Vascular tumours

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This article covers soft tissue vascular lesions.

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]

  1. Patch stage.
  2. Plaque stage.
  3. Nodular stage.
  4. 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:

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.
  • Mitoses.
  • Cytoplasmic vacuoles.
    • Cells trying to form lumina - embryologic.

Notes:

Images:

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

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

  1. ↑ Prieto VG, Shea CR (July 1999). "Selected cutaneous vascular neoplasms. A review". Dermatol Clin 17 (3): 507–20, viii. PMID 10410855.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ URL: http://www.histopathology-india.net/KS.htm. Accessed on: 31 January 2010.
  5. ↑ Klatt, Edward C. (2006). Robbins and Cotran Atlas of Pathology (1st ed.). Saunders. pp. 23. ISBN 978-1416002741.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ 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. ↑ 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.
  10. ↑ 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.
  11. ↑ 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.
  12. ↑ 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. ↑ 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.
  14. ↑ URL: http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2971574-1. Accessed on: 5 May 2011.
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