Cutaneous vascular proliferations. Part II. Hyperplasias and benign neoplasms,☆☆,

https://doi.org/10.1016/S0190-9622(97)70065-3Get rights and content

Abstract

This second part of our review about vascular proliferations summarizes the clinicopathologic features of the cutaneous vascular hyperplasias and benign neoplasms. Hyperplasias comprise a heterogeneous group of vascular proliferations that eventually show a tendency to regression. Angiolymphoid hyperplasia with eosinophilia is included within the group of hyperplasias because of its historical denomination and its reactive nature, probably as a consequence of an arteriovenous shunt, although usually the lesions do not regress. Pyogenic granuloma, bacillary angiomatosis, intravascular papillary endothelial hyperplasia, and pseudo–Kaposi's sarcoma qualify as vascular hyperplasias because they regress when the stimulus that initiated them is removed. Benign neoplasms form a large group of hemangiomas with distinctive clinicopathologic characteristics, although some of them are of recent description and may produce diagnostic difficulties. We classified cutaneous benign vascular neoplasms according to their cell lineage of differentiation, for example, endothelial, glomus cell, and pericytic differentiation. Subsequent categories are established according to the size of the involved vessels (capillaries, venules and arterioles, or veins and arteries) or the nature of the proliferating vessels (blood or lymphatic vessels). Capillary and cavernous hemangiomas have been the terms classically used to name the most common variants of benign vascular neoplasms (i.e., infantile hemangiomas), but they are not the most appropriate denominations for these lesions. First, these names are not contrasting terms. Furthermore, most of the so-called "cavernous" hemangiomas are not hemangiomas (neoplasms) at all, but venous malformations. The most important conceptual issue is that, at any point in time, a particular hemangioma has its own histopathologic pattern throughout the depth of the lesion. For these reasons, we classified hemangiomas into superficial and deep categories. Some of the lesions reviewed have been recently described in the literature, and they may histopathologically mimic lesions of Kaposi's sarcoma; these include targetoid hemosiderotic hemangioma, microvenular hemangioma, tufted hemangioma, glomeruloid hemangioma, kaposiform hemangioendothelioma, spindle-cell hemangioendothelioma, and benign lymphangioendothelioma. In each of these lesions, we update and emphasize those clinical and histopathologic features that are helpful for differential diagnosis with lesions of authentic Kaposi's sarcoma in any of its three stages of development (patch, plaque, or nodule). (J Am Acad Dermatol 1997;37:887-920.) Learning objective: At the conclusion of this learning activity, participants should be able to describe the clinicopathologic characteristics of the cutaneous vascular hyperplasias and benign neoplasms and their classification according to their cell lineage of differentiation. The differential diagnosis between some of the more recently described vascular neoplasms and cutaneous lesions of Kaposi's sarcoma should be comprehensible to the participants in terms of the histopathologic features.

Section snippets

Cutaneous Vascular Hyperplasias

(Table I)*

Angioma serpiginosum

We agree with others102 that angioma serpiginosum extends by proliferation of endothelial cells and new formation of capillaries and not simply by dilation of preexisting capillaries, as in telangiectases. Therefore we include this lesion among the benign vascular neoplasms.

Angioma serpiginosum was originally described by Hutchinson103 in 1889 under the title "a peculiar form of serpiginous and infective nevoid disease." He used the term infective to describe the form in which the lesion

References (345)

  • JP Campbell et al.

    Retinoid therapy is associated with excess granulation tissue responses

    J Am Acad Dermatol

    (1983)
  • G. Blumental

    Paronychia and pyogenic granuloma–like lesions with isotretinoin

    J Am Acad Dermatol

    (1984)
  • E Hodak et al.

    Excess granulation tissue during etretinate therapy

    J Am Acad Dermatol

    (1984)
  • RAW Miller et al.

    Multiple granulation tissue lesions occurring in isotretinoin treatment of acne vulgaris: successful response to topical corticosteroid therapy

    J Am Acad Dermatol

    (1985)
  • MG Davies et al.

    The abnormal dermis in pyogenic granuloma: histochemical and ultrastructural observations

    J Am Acad Dermatol

    (1980)
  • CJ Cockerell et al.

    Epithelioid angiomatosis: a distinct vascular disorder in patients with the acquired immunodeficiency syndrome or AIDS-related complex

    Lancet

    (1987)
  • PE LeBoit et al.

    Epithelioid hemangioma-like vascular proliferation in AIDS: Manifestation of cat-scratch disease bacillus or infection?

    Lancet

    (1988)
  • CJ. Cockerell

    Bacillary angiomatosis and related diseases caused by Rochalimaea

    J Am Acad Dermatol

    (1995)
  • CJ Cockerell et al.

    Bacillary angiomatosis: a newly characterized pseudoneoplastic, infectious, cutaneous vascular disorder

    J Am Acad Dermatol

    (1990)
  • WK Szaniawski et al.

    Epithelioid angiomatosis in patients with AIDS: report of seven cases and review of the literature

    J Am Acad Dermatol

    (1990)
  • DA. Paslin

    Localized primary cutaneous intravascular papillary endothelial hyperplasia

    J Am Acad Dermatol

    (1981)
  • CN Reed et al.

    Intravascular papillary endothelial hyperplasia: multiple lesions simulating Kaposi's sarcoma

    J Am Acad Dermatol

    (1984)
  • M Landthaler et al.

    Pseudo-Kaposi's sarcoma occurring after placement of arteriovenous shunt: a case report with DNA content analysis

    J Am Acad Dermatol

    (1989)
  • GC Wells et al.

    Subcutaneous angiolymphoid hyperplasia with eosinophilia

    Br J Dermatol

    (1969)
  • T Kimura et al.

    Abnormal granuloma with proliferation of lymphoid tissue

    Trans Soc Pathol Jpn

    (1948)
  • JKC Chan et al.

    Epithelioid hemangioma (angiolymphoid hyperplasia with eosinophilia) and Kimura's disease in Chinese

    Histopathology

    (1989)
  • PB Googe et al.

    Kimura's disease and angiolymphoid hyperplasia with eosinophilia: two distinct histopathological entities

    J Cutan Pathol

    (1987)
  • TT Kuo et al.

    Kimura's disease: involvement of regional lymph nodes and distinction from angiolymphoid hyperplasia with eosinophilia

    Am J Surg Pathol

    (1988)
  • J. Rosai

    Angiolymphoid hyperplasia with eosinophilia of the skin: its nosological position in the spectrum of the histocytoid hemangioma

    Am J Dermatopathol

    (1982)
  • A Urabe et al.

    Epithelioid hemangioma versus Kimura's disease: a comparative clinicopathologic study

    Am J Surg Pathol

    (1987)
  • WC Peterson et al.

    Atypical pyogenic granuloma: a case of benign hemangioendotheliomatosis

    Arch Dermatol

    (1964)
  • E Wilson Jones et al.

    Inflammatory angiomatous nodules with abnormal blood vessels occurring about the ears and scalp (pseudo- or atypical pyogenic granuloma)

    Br J Dermatol

    (1969)
  • E Wilson Jones et al.

    Papular angioplasia: vascular papules of the face and scalp simulating malignant vascular tumors

    Arch Dermatol

    (1970)
  • C Girard et al.

    Arteriovenous hemangioma (arteriovenous shunt): a clinicopathological and histochemical study

    J Cutan Pathol

    (1974)
  • J Rosai et al.

    Intravenous atypical vascular proliferation: a cutaneous lesion simulating a malignant blood vessel tumor

    Arch Dermatol

    (1974)
  • JF Fetsch et al.

    Observations concerning the pathogenesis of epithelioid hemangioma (angiolymphoid hyperplasia)

    Mod Pathol

    (1991)
  • AH Mehregan et al.

    Angiolymphoid hyperplasia with eosinophilia

    Arch Dermatol

    (1971)
  • RJ Reed et al.

    Subcutanous angioblastic lymphoid hyperplasia with eosinophilia (Kimura's disease)

    Cancer

    (1972)
  • C Castro et al.

    Angiolymphoid hyperplasia with eosinophilia in the skin

    Cancer

    (1974)
  • FC Masa et al.

    Angiolymphoid hyperplasia demonstrating extensive skin and mucosal lesions controlled with vinblastine therapy

    J Am Acad Dermatol

    (1984)
  • A Aguilar et al.

    Angiolymphoid hyperplasia with eosinophilia limited to the vulva

    Clin Exp Dermatol

    (1990)
  • JR Srigley et al.

    Epithelioid hemangioma of the penis: a rare and distinctive vascular lesion

    Arch Pathol Lab Med

    (1985)
  • BJ Bendl et al.

    Nodular angioblastic hyperplasia with eosinophilia and lymphofolliculosis

    Cutis

    (1977)
  • L Angervall et al.

    Atypical hemangioendothelioma of venous origin: a clinicopathologic angiographic immunohistochemical and ultrastructural study of two endothelial tumors within the concept of histiocytoid hemangioma

    Am J Surg Pathol

    (1985)
  • DH Wright et al.

    Angiolymphoid hyperplasia with eosinophilia simulating lymphadenopathy

    Histopathology

    (1981)
  • D Ose et al.

    Histiocytoid hemangioma of the skin and scapula: a case report with electron microscopy and immunohistochemistry

    Cancer

    (1983)
  • WHC Burgdorf et al.

    Immunohistochemical identification of factor VIII related antigen in endothelial cells of cutaneous lesions of alleged vascular nature

    Am J Clin Pathol

    (1981)
  • DG Daniels et al.

    Ultrastructural study of a case of angiolymphoid hyperplasia with eosinophilia

    Arch Dermatol

    (1974)
  • SE Mills et al.

    Lobular capillary hemangioma: the underlying lesion of pyogenic granuloma

    Am J Surg Pathol

    (1980)
  • DA. Kerr

    Granuloma pyogenicum

    Oral Surg Oral Med Oral Pathol

    (1950)
  • Cited by (317)

    • Intravascular Endothelial Hyperplasia of the Foot

      2023, Journal of Foot and Ankle Surgery
    • Neonatal dermatology

      2021, Pediatric Dermatology
    View all citing articles on Scopus

    From the Department of Dermatology,a Fundación Jiménez Díaz, Universidad Autónoma, Madrid; and the Departments of Pathology and Medicine (Division of Dermatology),b,c Medical College of Georgia, Augusta.

    ☆☆

    Reprint requests: Luis Requena, MD, C/ Leopoldo Alas Clarin 4-3°D 28035, Madrid, Spain.

    0190-9622/97/$5.00 + 0 16/2/85356

    View full text