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Soft tissue tumors

Benign vascular tumors

Symplastic hemangioma


Reviewer: Vijay Shankar, M.D. (see Reviewers page)
Revised: 24 February 2013, last major update November 2012
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

Definition
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● Hemangioma with bizarre stromal cells in fibrinous material around vessels

Epidemiology
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● Limited published reports

Etiology
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● Due to degenerative atypia of vascular smooth muscle and interstitial cells, similar to symplastic leiomyoma of uterus or ancient schwannoma

Treatment
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● Excision, does not recur or metastasize (Hautarzt 2000;51:327)

Micro description
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● Vascular lesion with thick walled and variably dilated vessels
● Degenerative atypia of vascular smooth muscle and interstitial cells within a pre-existing vascular lesion, with minimal endothelial cell atypia
● Atypical cells are spindled or epithelioid with variable hyperchromasia, nuclear enlargement, pleomorphism and multinucleation (J Cutan Pathol 2006;33:735)
● Perivascular hemorrhage, vascular thrombosis and focal papillary endothelial hyperplasia are common
● Stroma has hemosiderin and mononuclear inflammation
● May have fibrous tissue, stromal edema or fat cells within superficial dermis
● May have rare atypical mitotic figures or bizarre lipoblast-like stromal cells
● No endothelial cell multilayering
● No mitotic figures

Micro images
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Lower extremity

Virtual slides
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16 year old girl with calf lesion

Positive stains
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● Smooth muscle actin (pleomorphic cells)

Differential diagnosis
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Angiosarcoma: endothelial cells are atypical, there is frequent multilayering of cells and prominent mitotic activity
Pleomorphic hyalinizing angiectatic tumor: infiltrative lesion of superficial soft tissue of distal extremities; shows heavily hyalinized, fibrin containing vessels, spindled and pleomorphic stromal cells with frequent intranuclear inclusions

End of Soft tissue tumors > Benign vascular tumors > Symplastic hemangioma


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