Limits...
Solid form of epithelioid hemangioma: a case report.

Roh J, Song MJ, Lee MW, Park CS - Korean J Pathol (2014)

View Article: PubMed Central - PubMed

Affiliation: Departments of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Epithelioid hemangioma (EH) is an uncommon benign vascular tumor, of controversial etiology that usually presents as a slowly growing nodule on the face or digit of a middle-aged woman... EH has been described in the literature as an inflammatory angiomatous nodule or, an atypical or pseudopyogenic granuloma, when infiltration of various inflammatory cells is predominant, and a histiocytoid hemangioma5 when cobble stone-like endothelial cells are conspicuous... The lesions slowly grew in size over the course of 4 months... The patient was otherwise healthy with no significant medical conditions... The differential diagnoses for cutaneous lesions that mostly consist of epithelioid cells include poorly differentiated squamous cell carcinoma, melanoma, epithelioid vascular tumor, atypical fibroxanthoma, cutaneous leiomyosarcoma, epithelioid fibrous histiocytoma, and epithelioid sarcoma... A few reports have indicated its aggressive clinical behavior... Immunohistochemical staining for HHV-8 confirm the diagnosis... In this patient, diagnosis was potentially confusing owing to the proliferation of solid endothelial cells... However, the mass did not have the typical myxohyaline or sclerotic stroma of EHE... EA is a highly malignant tumor and more than half of patients die within the first year... In our case, histologic features such as a lobular architecture, peripheral maturation, absence of necrosis or atypical mitotic figures, and the lack of significant nuclear atypia decreased the index of suspicion for high-grade malignancy... One study reported that 80% of solid form of EH cases were interpreted as malignant vascular tumors by at least one contributing pathologist... To our knowledge, our present study is the first report of a solid form of EH in the Korean pathologic literature... It is important that the solid form of EH be distinguished from malignant vascular tumors to avoid overly aggressive intervention.

No MeSH data available.


Related in: MedlinePlus

Histologic features of the first lesion. (A) The lesion is a poorly differentiated cellular tumor with focally infiltrating borders in the superficial dermis. (B) Most of the lesion shows solid proliferation of epithelioid endothelial cells. (C) Epithelioid endothelial cells are focally positive for CD34 immunohistochemical staining. (D) At the periphery, well-canalized vessels are observed. (E) Human herpesvirus-8 related antigen is negative.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4215969&req=5

f2-kjpathol-48-5-394: Histologic features of the first lesion. (A) The lesion is a poorly differentiated cellular tumor with focally infiltrating borders in the superficial dermis. (B) Most of the lesion shows solid proliferation of epithelioid endothelial cells. (C) Epithelioid endothelial cells are focally positive for CD34 immunohistochemical staining. (D) At the periphery, well-canalized vessels are observed. (E) Human herpesvirus-8 related antigen is negative.

Mentions: A 35-year-old female patient presented with multiple consecutive dermal nodules in her left forearm. On the initial physical examination, there were approximately ten well-defined, erythematous, round nodules up to 0.6 cm in size. The lesions were nontender, nonpruritic, and without ulceration (Fig. 1). The lesions slowly grew in size over the course of 4 months. The patient was otherwise healthy with no significant medical conditions. Excisional biopsies were performed in three nodules in the left forearm and elbow area. Microscopic examination of skin biopsies of the lesions revealed ill-defined lobular architecture with focally infiltrative borders in the superficial dermis (Fig. 2A). Most of the lesions consisted of solid sheets of epithelioid and spindle cells. Those cells had a moderate amount of eosinophilic cytoplasm, and some had cytoplasmic vacuoles (Fig. 2B). They had moderately pleomorphic nuclei and prominent nucleoli. Some of the epithelioid cells formed immature vessels. Vascular structures of variable size were identified at the periphery of the lesion (Fig. 2D). The vascular spaces were canalized and lined by plump epithelioid endothelial cells. Few inflammatory cell infiltrations were visualized and extravasated red blood cells were prominent. No necrosis was present. Up to five mitotic figures per high-powered field were identified with no atypical mitoses. These cells were focally positive for CD31 and CD34, but negative for human herpesvirus-8 (HHV-8) on immunohistochemical staining (Fig. 2C, E). Resection margins were clear. The initial presumptive diagnosis was epithelioid vascular tumor of borderline malignancy.


Solid form of epithelioid hemangioma: a case report.

Roh J, Song MJ, Lee MW, Park CS - Korean J Pathol (2014)

Histologic features of the first lesion. (A) The lesion is a poorly differentiated cellular tumor with focally infiltrating borders in the superficial dermis. (B) Most of the lesion shows solid proliferation of epithelioid endothelial cells. (C) Epithelioid endothelial cells are focally positive for CD34 immunohistochemical staining. (D) At the periphery, well-canalized vessels are observed. (E) Human herpesvirus-8 related antigen is negative.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4215969&req=5

f2-kjpathol-48-5-394: Histologic features of the first lesion. (A) The lesion is a poorly differentiated cellular tumor with focally infiltrating borders in the superficial dermis. (B) Most of the lesion shows solid proliferation of epithelioid endothelial cells. (C) Epithelioid endothelial cells are focally positive for CD34 immunohistochemical staining. (D) At the periphery, well-canalized vessels are observed. (E) Human herpesvirus-8 related antigen is negative.
Mentions: A 35-year-old female patient presented with multiple consecutive dermal nodules in her left forearm. On the initial physical examination, there were approximately ten well-defined, erythematous, round nodules up to 0.6 cm in size. The lesions were nontender, nonpruritic, and without ulceration (Fig. 1). The lesions slowly grew in size over the course of 4 months. The patient was otherwise healthy with no significant medical conditions. Excisional biopsies were performed in three nodules in the left forearm and elbow area. Microscopic examination of skin biopsies of the lesions revealed ill-defined lobular architecture with focally infiltrative borders in the superficial dermis (Fig. 2A). Most of the lesions consisted of solid sheets of epithelioid and spindle cells. Those cells had a moderate amount of eosinophilic cytoplasm, and some had cytoplasmic vacuoles (Fig. 2B). They had moderately pleomorphic nuclei and prominent nucleoli. Some of the epithelioid cells formed immature vessels. Vascular structures of variable size were identified at the periphery of the lesion (Fig. 2D). The vascular spaces were canalized and lined by plump epithelioid endothelial cells. Few inflammatory cell infiltrations were visualized and extravasated red blood cells were prominent. No necrosis was present. Up to five mitotic figures per high-powered field were identified with no atypical mitoses. These cells were focally positive for CD31 and CD34, but negative for human herpesvirus-8 (HHV-8) on immunohistochemical staining (Fig. 2C, E). Resection margins were clear. The initial presumptive diagnosis was epithelioid vascular tumor of borderline malignancy.

View Article: PubMed Central - PubMed

Affiliation: Departments of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Epithelioid hemangioma (EH) is an uncommon benign vascular tumor, of controversial etiology that usually presents as a slowly growing nodule on the face or digit of a middle-aged woman... EH has been described in the literature as an inflammatory angiomatous nodule or, an atypical or pseudopyogenic granuloma, when infiltration of various inflammatory cells is predominant, and a histiocytoid hemangioma5 when cobble stone-like endothelial cells are conspicuous... The lesions slowly grew in size over the course of 4 months... The patient was otherwise healthy with no significant medical conditions... The differential diagnoses for cutaneous lesions that mostly consist of epithelioid cells include poorly differentiated squamous cell carcinoma, melanoma, epithelioid vascular tumor, atypical fibroxanthoma, cutaneous leiomyosarcoma, epithelioid fibrous histiocytoma, and epithelioid sarcoma... A few reports have indicated its aggressive clinical behavior... Immunohistochemical staining for HHV-8 confirm the diagnosis... In this patient, diagnosis was potentially confusing owing to the proliferation of solid endothelial cells... However, the mass did not have the typical myxohyaline or sclerotic stroma of EHE... EA is a highly malignant tumor and more than half of patients die within the first year... In our case, histologic features such as a lobular architecture, peripheral maturation, absence of necrosis or atypical mitotic figures, and the lack of significant nuclear atypia decreased the index of suspicion for high-grade malignancy... One study reported that 80% of solid form of EH cases were interpreted as malignant vascular tumors by at least one contributing pathologist... To our knowledge, our present study is the first report of a solid form of EH in the Korean pathologic literature... It is important that the solid form of EH be distinguished from malignant vascular tumors to avoid overly aggressive intervention.

No MeSH data available.


Related in: MedlinePlus