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| | [[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. | | This article covers [[soft tissue lesions|soft tissue]] '''vascular tumours'''. Vascular malformations are covered in the ''[[vascular malformations]]'' article. |
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| =Distinct entities= | | =Distinct entities= |
| ==Hemangioma== | | ==Hemangioma== |
| {{ Infobox external links | | {{Main|Hemangioma}} |
| | Name = Hemangioma | | {{Main|Liver hemangioma}} |
| | EHVSC = 10172
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| | pathprotocols =
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| | wikipedia =
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| | pathoutlines =
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| }}
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| ===General===
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| *May be found in the liver.
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| **Classically subcapsular.
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| ***May rupture and be life-threatening.<ref>{{Cite journal | last1 = Vokaer | first1 = B. | last2 = Kothonidis | first2 = K. | last3 = Delatte | first3 = P. | last4 = De Cooman | first4 = S. | last5 = Pector | first5 = JC. | last6 = Liberale | first6 = G. | title = Should ruptured liver haemangioma be treated by surgery or by conservative means? A case report. | journal = Acta Chir Belg | volume = 108 | issue = 6 | pages = 761-4 | month = | year = | doi = | PMID = 19241936 }}</ref>
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| Hemangiomas to remember - if you're only going remember a few:
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| *''Glomeruloid'', ''infantile'', ''caverous'', ''capillary'', ''arteriovenous'', ''venous'' and ''intramuscular''.
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| ====Childhood====
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| Common childhood hemangiomas:<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>
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| *Tufted - 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 - see ''[[angiolymphoid hyperplasia with eosinophilia]]''.
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| *Targetoid hemosideric hemangioma.
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| *Infantile hemangioma (AKA juvenile hemangioma<ref name=pmid10665907>{{Cite journal | last1 = North | first1 = PE. | last2 = Waner | first2 = M. | last3 = Mizeracki | first3 = A. | last4 = Mihm | first4 = MC. | title = GLUT1: a newly discovered immunohistochemical marker for juvenile hemangiomas. | journal = Hum Pathol | volume = 31 | issue = 1 | pages = 11-22 | month = Jan | year = 2000 | doi = | PMID = 10665907 }}</ref>) - these tumours are ''GLUT-1'' +ve. They tumours grow and then spontaneously regress.<ref name=pmid15143338>{{Cite journal | last1 = Dadras | first1 = SS. | last2 = North | first2 = PE. | last3 = Bertoncini | first3 = J. | last4 = Mihm | first4 = MC. | last5 = Detmar | first5 = M. | title = Infantile hemangiomas are arrested in an early developmental vascular differentiation state. | journal = Mod Pathol | volume = 17 | issue = 9 | pages = 1068-79 | month = Sep | year = 2004 | doi = 10.1038/modpathol.3800153 | PMID = 15143338 }}</ref>
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| ====Soft tissue====
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| Several types are seen in soft tissue:<ref>{{Ref WMSP|602}}</ref>
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| *Capillary.
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| *Cavernous.
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| *Arteriovenous.
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| *Venous.
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| *Intramuscular.
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| *Synovial.
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| ===Microscopic===
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| Features:
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| *Channels lined by benign endothelium containing [[RBC]]s.
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| DDx:
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| *[[Lymphangioma]].
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| *[[Angiokeratoma]].
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| *[[Lobular capillary hemangioma]] (pyogenic granuloma).
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| ====Images====
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| <gallery>
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| Image:Capillary_hemangioma_-_intermed_mag.jpg | Capillary hemangioma - intermed. mag. (WC/Nephron)
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| Image:Capillary_hemangioma_-_very_high_mag.jpg | Capillary hemangioma - very high mag. (WC/Nephron)
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| Image:Cavernous liver hemangioma - intermed mag.jpg | Cavernous liver hemangioma - intermed. mag. (WC/Nephron)
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| Image:Cavernous_liver_hemangioma_-_high_mag.jpg | Cavernous liver hemangioma - high mag. (WC/Nephron)
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| Image:Cavernous_hemangioma_histopathology_(1).jpg | Cavernous hemangioma. (WC/KGH)
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| Image:Cavernous_hemangioma_histopathology_%282%29.jpg | Cavernous hemangioma. (WC/KGH)
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| </gallery>
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| www:
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| *[http://path.upmc.edu/cases/case277.html Diffuse hemangioma - several images (upmc.edu)].
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| ===IHC===
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| *CD31 +ve.
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| *D2-40 -ve.<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 | URL = http://www.nature.com/modpathol/journal/v15/n4/full/3880543a.html }}</ref>
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| ''Juvenile hemangioma'':<ref name=pmid10665907/>
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| *GLUT-1 +ve.
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| ===Sign out===
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| <pre>
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| SUBCUTANEOUS NECK LESION, LEFT, EXCISION:
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| - CAVERNOUS HEMANGIOMA.
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| - NEGATIVE FOR MALIGNANCY.
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| </pre>
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| <pre>
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| LESION, LEFT SIDE OF FACE, EXCISION:
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| - CAPILLARY HEMANGIOMA.
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| - NEGATIVE FOR MALIGNANCY.
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| </pre>
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| ====Micro====
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| The sections show hair-bearing skin with abundant small superficial vascular channels containing red blood cells. The endothelial cells of the vascular channels do not have atypia. No mitotic activity is appreciated. The overlying epidermis is unremarkable. Extensive solar elastosis is present. No nevus is identified.
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| ==Lymphangioma== | | ==Lymphangioma== |
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| ===IHC=== | | ===IHC=== |
| 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/> | | 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> |
| *D2-40 +ve. | | *D2-40 +ve. |
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| ==Kaposi sarcoma== | | ==Kaposi sarcoma== |
| *Abbreviated ''KS''.
| | {{Main|Kaposi sarcoma}} |
| ===General===
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| *Caused by [[Human herpesvirus-8]] (HHV-8).
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| *In the North American context, it is often associated with immunodeficiency, e.g. [[HIV]]/AIDS.
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| Interesting note:
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| *It has been said that KS is not really a sarcoma.<ref name=pmid14521707>{{Cite journal | last1 = Pérez | first1 = A. | last2 = Sánchez | first2 = JL. | last3 = Almodóvar | first3 = PI. | title = Kaposi's sarcoma is not a neoplasm let alone a sarcoma. | journal = Int J Dermatol | volume = 42 | issue = 10 | pages = 844-5 | month = Oct | year = 2003 | doi = | PMID = 14521707 }}</ref>
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| ====Stages====
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| 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><ref>URL: [http://emedicine.medscape.com/article/1083998-clinical#a0217 http://emedicine.medscape.com/article/1083998-clinical#a0217]. Accessed on: 17 November 2011.</ref>
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| #Patch stage.
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| #Plaque stage.
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| #Nodular stage.
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| #Exophytic stage.
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| #Infiltrative stage.
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| #Lymphadenopathic stage.
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| Note:
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| *The first three are the classic ones.
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| ====Type or form====
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| Classically divided into four types:<ref name=pmid18219366>{{Cite journal | last1 = Szajerka | first1 = T. | last2 = Jablecki | first2 = J. | title = Kaposi's sarcoma revisited. | journal = AIDS Rev | volume = 9 | issue = 4 | pages = 230-6 | month = | year = | doi = | PMID = 18219366 }}</ref><ref name=pmid17691428>{{Cite journal | last1 = Morand | first1 = JJ. | last2 = Lightburn | first2 = E. | last3 = Simon | first3 = F. | last4 = Patte | first4 = JH. | title = [Update on Kaposi's sarcoma]. | journal = Med Trop (Mars) | volume = 67 | issue = 2 | pages = 123-30 | month = Apr | year = 2007 | doi = | PMID = 17691428 }}</ref><ref name=pmid10749966>{{Cite journal | last1 = Antman | first1 = K. | last2 = Chang | first2 = Y. | title = Kaposi's sarcoma. | journal = N Engl J Med | volume = 342 | issue = 14 | pages = 1027-38 | month = Apr | year = 2000 | doi = 10.1056/NEJM200004063421407 | PMID = 10749966 | URL = http://www.nejm.org/doi/full/10.1056/NEJM200004063421407 }}</ref>
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| *Classic = old men Mediterranean or Ashkenazi Jew.
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| *Endemic = African infants and young males.
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| *Immunosuppression-associated or transplant-associated - iatrogenic.
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| *AIDS-associated.
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| ===Microscopic===
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| Features:<ref name=Ref_Klatt23>{{Ref Klatt|23}}</ref>
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| *Vascular lesion (abundant [[RBC]]s) with:
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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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| **+/-Spindle cells with minimal nuclear atypia.
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| **[[RBC extravasation]] - very useful - '''important feature'''.<ref name=pmid2229644>{{Cite journal | last1 = Kato | first1 = H. | last2 = Hamada | first2 = T. | last3 = Tsuji | first3 = T. | last4 = Baba | first4 = T. | last5 = Seki | first5 = J. | last6 = Kobayashi | first6 = Y. | title = Kaposi's sarcoma: a light and electron microscopic study. | journal = J Dermatol | volume = 17 | issue = 7 | pages = 414-22 | month = Jul | year = 1990 | doi = | PMID = 2229644 }}</ref>
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| *+/-Intracytoplasmic [[hyaline globules]] - uncommon - one usu. needs to search for 'em.<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>
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| **Pale pink globs (that are paler than RBCs) - '''important feature'''.
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| *+/-Hemosiderin deposits.
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| *+/-Plasma cells.<ref name=pmid17912148>{{Cite journal | last1 = Douglas | first1 = JL. | last2 = Gustin | first2 = JK. | last3 = Dezube | first3 = B. | last4 = Pantanowitz | first4 = JL. | last5 = Moses | first5 = AV. | title = Kaposi's sarcoma: a model of both malignancy and chronic inflammation. | journal = Panminerva Med | volume = 49 | issue = 3 | pages = 119-38 | month = Sep | year = 2007 | doi = | PMID = 17912148 }}</ref>
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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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| DDx:
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| *[[Angiosarcoma]] - have many mitoses, nuclear atypia, RBC extravasation not common.
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| *[[Masson's hemangioma]] - [[AKA]] ''intravascular papillary endothelial hyperplasia''.
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| *Benign lymphangioendothelioma.<ref>{{Cite journal | last1 = Guillou | first1 = L. | last2 = Fletcher | first2 = CD. | title = Benign lymphangioendothelioma (acquired progressive lymphangioma): a lesion not to be confused with well-differentiated angiosarcoma and patch stage Kaposi's sarcoma: clinicopathologic analysis of a series. | journal = Am J Surg Pathol | volume = 24 | issue = 8 | pages = 1047-57 | month = Aug | year = 2000 | doi = | PMID = 10935645 }}</ref>
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| **Histologically very similar.<ref>URL: [http://path.upmc.edu/cases/case134/dx.html http://path.upmc.edu/cases/case134/dx.html]. Accessed on: 5 January 2012.</ref>
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| ====Images====
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| <gallery>
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| Image:Kaposi_sarcoma_high_mag.jpg | Kaposi sacoma - high mag. (WC)
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| Image:Kaposi_sarcoma_low_intermed_mag.jpg | Kaposi sarcoma - intermed. mag. (WC)
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| </gallery>
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| www:
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| *[http://www.diagnosticpathology.org/content/3/1/31/figure/F1 Promontory sign (diagnosticpathology.org)].
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| ===Stains===
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| *PAS +ve -- hyaline globules.
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| ===IHC===
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| *CD31 +ve.
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| *CD34 +ve.
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| *[[HHV-8]] +ve.
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|
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| ==Masson hemangioma== | | ==Masson hemangioma== |
| *[[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> |
| *[[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> | | *[[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> |
| ===General===
| | {{Main|intravascular papillary endothelial hyperplasia}} |
| *Benign non-neoplastic lesion - a vessel that has thrombosed and recanalized.
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| *Histomorphologically may be confused with low-grade [[angiosarcoma]] or other soft tissue sarcomas.<ref name=pmid15865098/>
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| ===Microscopic===
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| 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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| *+/-Papillary formation with a fibrotic core covered by benign endothelium.<ref>URL: [http://path.upmc.edu/cases/case544.html http://path.upmc.edu/cases/case544.html]. Accessed on: 25 January 2012.</ref>
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| Notes:
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| *Looks like [[Kaposi sarcoma]] at high power.
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| Images:
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| *[http://path.upmc.edu/cases/case544.html Masson hemangioma - several images (upmc.edu)].
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| ==Angiosarcoma== | | ==Angiosarcoma== |
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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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| *Adults - wide age range.
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| *Associated with oral contraceptives, vinyl chloride.<ref name=pmid20165548/>
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| ===Microscopic===
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| Features:<ref name=pmid20165548>{{Cite journal | last1 = Gupta | first1 = R. | last2 = Mathur | first2 = SR. | last3 = Gupta | first3 = SD. | last4 = Durgapal | first4 = P. | last5 = Iyer | first5 = VK. | last6 = Das | first6 = CJ. | last7 = Shalimar | first7 = SK. | last8 = Acharya | first8 = . | title = Hepatic epithelioid hemangioendothelioma: A diagnostic pitfall in aspiration cytology. | journal = Cytojournal | volume = 6 | issue = | pages = 25 | month = | year = 2010 | doi = 10.4103/1742-6413.58951 | PMID = 20165548 | URL = http://www.biomedsearch.com/nih/Hepatic-epithelioid-hemangioendothelioma-diagnostic-pitfall/20165548.html }}</ref>
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| *Large epithelioid perivascular cells with:
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| **Abundant pale eosinophilic cytoplasm.
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| **Cytoplasmic vacuolation (some cells) - [[AKA]] "blister cells" - '''key feature'''.
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| ***May form lumen and have RBC within.
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| **Vesicular nucleus with prominent nucleolus in some cells.
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| *Tuft-like projections into capillaries.
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| *Tumour cells may be in well-circumscribed paucicellular nodules ''or'' more cellular poorly formed aggregates.
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|
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|
| DDx:
| | ==Retiform hemangioendothelioma== |
| *[[Angiosarcoma]], epithelioid.
| | {{Main|Retiform hemangioendothelioma}} |
| *[[Hemangioma]].
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|
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| ====Images==== | | ==Intimal sarcoma== |
| <gallery>
| | {{Main|Intimal sarcoma}} |
| Image:Epithelioid_hemangioendothelioma.jpg | Epithelioid hemangioendothelioma. (WC)
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| </gallery>
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| www:
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| *[http://www.flickr.com/photos/pulmonary_pathology/5600772691/in/photostream/ Epithelioid hemangioendothelioma - low mag. (flickr.com/Rosen)].
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| *[http://www.flickr.com/photos/pulmonary_pathology/5601354962/ Epithelioid hemangioendothelioma - high mag. (flickr.com/Rosen)].
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| *[http://www.surgicalpathologyatlas.com/glfusion/mediagallery/media.php?f=0&sort=0&s=20080802170854495 Epithelioid hemangioendothelioma (surgicalpathologyatlas.com)].
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| ===IHC===
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| Features:<ref name=pmid20165548>{{Cite journal | last1 = Gupta | first1 = R. | last2 = Mathur | first2 = SR. | last3 = Gupta | first3 = SD. | last4 = Durgapal | first4 = P. | last5 = Iyer | first5 = VK. | last6 = Das | first6 = CJ. | last7 = Shalimar | first7 = SK. | last8 = Acharya | first8 = . | title = Hepatic epithelioid hemangioendothelioma: A diagnostic pitfall in aspiration cytology. | journal = Cytojournal | volume = 6 | issue = | pages = 25 | month = | year = 2010 | doi = 10.4103/1742-6413.58951 | PMID = 20165548 | URL = http://www.biomedsearch.com/nih/Hepatic-epithelioid-hemangioendothelioma-diagnostic-pitfall/20165548.html }}</ref>
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| *CD31 +ve.
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| *CD34 +ve.
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| *Factor VIII +ve.
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|
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| =See also= | | =See also= |
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| {{Reflist|2}} | | {{Reflist|2}} |
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| | [[Category:Vascular tumours]] |
| [[Category:Soft tissue lesions]] | | [[Category:Soft tissue lesions]] |
