Vascular tumors

Dirk M. Elston

Angiokeratoma

Key features

• Hyperkeratosis

• Acanthosis

• Ectatic thin-walled vessels in contact with the epidermis

• Resembles a “bloody seborrheic keratosis”

Fig 23-1 Angiokeratoma

Lymphangioma

Key features

• “Frog spawn” clinically

• D2-40+

Fig 23-2 Lymphangioma

Nevus flammeus

Key features

• Dilated capillary-sized vessels

Fig 23-3 Nevus flammeus

Angioma serpiginosum

Key features

• Dilated tortuous capillaries in dermal papillae and the upper dermis

• Vessels lack alkaline phosphatase activity

Fig 23-4 Angioma serpiginosum

Angioma serpiginosum presents as a progressive vascular lesion on a woman’s leg. The ectatic vessels begin as minute puncta in clusters, but merge to form a serpiginous array. They often bleed freely when traumatized.

Venous lake

Key features

• Irregular, thin-walled, ectatic vessel

• Usually collapses after biopsy

Fig 23-5 Venous lake

Venous lakes are common on the lips and ears of older patients. They may appear very dark, but blanch easily when compressed.

Glomus tumor

Key features

• Rows of round dark nuclei with little cytoplasm (“string of black pearls”)

• Glomus cells surround delicate vascular spaces

• Commonly tender

Fig 23-6 Glomus tumor

Pearl

• Normal glomus bodies are found on the sides of digits. A large physiologic glomus coccygeum is present in the sacral area

• Glomus cells are modified smooth muscle cells (SMA+/CD31−)

• In general, vascular smooth muscle stains reliably with vimentin and smooth muscle actin, but not with desmin.

Glomangioma

Key features

• Commonly multiple

• One to two layers of glomus cells around prominent vessels

Fig 23-7 Glomangioma

The vessels usually have thicker walls than the vessels in a glomus tumor. Glomangiomas have been described as vascular malformations with a few glomus cells, whereas glomus tumors have been described as tumors of glomus cells surrounding inconspicuous vessels.

Pyogenic granuloma

Key features

• Eruptive lobular capillary hemangioma

• Early lesions show solidly packed endothelial cells

• Later lesions show more ectatic vessels, erosion, and crusting

• Epidermal collarette common

• Commonly impetiginized on surface

Fig 23-8 Pyogenic granuloma

Bacillary angiomatosis

Key features

• Usually not distinctly lobular

• Clusters of neutrophils within lesion

• Amphophilic collections of organisms

Fig 23-9 Bacillary angiomatosis

Differential Diagnosis

Pyogenic granulomas are distinctly lobular. Although surface crusting is common in pyogenic granulomas, they lack the deep clusters of neutrophils that characterize bacillary angiomatosis.