Tufted Angioma:Clinicopathologic Surveys and the Response to Intralesional Steroid

ABSTRACT

BACKGROUND: Tufted angioma is an uncommon slowly progressive vascular tumor found typically in infants and young children with characteristic histologic findings, so called "cannonball" appearance. OBJECTIVE: The purpose of this study was aimed to investigate the clinical and histopathological characteristics of tufted angioma and the response to intralesional steroid. METHODS: Clinical information of 10 patients with tufted angioma diagnosed in Severance hospital and Pundang CHA hospital from 1983 to 1999 was obtained from the medical records and clinical follow-ups. We re-evaluated 10 biopsy specimens obtained from them with routine H&E staining. RESULTS: Five male and five female patients were included. In 9 patients the lesion appeared before 2 months of age. Four had a lesion at birth. The thigh was the most common site. The clinical symptoms were diverse, but characteristically tenderness was present in most cases. In all the patients the lesions had a tendency to spread progressively. Microscopically, numerous, distinct, variably sized, tightly packed capillary and endothelial cellular lobules were scattered in the dermis. There were characteristic semilunar spaces adjacent to the capillary tufts. Six patients received intralesional triamcinolone. This treatment was found to be effective in 5 patients who experienced remarkable improvement. The improved cases had similar histologic findings which were composed of cellular mass more than lumen formation. We classified our specimens into two categories, one with more cellular mass and the other with more lumen formation in relative proportion. The former was different from the latter in that it had more solid appearance and more definite margin. And we realized that it was useful to divide into these two categories since its response to treatment could be different. CONCLUSIONS: Tufted angioma is a relatively uncommon disease with characteristic histopathologic findings. It seems not to regress spontaneously. So early treatment is required to pre-vent further spreading up to the extent. We treated 6 patients with intralesional injection of triamcinolone and 5 patients experienced marked improvement which had more cellular mass more than lumen formation histopathologically.