Difference between revisions of "Vascular tumours"

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(→‎Hemangioma: split-out)
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=Distinct entities=
=Distinct entities=
==Hemangioma==
==Hemangioma==
{{ Infobox external links
{{Main|Hemangioma}}
| Name          = Hemangioma
| EHVSC          = 10172
| pathprotocols  =
| wikipedia      =
| pathoutlines  =
}}
===General===
*May be found in the liver.
**Classically subcapsular.
***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>
 
Hemangiomas to remember - if you're only going remember a few:
*''Glomeruloid'', ''infantile'', ''caverous'', ''capillary'', ''arteriovenous'', ''venous'' and ''intramuscular''.
 
====Childhood====
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>
*Tufted - small clusters of blood vessels.
*Microvenular hemangioma.
*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>
*Epithelioid hemangioma - see ''[[angiolymphoid hyperplasia with eosinophilia‎]]''.
*Targetoid hemosideric hemangioma.
*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>
 
====Soft tissue====
Several types are seen in soft tissue:<ref>{{Ref WMSP|602}}</ref>
*Capillary.
*Cavernous.
*Arteriovenous.
*Venous.
*Intramuscular.
*Synovial.
 
===Microscopic===
Features:
*Channels lined by benign endothelium containing [[RBC]]s.
 
DDx:
*[[Lymphangioma]].
*[[Angiokeratoma]].
*[[Lobular capillary hemangioma]] (pyogenic granuloma).
 
====Images====
<gallery>
Image:Capillary_hemangioma_-_intermed_mag.jpg | Capillary hemangioma - intermed. mag. (WC/Nephron)
Image:Capillary_hemangioma_-_very_high_mag.jpg | Capillary hemangioma - very high mag. (WC/Nephron)
Image:Cavernous liver hemangioma - intermed mag.jpg | Cavernous liver hemangioma - intermed. mag. (WC/Nephron)
Image:Cavernous_liver_hemangioma_-_high_mag.jpg | Cavernous liver hemangioma - high mag. (WC/Nephron)
Image:Cavernous_hemangioma_histopathology_(1).jpg | Cavernous hemangioma. (WC/KGH)
Image:Cavernous_hemangioma_histopathology_%282%29.jpg | Cavernous hemangioma. (WC/KGH)
</gallery>
www:
*[http://path.upmc.edu/cases/case277.html Diffuse hemangioma - several images (upmc.edu)].
 
===IHC===
*CD31 +ve.
*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>
 
''Juvenile hemangioma'':<ref name=pmid10665907/>
*GLUT-1 +ve.
 
===Sign out===
<pre>
SUBCUTANEOUS NECK LESION, LEFT, EXCISION:
- CAVERNOUS HEMANGIOMA.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
<pre>
LESION, LEFT SIDE OF FACE, EXCISION:
- CAPILLARY HEMANGIOMA.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
====Micro====
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.


==Lymphangioma==
==Lymphangioma==

Revision as of 03:30, 24 October 2013

This article covers soft tissue vascular tumours. Vascular malformations are covered in the vascular malformations article.

Normal histology

Normal blood vessel histology is dealt with in the vascular disease article.

Mimics

Distinct entities

Hemangioma

Main article: Hemangioma

Lymphangioma

General

Treatment:

  • Surgical excision.

Microscopic

Features:[2][1]

  • Thin-walled channels lined by endothelium.
  • +/-Eosinophilic intraluminal material.
  • +/-Clusters of intraluminal lymphocytes.
  • +/-Occasional RBCs.

DDx:

Images:

IHC

Features:[3][4]

  • D2-40 +ve.

Kaposi sarcoma

Main article: Kaposi sarcoma

Masson hemangioma

  • AKA intravascular papillary endothelial hyperplasia.[5]
  • AKA Masson tumor.[6]

General

  • Benign non-neoplastic lesion - a vessel that has thrombosed and recanalized.
  • Histomorphologically may be confused with low-grade angiosarcoma or other soft tissue sarcomas.[5]

Microscopic

Features:

  • Well-circumscribed - key (low power) feature.
  • Abundant small vascular channels with benign endothelium.
  • +/-Papillary formation with a fibrotic core covered by benign endothelium.[7]

Notes:

Images:

Angiosarcoma

Main article: Angiosarcoma

Kaposiform hemangioendothelioma

General

  • Locally aggressive.[8]
  • Childhood tumour.[9]
  • Approximately half have Kasabach–Merritt phenomenon[9] = vascular tumour --> coagulopathy.

Microscopic

Features:[10]

  • Spindle cells lesions in sheets or nodules.
  • +/-Round tumour nodules - "cannon ball" appearance.

DDx:

IHC

Features:[10]

  • Vimentin +ve.
  • C31 +ve.
  • CD34 +ve.
  • UEA-1 lectin +ve.

Epithelioid hemangioendothelioma

General

  • Malignant.[8]
  • Adults - wide age range.
  • Associated with oral contraceptives, vinyl chloride.[11]

Microscopic

Features:[11]

  • Large epithelioid perivascular cells with:
    • Abundant pale eosinophilic cytoplasm.
    • Cytoplasmic vacuolation (some cells) - AKA "blister cells" - key feature.
      • May form lumen and have RBC within.
    • Vesicular nucleus with prominent nucleolus in some cells.
  • Tuft-like projections into capillaries.
  • Tumour cells may be in well-circumscribed paucicellular nodules or more cellular poorly formed aggregates.

DDx:

Images

  • Epithelioid hemangioendothelioma. (WC)

www:

IHC

Features:[11]

  • CD31 +ve.
  • CD34 +ve.
  • Factor VIII +ve.

See also

References

  1. ↑ 1.0 1.1 1.2 Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 12. ISBN 978-0781765275.
  2. ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 489. ISBN 978-0781765275.
  3. ↑ Kalof, AN.; Cooper, K. (Jan 2009). "D2-40 immunohistochemistry--so far!". Adv Anat Pathol 16 (1): 62-4. doi:10.1097/PAP.0b013e3181915e94. PMID 19098468.
  4. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named pmid11950918
  5. ↑ 5.0 5.1 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.
  6. ↑ URL: http://path.upmc.edu/cases/case544/dx.html. Accessed on: 25 January 2012.
  7. ↑ URL: http://path.upmc.edu/cases/case544.html. Accessed on: 25 January 2012.
  8. ↑ 8.0 8.1 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.
  9. ↑ 9.0 9.1 Lyons, LL.; North, PE.; Mac-Moune Lai, F.; Stoler, MH.; Folpe, AL.; Weiss, SW. (May 2004). "Kaposiform hemangioendothelioma: a study of 33 cases emphasizing its pathologic, immunophenotypic, and biologic uniqueness from juvenile hemangioma.". Am J Surg Pathol 28 (5): 559-68. PMID 15105642.
  10. ↑ 10.0 10.1 10.2 Miller, K. (Mar 1991). "Sister-chromatid exchange in human B- and T-lymphocytes exposed to bleomycin, cyclophosphamide, and ethyl methanesulfonate.". Mutat Res 247 (1): 175-82. PMID 1706068. http://www.nature.com/modpathol/journal/v14/n11/full/3880441a.html.
  11. ↑ 11.0 11.1 11.2 Gupta, R.; Mathur, SR.; Gupta, SD.; Durgapal, P.; Iyer, VK.; Das, CJ.; Shalimar, SK.; Acharya, . (2010). "Hepatic epithelioid hemangioendothelioma: A diagnostic pitfall in aspiration cytology.". Cytojournal 6: 25. doi:10.4103/1742-6413.58951. PMID 20165548.
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