Home   Chapter Home   Jobs   Conferences   Fellowships   Books



Advertisement

Skin - Nonmelanocytic tumors

Vascular tumors

Hemangioma


Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 21 August 2014, last major update July 2012
Copyright: (c) 2001-2014, PathologyOutlines.com, Inc.

General
=========================================================================

● Childhood tumors are often malformations, not neoplasms


Capillary hemangioma

General
=========================================================================

● Small (usually 1-3 mm) benign vascular lesions
● Also called strawberry hemangioma or Campbell de Morgan spot
Children: usually regress by fibrosis
Adults: may slowly enlarge or thrombose

Differential diagnosis
=========================================================================

● Dermal vascular hyperplasia (with venous stasis)
● Pyogenic granuloma
● Kaposi sarcoma
● Angiosarcoma
● Hemangioendothelioma


Cavernous hemangioma

General
=========================================================================

● Markedly dilated dermal vessels, may elevate overlying epidermis, which may be atrophic
● Associated with Maffucci syndrome, blue rubber bleb nevus syndrome, Kasabach-Merritt syndrome


Epithelioid hemangioma

General
=========================================================================

● Also called histiocytoid hemangioma, angiolymphoid hyperplasia with eosinophilia (ALHE)
● All racial groups
● Head and neck nodules, often periauricular
● Benign in skin
● May be reactive
● May occur in bone
● No/rare regional lymphadenopathy
● Normal serum eosinophils, IgE

Case reports
=========================================================================

● 51 year old male with 8 ◊ 6 cm subcutaneous mass in right cheek (Int J Surg Case Rep 2011;2:258)

Gross description
=========================================================================

● Small, superficial, dermal papulonodules, frequently erythematous, with bleeding

Micro description
=========================================================================

● Proliferation of blood vessels with epithelioid endothelial cells exhibiting abundant eosinophilic cytoplasm with variable cytoplasmic vacuoles resembling intracytoplasmic lumina and large vesicular nuclei with variable atypia
● Usually heavy infiltrate of eosinophils and lymphocytes with germinal centers
● May have lobular solid pattern

Micro images
=========================================================================



Aggregate of lymphoid tissue and numerous blood vessels


Blood vessels lined by cuboidal endothelial cells and numerous eosinophils in background

Differential diagnosis
=========================================================================

● Epithelioid hemangioendothelioma (usually not cutaneous)
● Epithelioid angiosarcoma (marked atypia)
● Lobular pyogenic granuloma (no epithelioid endothelial cells)
● Kimuraís disease (usually Asians with elevated serum eosinophils and IgE, usually regional lymphadenopathy)


Glomeruloid hemangioma

General
=========================================================================

● Associated with Castleman disease and POEMS syndrome (Polyneuropathy, Organomegaly, Endocrinopathy, M-protein and Skin changes)

Case reports
=========================================================================

● 49 year old milkman with 6 mm purple nodule on anterior chest (Nephrol Dial Transplant 2001;16:2105)

Micro description
=========================================================================

● Dermal vascular spaces contain glomeruloid structures formed by capillaries
● Occasional cells have PAS+ eosinophilic globules

Micro images
=========================================================================

Contributed by Angel Fernandez-Flores, MD, PhD, Hospital El Bierzo and Clinica Ponferrada, Spain:

   
Various images

Additional references
=========================================================================

Am J Dermatopathol 2008;30:539, Clin Exp Dermatol 2009;34:800


Hobnail hemangioma

General
=========================================================================

● Endothelial cells protrude into vessel lumina

Case reports
=========================================================================

● 7 year old boy with dark brown papule with ecchymotic halo on left upper back (Ann Dermatol 2011;23:539)

Micro description
=========================================================================

● Proliferation of irregular dissecting vascular channels lined by plump endothelial cells

Micro images
=========================================================================

Contributed by Drs. Asmaa Gaber Abdou and Nancy Asaad, Menofiya University, Egypt:

           
Various images - lower lip of female

Positive stains
=========================================================================

● CD31, CD34, D2-40

Negative stains
=========================================================================

● HHV8

Differential diagnosis
=========================================================================

● Kaposi's sarcoma (patch stage)
● Benign vascular tumors
● Progressive lymphangioma


Juvenile hemangioma

General
=========================================================================

● Usually congenital or perinatal and grow during the first few months of life
● Spontaneously involutes, not associated with Kasabach-Merritt phenomenon

Case reports
=========================================================================

● 3 year old male child with painless, dome-shaped lesion of the upper lip (J Oral Maxillofac Pathol 2011;15:316)

Clinical images
=========================================================================


   
Various images

Micro images
=========================================================================


               
Various images

Positive stains
=========================================================================

● GLUT1+, LewisY+

Differential diagnosis
=========================================================================

● Kaposiform hemangioendothelioma: doesnít involute, GLUT1-, LewisY-, often associated with Kasabach-Merritt phenomenon


Microvenular hemangioma

General
=========================================================================

● Young to middle-aged adults
● Also pregnant women or women on oral contraceptives
● Small, enlarging, purple-red nodules or plaques of extremities
● Duration up to 4 years

Micro description
=========================================================================

● Transdermal proliferation of irregular branching venules with indistinct lumina, no atypia, no fat invasion (although may grow along collagenous septa of subcutis)
● Variable dermal fibrosis and lymphocytes
● Resembles acquired (tufted) angioma, stasis change, sclerosing hemangioma

Positive stains
=========================================================================

● Endothelial cells are strongly Ulex europaeus lectin 1+, weakly positive for factor VIII related antigen

Differential diagnosis
=========================================================================

● Dermatofibroma
● Kaposiís sarcoma: irregularly anastomosing vascular spaces, plasma cells, hyaline globules, fascicles of spindle cells


Spindle cell hemangioma

General
=========================================================================

● Formerly called spindle cell hemangioendothelioma
● Associated with Mafucci syndrome

Case reports
=========================================================================

● 43 year old Japanese man with Maffucci syndrome (J Med Case Reports 2011;5:224)

Micro description
=========================================================================

● Bland spindle cell proliferations between vascular lumina with extravasated erythrocytes (similar to Kaposiís sarcoma), but also with vacuolated cells and epithelioid endothelial cells (unlike Kaposiís sarcoma)

Micro images
=========================================================================



Various images


Verrucous hemangioma

Micro images
=========================================================================

Contributed by Dr. Semir Vranić, Clinical Center of the University of Sarajevo (Bosnia and Herzegovina):


Various images

End of Skin - Nonmelanocytic tumors > Vascular tumors > Hemangioma


This information is intended for physicians and related personnel, who understand that medical information is often imperfect, and must be interpreted in the context of a patient's clinical data using reasonable medical judgment. This website should not be used as a substitute for the advice of a licensed physician.

All information on this website is protected by copyright of PathologyOutlines.com, Inc. Information from third parties may also be protected by copyright. Please contact us at copyrightPathOut@gmail.com with any questions (click here for other contact information).