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Soft tissue tumors

Benign vascular tumors

Hemangioma


Reviewer: Vijay Shankar, M.D. (see Reviewers page)
Revised: 8 February 2013, last major update November 2012
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

See variants below: capillary, cavernous, intramuscular, large vessel, pyogenic granuloma

General
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● Common benign tumor, particularly in childhood; some may be hamartomas
● Usually superficial (head/neck), may occur internally (1/3 in liver), malignant transformation rare
● Usually localized, but may involve large segments of body (termed angiomatosis)
● Most pediatric angiomas are present at birth and expand with growth of child, may regress at puberty

Micro description
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● Increased number of vessels (normal/abnormal)
● Readily recognizable vascular structures with red blood cells or transudate
● Lined by monolayer of non-atypical endothelial cells


Capillary hemangioma

General
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● Blood vessels resemble capillaries
● Present in skin, subcutaneous tissue, mucous membranes of lips, mouth, internal viscera
● Strawberry type is seen in juveniles in 1/200 births, may be multiple, grow in first year, fade at ages 1-3, regress by age 7 in 75%

Micro description
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● Closely packed spindle cells with spaces containing little blood
● Lumens may be thrombosed or organized, hemosiderin present due to rupture
● Scant fibrous stroma

Micro images
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Thigh


VEGFR-3ľnegative tumor vessels and positive normal lymphatics (Mod Pathol 2000;13:180)


Cavernous hemangioma

General
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● In skin, called port-wine nevus or nevus flammeus
● Present at birth, grows slowly with patient; does not regress
● In deep locations may thrombose, ulcerate, become infected; associated with thrombocytopenia, intravascular coagulation
● Associated with von Hippel Lindau disease, which has cavernous hemangiomas in cerebellum, brain stem, eye grounds
Sinusoidal hemangiomas: cavernous hemangiomas with dilated, interconnected, thin-walled channels with occasional pseudopapillary projections

Gross description
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● 1-2 cm (larger than capillary), sharply defined

Micro description
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● Large cystically dilated vessels with thin walls
● Intravascular thrombosis or calcification is common

Micro images
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Various images


Intramuscular hemangioma

General
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● Resemble cavernous hemangiomas
● May resemble angiosarcoma due to high cellularity with mitotic figures, intraluminal papillary projections, plump endothelial cells, perineurial infiltration, but no atypia
● Also, angiosarcomas extremely uncommon in skeletal muscle

Micro images
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Various images


Large vessel hemangioma

General
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● Veins, arteries or a mixture
● May have abnormal vascular wall structure that defies classification
● Back, gluteal region, thigh; occasionally entire extremity
● Thrombosis and calcification common
Klippel-Trenaunay syndrome: varicose veins, dysplastic cutaneous hemangiomas and soft tissue and bone hypertrophy


Pyogenic granuloma

General
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● Also called lobular capillary hemangioma
● Rapidly growing, exophytic red nodule, attached by a stalk to skin or gingival mucosa
● Bleeds easily, ulcerates
● 1/3 due to trauma (1-2 cm after 1-2 weeks)
Pregnancy tumor: also called granuloma gravidarum, a pyogenic granuloma found in 1% of pregnant women, regresses after delivery

Micro images
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Polypoid red-brown mass

Micro description
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● Vessels, edema, acute and chronic inflammation
● Resembles granulation tissue

End of Soft tissue tumors > Benign vascular tumors > Hemangioma


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