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Saleh JS, Whittington CP, Bresler SC, Patel RM. Cutaneous vascular tumors: an updated review. Hum Pathol 2023; 140:53-65. [PMID: 37059271 DOI: 10.1016/j.humpath.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/30/2023] [Accepted: 04/06/2023] [Indexed: 04/16/2023]
Abstract
Cutaneous vascular tumors constitute a heterogeneous group of entities that share overlapping morphologic and immunohistochemical features, which can be diagnostically challenging for pathologists and dermatopathologists. Our understanding and knowledge of vascular neoplasms have improved over time, resulting in both a refinement of their classification by the International Society for the Study of Vascular Anomalies (ISSVA) and an improvement in the accurate diagnosis and clinical management of vascular neoplasms. This review article aims to summarize the updated clinical, histopathological, and immunohistochemical characteristics of cutaneous vascular tumors, as well as to highlight their associated genetic mutations. Such entities include infantile hemangioma, congenital hemangioma, tufted angioma, spindle cell hemangioma, epithelioid hemangioma, pyogenic granuloma, Kaposiform hemangioendothelioma, retiform hemangioendothelioma, pseudomyogenic hemangioendothelioma, Kaposi sarcoma, angiosarcoma, and epithelioid hemangioendothelioma.
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Affiliation(s)
- Jasmine S Saleh
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Scott C Bresler
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Rajiv M Patel
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI 48109, USA; Cutaneous Pathology, WCP Laboratories, Inc., Maryland Heights, MO 63043, USA.
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2
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Abstract
RATIONALE Spindle cell hemangioma (SCH) is considered a benign vascular lesion. It typically develops as a solitary nodule or multiple masses located in the dermal or subcutaneous layers of the distal extremities. To the best of our knowledge, there are no prior reports of SCH in the spleen. PATIENT CONCERNS A 41-year-old male was admitted to our hospital with recurrent headaches, nausea, and vomiting persisting for 5 days. Ultrasound, computed tomography, and magnetic resonance imaging revealed multiple space-occupying lesions in the spleen, and the biggest lesion was 4.8 cm × 5.4 cm in size. INTERVENTIONS The patient underwent laparoscopic splenectomy. DIAGNOSIS A diagnosis of spindle cell hemangioma of the spleen was made based on the histopathology. OUTCOMES No evidence of local recurrence or distant metastases was observed over 4-year follow-up. LESSONS Splenic SCH may exhibit relatively high proliferative activity and be comorbid with epithelioid hemangioendothelioma or angiosarcoma, raising the possibility of malignant potential. However, the patient remained alive and disease-free 4 years after the operation. The nature of SCH in deep soft tissues requires further study.
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Affiliation(s)
- Bing-Qiang Gao
- Division of Hepatobiliary and Pancreatic Surgery
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
| | - Dong-Kai Zhou
- Division of Hepatobiliary and Pancreatic Surgery
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
| | - Xiao-Hui Qian
- Division of Hepatobiliary and Pancreatic Surgery
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
| | - Wang Zhang
- Division of Hepatobiliary and Pancreatic Surgery
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
| | | | - Wei-Lin Wang
- Division of Hepatobiliary and Pancreatic Surgery
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
- Clinical Research Center of Hepatobiliary and Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital, School of Medicine, Zhejiang University
- State Key Laboratory & Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China
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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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Nasser R, Ashayeri K, Legatt AD, Houten JK. Intramedullary spindle cell hemangioma: case report. J Neurosurg Spine 2016; 25:379-82. [PMID: 27058496 DOI: 10.3171/2015.11.spine15641] [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: 11/06/2022]
Abstract
The authors describe the case of a 48-year-old man found to have the first reported intramedullary spinal cord spindle cell hemangioma. Previous research indicates that spindle cell hemangiomas are rarely found in the spine. Only 3 previous cases exist, all in the intradural, extramedullary space. In the present case, gross-total resection of the tumor was possible with no loss of function from baseline. This report presents the successful resection of the first reported intramedullary spindle cell hemangioma and reports 4-month follow-up, demonstrating the biological behavior of this rare tumor.
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Affiliation(s)
| | | | - Alan D Legatt
- Neurology, and.,Neuroscience, Albert Einstein College of Medicine/Montefiore Medical Center
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5
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Histopathology and Pathogenesis of Vascular Tumors and Malformations. VASCULAR TUMORS AND DEVELOPMENTAL MALFORMATIONS 2016. [DOI: 10.1007/978-1-4939-3240-5_1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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6
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Granger J, Manton N, Hamilton M, Dawson J. Spindle cell haemangioma mimicking a popliteal aneurysm. ANZ J Surg 2014; 87:98-100. [PMID: 25267337 DOI: 10.1111/ans.12861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jeremy Granger
- Department of Paediatric Surgery, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Nick Manton
- Department of Pathology, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Mark Hamilton
- Department of Vascular Surgery, The University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Joseph Dawson
- Department of Vascular Surgery, The University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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7
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Requena L, Torrelo A. Paediatric vascular tumours other than infantile haemangioma. Br J Dermatol 2014; 171:464-5. [DOI: 10.1111/bjd.12917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L. Requena
- Department of Dermatology Fundación Jiménez Díaz Universidad Autónoma Avda. Reyes Católicos 2 28040 Madrid Spain
| | - A. Torrelo
- Department of Dermatology Hospital del Niño Jesús Universidad Autónoma Madrid Spain
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8
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Hoeger P, Colmenero I. Vascular tumours in infants. Part I: benign vascular tumours other than infantile haemangioma. Br J Dermatol 2014; 171:466-73. [DOI: 10.1111/bjd.12650] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2013] [Indexed: 11/28/2022]
Affiliation(s)
- P.H. Hoeger
- Department of Paediatric Dermatology Catholic Children's Hospital Wilhelmstift Hamburg Germany
| | - I. Colmenero
- Histopathology Department Birmingham Children's Hospital Birmingham U.K
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9
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Cai Y, Wang R, Chen XM, Zhao YF, Sun ZJ, Zhao JH. Maffucci syndrome with the spindle cell hemangiomas in the mucosa of the lower lip: a rare case report and literature review. J Cutan Pathol 2013; 40:661-6. [PMID: 23506121 DOI: 10.1111/cup.12131] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Revised: 05/16/2012] [Accepted: 07/24/2012] [Indexed: 11/30/2022]
Abstract
The presence of non-cutaneous vascular lesions in the syndrome of multiple enchondromas and subcutaneous hemangiomas, also named Maffucci syndrome, is exceedingly rare. Until now, non-cutaneous vascular lesions have been described in nine patients, while only three cases were present in the oral cavity; they were found in the tongue in two patients and in the lower lip in one patient. Herein, we report the second case of vascular lesions localized in the mucosa of lower lip in a patient with Maffucci syndrome. Histopathologic examination showed spindle cell hemangioma.
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Affiliation(s)
- Yu Cai
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, P R China
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10
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Abstract
Hemangioendothelioma is the term used to name those vascular neoplasms that show a borderline biological behavior, intermediate between entirely benign hemangiomas and highly malignant angiosarcomas. Although originally spindle cell hemangioendothelioma was proposed as a specific clinicopathologic variant of hemangioendothelioma, currently, it is considered as an entirely benign lesion, and thus, the name spindle cell hemangioma seems to be the most accurate for this lesion. Authentic hemangioendotheliomas involving the skin and soft tissues include papillary intralymphatic angioendothelioma (also known as Dabska tumor), retiform hemangioendothelioma, kaposiform hemangioendothelioma, epithelioid hemangioendothelioma, pseudomyogenic hemangioendothelioma (also known as epithelioid sarcoma-like hemangioendothelioma), and composite hemangioendothelioma. Each of these neoplasms exhibit characteristic histopathologic features. The most characteristic finding of papillary intralymphatic hemangioendothelioma consists of papillary tufts, with a central hyaline core lined by hobnail-like endothelial cells protruding into the lumina. Retiform hemangioendothelioma is an infiltrative neoplasm composed of elongated arborizing vessels, arranged in an anastomosing pattern that resembles that of the rete testis, and lined by a single layer of hobnail-like endothelial cells that protrude within the narrow lumina. Kaposiform hemangioendothelioma is composed of several solid poorly circumscribed nodules, and each nodule is composed of a mixture of small capillaries and solid lobules of endothelial cells arranged in a glomeruloid pattern. A frequent finding consists of the presence of areas of lymphangiomatosis adjacent to the solid nodules. Epithelioid hemangioendothelioma is composed of cords, strands, and solid aggregates of round, oval, and polygonal cells, with abundant pale eosinophilic cytoplasm, vesicular nuclei, and inconspicuous nucleoli, embedded in a fibromyxoid or sclerotic stroma. Many neoplastic cells exhibit prominent cytoplasmic vacuolization as an expression of primitive vascular differentiation. Pseudomyogenic hemangioendothelioma is a poorly circumscribed, fascicular lesion with infiltrative borders composed of round or oval neoplastic cells, with vesicular nuclei and inconspicuous nucleoli, and ample homogeneous eosinophilic cytoplasm, giving them a rhabdomyoblastic appearance. Finally, composite hemangioendothelioma is the term used to name locally aggressive vascular neoplasms of low-grade malignancy showing varying combinations of benign, low-grade malignant, and high-grade malignant vascular components. From the immunohistochemical point of view, proliferating cells of all hemangioendotheliomas express a lymphatic endothelial cell immunophenotype. Most hemangioendotheliomas are low-grade vascular neoplasms, with a tendency to recur locally and a low metastatic potential, mostly to regional lymph nodes. Epithelioid hemangioendothelioma, especially large lesions and those located in deep soft tissues, seems to have a more aggressive biological behavior.
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Affiliation(s)
- Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain.
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11
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Gray SS, Eltorky MA, Riascos RF, Montilla RD. Spindle cell hemangioma reoccurrence in the hand: case report. Hand (N Y) 2012; 7:194-9. [PMID: 23730241 PMCID: PMC3351523 DOI: 10.1007/s11552-012-9397-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sylvia S. Gray
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX USA
| | - Mahmoud A. Eltorky
- Department of Pathology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX USA
| | - Roy F. Riascos
- Department of Radiology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX USA
| | - Richard D. Montilla
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX USA ,299 Lincoln Street, Suite 201, Worcester, MA 01605 USA
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12
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Lowe LH, Marchant TC, Rivard DC, Scherbel AJ. Vascular Malformations: Classification and Terminology the Radiologist Needs to Know. Semin Roentgenol 2012; 47:106-17. [DOI: 10.1053/j.ro.2011.11.002] [Citation(s) in RCA: 164] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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14
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Tardío JC. CD34-reactive tumors of the skin. An updated review of an ever-growing list of lesions. J Cutan Pathol 2009; 36:89-102. [PMID: 19125742 DOI: 10.1111/j.1600-0560.2008.01212.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Over the past few years, a growing number of cutaneous tumors expressing CD34 is being reported. The list contains benign and malignant neoplasms as well as reactive and hamartomatous lesions of diverse lineages of differentiation, including fibroblastic, myofibroblastic, fibrohistiocytic, vascular, neural, adipocytic, smooth muscle, hematopoietic, melanocytic and epithelial. The more frequent diagnostic difficulties are found in spindle cell proliferations, mainly in those of the fibrocytic lineage. In part, this is because of the fact that in this area are, aside to well-defined entities, histologically and clinically diverse, recently reported cutaneous CD34-reactive lesions, whose definitions, limits and relationships are not completely established. The CD34 expression plays a key role in the differential diagnosis of some tumors, such as dermatofibrosarcoma protuberans, epithelioid sarcoma or pleomorphic hyalinizing angiectatic tumor of soft parts, with important therapeutic consequences. In others, as in desmoplastic trichilemmoma, it can help to resolve diagnostic problems in concrete cases. Finally, in many of the CD34-positive lesions, the diagnosis with the hematoxylin and eosin stain is straightforward. However, in all of them, the knowledge of the immunohistochemical profile contributes to our understanding of the cutaneous pathology.
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Affiliation(s)
- Juan C Tardío
- Department of Pathology, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain.
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15
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Tardío JC. THIS ARTICLE HAS BEEN RETRACTED
CD34-reactive tumors of the skin. An updated review of an ever-growing list of lesions. J Cutan Pathol 2008; 35:1079-92. [DOI: 10.1111/j.1600-0560.2008.01124.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Abstract
Composite hemangioendothelioma (HE) is a low-grade malignant vascular tumor showing varying combinations of benign, low-grade malignant, and malignant vascular components. The predominant histologic components are histologically identical to epithelioid HE and retiform HE. To our knowledge, there have been only 12 cases of composite HE reported in the English literature and its nature and biologic behavior remains unknown. In this study, the clinicopathologic and immunohistochemical features of 5 cases of composite HE including a case with associated Maffucci syndrome are described. The patients were 4 females and 1 male with a median age of 43.4 years (range, 22 to 75 y). All tumors occurred in the dermis and/or subcutis. The tumors arose in the foot or lower leg in 3 patients, in the jaw in 1 patient, and as multiple tumors in the left upper extremity in 1 patient. Two patients had congenital tumors, in the lower thigh and foot, and upper extremity, respectively. The lesions were usually of several years duration. The size of individual tumors ranged from 1.5 to 30 cm. The tumors were composed of a complex admixture of histologic components resembling various vascular lesions. The predominant components, present in all cases, resembled retiform HE and epithelioid HE. Angiosarcomalike areas were observed in 3 cases. Lymphangiomalike areas were found in 2 cases. Areas of spindle cell hemangioma, cavernous hemangioma, or arteriovenous malformation were identified in 1 case each. The 2 congenital cases, which exhibited multiple lesions, had angiosarcomalike components and an angiomatosislike growth pattern. One patient each was associated with Kasabach-Merritt or Maffucci syndrome. Immunohistochemically, all tumors showed expression of at least 2 endothelial markers (CD31, CD34, and/or factor VIII-related antigen). Of 4 cases with follow up (median duration, 8.6 y), 1 tumor recurred locally. To date, none of the patients have developed metastases. There was no difference of biologic behavior among cases with various combinations of histology in this study and previously reported cases. We conclude that composite HE should continue to be regarded as a low-grade malignant vascular tumor (HE), with significant potential for local recurrence, but little if any potential for distant metastasis.
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Affiliation(s)
- Masaharu Fukunaga
- Department of Pathology, The Jikei University School of Medicine, Jikei Daisan Hospital, 4-11-1 Izumihoncho, Komaeshi, Tokyo 201-8601, Japan.
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Talan-Hranilović J, Vucić M, Sajko T, Bedek D, Tomić K, Lupret V. Spinal spindle cell haemangioma: an atypical location. Acta Neurochir (Wien) 2007; 149:325-8; discussion 328. [PMID: 17310275 DOI: 10.1007/s00701-006-1109-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2006] [Accepted: 12/12/2006] [Indexed: 10/23/2022]
Abstract
We present a case of the 31-year-old male patient who complained of weakness in both legs and progressed slowly. Neuroimagine of the thoracic spine showed an intraspinal, extradural mass lesion, measuring 5.3 x 1.2 cm at the Th1-Th3 level. Histologically the lesion was a spindle cell haemangioma composed of dilated vascular spaces and a proliferation of bland appearing interspersed spindle cells. Immunohistochemical analysis was diffusely positive for VIM, SMA and focally for CD34. This lesion is uncommon and shows a predilection for distal extremities. Spindle cell haemangioma within the spine has not been previously reported in the literature.
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Affiliation(s)
- J Talan-Hranilović
- "Ljudevit Jurak" University Department of Pathology, University Hospital "Sestre milosrdnice", Zagreb, Croatia.
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Gupta SC, Tewarson SL, Malhotra M. Haemangioendothelioma of paranasal sinuses with intracranial extension. Indian J Otolaryngol Head Neck Surg 2006; 58:196-8. [PMID: 23120286 DOI: 10.1007/bf03050789] [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: 11/26/2022] Open
Abstract
Maxillary sinus is a rare site for the occurrence of haemangioendothelioma. The present case is being reported in a 45 year old Hindu Male. The main complaint ware bilateral nasal obstruction und a mass protruding from he right nostril along with episodes of headache, vomiting and nasal bleeding. The. C.T. scan showed evidence of erosion of bony walls of maxillary antrum with intracranial extension of the tumor. There was no evidence of regional lymph nodes or distance metastasis. Histology of the tissue revealed a highly cellular and vascular tumor the diagnosis of haemangioendothelioma of the maxillary sinus retiform variety was established.
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Affiliation(s)
- S C Gupta
- Dept. Of ENT, S.R.N. Hospital, M.L.N. Medical College, 211 002 Allahabad, India
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Fernández-Aguilar S, Fayt I, Noël JC. Spindle cell vulvar hemangiomatosis associated with enchondromatosis: a rare variant of Maffucci's syndrome. Int J Gynecol Pathol 2003; 23:68-70. [PMID: 14668554 DOI: 10.1097/01.pgp.0000101149.01933.f7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Spindle cell hemangioma is a rare vascular tumor that most frequently involves the distal extremities, especially the hand. We report a case of spindle cell hemangiomatosis of the vulva in an 18-year-old woman with Maffucci's syndrome, the first report of such a case, to the best of our knowledge. The vascular lesions, present from the age of 2, were located in the right olecranon, the third left toe, and the vulva. Spindle cell hemangiomas are either benign neoplasms or hamartomatous malformations.
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Abstract
This article reviews the pathology of benign, borderline, and malignant vascular neoplasms of the skin. The classification of vascular lesions of childhood is presented. Defined variants of hemangioma (including sinusoidal, microvenular, glomeruloid, epithelioid, and targetoid hemosideric hemangioma, as well as acquired tufted hemangioma and angiofibroma) are discussed. Borderline hemangioendotheliomas are classified. Kaposi sarcoma is reviewed with an update on the role of human herpesvirus type 8 in its pathogenesis. Angiosarcoma and acquired progressive lymph-angioma are also discussed.
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Affiliation(s)
- V G Prieto
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA.
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Hiraiwa H, Hamazaki M, Tsuruta S, Hattori H, Mimaya J, Hasegawa S, Kohno S, Aoki K. Infantile hemangioendothelioma of the thymus with massive pleural effusion and Kasabach--Merritt syndrome: histopathological, flow cytometrical analysis of the tumor. ACTA PAEDIATRICA JAPONICA : OVERSEAS EDITION 1998; 40:604-7. [PMID: 9893299 DOI: 10.1111/j.1442-200x.1998.tb01999.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Infantile hemangioendothelioma of the thymus is a rare disease. We describe a patient who developed a large anterior mediastinal mass, severe thrombocytopenia and massive pleural effusion at 1 month of age. Glucocorticosteroid and irradiation therapy had no effect on either the tumor size or clinical symptoms and the tumor was resected subtotally. Three months after the subtotal resection, the remaining tumor had almost disappeared and the symptoms had resolved. The patient has now been well for 1 year after surgery without evidence of recurrence. The tumor tissue was characterized by prominent vascular endothelial proliferation intermixed with a normal thymic structure, producing a picture consistent with that of an infantile hemangioendothelioma in the thymus. Immunohistochemically, the tumor cells showed positive staining for vimentin, factor VIII and CD34. The DNA stemline and proliferative activity were examined by flow cytometry, which revealed a diploid stemline with a low growth fraction. DNA content and cell cycle analyses of the tumor tissue may be useful for predicting the biological behavior of the tumor.
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Affiliation(s)
- H Hiraiwa
- Department of Pathology, Shizuoka Children's Hospital, Japan.
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Requena L, Sangueza OP. Cutaneous vascular proliferation. Part II. Hyperplasias and benign neoplasms. J Am Acad Dermatol 1997; 37:887-919; quiz 920-2. [PMID: 9418757 DOI: 10.1016/s0190-9622(97)70065-3] [Citation(s) in RCA: 236] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
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).
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Affiliation(s)
- L Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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Requena L, Sangueza OP. Cutaneous vascular anomalies. Part I. Hamartomas, malformations, and dilation of preexisting vessels. J Am Acad Dermatol 1997; 37:523-49; quiz 549-52. [PMID: 9344191 DOI: 10.1016/s0190-9622(97)70169-5] [Citation(s) in RCA: 176] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Classification of cutaneous vascular anomalies is difficult because conceptual confusion persists between vascular neoplasms and malformations. However, hemangiomas of the infancy fulfill criteria both for hyperplasia and neoplasm because they result from proliferation of endothelial cells, but often undergo complete regression. Despite these pitfalls we have classified cutaneous vascular anomalies into the following categories: hamartomas, malformations, dilatations of preexisting vessels, hyperplasias, benign neoplasms, and malignant neoplasms. In this first part of our clinicopathologic review of vascular anomalies, hamartomas, malformations, and dilatation of preexisting vessels are covered. Hamartomas include several combined vascular and melanocytic proliferations grouped as phakomatosis pigmentovascularis and the so-called eccrine angiomatous hamartoma that consists of proliferations of both eccrine glands and blood vessels. Vascular malformations result from anomalies of embryologic development, and in some of them the abnormalities of the involved vessels are more functional than anatomic, as is the case of nevus anemicus. In contrast, other cutaneous vascular malformations show striking morphologic abnormalities of the vascular structures. These anatomic vascular malformations are subdivided into the following groups: capillary, venous, arterial, lymphatic, and combined anomalies. Spider angioma, capillary aneurysm-venous lake, and telangiectases are not vascular proliferations at all, but dilations of preexisting vessels. In our opinion, most of the lesions described with the generic term of "angiokeratoma" are not authentic vascular neoplasms, but hyperkeratotic malformations of capillaries and venules or acquired telangiectases of preexisting blood vessels of the papillary dermis. Therefore the first group of these "angiokeratomas" are included in the vascular malformations section, and the second group are covered in the section of dilation of preexisting vessels. Lymphangiectases are considered the lymphatic counterpart of angiokeratomas because they result from ectasia of preexisting lymphatic vessels of the papillary dermis.
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Affiliation(s)
- L Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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Hisaoka M, Aoki T, Kouho H, Chosa H, Hashimoto H. Maffucci's syndrome associated with spindle cell hemangioendothelioma. Skeletal Radiol 1997; 26:191-4. [PMID: 9108232 DOI: 10.1007/s002560050219] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The case of a 49-year-old man with Maffucci's syndrome, who developed multiple spindle cell hemangioendotheliomas, is presented. The case provides support for recent reports suggesting an association between this peculiar vascular lesion and skeletal enchondromatosis.
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Affiliation(s)
- M Hisaoka
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu, Japan
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