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| This article covers [[soft tissue lesions|soft tissue]] '''vascular lesions'''. | | [[Image:Capillary_hemangioma_-_very_high_mag.jpg|thumb|right|[[Micrograph]] showing a [[capillary hemangioma]], a common type of vascular tumour. [[H&E stain]].]] |
| | This article covers [[soft tissue lesions|soft tissue]] '''vascular tumours'''. Vascular malformations are covered in the ''[[vascular malformations]]'' article. |
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| ==Normal histology==
| | =Normal histology= |
| [[Vascular_disease#Normal_blood_vessels|Normal blood vessel histology]] is dealt with in the ''[[vascular disease]]'' article. | | [[Vascular_disease#Normal_blood_vessels|Normal blood vessel histology]] is dealt with in the ''[[vascular disease]]'' article. |
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| | =Mimics= |
| | *[[Vascular malformations]]. |
| | **[[Arteriovenous malformation]]. |
| | **[[Varix]]. |
| | **[[Venous angioma]]. |
| | **[[Caverous malformation]]. |
| | *[[Angiomatoid fibrous histiocytoma]]. |
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| | =Distinct entities= |
| ==Hemangioma== | | ==Hemangioma== |
| ===General===
| | {{Main|Hemangioma}} |
| Comes is various flavours:<ref name=pmid10410855>{{cite journal |author=Prieto VG, Shea CR |title=Selected cutaneous vascular neoplasms. A review |journal=Dermatol Clin |volume=17 |issue=3 |pages=507–20, viii |year=1999 |month=July |pmid=10410855 |doi= |url=}}</ref>
| | {{Main|Liver hemangioma}} |
| *Tufted.
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| **Small clusters of blood vessels.
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| *Microvenular hemangioma.
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| *Glomeruloid hemangioma - associated with [[POEMS syndrome]], [[Castleman disease]].<ref name=pmid16860182>{{cite journal |author=Uthup S, Balachandran K, Ammal VA, ''et al.'' |title=Renal involvement in multicentric Castleman disease with glomeruloid hemangioma of skin and plasmacytoma |journal=Am. J. Kidney Dis. |volume=48 |issue=2 |pages=e17–24 |year=2006 |month=August |pmid=16860182 |doi=10.1053/j.ajkd.2006.04.089 |url=}}</ref><ref name=Ref_WMSP618>{{Ref WMSP|618}}</ref>
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| *Epithelioid hemangioma.
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| *Targetoid hemosideric hemangioma.
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| ===Microscopic=== | | ==Lymphangioma== |
| Features:
| | *[[AKA]] ''cystic hygroma''.<ref name=Ref_WMSP12>{{Ref WMSP|12}}</ref> |
| *Abundance of benign small blood vessels. (???) | |
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| ==Kaposi sarcoma==
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| ===General=== | | ===General=== |
| *Not really a sarcoma. | | *Benign. |
| *Caused by HHV-8. | | *Classically in the left neck.<ref name=Ref_WMSP12>{{Ref WMSP|12}}</ref> |
| *Associated with immunodeficiency, e.g. [[HIV]]/AIDS. | | *May be seen in [[Turner syndrome]]. |
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| ===Stages===
| | Treatment: |
| It is seen in different stages:<ref>URL: [http://www.histopathology-india.net/KS.htm http://www.histopathology-india.net/KS.htm]. Accessed on: 31 January 2010.</ref>
| | *Surgical excision. |
| #Patch stage.
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| #Plaque stage.
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| #Nodular stage.
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| #Lymphangioma-like. (???)
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| ===Microscopic=== | | ===Microscopic=== |
| Features:<ref name=Ref_Klatt23>{{Ref Klatt|23}}</ref>- '''key feature'''. | | Features:<ref name=Ref_WMSP489>{{Ref WMSP|489}}</ref><ref name=Ref_WMSP12>{{Ref WMSP|12}}</ref> |
| *+/-Nuclear atypia.
| | *Thin-walled channels lined by endothelium. |
| *Hyaline globules (intracytoplasmic)<ref name=pmid7528163>{{cite journal |author=del Rosario AD, Bui HX, Singh J, Ginsburg R, Ross JS |title=Intracytoplasmic eosinophilic hyaline globules in cartilaginous neoplasms: a surgical, pathological, ultrastructural, and electron probe x-ray microanalytic study |journal=Hum. Pathol. |volume=25 |issue=12 |pages=1283–9 |year=1994 |month=December |pmid=7528163 |doi= |url=}}</ref> - pale pink globs (that are paler than RBCs) - '''important feature'''.
| | *+/-Eosinophilic intraluminal material. |
| *+/-Hemosiderin deposits. | | *+/-Clusters of intraluminal lymphocytes. |
| | *+/-Occasional [[RBC]]s. |
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| DDx: | | DDx: |
| *Angiosarcoma (have many mitoses, nuclear atypia). | | *[[Hemangioma]]. |
| *Masson's hemangioma (Intravascular papillary endothelial hyperplasia).
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| Notes:
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| *Hyaline globules have a DDx ([[hepatocellular carcinoma]], lung adenocarcinoma, [[chondrosarcoma]]s + others).<ref name=pmid7528163/>
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| *Promontory sign - small vessel protruding into an abnormal vascular space.<ref name=pmid19318797>{{cite journal |author=Lazova R, McNiff JM, Glusac EJ, Godic A |title=Promontory sign--present in patch and plaque stage of angiosarcoma! |journal=Am J Dermatopathol |volume=31 |issue=2 |pages=132–6 |year=2009 |month=April |pmid=19318797 |doi=10.1097/DAD.0b013e3181951045 |url=}}</ref>
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| **Not pathognomonic for KS.<ref name=pmid20577080>{{cite journal |author=Fernandez-Flores A, Rodriguez R |title=Promontory Sign in a Reactive Benign Vascular Proliferation |journal=Am J Dermatopathol |volume= |issue= |pages= |year=2010 |month=June |pmid=20577080 |doi=10.1097/DAD.0b013e3181cf0ae5 |url=}}</ref>
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| **Image: [http://www.diagnosticpathology.org/content/3/1/31/figure/F1 Promontory sign (diagnosticpathology.org)].
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| Images: | | Images: |
| *[http://commons.wikimedia.org/wiki/File:Kaposi_sarcoma_high_mag.jpg Kaposi sacoma - high mag. (WC)]. | | *[http://www.webpathology.com/image.asp?n=5&Case=412 Lymphangioma - low mag. (webpathology.com)]. |
| *[http://commons.wikimedia.org/wiki/File:Kaposi_sarcoma_low_intermed_mag.jpg Kaposi sarcoma - intermed. mag. (WC)]. | | *[http://www.webpathology.com/image.asp?case=412&n=6 Lymphangioma - high mag. (webpathology.com)]. |
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| ===IHC=== | | ===IHC=== |
| *CD31 +ve.
| | Features:<ref name=pmid19098468>{{Cite journal | last1 = Kalof | first1 = AN. | last2 = Cooper | first2 = K. | title = D2-40 immunohistochemistry--so far! | journal = Adv Anat Pathol | volume = 16 | issue = 1 | pages = 62-4 | month = Jan | year = 2009 | doi = 10.1097/PAP.0b013e3181915e94 | PMID = 19098468 }}</ref><ref name=pmid11950918>{{Cite journal | last1 = Kahn | first1 = HJ. | last2 = Bailey | first2 = D. | last3 = Marks | first3 = A. | title = Monoclonal antibody D2-40, a new marker of lymphatic endothelium, reacts with Kaposi's sarcoma and a subset of angiosarcomas. | journal = Mod Pathol | volume = 15 | issue = 4 | pages = 434-40 | month = Apr | year = 2002 | doi = 10.1038/modpathol.3880543 | PMID = 11950918 }}</ref> |
| *CD34 +ve.
| | *D2-40 +ve. |
| *HHV-8 +ve. | | |
| | ==Kaposi sarcoma== |
| | {{Main|Kaposi sarcoma}} |
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| ==Masson hemangioma== | | ==Masson hemangioma== |
| ===General===
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| *Benign non-neoplastic lesion - a vessel that has thrombosed and recanalized.
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| *[[AKA]] ''intravascular papillary endothelial hyperplasia''.<ref name=pmid15865098>{{cite journal |author=Korkolis DP, Papaevangelou M, Koulaxouzidis G, Zirganos N, Psichogiou H, Vassilopoulos PP |title=Intravascular papillary endothelial hyperplasia (Masson's hemangioma) presenting as a soft-tissue sarcoma |journal=Anticancer Res. |volume=25 |issue=2B |pages=1409–12 |year=2005 |pmid=15865098 |doi= |url=}}</ref> | | *[[AKA]] ''intravascular papillary endothelial hyperplasia''.<ref name=pmid15865098>{{cite journal |author=Korkolis DP, Papaevangelou M, Koulaxouzidis G, Zirganos N, Psichogiou H, Vassilopoulos PP |title=Intravascular papillary endothelial hyperplasia (Masson's hemangioma) presenting as a soft-tissue sarcoma |journal=Anticancer Res. |volume=25 |issue=2B |pages=1409–12 |year=2005 |pmid=15865098 |doi= |url=}}</ref> |
| *Histomorphologically may be confused with low-grade angiosarcoma or other soft tissue sarcomas.<ref name=pmid15865098/> | | *[[AKA]] ''Masson tumor''.<ref>URL: [http://path.upmc.edu/cases/case544/dx.html http://path.upmc.edu/cases/case544/dx.html]. Accessed on: 25 January 2012.</ref> |
| ===Microscopic===
| | {{Main|intravascular papillary endothelial hyperplasia}} |
| Features:
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| *Well-circumscribed - '''key (low power) feature'''.
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| *Abundant small vascular channels with benign endothelium.
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| Notes:
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| *Looks like Kaposi sarcoma at high power.
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| ==Angiosarcoma== | | ==Angiosarcoma== |
| ===General===
| | {{Main|Angiosarcoma}} |
| *Malignant tumour - with a horrible prognosis.<ref name=pmid20537949>{{cite journal |author=Young RJ, Brown NJ, Reed MW, Hughes D, Woll PJ |title=Angiosarcoma |journal=Lancet Oncol |volume= |issue= |pages= |year=2010 |month=May |pmid=20537949 |doi=10.1016/S1470-2045(10)70023-1 |url=}}</ref>
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| *Classically on the scalp or head & neck.
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| Epidemiology:
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| *May arise secondary to therapeutic radiation or chronic lymphoedema related to breast carcinoma.
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| *Liver angiosarcomas are assoc. with vinyl chloride exposure.<ref>{{Ref PCPBoD8|212}}</ref>
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| ===Microscopic===
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| Features:
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| *Very many small capillaries of irregular shape lined with:
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| **Pleomorphic nuclei.
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| ***May have hobnail morphology.
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| *Mitoses.
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| *Cytoplasmic vacuoles.
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| **Cells trying to form lumina - embryologic.
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| Notes:
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| *Epithelioid variant (with abundant cytoplasm & sheeting architecture) may resemble ''[[melanoma]]'' or ''[[hepatocellular carcinoma]]''.
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| Images:
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| *[http://commons.wikimedia.org/wiki/File:Epithelioid_angiosarcoma_-_very_low_mag.jpg Epithelioid angiosarcoma - very low mag. (WC)].
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| *[http://commons.wikimedia.org/wiki/File:Epithelioid_angiosarcoma_-_intermed_mag.jpg Epithelioid angiosarcoma - intermed mag. (WC)].
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| *[http://commons.wikimedia.org/wiki/File:Epithelioid_angiosarcoma_-_very_high_mag.jpg Epithelioid angiosarcoma - very high mag. (WC)].
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| ===IHC===
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| *CD34 +ve.
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| *D2-40 +ve. (???)
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| *CD31 +ve.
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| *FLI-1 +ve.<ref name=pmid15001993>{{Cite journal | last1 = Rossi | first1 = S. | last2 = Orvieto | first2 = E. | last3 = Furlanetto | first3 = A. | last4 = Laurino | first4 = L. | last5 = Ninfo | first5 = V. | last6 = Dei Tos | first6 = AP. | title = Utility of the immunohistochemical detection of FLI-1 expression in round cell and vascular neoplasm using a monoclonal antibody. | journal = Mod Pathol | volume = 17 | issue = 5 | pages = 547-52 | month = May | year = 2004 | doi = 10.1038/modpathol.3800065 | PMID = 15001993 }}</ref>
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| ==Kaposiform hemangioendothelioma== | | ==Kaposiform hemangioendothelioma== |
| ===General=== | | ===General=== |
| *Locally aggressive.<ref name=Ref_WMSP603>{{Ref WMSP|603}}</ref> | | *Locally aggressive.<ref name=Ref_WMSP603>{{Ref WMSP|603}}</ref> |
| | *Childhood tumour.<ref name=pmid15105642>{{Cite journal | last1 = Lyons | first1 = LL. | last2 = North | first2 = PE. | last3 = Mac-Moune Lai | first3 = F. | last4 = Stoler | first4 = MH. | last5 = Folpe | first5 = AL. | last6 = Weiss | first6 = SW. | title = Kaposiform hemangioendothelioma: a study of 33 cases emphasizing its pathologic, immunophenotypic, and biologic uniqueness from juvenile hemangioma. | journal = Am J Surg Pathol | volume = 28 | issue = 5 | pages = 559-68 | month = May | year = 2004 | doi = | PMID = 15105642 }}</ref> |
| | *Approximately half have ''Kasabach–Merritt phenomenon''<ref name=pmid15105642/> = vascular tumour --> coagulopathy. |
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| ===Microscopic=== | | ===Microscopic=== |
| Features: | | Features:<ref name=pmid1706068/> |
| *? | | *Spindle cells lesions in sheets or nodules. |
| | *+/-Round tumour nodules - "cannon ball" appearance. |
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| | DDx: |
| | *[[Kaposi sarcoma]].<ref name=pmid1706068>{{Cite journal | last1 = Miller | first1 = K. | title = Sister-chromatid exchange in human B- and T-lymphocytes exposed to bleomycin, cyclophosphamide, and ethyl methanesulfonate. | journal = Mutat Res | volume = 247 | issue = 1 | pages = 175-82 | month = Mar | year = 1991 | doi = | PMID = 1706068 | url = http://www.nature.com/modpathol/journal/v14/n11/full/3880441a.html }}</ref> |
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| ===IHC=== | | ===IHC=== |
| ?
| | Features:<ref name=pmid1706068/> |
| | *Vimentin +ve. |
| | *C31 +ve. |
| | *CD34 +ve. |
| | *UEA-1 lectin +ve. |
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| ==Epithelioid hemangioendothelioma== | | ==Epithelioid hemangioendothelioma== |
| *Should not be confused with ''epithelioid hemangioma''.
| | {{Main|Epithelioid hemangioendothelioma}} |
| ===General===
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| *Malignant.<ref name=Ref_WMSP603>{{Ref WMSP|603}}</ref>
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| ===Microscopic=== | | ==Retiform hemangioendothelioma== |
| Features:<ref>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2971574-1 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2971574-1]. Accessed on: 5 May 2011.</ref>
| | {{Main|Retiform hemangioendothelioma}} |
| *Perivascular cells with abundant pale eosinophilic cytoplasm.
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| *Cytoplasmic vacuolation (uncommon).
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| *Tuft-like projections into capillaries.
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| *Fibrosis -- centre of lesion. (???)
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| Image:
| | ==Intimal sarcoma== |
| *[http://en.wikipedia.org/wiki/File:Epithelioid_hemangioendothelioma_EHE.Image5.jpg Epithelioid hemangioendothelioma (WP)].
| | {{Main|Intimal sarcoma}} |
| *[http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2971574-1&figureId=fig1 Epithelioid hemangioendothelioma (pathconsultddx.com)].
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| ==See also==
| | =See also= |
| *[[Cardiovascular pathology]]. | | *[[Cardiovascular pathology]]. |
| *[[Vasculitides]]. | | *[[Vasculitides]]. |
| *[[Soft tissue lesions]]. | | *[[Soft tissue lesions]]. |
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| ==References==
| | =References= |
| {{Reflist|2}} | | {{Reflist|2}} |
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| | [[Category:Vascular tumours]] |
| [[Category:Soft tissue lesions]] | | [[Category:Soft tissue lesions]] |