Cutaneous tumours of vascular origin: two rare entities

Skin and subcutaneous tissue are the most common location of benign and malignant vascular tumors. The benign or malignant nature of the lesion may not always be identified clinically because of the varying presentations. The histology of the lesion, especially in malignancies may not exhibit definite vascular pattern.  In such cases, clinical presentation has to be correlated with histopathological picture as well as immunohistochemical characteristics to reach a specific diagnosis. Judicious use of immunohistochemical markers proves to be invaluable.  Two rare cases of cutaneous vascular tumors which presented at our institution are cited, the diagnosis of which involved correlation of these modalities.

Verrucous Hemangioma of the Thumb in Children: A Rare Presentation

Verrucous Hemangioma (VH) is a rare capillary vascular anomaly, frequently clinically mistaken toAngiokeratoma. It’s frequently reported to manifest in lower extremity and is commonly unilateral.Other locations of its presentation are scarcely reported. We demonstrated a Verrucous Hemangiomaof unusual location at the thumb of child and its surgical management which remain as a primarymodality of the treatment.

Verrucous hemangioma of the oral cavity: A rare diagnostic dilemma.

Verrucous hemangioma (VH) is an uncommon, congenital, vascular malformation that involves dermis and subcutaneous connective tissue of skin. VH lesions are initially present at birth, and therefore, the diagnosis in the elderly may be difficult. Review of literature reveals that VH lesions are commonly located unilaterally on the lower extremities. VH may clinically present as keratotic, papular, nodular, or plaque-like lesions that are reddish-blue in color. VH does not resolve spontaneously and has a tendency to relapse. The diagnosis of VH is generally done on the basis of histopathology. Early diagnosis is important to get a better cosmetic result. VH requires a large, deep excision to avoid recurrence because of frequent extension into subcutaneous fat planes. Intra-oral lesions of VH have rarely been reported in the literature. We present an extremely rare case of VH occurring in the retromolar triangle area of oral cavity.

Hemangioma verrugoso: comunicación de un caso / Verrucous hemangioma: case report

El hemangioma verrugoso es una anomalía vascular poco frecuente, de aspecto verrugoso, que puede estar presente desde el nacimiento yquese caracteriza histopatológicamente por estar compuestapor capilares dilatados y vasos de tamaño venular dispuestos en la dermis y el tejido celular subcutáneo. Secomunicael caso de un niño de 7 años de edad, cuya enfermedad estaba presente desde el nacimiento en la cara anterior de la pierna izquierda.

Verrucous hemangioma is rare vascular anomaly with verrucous aspect, that may be present since birth, and consists of dilated capillary and venular vessels that occupy the dermis and hypodermis. We report a 7-year-old boy whose disease appeared at birth and was located at the anterior side of his left leg.

Hemangioma verrucoso / Verrucous hemangioma

El hemangioma verrucoso, es una malformación vascular poco frecuente. Básicamente consiste en una proliferación con dilataciones de vasos de distintos calibres que ocupan la dermis y la hipodermis. La epidermis de la zona afectada presenta una reacción proliferativa epidermal costosa que le da un aspecto verrucoso. Se presenta el caso de una paciente de 16 años, cuya enfermedad aparece desde el nacimiento, localizado en brazo derecho. Se analizan los aspectos clínicos y terapéuticos de esta afección.

Verrucous hemangioma is a rare vascular malformation. It basically consists of a proliferation with dilation of vessels of different sizes that occupy the dermis and hypodermis. The epidermis of that affected area presents a costly epidermal proliferative reaction that gives a warty appearance. A case of a 16 years old, whose disease appears at birth, located in right arm. We analyzed clinical and therapeutic aspect of this condition.

A Case of Eccrine Angiomatous Hamartoma Associated with Verrucous Hemangioma

Eccrine angiomatous hamartomas are benign vascular and eccrine malformations often accompanied by hyperhidrosis or pain, increased eccrine glands, and aggregates of vessels. Verrucous hemangiomas are congenital vascular malformations presenting as unilateral grouped papules. Histologically, they show verrucous epidermal change and proliferation of capillaries in the dermis. We report a case of a 47-year-old woman with a red keratotic patch overlying a bluish plaque on the right sole, which had been present since birth. It was accompanied by pain and hyperhidrosis. Histologically, there were verrucous changes in the epidermis, numerous dilated capillaries in the papillary dermis, and increased eccrine glands with angiomatous foci in the deep dermis. The epithelial cells of the eccrine glands were positive for CEA, and the endothelial cells were positive for CD31 and GLUT-1. Eccrine angiomatous hamartomas have been reported in conjunction with other vascular tumors in only a few instances. We report an interesting case of an eccrine angiomatous hamartoma associated with a verrucous hemangioma.

Verrucous Hemangioma and Angiokeratoma: Their Similarilities and Differences according to the Clinicopathological Features / 대한피부과학회지

BACKGROUND: Verrucous hemangioma (VH) and angiokeratoma (AK) are vascular birthmarks of an unclear nosology and these birthmarks commonly show a superficial hyperkeratotic vascular component. There are both similarilities and differences between VH and AK with some confusion concerning their overlapping features. OBJECTIVE: This study was undertaken to review the clinicopathological features of VHs and AKs and to determine the similarilities and differences between them. METHODS:We retrospectively reviewed 11 VHs and 7 AKs at the Vascular Anomaly Clinic of our hospital over the past 10 years. They were evaluated from the clinicopathologic point of view for factors such as the age of onset, location, size, symptoms, the histopathological epithelial change and involvement of deeper tissue. RESULTS: These birthmarks share common clinical features with the exception of gender and lesion size. Histopathologically, hyperkeratosis, acanthosis and capillary dilatation in the upper dermis were commonly seen. Yet lobular proliferation and dilatation of blood vessels in the deep dermis, or more importantly, the subcutis were detected in VH only. Furthermore there was a case of VH that showed diffusely scattered increased blood vessels in the subcutis, suggesting an evolving stage of VH and there was another case of VH that was erroneously diagnosed as AK via the initial biopsy, and the final diagnosis was changed according to the excised lesion. CONCLUSION:The two diseases share most of their clinicopathological features, but small parts of features like gender, the clinical size and the histological deep dermis/subcutis involvement were differences. Making the correct differential diagnosis between VH and AK through a deep biopsy with appropriate timing and long-term follow-up and/or radiological examination is helpful to avoid erroneous management.

Atypical Linear Verrucous Hemangioma on the Upper Extremity / 대한피부과학회지

Verrucous hemangioma (VH) is a rare vascular malformation, a structural variant of capillary or cavernous hemangioma, with reactive epidermal changes. Most VHs have been known to locate on the lower extremities and develop from birth or childhood. The patient was a 17-year-old girl and presented multiple dark red colored, verrucous, hemangiomatous nodular plaques affecting nearly all of the left arm with linear distribution. Skin biopsy revealed epidermal hyperkeratosis with irregular acanthosis, and diffuse proliferation and dilatation of blood vessels in dermis and subcutis. This is an interesting case of VH affecting nearly total left arm with linear distribution.

A Case of Verrucous Hemangioma in Flank, an Unusual Location / 대한피부과학회지

Verrucous hemangioma is an infrequent variant of deep-seated capillary or cavernous hemangioma with reactive epidermal hyperplasia. The lesion generally appears at birth or in early childhood, mostly on the lower limbs and typically present as warty, bluish, vascular papule, plaque or nodule. A 6-year old girl presented with well-circumscribed, hyperkeratotic, red-black, vascular nodule on her right flank. Histopathologic examination showed characteristic features of verrucous hemangioma. We report a case of verrucous hemangioma developed on an unusual site.

A Case of Adult Onset Verrucous Hemangioma / 대한피부과학회지

Verrucous hemangiomas are usually congenital lesions which typically present as warty, bluish, vascular papules, plaques, or nodules mainly on the lower limbs of children. It is a structural variant of capillary or cavernous hemangioma, in which reactive epidermal changes develop secondarily. They show no tendency to spontaneous resolution, and tend to spread and recur after inadequate treatments. It is important, from a prognostic and therapeutic point of view, to make a correct diagnosis between verrucous hemangioma and angiokeratoma circumscriptum, because the former needs a large and deep excision and the latter responds to the common means of physical therapy. We report a case of 37-year-old man with verrucous hemangioma which was developed at his third decade.

A Case of Bilateral Verrucous Hemangioma Combined with Tuberous Sclerosis / 대한피부과학회지

We report a 37-year-old man who had a cutaneous marker of tuberous sclerosis with angiofibromas, periungal fibromas and who also showed bilateral verrucous hemangiomas on buttock. It is not known whether there is association between verrucous hemangioma and tuberous sclerosis, but there are some evidence suggest a more than chance association. We describe a case of bilateral verrucous hemangiomas combined with tuberous sclerosis.

A Case of Hyperkeratotic Vascular Stains / 대한피부과학회지

The term, hyperkeratotic vascular stains is a peculiar form of capillary malformations commonly called as angiokeratoma or verrucous hemangioma. Hyperkeratotic vascular stains present at birth and consist of vascular dilatation and epidermal proliferation manifested as hyperkeratosis, acanthosis, and papillomatosis. Some authors insisted that angiokeratoma and verrucous hemangioma are not proper terms because they are not true tumors but malformations due to their lack of endothelial proliferation. Wide and deep excisions have been preferred as a curative therapy. The patient was a 9-year-old girl with multiple, linear, bluish black colored, hyperkeratotic plaques on her left lower leg. The red patches at birth had slowly enlarged and had become verrucous. Some satellite lesions had also developed. Histopathologic examination showed dilated capillaries filled with red blood cells in the papillary dermis and subcutaneous fat layer. The carbon dioxide laser was used to remove hyperkeratotic plaques. The flash-lamp pumped-pulsed dye laser and intense noncoherent pulsed light were used to remove satellite lesions and vascular lesions for a year. One of the lesions resistant to laser therapy was completely excised. Because multiple hyperkeratotic vascular stains are often impossible to be excised completely, laser therapy may be tried as the first choice.

A Case of Verrucous Hemangioma

We report a case of a 6-month-old female who had had verrucous hemangioma since birth. The lesions were dark red, verrucous surfaced, hyperkeratotic papules on the right sole. A histopathological examination showed hyperkeratosis, papillomatosis, irregular acanthosis, lobular proliferation and dilatation of blood vessels in the deep dermis with a gap devoid of vessel proliferation in the mid dermis.