Soft tissue



Atypical vascular lesion post radiation

Last author update: 1 November 2012
Last staff update: 2 August 2023

Copyright: 2002-2024,, Inc.

PubMed Search: Radiation associated cutaneous atypical vascular lesion

Vijay Shankar, M.D.
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Cite this page: Shankar V. Atypical vascular lesion post radiation. website. Accessed February 23rd, 2024.
Definition / general
  • Due to obstruction / destruction of lymphatic drainage, often postradiation therapy (Histopathology 1999;35:319) or idiopathic in elderly
  • In breast, often called lymphangioma circumscriptum, although the classic lesion of lymphangioma circumscriptum appears at birth or in the early years, and most breast cases are actually postsurgery or radiation therapy within the field of radiation (Am J Clin Pathol 1994;102:757)
  • In women, age 33 - 72 years
  • Arises 3 - 20 years after radiation therapy for breast (93%) or ovarian (7%) carcinoma
  • Associated with pain, chronic drainage, cellulitis (South Med J 1999;92:69)
Clinical features
Case reports
  • Cryosurgery, electrocautery or laser therapy to vaporize surface lymphatics (Dermatol Surg 1998;24:893); frequently recurs and causes substantial morbidity so must monitor for recurrence
Clinical images

Images hosted on other servers:

Breast: multiple small vesicles

Breast: multiple vesicles of lymphangioma circumscriptum

Chest: asymptomatic vesicular eruption

Gross description
  • One or more circumscribed papules, small vesicles or erythematous plaques, usually in irradiated field, median 0.5 cm
  • Frequently multiple synchronous lesions with discoloration
Microscopic (histologic) description
  • Irregular dilated vascular spaces with branching and anastomosing pattern in superficial and deep dermis
  • Thin walls, lymphatic appearance
  • Vascular channels lined by single discontinuous layer of endothelial cells with numerous small stromal papillary formations and flattened nuclei; also lined by endothelial cells projecting into lumina (lymphatic counterpart of intravascular papillary endothelial hyperplasia / Masson’s tumor)
  • May have poorly circumscribed and focally infiltrating irregular jagged vascular spaces involving the entire dermis, lined by inconspicuous endothelial cells, dissecting collagen bundles of the dermis and mimicking Kaposi's sarcoma (Am J Surg Pathol 2002;26:328)
  • No necrosis, no mitotic figures, no blood lakes

  • Lymphatic type: predominantly thin walled, variably anastomosing lymphatics primarily in superficial dermis
  • Vascular type: predominantly small, irregularly dispersed, capillary type vessels, invested by pericytes, often blood filled, in superficial or deep dermis; associated with extravasated red blood cells or hemosiderin, minor lymphatic type component
Microscopic (histologic) images

Images hosted on other servers:

Benign lymphangio-endothelioma-like lesions

Superficial lymphangioma-like patterns

Mixed histologic patterns

Nuclear hyperchromasia

D2-40+ lymphangioma-like lesion

Breast: ectatic lymphatic spaces in papillary dermis

Chest: asymptomatic vesicular eruption

Positive stains
Negative stains
Electron microscopy description
  • Endothelial cells have cytoplasmic microfilaments and pinocytotic vesicles; intermediate junctions are present between adjacent cells (Jpn J Clin Oncol 1991;21:129)
Differential diagnosis
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