, exhibiting a "cannonball" appearance. Immunohistochemical evaluation found positivity for CD31, CD34, and smooth muscle actin, and a final diagnosis of tufted angioma with osseous involvement was rendered. A thorough review of the pertinent literature revealed only 9 previously published intraoral tufted angioma cases, the salient demographic and clinicopathologic features of which are summarized.
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Affiliation(s)
- Nikolaos Katsoulas
- Department of Oral Medicine and Pathology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
| | - Nikolaos Nikitakis
- Department of Oral Medicine and Pathology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Nadia Theologie-Lygidakis
- Department of Oral and Maxillofacial Surgery, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Violetta Lianou
- Department of Oral and Maxillofacial Surgery, General Hospital of Rio, Patras, Greece
| | - Konstantinos Tsiklakis
- Department of Oral Diagnosis and Radiology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Iatrou
- Department of Oral and Maxillofacial Surgery, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
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Pesapane F, Nazzaro G, Alberti-Violetti S, Gianotti R. A case of acquired tufted angioma in adulthood. An Bras Dermatol 2015; 90:16-8. [PMID: 26312663 PMCID: PMC4540497 DOI: 10.1590/abd1806-4841.20153733] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 06/16/2014] [Indexed: 12/02/2022] Open
Abstract
Tufted angioma is a rare vascular tumor whose name derives from its histopathological
appearance, characterized by tufts of capillaries within the dermis. Its etiology and
pathogenesis are uncertain. Tufted angioma typically occurs during infancy or early
childhood and displays various clinical patterns. It may present as a subtle
stain-like area that later thickens as a large plaque, infi ltrated or dusky
blue-purple lesion, or as an exophytic, fi rm, violaceous, cutaneous nodule. Medical
treatment is not necessary for tufted angioma, given its benign nature and slow
progression. Only clinical follow-up is therefore recommended.
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Affiliation(s)
- Filippo Pesapane
- Ospedale Maggiore Policlinico, Fondazione IRCCS Ca' Granda, Milan, IT
| | - Gianluca Nazzaro
- Ospedale Maggiore Policlinico, Fondazione IRCCS Ca' Granda, Milan, IT
| | | | - Raffaele Gianotti
- Ospedale Maggiore Policlinico, Fondazione IRCCS Ca' Granda, Milan, IT
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12
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Adult-Onset Tufted Angiomas Associated With an Arteriovenous Malformation in a Renal Transplant Recipient. Am J Dermatopathol 2015; 37:162-5. [DOI: 10.1097/dad.0000000000000221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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13
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Kikuchi H, Kurokawa M, Setoyama M. Two Cases of Angiosarcoma of the Face. J Dermatol 2014; 31:47-50. [PMID: 14739504 DOI: 10.1111/j.1346-8138.2004.tb00504.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2003] [Accepted: 09/24/2003] [Indexed: 11/30/2022]
Abstract
Angiosarcoma is a rare vascular malignant tumor most commonly seen on the scalp of elderly people. We report here two cases of angiosarcoma of the face in 74- and 75-year-old males. It is very unusual to find the development of an angiosarcoma with a rosacea on the face. To the best of our knowledge, only three such cases have been reported.
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Affiliation(s)
- Hidezumi Kikuchi
- Department of Dermatology, School of Medicine, University of the Miyazaki, Japan
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14
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Corrales Millán R, Sánchez Torices MS, Moñux Martínez A. Tufted Angioma of the Face. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2014. [DOI: 10.1016/j.otoeng.2014.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Corrales Millán R, Sánchez Torices MS, Moñux Martínez A. [Tufted angioma of the face]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2013; 65:266-8. [PMID: 23706996 DOI: 10.1016/j.otorri.2013.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 01/10/2013] [Accepted: 01/14/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Rocío Corrales Millán
- Servicio de Otorrinolaringología, Complejo Hospitalario La Mancha Centro, Alcázar de San Juan, Ciudad Real, España.
| | | | - Alfonso Moñux Martínez
- Servicio de Otorrinolaringología, Complejo Hospitalario La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
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Sabharwal A, Aguirre A, Zahid TM, Jean-Charles G, Hatton MN. Acquired tufted angioma of upper lip: case report and review of the literature. Head Neck Pathol 2013; 7:291-4. [PMID: 23526035 PMCID: PMC3738756 DOI: 10.1007/s12105-013-0437-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 03/13/2013] [Indexed: 11/25/2022]
Abstract
Acquired tufted angioma is a rare, cutaneous and slow growing benign vascular neoplasm that usually affects pediatric populations. Only six cases of oral mucosal acquired tufted angioma have been reported in the English language literature. We present in this report the seventh case and discuss its clinical and pathological features.
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Affiliation(s)
- Amarpreet Sabharwal
- />Department of Oral Diagnostic Sciences, Advanced Oral and Maxillofacial Pathology Program, School of Dental Medicine, University at Buffalo, 355 Squire Hall, Buffalo, NY 14214 USA
| | - Alfredo Aguirre
- />Department of Oral Diagnostic Sciences, Advanced Oral and Maxillofacial Pathology Program, School of Dental Medicine, University at Buffalo, 355 Squire Hall, Buffalo, NY 14214 USA
| | - Talal M. Zahid
- />University at Buffalo, Buffalo, NY USA
- />Dr. Sulaiman Al Habib Medical Center Group, Riyadh, Saudi Arabia
| | - Germain Jean-Charles
- />Department of Medicine and Director of Dental Clinic Division of HIV Medicine, Albany Medical Center, Albany, NY USA
| | - Michael N. Hatton
- />Department of Oral Diagnostic Sciences, Advanced Oral and Maxillofacial Pathology Program, School of Dental Medicine, University at Buffalo, 355 Squire Hall, Buffalo, NY 14214 USA
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17
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Wang L, Liu L, Wang G, Gao T. Congenital disseminated tufted angioma. J Cutan Pathol 2013; 40:405-8. [PMID: 23373432 DOI: 10.1111/cup.12089] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 10/19/2012] [Accepted: 11/10/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Lei Wang
- Department of Dermatology, Xijing Hospital; Fourth Military Medical University; Xian; China
| | - Ling Liu
- Department of Dermatology, Xijing Hospital; Fourth Military Medical University; Xian; China
| | - Gang Wang
- Department of Dermatology, Xijing Hospital; Fourth Military Medical University; Xian; China
| | - Tianwen Gao
- Department of Dermatology, Xijing Hospital; Fourth Military Medical University; Xian; China
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18
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Revelles JM, Díaz JL, Angulo J, Santonja C, Kutzner H, Requena L. Giant benign lymphangioendothelioma. J Cutan Pathol 2012; 39:950-6. [PMID: 22834950 DOI: 10.1111/j.1600-0560.2012.01971.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 01/29/2012] [Accepted: 01/31/2012] [Indexed: 12/01/2022]
Abstract
Benign lymphangioendothelioma is a rare locally infiltrative vascular neoplasm, presenting as a slow-growing, asymptomatic, reddish-violaceous plaque. Histopathologically, it is characterized by irregular and thin-walled vascular spaces, lined by a single and discontinuous layer of flat endothelial cells, dissecting dermal collagen bundles. We present the case of a 75-year-old man with a giant benign lymphangioendothelioma, to our knowledge, the largest example described in the literature. The immunohistochemical expression of Wilms tumor 1 gene is useful in vascular lesions to differentiate malformations from proliferative endothelial lesions. In our case, the positivity for WT1 supports the neoplastic nature of this lesion.
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Affiliation(s)
- Juan M Revelles
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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Collins D, Sebire N, Barnacle A, Ramakrishnan V, Kangesu L. ‘Mini’ free groin flap for treatment of a tufted angioma of the finger. J Plast Reconstr Aesthet Surg 2011; 64:e128-31. [DOI: 10.1016/j.bjps.2011.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 01/05/2011] [Indexed: 11/16/2022]
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20
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Tong PL, Beer TW, Fick D, Kumarasinghe SP. Acquired Progressive Lymphangioma in a 75-year-old Man at the Site of Surgery 22 Years Previously. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2011. [DOI: 10.47102/annals-acadmedsg.v40n2p106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
| | | | - Daniel Fick
- Sir Charles Gairdner Hospital, Perth, Australia
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Vascular skin lesions in a child with Klippel-Trénaunay syndrome. COR ET VASA 2010. [DOI: 10.33678/cor.2010.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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22
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A case of regressing central facial cutaneous angiosarcoma. J Am Acad Dermatol 2008; 58:S113-5. [PMID: 18489041 DOI: 10.1016/j.jaad.2007.04.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2005] [Revised: 04/22/2007] [Accepted: 04/27/2007] [Indexed: 11/20/2022]
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Sinonasal tract angiosarcoma: a clinicopathologic and immunophenotypic study of 10 cases with a review of the literature. Head Neck Pathol 2007; 1:1-12. [PMID: 20614274 PMCID: PMC2807511 DOI: 10.1007/s12105-007-0017-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2007] [Accepted: 07/20/2007] [Indexed: 02/06/2023]
Abstract
BACKGROUND Primary sinonasal tract angiosarcoma are rare tumors that are frequently misclassified, resulting in inappropriate clinical management. There are only a few reported cases in the English literature. MATERIALS AND METHODS Ten patients with sinonasal tract angiosarcoma were retrospectively retrieved from the Otorhinolaryngic Registry of the Armed Forces Institute of Pathology. RESULTS Six males and four females, aged 13 to 81 years (mean, 46.7 years), presented with epistaxis and bloody discharge. Females were on average younger than their male counterparts (37.8 vs. 52.7 years, respectively). The tumors involved the nasal cavity alone (n = 8) or the maxillary sinus (n = 2), with a mean size of 4.3 cm; the average size was different between the genders: males: 2.8 cm; females: 6.4 cm. Histologically, all tumors had anastomosing vascular channels lined by remarkably atypical endothelial cells protruding into the lumen, neolumen formation, frequent atypical mitotic figures, necrosis, and hemorrhage. All cases tested (n = 6) demonstrated immunoreactivity with antibodies to Factor VIII-RA, CD34, CD31, and smooth muscle actin, while non-reactive with keratin and S-100 protein. The principle differential diagnosis includes granulation tissue, lobular capillary hemangioma (pyogenic granuloma), and Kaposi's sarcoma. All patients had surgery followed by post-operative radiation (n = 4 patients). Follow-up was available in all patients: Six patients died with disease (mean, 28.8 months); two patients had died without evidence of disease (mean, 267 months); and two are alive with no evidence of disease at last follow-up (mean, 254 months). CONCLUSIONS Sinonasal tract angiosarcoma is a rare tumor, frequently presenting in middle-aged patients as a large mass usually involving the nasal cavity with characteristic histomorphologic and immunophenotypic features. Sinonasal tract angiosarcoma will often have a poor prognosis making appropriate separation from other conditions important.
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Na JI, Cho KH, Kim YG, Park KC. Angioblastoma showing aggravation after treatment with long-pulsed Nd:YAG laser (1064 nm). Pediatr Dermatol 2007; 24:397-400. [PMID: 17845165 DOI: 10.1111/j.1525-1470.2007.00495.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Angioblastoma usually develops in infancy or early childhood on the neck or upper trunk. It is known to be slowly progressive and benign in nature, but treatment guidelines have not yet been established. Spontaneous regression has been occasionally documented, and treatment with pulsed dye laser, excision, high-dose steroids, and interferon alpha have been successful in individual patients. Our patient experienced partial response to interferon alpha injection, and for further treatment, long-pulsed Nd:YAG laser (1064 nm) treatment was performed. However, unexpectedly, the tumor was rapidly aggravated. We report this occurrence to increase awareness of trauma-induced aggravation phenomena in angioblastoma.
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Affiliation(s)
- Jung-Im Na
- Department of Dermatology, Seoul National University College of Medicine and Clinical Research Institute, Bundang Seoul National University Hospital, Gyeonggi-do, Korea
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Cardoso AO, Tayti T, Oliveira JPD, Torezan LA, Sotto MN, Vilela MA, Nico MMS, Osório NDS, Festa Neto C. Angioma em tufos: relato de um caso tratado com laser corante pulsado. An Bras Dermatol 2006. [DOI: 10.1590/s0365-05962006000900003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O angioma em tufos é quadro raro, benigno, de proliferação cutânea angiomatosa. Acomete mais crianças e clinicamente caracteriza-se por lesões em placas, vermelho-violáceas, dolorosas e mais freqüentes no tronco. Quando não regride espontaneamente, os tratamentos propostos (cirurgia convencional, corticoterapia, interferon e laser) alcançam pouco sucesso. Descreve-se o caso de uma menina de 11 anos, com angioma em tufos no tronco, tratada com laser corante pulsado que mostrou alívio importante da dor local e redução discreta do tamanho da lesão. A raridade de casos relatados no Brasil e a tentativa terapêutica com laser corante pulsado motivaram a divulgação do caso.
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Bienaimé A, Rojat-Habib MC, Hesse S, Pelissier JF, Bonerandi JJ. Tumeur vasculaire géante de l’adulte : angiome en touffe ou hémangioendothéliome kaposiforme. Ann Dermatol Venereol 2006; 133:553-6. [PMID: 16885843 DOI: 10.1016/s0151-9638(06)70961-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Tufted angioma and kaposiform hemangioendothelioma are two rare benign but aggressive vascular tumours that occur mainly in children. OBSERVATION A 72 year-old man consulted for a 50 cm wide vascular tumour of the right shoulder which was increasing for 10 years. On histological examination there were features of tufted angioma and kaposiform hemangioendothelioma. DISCUSSION The tumour of this patient was atypical because of its big size never described before. The histological association of aspects which could correspond to tufted angioma and kaposiform hemangioendothelioma seems to confirm recent publications which support the hypothesis that these two tumours are two evolutive stages of one and only entity.
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Affiliation(s)
- A Bienaimé
- Service de Dermatologie, Hôpital La Timone, Marseille.
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Yeung J, Somers G, Viero S, Pope E. Multifocal lymphangioendotheliomatosis with thrombocytopenia. J Am Acad Dermatol 2006; 54:S214-7. [PMID: 16631943 DOI: 10.1016/j.jaad.2005.07.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2005] [Revised: 07/05/2005] [Accepted: 07/09/2005] [Indexed: 11/22/2022]
Abstract
Multifocal lymphangioendotheliomatosis with thrombocytopenia is an extremely rare disease. This condition manifests as diffuse congenital vascular lesions in the skin and gastrointestinal tract leading to severe gastrointestinal bleeding and thrombocytopenia. Histopathologic and immunohistochemical studies of vascular lesions demonstrate a lymphatic endothelial cell origin. Treatment often is not satisfactory. We herein describe a 4-week-old infant with this uncommon clinicopathologic entity.
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Affiliation(s)
- Jensen Yeung
- Department of Dermatology, University of Toronto, Canada
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29
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WARD K, KENNEDY C, Ashworth M. Acquired tufted angioma frequently develops at sites other than the neck and upper trunk. Clin Exp Dermatol 2006. [DOI: 10.1111/j.1365-2230.1996.tb00023.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Scott RN, Taylor WAS, McGrouther DA, Soutar DS, McKay AJ. Lymphangiosarcoma. Br J Surg 2005. [DOI: 10.1002/bjs.1800750539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Leowardi C, Hinz U, Hormann Y, Wente MN, Mechtersheimer G, Willeke F, Böckler D, Friess H, Allenberg JR, Herfarth C, Büchler MW, Schwarzbach MHM. Malignant vascular tumors: clinical presentation, surgical therapy, and long-term prognosis. Ann Surg Oncol 2005; 12:1090-101. [PMID: 16252137 DOI: 10.1245/aso.2005.09.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2004] [Accepted: 07/30/2005] [Indexed: 01/20/2023]
Abstract
BACKGROUND The aim of this study was to analyze the presentation of, surgery for, and prognosis of malignant vascular tumors (MVTs). METHODS This was an observational single-center study. Patients who underwent operation for MVTs between 1988 and 2004 were included. Data were gathered prospectively in a computerized registry. RESULTS Of 568 adult patients with soft tissue malignancies, 43 (7.6%) were treated for MVTs. Twenty-four men and 19 women (median age, 55.3 years) were referred for 30 primary tumors and 13 recurrences. Symptoms were observed in 90.7% of the cases (swelling [37.2%], pain [34.9%], extrusion [11.6%], hemorrhage [7%], weight loss [4.7%], loss of energy [4.7%], impaired function [4.7%], and others [30.2%]). Tumors were located in the extremities (n = 16), trunk (n = 3), abdomen (n = 15), retroperitoneum (n = 7), and thyroid gland (n = 2). Twenty-two (51.2%) angiosarcomas, nine (20.9%) malignant hemangiopericytomas, eight (18.6%) malignant epithelioid hemangioendotheliomas, and four (9.3%) lymphangiosarcomas were seen. The median overall survival after surgery was 21.4 months, with 2-, 5-, and 10-year overall survival rates of 41.5%, 38.3%, and 18.8%, respectively. MVTs of the extremities and trunk and localized disease indicated a better prognosis than abdominal or retroperitoneal MVTs (univariate and multivariate analyses: P = .0122 and P = .0287) and metastasized stages (univariate and multivariate analyses: P = .0187 and P = .0287). CONCLUSIONS A considerable number of patients with soft tissue malignancies undergo surgery for MVT. Various symptoms and a multilocular occurrence are typical. The course of MVTs is aggressive. Tumor site and stage are important prognostic factors. Surgery is potentially curative, especially for localized disease of the extremities and trunk.
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Affiliation(s)
- Christine Leowardi
- Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg 69120, Germany
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F4 - Angiome en touffes, première observation vietnamienne. Ann Dermatol Venereol 2005. [DOI: 10.1016/s0151-9638(05)80074-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Angiosarcoma of the head and neck is a rare and lethal neoplasm. Data from the Connecticut Tumor Registry was analyzed for all head and neck angiosarcomas between 1980 and 2001. The authors also present the first reported case of familial angiosarcoma of the head and neck region. The 1-year mortality was 48% for all patients with angiosarcomas (38% for males, 69% for females). The 5-year survival was 28% for all patients (38% for males, 15% for females). The combination of surgery and radiotherapy resulted in improved survival compared with either treatment alone.
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Gruman A, Liang MG, Mulliken JB, Fishman SJ, Burrows PE, Kozakewich HPW, Blei F, Frieden IJ. Kaposiform hemangioendothelioma without Kasabach-Merritt phenomenon. J Am Acad Dermatol 2005; 52:616-22. [PMID: 15793511 DOI: 10.1016/j.jaad.2004.10.880] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Kasabach-Merritt phenomenon is a serious coagulopathy associated with kaposiform hemangioendothelioma (KHE), tufted angioma, and possibly other vascular neoplasms. KHE presenting in the absence of Kasabach-Merritt phenomenon is rare, although tufted angioma frequently occurs without thrombocytopenia. We retrospectively reviewed 10 cases of KHE without Kasabach-Merritt phenomenon. The tumors appeared as soft tissue masses with the overlying skin being either normal, erythematous, or violaceous. There were no radiologic or microscopic differences in noncoagulopathic KHE as compared with coagulopathic KHE. Evidence of platelet trapping and hemosiderin deposition was seen histologically, despite normal serum platelet levels. All KHE were less than 8 cm in diameter, suggesting that tumors that grow no larger than this size are less likely to trap platelets in sufficient quantity to cause thrombocytopenia. Our series confirms that KHE appears with a wide spectrum of behavior and response to treatment. The decision as to whether or not to treat a noncoagulopathic KHE should be based on the size and location of the tumor and the possible side effects of therapy.
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Affiliation(s)
- Alla Gruman
- Department of Medicine, Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Al-Za'abi AM, Ghazarian D, Greenberg GR, Shaw JC. Eruptive tufted angiomas in a patient with Crohn's disease. J Clin Pathol 2005; 58:214-6. [PMID: 15677546 PMCID: PMC1770572 DOI: 10.1136/jcp.2004.019018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Angioblastoma is a rare, benign vascular tumour composed of undifferentiated mesenchymal cells with a tendency to form lumina. This entity was first described by Nakagawa in 1949 as angioblastoma, and Wilson Jones was the first to use the term "tufted angioma" in 1976. Tufted angiomas usually occur in infancy and spread slowly. This report describes lesions from the right side of the forehead, forearms, and thighs of a 24 year old man with a four year history of Crohn's disease, who was receiving infliximab in addition to long standing azathioprine and ciprofloxacillin. He developed numerous small itchy erythematous vascular appearing papules, which on histological examination resembled tufted angiomas, showing the classic "cannon ball" appearance. The lesions regressed within three months. This case may represent an eruptive acquired tufted angioma in which immunosuppression or drug induced modification of angiogenesis played a role in its development and regression. One previous case of eruptive tufted angioma has been reported in an immunosuppressed patient.
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Affiliation(s)
- A M Al-Za'abi
- Department of Pathology, University of Toronto, Toronto M5T 2S8, Canada
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Romano C, Maritati E, Miracco C, Andreassi L, Fimiani M. Partial response to treatment with recombinant interferon-alpha2a in an adult patient with tufted angioma. J Eur Acad Dermatol Venereol 2004; 18:115-6. [PMID: 14678556 DOI: 10.1111/j.1468-3083.2004.00844.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Acquired progressive lymphangioma is a very rare disorder that presents in childhood or early adolescence as a lymphatic proliferation that gradually enlarges. It most commonly involves an extremity and is typically characterized as an indurated plaque that may be brownish-red, violaceous, or yellow. We report the case of a 15-year-old boy with a 10-year history of acquired progressive lymphangioma on the sole.
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Affiliation(s)
- Linda Y Hwang
- Department of Dermatology, Baylor College of Medicine, Houston, Texas 77030, USA
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O'Hara CD, Nascimento AG. Endothelial lesions of soft tissues: a review of reactive and neoplastic entities with emphasis on low-grade malignant ("borderline") vascular tumors. Adv Anat Pathol 2003; 10:69-87. [PMID: 12605089 DOI: 10.1097/00125480-200303000-00002] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Soft tissue proliferations composed of endothelial cells are a heterogeneous group of lesions that can cause diagnostic difficulty. Further complicating the issue is the constantly changing nomenclature of some entities, as well as reclassification of some vascular tumors from the high-grade malignant category to the low-grade malignant or borderline category. Modern ancillary techniques such as immunohistochemistry and cytogenetics have done little to advance our knowledge of these lesions. This review article outlines the most recent classification of endothelial lesions of the skin and soft tissues, with emphasis on the low-grade malignant (borderline) category. In addition, many tumor-like lesions containing an endothelial component are also discussed.
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Affiliation(s)
- Carolyn D O'Hara
- Department of Laboratory Medicine and Pathalogy, Mayo Clinic, Rochester, Minnesota 55905, USA
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Mahendran R, White SI, Clark AH, Sheehan-Dare RA. Response of childhood tufted angioma to the pulsed-dye laser. J Am Acad Dermatol 2002; 47:620-2. [PMID: 12271313 DOI: 10.1067/mjd.2002.124074] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Tufted angioma is a rare, benign cutaneous angiomatous proliferation, which often presents in the first few years of life. Lesions commonly affect the neck, upper trunk, and shoulders and can sometimes be tender. Effective treatments reported in the literature are scarce. We report a case of tufted angioma in a child, which had a successful outcome after treatment with the pulsed-dye laser both in terms of cosmesis and alleviation of pain and discomfort.
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Abstract
Tufted angioma is a rare, benign, vascular tumor, characterized histologically by tufts of capillary-sized vessels in the dermis. Five patients were diagnosed over a 10-year period. All developed the lesions within the first year of life. Four were Chinese and one was Indian. There was no sex predilection. All the lesions occurred on the limbs, mainly proximally, with 40% affecting the upper and 60% the lower limbs. The appearance ranged from erythematous, indurated, annular nodules to plaques. In two patients the lesions had overlying red papules, and hypertrichosis was present in three cases. The lesions were tender in all patients. No complications such as ulceration, bleeding, or Kasabach-Merritt syndrome occurred. All were treated conservatively, with improvement in tenderness in three of four patients after a period of 5 months to 4 years. Decrease in size occurred in one of four patients after 2 years. Our series differs from previous ones in that all the patients developed the lesions before the age of 1 year, all lesions occurred on the limbs, and all were tender. Tenderness and hypertrichosis, in addition to induration, may be useful in the clinical differentiation from common hemangioma.
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Abstract
A 7-year-old Filipino girl presented to the dermatology clinic with a slowly enlarging plaque on the inner aspect of her upper left arm. Although she had this lesion since birth, it had gradually enlarged and become indurated and slightly painful. The histopathologic examination showed a vascular proliferation within the dermis, with a "cannonball" appearance consistent with a tufted angioma. We review the literature and discuss the clinical presentation of this rare vascular tumor.
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Affiliation(s)
- Elizabeth K Satter
- Department of Dermatology, Naval Medical Center San Diego, San Diego, California 92134, USA.
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Requena L, Kutzner H, Mentzel T. Acquired elastotic hemangioma: A clinicopathologic variant of hemangioma. J Am Acad Dermatol 2002; 47:371-6. [PMID: 12196746 DOI: 10.1067/mjd.2002.122737] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND In recent years, many new cutaneous vascular proliferations have been described. This is partly due to the current epidemic of AIDS, which has forced dermatopathologists to establish the diagnosis of the earliest patch-stage lesions of AIDS-related Kaposi's sarcoma and some of the recently described cutaneous vascular proliferations that may histopathologically mimic lesions of early Kaposi's sarcoma. OBJECTIVE This article reports the clinical, histopathologic, and immunohistochemical findings in 6 cases of a clinicopathologic variant of cutaneous hemangioma, which we have named acquired elastotic hemangioma. METHODS Six cases of acquired elastotic hemangioma were studied from clinical, histopathologic, and immunohistochemical standpoints. The histopathologic differential diagnosis with other similar cutaneous vascular proliferations is discussed. RESULTS Acquired elastotic hemangioma appears on the sun-damaged skin of the dorsal aspect of the forearms or on the lateral aspects of the neck of middle-aged or elderly women. Clinically, lesions present as solitary erythematous plaques with variable morphology and in only some cases have a clearly angiomatous appearance. On histopathologic examination, acquired elastotic hemangioma is characterized by a band-like proliferation of capillary blood vessels involving the superficial dermis and arranged horizontally parallel to the epidermis. CONCLUSION Acquired elastotic hemangioma is a distinctive clinicopathologic variant of hemangioma that should be differentiated from other cutaneous vascular proliferations. On histopathologic examination, it is characterized by capillary proliferation involving the dermis.
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Affiliation(s)
- Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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McMenamin ME, Fletcher CDM. Reactive angioendotheliomatosis: a study of 15 cases demonstrating a wide clinicopathologic spectrum. Am J Surg Pathol 2002; 26:685-97. [PMID: 12023572 DOI: 10.1097/00000478-200206000-00001] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Reactive angioendotheliomatosis (RAE) is a rare condition characterized by cutaneous vascular proliferation that usually occurs in patients with diverse types of coexistent systemic disease. Although intravascular proliferation of endothelial cells has been considered to be the key histologic feature in RAE, other patterns of vascular proliferation have also been described. We reviewed the clinicopathologic features in 15 cases of RAE. The study group comprised eight males and seven females with an age range of 47-88 years (median 65 years). Eleven patients had coexistent systemic disease: renal disease (six patients, including three post renal transplantation); valvular cardiac disease (two patients); one patient each had alcoholic cirrhosis, glioblastoma multiforme (on chemotherapy), and rheumatoid arthritis/polymyalgia rheumatica. Six patients were iatrogenically immunosuppressed at the onset of the skin lesions. The clinical appearance included multiple erythematous macules, plaques, tumors, and ulcerated lesions, with a wide distribution but a propensity to involve limbs. Lesions had been present for 1 month to 4 years (median 4 months). Lesions resolved in four cases, improved in two cases, remained static in one case, and progressed in four cases. Two cases were recent and follow-up was not available in two other cases. Three patients died of their coexistent systemic disease with resolution, improvement, and progression of lesions, respectively. All lesions were characterized histologically by a proliferation of capillaries in the dermis, with variably diffuse (seven cases), lobular (six cases), or mixed lobular and diffuse patterns (two cases). There was marked intercase and intracase heterogeneity in histologic features. Common features included fibrin microthrombi (nine cases), reactive (fasciitis-like) dermal alterations (seven cases), and foci of epithelioid endothelium (four cases). Four of 10 cases tested showed positive immunohistochemical staining for HHV-8 latent nuclear antigen in lesional endothelial cell nuclei. This study suggests that RAE has a broader clinicopathologic spectrum than previously described. The pathogenesis of this rare disorder is unknown, but it is likely that immunologic factors play a role.
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Affiliation(s)
- Máirín E McMenamin
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
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Sasaki R, Soejima T, Kishi K, Imajo Y, Hirota S, Kamikonya N, Murakami M, Kawabe T, Ejima Y, Matsumoto A, Sugimura K. Angiosarcoma treated with radiotherapy: impact of tumor type and size on outcome. Int J Radiat Oncol Biol Phys 2002; 52:1032-40. [PMID: 11958899 DOI: 10.1016/s0360-3016(01)02753-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Angiosarcoma is a rare and highly malignant vascular neoplasm. The purpose of this study was to elucidate the tumor characteristics and evaluate the efficacy of radiotherapy (RT) for angiosarcoma. MATERIALS AND METHODS Thirty patients with angiosarcoma (20 males and 10 females, age range 4-89 years, median 66) who received RT from 1986 to 1999 were enrolled in the study. Twenty-four patients had angiosarcoma of the face and scalp (AFS), and 6 patients had angiosarcomas at other sites. AFS was classified into two categories (according to the macroscopic features): nodular AFS (14 patients) and endophytic AFS (10 patients). The median prescribed irradiation dose was 68 Gy. Surgery had been previously performed in 9 patients, and adjuvant immunotherapy using recombinant interleukin-2 (rIL-2) was combined during and after RT in 20 patients. Univariate analyses and calculation of survival by Kaplan-Meier methods were performed. RESULTS Local tumor control was obtained in 17 patients (57%). However, 7 (47%) of them developed distant metastases. The median survival time for all patients was 8 months (7 months for AFS), and the 13-year overall survival rate was 25% (20% for AFS). Twenty-one patients died of angiosarcoma, with the cause of death local failure in 7 patients, distant failure in 7, and both in 7. Tumor type and size were found to be significant prognostic factors (p = 0.004 and p = 0.007, respectively), and age, total amount of rIL-2, gender, radiation dose, and surgery were not. Six patients (4 with nodular AFS and 2 with angiosarcoma in other parts) survived >2 years. No patient with endophytic AFS survived >2 years. Ten patients (33%) died of respiratory failure secondary to pulmonary metastases. High-dose rIL-2 administration suppressed the occurrence of distant metastases (p = 0.006). Two patients developed radiation dermatitis (Radiation Therapy Oncology Group Grade 4). CONCLUSION RT, combined with complete resection or adjuvant rIL-2 immunotherapy, could be a promising treatment strategy, leading to prolonged survival in patients with angiosarcoma.
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Affiliation(s)
- Ryohei Sasaki
- Divisions of Radiology, Kobe University School of Medicine, Hyogo, Japan.
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Requena L, Kutzner H, Mentzel T, Durán R, Rodríguez-Peralto JL. Benign vascular proliferations in irradiated skin. Am J Surg Pathol 2002; 26:328-37. [PMID: 11859204 DOI: 10.1097/00000478-200203000-00006] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Several types of cutaneous vascular proliferations have been described in areas of irradiated skin, including both benign lesions, such as benign lymphangiomatous papules, atypical vascular lesions, or benign lymphangioendothelioma, and malignant neoplasms such as high-grade angiosarcomas. This report describes the clinicopathologic features of 15 cases of different types of benign cutaneous vascular proliferations arisen within irradiated skin. All patients were female ranging in age from 33 to 72 years, and they had received postoperative external radiotherapy for treatment of breast carcinoma (14 cases) or ovarian carcinoma (one case). In those cases in which the latency interval period between radiotherapy and the development of the vascular lesion was known from the clinical records, the latency interval period elapsed between radiotherapy and diagnosis of the vascular lesion ranged from 3 to 20 years. The most common clinical presentation of the cutaneous lesions consisted of papules, small vesicles, or erythematous plaques on the irradiated field. Histopathologically, most lesions consisted of irregular dilated vascular spaces, with a branching and anastomosing pattern, thin walls, and lymphatic appearance involving the superficial dermis. A discontinuous single layer of endothelial cells with flattened nuclei lined these vascular channels, and numerous small stromal papillary formations also lined by endothelial cells projected into the lumina of the dilated lymphatic vessels. These cases were classified as benign lymphangiomatous papules or plaques. Two cases showed different histopathologic findings because they consisted of poorly circumscribed and focally infiltrating irregular jagged vascular spaces involving the entire dermis and lined by inconspicuous endothelial cells. In some areas these irregular slit-like vascular spaces dissected collagen bundles of the dermis. These cases were classified as atypical vascular proliferations mimicking benign lymphangioendothelioma or patch-stage Kaposi's sarcoma. All cases showed similar immunohistochemical findings and the endothelial cells lining the vascular spaces expressed immunoreactivity for CD31, but they stained only focally positive for CD34 or were negative for this marker. Immunohistochemical investigations for alpha-smooth muscle actin failed to demonstrate a complete peripheral ring of actin-positive pericytes in most of the neoformed vascular structures. This immunohistochemical profile also supported the lymphatic nature of these vascular proliferations developed in irradiated skin. Although some of these lesions may mimic histopathologically patch-stage Kaposi's sarcoma or well-differentiated angiosarcoma, the follow-up of the patients of this series demonstrated that the vascular proliferations arisen in irradiated skin invariably showed a benign biologic behavior.
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Affiliation(s)
- Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain.
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Agnihotri S, Ramesh V, Mukherjee A, Mitra RS, Kubba A. Case 4. Diagnosis: Tufted angioma (angioblastoma). Clin Exp Dermatol 2001; 26:111-2. [PMID: 11260197 DOI: 10.1046/j.1365-2230.2001.00743.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- S Agnihotri
- Department of Dermatology, Safdarjang Hospital, New Delhi, India, Institute of Pathology (ICMR), New Delhi, India
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Igarashi M, Oh-i T, Koga M. The relationship between angioblastoma (Nakagawa) and tufted angioma: report of four cases with angioblastoma and a literature-based comparison of the two conditions. J Dermatol 2000; 27:537-42. [PMID: 10989580 DOI: 10.1111/j.1346-8138.2000.tb02223.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report four recent cases of angioblastoma (Nakagawa). Histopathologic examinations of all cases revealed dispersed islets of clear marginal lobules of varying sizes in the dermis. Neoplastic endothelioid cells with moderate atypia and enlarged capillaries containing erythrocytes were found in the conglomerates. Recently, the features of this disease have been compared to the tufted angioma that has been reported in Europe and the U.S. Our evaluation suggests that these two diseases are very likely the same. We suggest that this disease should be called "angioblastoma" in agreement with the first report of this disease by Nakagawa.
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Affiliation(s)
- M Igarashi
- Department of Dermatology, Tokyo Medical University, Japan
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Guillou L, Fletcher CD. Benign lymphangioendothelioma (acquired progressive lymphangioma): a lesion not to be confused with well-differentiated angiosarcoma and patch stage Kaposi's sarcoma: clinicopathologic analysis of a series. Am J Surg Pathol 2000; 24:1047-57. [PMID: 10935645 DOI: 10.1097/00000478-200008000-00002] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The clinicopathologic features of 12 cases of benign lymphangioendothelioma (acquired progressive lymphangioma) are reported. There were five male and seven female patients. Age at diagnosis ranged from 17 to 90 years (median age, 54 yrs). Development of a single macular/papular hemangiomatous or pigmented lesion was the main presenting symptom. Symptom duration before diagnosis ranged from 2 months to 20 years (median, 5.5 yrs). Tumor size ranged from 0.3 cm to 10 cm (median. 1.5 cm). Location included skin of the head and neck (n = 5), back (n = 1), breast (n = 1), shoulder (n = 1), forearm (n = 1), plantar aspect of the foot (n = 2), and oral mucosa (n = 1). No patient had any other concomitant vascular anomaly (for example, lymphangiomatosis) or was suspected to have acquired immunodeficiency syndrome. Treatment consisted of excisional biopsy in nine patients, incisional biopsy in two, and wide excision in one. Follow-up information on nine patients (range, 4-40 mos; median, 12 mos) showed two local recurrences in one patient. Microscopically, the lesions consisted of anastomosing, often widely dilated vascular structures developing in the superficial dermis. As the lesion grew within deeper dermis, the vascular spaces collapsed and dissected the dermal collagen in an angiosarcoma-like pattern. The lining endothelium was flat and monolayered, with little or no cytologic atypia and no evident mitoses. Some vascular structures contained stromal papillary projections resembling papillary endothelial hyperplasia, and intravascular red blood cells were present occasionally. Immunohistochemistry performed in eight specimens showed variable endothelial cell reactivity for CD31 (7 of 8), CD34 (7 of 7), and factor VIII-related antigen (4 of 6). A smooth muscle cell layer was observed focally around the vascular spaces in six lesions. Benign lymphangioendothelioma (acquired progressive lymphangioma) is an uncommon benign lesion that, in view of major differences in treatment and prognosis, should be distinguished from well-differentiated angiosarcoma and Kaposi's sarcoma, especially the patch stage and lymphangioma-like variants of the latter.
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Affiliation(s)
- L Guillou
- University Institute of Pathology, Lausanne, Switzerland
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