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Soft Tissue Tumors Part 3 - Muscle, Vascular, Nerve, Other
Intravascular papillary endothelial hyperplasia
Author: Nat Pernick, M.D, PathologyOutlines.com, Inc.
Revised: 16 October 2009, last major update - October 2009
Copyright: (c) 2002-2009, PathologyOutlines.com, Inc.
Definition
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● Reactive lesion, not neoplastic, representing exuberant organization and recanalization of thrombus
Terminology
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● Also known as Masson’s tumor; initially called vegetant intravascular hemangioendothelioma by Masson (Bull Soc Anat 1923;93:517)
Sites
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● In normal vessels but also varices, hemorrhoids, pyogenic granulomas, hematomas, angiosarcomas
● Dermis and subcutis of head and neck, lip, tongue, buccal mucosa
Case reports
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● 75 year old man with liver dysfunction and multiple lesions (Clin Exp Dermatol 2009 Jul 29 [Epub ahead of print])
● Cases in renal vein (Arch Pathol Lab Med 2005;129:516, Hum Pathol 1996;27:986)
Treatment
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● Local excision; rarely recurs (J Bone Joint Surg Br 2008;90:95)
Gross description
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● Small, firm, red-blue superficial mass in skin
Micro description
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● Intravascular lesion only
● Papillary formations with hyaline or fibrous stalks, anastomosing vascular channels, plump endothelial cells
● Residual organizing thrombi
● No necrosis, no atypia, no atypical mitotic figures
● Pure type: within a dilated vascular space
● Mixed type: with preexisting vascular disorder or in a hematoma
Micro images
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Lesion of hand Chest wall Renal vein
Confined to vascular lumen; papillae have hyaline cores
Heart tumor with focus of papillary endothelial
hyperplasia within cavernous hemangioma (AFIP)
Positive stains
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● CD31 (Hum Path 1996;27:986), CD34
Negative stains
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● Ki-67 < 20% (Med Oral Patol Oral Cir Bucal 2009;14:e506)
Differential Diagnosis
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● Angiosarcoma - anastomosing vascular spaces and more than mildly atypical cells
End of Soft Tissue Tumors Part 3 - Muscle, Vascular, Nerve, Other > Intravascular papillary endothelial hyperplasia
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