Vascular tumours
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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
- Benign.
- Classically in the left neck.[1]
- May be seen in Turner syndrome.
Treatment:
- Surgical excision.
Microscopic
- Thin-walled channels lined by endothelium.
- +/-Eosinophilic intraluminal material.
- +/-Clusters of intraluminal lymphocytes.
- +/-Occasional RBCs.
DDx:
Images:
IHC
- D2-40 +ve.
Kaposi sarcoma
Main article: Kaposi sarcoma
Masson hemangioma
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:
- Looks like Kaposi sarcoma at high power.
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
- Should not be confused with epithelioid hemangioma.
General
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:
- Angiosarcoma, epithelioid.
- Hemangioma.
Images
Epithelioid hemangioendothelioma. (WC)
www:
- Epithelioid hemangioendothelioma - low mag. (flickr.com/Rosen).
- Epithelioid hemangioendothelioma - high mag. (flickr.com/Rosen).
- Epithelioid hemangioendothelioma (surgicalpathologyatlas.com).
IHC
Features:[11]
- CD31 +ve.
- CD34 +ve.
- Factor VIII +ve.
See also
References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Kahn, HJ.; Bailey, D.; Marks, A. (Apr 2002). "Monoclonal antibody D2-40, a new marker of lymphatic endothelium, reacts with Kaposi's sarcoma and a subset of angiosarcomas.". Mod Pathol 15 (4): 434-40. doi:10.1038/modpathol.3880543. PMID 11950918.
- ↑ 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.
- ↑ URL: http://path.upmc.edu/cases/case544/dx.html. Accessed on: 25 January 2012.
- ↑ URL: http://path.upmc.edu/cases/case544.html. Accessed on: 25 January 2012.
- ↑ 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.
- ↑ 9.0 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.
- ↑ 10.0 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.
- ↑ 11.0 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.