Acquired tufted angioma associated with pregnancy

Surgical excision of a tufted angioma of the hand in an adult-a rare case report with a review of literature

Tufted Angiomas, also known as angioblastomas/Angioblastoma of Nagakawa, are rare vascular neoplasms of both sexes localised to the skin and subcutaneous tissues with the upper trunk and neck being the most common sites. They are more common in children but a few cases in juveniles and adults have been reported. Typically, Tufted Angioma remains stable or can show rarely a spontaneous regression. This article wants to evaluate the efficacy of current treatment modalities for tufted angioma (TA). A review was performed using PubMed database (Medline) for clinical studies. We report our case, a 29-year-old female who presented with a second finger of the left hand, painful, slowly progressive, firm swelling diagnosed as Tufted Angioma on histopathology and immunohistochemistry after complete surgical excision.

Invited Review : Three New Vascular Tumors—Tufted Angioma, Kaposiform Infantile Hemangioendothelioma, and Proliferative Cutaneous Angiomatosis

The features of tufted angioma (Nakagawa), Kaposiform infantile hemangioendotheli oma, and proliferative cutaneous angiomatosis are reviewed. Tufted angioma, which usually appears before the age of ten years, is a large, poorly demarcated, macular, cutaneous and subcutaneous lesion most commonly located on the neck or trunk. Histologically, there is a "cannon ball" pattern of concentrically whorled lobules and tufts of endothelial and perithelial cells. Tufted angioma is difficult to excise and usually persists throughout life but causes no serious symptoms. Kaposiform infantile heman gioendothelioma is a rare, aggressive vascular tumor of the deep soft tissues, bone, and skin that presents during the first year of life and is often complicated by Kasabach- Merritt syndrome. Histologically, there is a Kaposiform pattern, but some cells may be arranged in nodules and tufts indistinguishable from tufted angioma. Kaposiform infantile hemangioendothelioma responds to interferon therapy. On the basis of the few cases so far recognized, proliferative cutaneous angiomatosis is a large, diffuse, mainly superficial angioma that grows insidiously and is biopsied in the second or third decade of life. Histologically, there are irregular, interconnecting cords and sheets of endothelial cells that form anastomosing spaces. Extravasated red cells and endothe lial hemosiderosis are prominent. The superficial location, older age, and the distinctive histology suggest that proliferative cutaneous angiomatosis differs from Kaposiform infantile hemangioendothelioma. Int J Surg Pathol 2(1):63-72, 1994

Tufted angioma of the maxilla: a rare case with unique clinical presentation

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.

Acquired tufted angioma of upper lip: case report and review of the literature

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.

Acquired multifocal tufted angiomas in an immunocompetent young adult

Tufted angioma (TA) is a rare benign vascular neoplasm, localized to the skin and subcutaneous tissues, occurring primarily on the trunk and extremities of children. The lesions are usually asymptomatic but, rarely, paroxysmal painful episodes may be associated. The occurrence of eruptive TA is still rarer and had been described almost exclusively in association with immunocompromised states. We report here a case of acquired painful multifocal tufted angiomas on the face and neck in an immunocompetent young adult.

Treatment of a tufted angioma with intense pulsed light

Tufted angioma is a rare cutaneous angiomatous proliferation named because of its characteristic histologic pattern of grouped dermal capillary tufts. Lesions usually begin in infancy or early childhood but rarely are congenital. Clinical manifestations are dull red coalescent papules and plaques, most commonly located on the neck, shoulders, and upper back, and can sometimes be tender. Although transformation to malignancy has not been described, tufted angiomas do not tend to regress. Effective treatments reported in the literature are scarce. We report an adult case of tufted angioma, with unusual presentation as annular plaques, which was alleviated after treatment with intense pulsed light in terms of both cosmetics and discomfort.

Angioma em tufos: relato de um caso tratado com laser corante pulsado

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.

The spontaneous regression of tufted angioma. A case of regression after two recurrences and a review of 27 cases reported in the literature

BACKGROUND

Tufted angioma, a peculiar angioma that is characterized by tufts of capillary-sized vessels scattered 'cannonball fashion' within the dermis, is known, on occasion, to regress spontaneously. However, the appropriate waiting period for spontaneous regression has remained unclear.

OBJECTIVE

To know the appropriate waiting period for spontaneous regression of tufted angioma.

METHODS

We report here a case of tufted angioma that regressed spontaneously after the lesions had recurred twice. We also review previously reported cases of tufted angioma with spontaneous regression, including cases in the Japanese and non-Japanese literature.

RESULTS

In 18 (86%) of the 21 cases, the waiting period was more than 6 months and in 20 cases (95%) it was less than 2 years.

CONCLUSION

The appropriate wait for spontaneous regression might be between 6 months and 2 years.

Familial predisposition to tufted angioma: identification of blood and lymphatic vascular components

Tufted angioma is a rare benign vascular lesion of unknown etiology which mainly affects children under 5 years. It is characterized by nodules or tufts of capillary-sized vessels in the dermis. Here we report the second familial occurrence of tufted angioma, with a mode of inheritance compatible with a monogenic autosomal dominant trait with reduced penetrance. A preliminary investigation was performed to exclude association between the predisposition and certain candidate genes including KDR (kinase insert domain receptor), TEK (TEK tyrosine kinase endothelial), ACVRL1 (activin receptor-like kinase 1), ENG (endoglin) and FLT4 (fms-like tyrosine kinase 4). KDR, ENG and FLT4 were all compatible with linkage, with haplotypes being shared between three affected individuals and the one obligate carrier available for testing. TEK and ACVRL1 could essentially be excluded. Finally, we provide definitive evidence for the existence of both blood and lymphatic vascular elements in the lesion.

Tufted angioma (angioblastoma): case report and review of 41 cases in the Japanese literature

We report a 53-year-old man with a 2-year history of a violaceous indurated plaque on the shoulder. Although angiosarcoma was clinically suspected, histological examination revealed numerous lobules ('tufts') with cleft-like vascular lumina throughout the dermis and subcutaneous tissue. Tumour cells had no nuclear atypia and were positive for CD34, but almost negative for factor VIII-related antigen. These findings were compatible with a diagnosis of tufted angioma, or angioblastoma. We reviewed 41 cases reported in Japan and found that, although most patients presented during the first year of life (23/41), the condition does occur throughout childhood and adult life. Both sexes are affected equally and, contrary to some reports, it is unlikely that oestrogens have a pathogenic role.

Acquired tufted angioma: a unique vascular lesion not previously reported in the oral mucosa

We describe two patients with acquired tufted angioma, a unique vascular lesion not previously reported in the oral mucosa. In one patient, the lesion manifested as a purple-red papule and, in the other, as a blue submucosal swelling. Both lesions were non-painful and neither was associated with a history of trauma. The histopathological features consisted of scattered, irregularly shaped tufts, primarily composed of poorly formed capillary spaces and slit-like vascular channels. Capillary spaces were often closely packed, producing solid areas which stained for smooth muscle actin. Staining for factor VIII-related antigen was positive only within endothelial cells lining well-formed vascular channels. Both lesions were treated by excision; short-term follow-up of one patient revealed no evidence of recurrence. Similarities between this and other vascular processes may have resulted in misdiagnosis of this lesion in the past. The clinical significance of acquired tufted angioma in the oral mucosa is not known.

Cutaneous vascular proliferation. Part II. Hyperplasias and benign neoplasms

This second part of our review about vascular proliferations summarizes the clinicopathologic features of the cutaneous vascular hyperplasias and benign neoplasms. Hyperplasias comprise a heterogeneous group of vascular proliferations that eventually show a tendency to regression. Angiolymphoid hyperplasia with eosinophilia is included within the group of hyperplasias because of its historical denomination and its reactive nature, probably as a consequence of an arteriovenous shunt, although usually the lesions do not regress. Pyogenic granuloma, bacillary angiomatosis, intravascular papillary endothelial hyperplasia, and pseudo-Kaposi's sarcoma qualify as vascular hyperplasias because they regress when the stimulus that initiated them is removed. Benign neoplasms form a large group of hemangiomas with distinctive clinicopathologic characteristics, although some of them are of recent description and may produce diagnostic difficulties. We classified cutaneous benign vascular neoplasms according to their cell lineage of differentiation, for example, endothelial, glomus cell, and pericytic differentiation. Subsequent categories are established according to the size of the involved vessels (capillaries, venules and arterioles, or veins and arteries) or the nature of the proliferating vessels (blood or lymphatic vessels). Capillary and cavernous hemangiomas have been the terms classically used to name the most common variants of benign vascular neoplasms (i.e., infantile hemangiomas), but they are not the most appropriate denominations for these lesions. First, these names are not contrasting terms. Furthermore, most of the socalled "cavernous" hemangiomas are not hemangiomas (neoplasms) at all, but venous malformations. The most important conceptual issue is that, at any point in time, a particular hemangioma has its own histopathologic pattern throughout the depth of the lesion. For these reasons, we classified hemangiomas into superficial and deep categories. Some of the lesions reviewed have been recently described in the literature, and they may histopathologically mimic lesions of Kaposi's sarcoma; these include targetoid hemosiderotic hemangioma, microvenular hemangioma, tufted hemangioma, glomeruloid hemangioma, kaposiform hemangioendothelioma, spindle-cell hemangioendothelioma, and benign lymphangioendothelioma. In each of these lesions, we update and emphasize those clinical and histopathologic features that are helpful for differential diagnosis with lesions of authentic Kaposi's sarcoma in any of its three stages of development (patch, plaque, or nodule).

Tufted angioma with complete regression

We describe 2 patients with tufted angioma (angioblastoma of Nakagawa) which regressed spontaneously. Both patients had a solitary but large lesion on the trunk. The 1st patient, a 3-month-old girl, presented with a 6-cm plaque which began to regress 2 years later. It regressed completely over 1 year and had not recurred after a further 6-year follow-up. The other patient, a 3-month-old boy, presented with a 12-cm mass of coalescent angiomatous papules which slowly regressed over 3-years, while small new lesions appeared in the adjacent contiguous skin. Eventually, gradual and near complete regression was observed after 8 years. The histology in both cases was typical, but bore some resemblance to the recently described kaposiform hemangioendothelioma, lobular capillary hemangioma and spindle cell hemangioendothelioma.