Vascular tumours
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.
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.
Epidemiology:
- May arise secondary to therapeutic radiation or chronic lymphoedema related to breast carcinoma.
- Liver angiosarcomas are assoc. with vinyl chloride exposure.[11]
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.
- FLI-1 +ve.[12]
Kaposiform hemangioendothelioma
General
- Locally aggressive.[13]
Microscopic
Features:
- ?
IHC
?
Epithelioid hemangioendothelioma
- Should not be confused with epithelioid hemangioma.
General
- Malignant.[13]
Microscopic
Features:[14]
- Perivascular cells with abundant pale eosinophilic cytoplasm.
- Cytoplasmic vacuolation (uncommon).
- Tuft-like projections into capillaries.
- Fibrosis -- centre of lesion. (???)
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.
- ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 212. ISBN 978-1416054542.
- ↑ Rossi, S.; Orvieto, E.; Furlanetto, A.; Laurino, L.; Ninfo, V.; Dei Tos, AP. (May 2004). "Utility of the immunohistochemical detection of FLI-1 expression in round cell and vascular neoplasm using a monoclonal antibody.". Mod Pathol 17 (5): 547-52. doi:10.1038/modpathol.3800065. PMID 15001993.
- ↑ 13.0 13.1 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.
- ↑ URL: http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2971574-1. Accessed on: 5 May 2011.