Soft tissue
Anastomosing hemangioma

Author: Ivy John, M.D.
Editorial Board Member Review: Lauren N. Stuart, M.D., M.B.A.

Revised: 31 January 2018, last major update January 2017

Copyright: (c) 2002-2018,, Inc.

PubMed search: Anastomosing hemangioma

Cite this page: John, I. Anastomosing hemangioma. website. Accessed December 16th, 2018.
Definition / general
Essential features
  • Benign vascular tumor which displays overlapping features with well differentiated forms of angiosarcoma
  • Recently described in soft tissue, showing a predilection to the paraspinal areas (Am J Surg Pathol 2016;40:1084)
  • Composed of anastomosing sinusoidal capillary sized vessels with mild endothelial nuclear variability and scattered hobnailed endothelial cells
  • Cured by simple excision
Gross description
  • Well demarcated with a hemorrhagic mahogany spongy cut surface
Microscopic (histologic) description
  • Nonlobular architecture
  • Anastomosing proliferation of capillary sized vessels, reminiscent of splenic sinusoids (Am J Surg Pathol 2010;34:942), within a framework of nonendothelial supporting cells
  • Rare to absent mitotic activity
  • Mild endothelial nuclear variability and scattered hobnailed endothelial cells
  • Fibrin thrombi are typical
  • Extramedullary hematopoiesis and mature fat in roughly 50% of cases
Microscopic (histologic) images

Images hosted on PathOut server:

Contributed by Ivy John, M.D.

Positive stains
Negative stains
Differential diagnosis
  • Angiosarcoma: diffusely infiltrative growth pattern; prominent cytological alterations, including high grade cytologic atypia, multilayering of endothelial cells and mitotic activity
  • Retiform hemangioendothelioma: predilection for the distal extremities; usually involves the skin; similar appearance to normal rete testis
  • Hobnail hemangioma: usually involves the skin; wedge shaped vascular proliferation with dilated vascular channels superficially and less conspicuous vessels in the deep aspect of the lesion
  • Splenic tissue: