Vascular tumours
This article covers soft tissue vascular lesions.
Hemangioma
General
Comes is various flavours:[1]
- Tufted.
- Small clusters of blood vessels.
- Microvenular hemangioma.
- Glomeruloid hemangioma - associated with POEMS syndrome, Castleman disease.[2][3]
- Epithelioid hemangioma.
- Targetoid hemosideric hemangioma.
Microscopic
Features:
- Abundance of benign small blood vessels. (???)
Kaposi sarcoma
General
- Not really a sarcoma.
- Caused by HHV-8.
- Associated with immunodeficiency, e.g. HIV/AIDS.
Stages
It is seen in different stages:[4]
- Patch stage.
- Plaque stage.
- Nodular stage.
- Lymphangioma-like. (???)
Microscopic
Features:[5]- key feature.
- +/-Nuclear atypia.
- Hyaline globules (intracytoplasmic)[6] - pale pink globs (that are paler than RBCs) - important feature.
- +/-Hemosiderin deposits.
DDx:
- Angiosarcoma (have many mitoses, nuclear atypia).
- Masson's hemangioma (Intravascular papillary endothelial hyperplasia).
Notes:
- Hyaline globules have a DDx (hepatocellular carcinoma, lung adenocarcinoma, chondrosarcomas + others).[6]
- Promontory sign - small vessel protruding into an abnormal vascular space.[7]
- Not pathognomonic for KS.[8]
- Image: Promontory sign (diagnosticpathology.org).
Images:
IHC
- CD31 +ve.
- CD34 +ve.
- HHV-8 +ve.
Masson hemangioma
General
- Benign non-neoplastic lesion - a vessel that has thrombosed and recanalized.
- AKA intravascular papillary endothelial hyperplasia.[9]
- Histomorphologically may be confused with low-grade angiosarcoma or other soft tissue sarcomas.[9]
Microscopic
Features:
- Well-circumscribed - key (low power) feature.
- Abundant small vascular channels with benign endothelium.
Notes:
- Looks like Kaposi sarcoma at high power.
Angiosarcoma
General
- Malignant tumour - with a horrible prognosis.[10]
- Classically on the scalp or head & neck.
- May arise secondary to therapeutic radiation or chronic lymphoedema related to breast carcinoma.
Microscopic
Features:
- Very many small capillaries of irregular shape lined with:
- Pleomorphic nuclei.
- May have hobnail morphology.
- Pleomorphic nuclei.
- Mitoses.
- Cytoplasmic vacuoles.
- Cells trying to form lumina - embryologic.
Notes:
- Epithelioid variant (with abundant cytoplasm & sheeting architecture) may resemble melanoma or hepatocellular carcinoma.
Images:
- Epithelioid angiosarcoma - very low mag. (WC).
- Epithelioid angiosarcoma - intermed mag. (WC).
- Epithelioid angiosarcoma - very high mag. (WC).
IHC
- CD34 +ve.
- D2-40 +ve. (???)
- CD31 +ve.
Kaposiform hemangioendothelioma
General
- Locally aggressive.[11]
Microscopic
Features:
- ?
IHC
?
Epithelioid hemangioendothelioma
- Should not be confused with epithelioid hemangioma.
General
- Malignant.[11]
Microscopic
Features:
- ?
Image:
See also
References
- ↑ Prieto VG, Shea CR (July 1999). "Selected cutaneous vascular neoplasms. A review". Dermatol Clin 17 (3): 507–20, viii. PMID 10410855.
- ↑ Uthup S, Balachandran K, Ammal VA, et al. (August 2006). "Renal involvement in multicentric Castleman disease with glomeruloid hemangioma of skin and plasmacytoma". Am. J. Kidney Dis. 48 (2): e17–24. doi:10.1053/j.ajkd.2006.04.089. PMID 16860182.
- ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 618. ISBN 978-0781765275.
- ↑ URL: http://www.histopathology-india.net/KS.htm. Accessed on: 31 January 2010.
- ↑ Klatt, Edward C. (2006). Robbins and Cotran Atlas of Pathology (1st ed.). Saunders. pp. 23. ISBN 978-1416002741.
- ↑ 6.0 6.1 del Rosario AD, Bui HX, Singh J, Ginsburg R, Ross JS (December 1994). "Intracytoplasmic eosinophilic hyaline globules in cartilaginous neoplasms: a surgical, pathological, ultrastructural, and electron probe x-ray microanalytic study". Hum. Pathol. 25 (12): 1283–9. PMID 7528163.
- ↑ Lazova R, McNiff JM, Glusac EJ, Godic A (April 2009). "Promontory sign--present in patch and plaque stage of angiosarcoma!". Am J Dermatopathol 31 (2): 132–6. doi:10.1097/DAD.0b013e3181951045. PMID 19318797.
- ↑ Fernandez-Flores A, Rodriguez R (June 2010). "Promontory Sign in a Reactive Benign Vascular Proliferation". Am J Dermatopathol. doi:10.1097/DAD.0b013e3181cf0ae5. PMID 20577080.
- ↑ 9.0 9.1 Korkolis DP, Papaevangelou M, Koulaxouzidis G, Zirganos N, Psichogiou H, Vassilopoulos PP (2005). "Intravascular papillary endothelial hyperplasia (Masson's hemangioma) presenting as a soft-tissue sarcoma". Anticancer Res. 25 (2B): 1409–12. PMID 15865098.
- ↑ Young RJ, Brown NJ, Reed MW, Hughes D, Woll PJ (May 2010). "Angiosarcoma". Lancet Oncol. doi:10.1016/S1470-2045(10)70023-1. PMID 20537949.
- ↑ 11.0 11.1 Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 603. ISBN 978-0781765275.