Case Number : Case 992 - 11th April Posted By: Guest

Spindle cell haemangioma.

Low-power magnification shows a polypoid vascular lesion resembling a pyogenic granuloma, except by the absence of lobularity. At higher power magnifications we can see epithelioid endothelial cells, intersticial neutrophils and nuclear dust. I hope a Warthin-Starry stain unmasks clumps of bacilli confirming my impression of bacillary angiomatosis.

Agree with Epithelioid Hemangioma.
Once I read the entity called Cutaneous Epithelioid Angiomatous Nodule (CEAN), described in 2004 (see [url="http://www.ncbi.nlm.nih.gov/pubmed/14726818"]http://www.ncbi.nlm.nih.gov/pubmed/14726818[/url]), which differs from Epithelioid Hemangioma by some clinical (trunk and extremities) and histologic features. In 2008, other paper (see [url="http://www.ncbi.nlm.nih.gov/pubmed/18212538"]http://www.ncbi.nlm.nih.gov/pubmed/18212538[/url], with Dr. Omar Sangueza and Dr. Luiz Requena) described CEAN lesions also compromising head and neck location, and suggestes that CEAN are part of the spectrum of Epithelioid Hemangioma. I would like to know what are the opinion of the participants of this site.

Cutaneous epithelioid angiomatous nodule.

Vascular proliferation with plump endothelial lining associated to slight microabscesses, the latter feature a clue for bacillary angiomatosis or, in the proper epidemiologic setting, verruga peruana.

My impression is: cutaneous epithelioid angiomatous nodule.

Sorry I was at Eduardo Calonje's update today. This is not a vascular tumour as far as I remember but I am away from the office. Why don't you have another think
Regards to all from very sunny London

So I will try the other idea that I thought as a DD: epithelioid benign fibrous histiocytoma.

If not vascular, then as Eman said it should be epithelioid fibrous histiocytoma...

Another differential diagnosis could be Angoimatoid Spitz nevus.

Agree with this new possibility: [color=#1C2837][font=arial, verdana, tahoma, sans-serif][size=4]epithelioid fibrous histiocytoma.[/size][/font][/color]

Immunohistochemistry for S100, MelanA, HMB45, EMA, MNF116 and AE1/AE3 is negative. CD31 and CD34 highlights the vessels. CD68, S100 and CD1a highlight scattered dendritic cells throughout the lesion and CD68 is weakly positive in tumour cells.

Indeterminate dendritic cell tumor.

This could be solitary reticulohistiocytoma. I see oncocytic mononuclear histiocytes, but no multinucleate giant cells. Are there other stains available, such as CD163, factor XIIIa, lysozyme?

No sorry it is from a few years ago and sadly we don't stock those markers in any case.

I am sorry. I think I made a mistake. Indeterminate dendritic cell tumor must be diffuse lay positive for S100 and CD1a..so it's not the case..I think I will agree with Tiberiu for solitary reticulohistiocytoma..

Yes I reported this as epithelioid fibrous histiocytoma. The polypoid nature and collarette are typical. Eduardo Calonje kindly reviewed this case and agreed. Looking forward to Mark's anecdote. Regards to all and pleased some of you are happy to contribute during your weekend.

Whoops just checked my database and this particular case was not seen by Eduardo, I was thinking of another case even older. I did call it epithelioid cell histiocytoma though but I am sure we use epithelioid fibrous histiocytoma synonymously.