Case Number : Case 54 Posted By: Guest

Juan Carlos Garcés - Hospital Oncológico / Hospital Luis Vernaza (Guayaquil Ecuador) Wrote:

Very nice case.. I only want to add that progresive lymphangioma could have promontory sign

Submitted on 25/08/2010 00:24
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Phillip McKee - Overseas consultations (USA) Wrote:

Well done those who diagnosed lymphangiomatous KS. It just goes to show that when you look at single images (which are often very difficult) that you have to have a very open mind. That however is the whole point of the spot diagnoses. Some are very easy to you all and are just beautiful images whereas others are real brain teasers!

Submitted on 24/08/2010 21:29
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Wayne Grayson - (Johannesburg, South Africa) Wrote:

Lovely promontory sign. In this part of the world, my no.1 spot diagnosis for this histological picture would be the lymphangioma-like variant of Kaposi's sarcoma. If, however, the clinical setting did not support the latter diagnosis, I would favour an acquired progressive lymphangioma. HHV-8 immunohistochemistry would be very helpful here.

Submitted on 24/08/2010 17:35
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Ana Cristina Ruiz S - Universidad CES (Medellín, Colombia) Wrote:

Acquired progressive lymphangioma vs low grade angiosarcoma.

Submitted on 24/08/2010 14:54
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Dear Dr McKee, I understood from ur comment that my opinion is not correct. I re-examined the section and expanded my thinking. I think I can see a small promontery sign in the dilated vascular space on the left side of the picture. Another promontery is seen in the top right corner (If I am not wrong). The nature of the vascular spaces being grossly dilated and lined by flattened endothelial cells and devoid of erythrocytes may point to Lymphangioma Like Kaposi Sarcoma. I think in this variant deeper areas may resemble the more usual forms of Kaposi. waiting to know the correct diagnosis.

Submitted on 24/08/2010 14:34
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Eman El-Nabarawy - Cairo University (Egypt) Wrote:

After more searching, I can see thin walled, irregular vascular channels with few papillary projections and hobnail endothelial cells.could be hobnail hemangioma ( Targetoid hemosiderotic hemangioma).

Submitted on 24/08/2010 14:22
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Phillip McKee - Overseas consultations (USA) Wrote:

Good morning all. This is a very difficult image to diagnose. You will have to indulge in marked lateral thinking. More obvious and readily diagnosable features have been excluded from this picture to make you think very hard. Lets see how others fare during the day.

Submitted on 24/08/2010 13:25
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Juan Carlos Garcés - Hospital Oncológico / Hospital Luis Vernaza (Guayaquil Ecuador) Wrote:

Agree.. Acquired progressive lymphangioma

Submitted on 24/08/2010 00:38
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Vascular spaces dissecting inbetween the collagen, however, no extravasated RBC, no hemosiderin or plasma cells. Although, they are not typically horizontally oriented, I think this could be progressive lymphangioma.

Submitted on 23/08/2010 23:11
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Eman El-Nabarawy - Cairo University (Egypt) Wrote:

Progressive lymphangioma.

Submitted on 23/08/2010 22:45
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