Case Number : Case 1707 - 13 December - Dr Uma Sundram Posted By: Guest

Dr Uma Sundram has a neat case for you today, enjoy.

Cheers, Geoff Cross - DermpathPRO Projects

thinking on the lines of a hobnail haemangioma. some lymphocyte aggregates between vascular channels and a retiform appearance in areas, so would also consider retiform haemangioendothelioma

Dilated vascular channels, lined by endothelial cells showing hobnail appearence in some areas. Papillae are seen as well as lymphocytes closely related to the blood vessels, first thought papillary intralymphatic angioendothelioma. Although mainly in infants and children, cases in adults can occur. Along the same line comes retiform hemangioendothelioma as a ddx 

wonder if just on morphology one should also consider a variant of Kaposi's...

For me this looks benign, I was thinking of vascular malformation with associated papillary endothelial hyperplasia. 

I think in superficial lymphangioma vs. cirsoid aneurysm.

Looks like a vascular venous/lymphatic malformation or something recalled by you all Colleagues...but before, thinking the same think like Urmila, I was estimating the possibility of a weird Kaposi's sarcoma, lymphamngioma variant...so I'd like know about HHV8 stain.

I favor lymphatic malformation due to cavernous lymphangioma-like vascular spaces occupying the full thickness of the dermis. Alternatively, maybe there is history of radiation therapy.

I haven’t seen perivascular spindle cells for lymphangioma-like Kaposi sarcoma.

"I haven’t seen perivascular spindle cells for lymphangioma-like Kaposi sarcoma."

Completely agree with Robledo's observations, and sincerely my first thought was been a sort of glomus-venous malformation, cell-poor type...but I was not able to see any glomus cell ( maybe in center first fig? ) and other vascular/lymphatic malformations appear so weird in this clinicopathological setting. So I thought of a KS, and when I checked the colleagues answers I found a similar option ( Urmila ). Sincerely this case is difficult for me, but I would check HHV8 and then, with HHV8-, I would favor GV-malformation.  

I would favour a lymphatic malformation. Have read the comments above. Such areas can occur in a lymphangioma like KS, where the deeper aspect of the lesion will show more typical KS like areas. I would definitely do a HHV8.

Great comments guys! Apologize in advance for the tardy answer post.

We also thought lymphatic-vascular malformation and were not very fancy in our classification. These are super difficult with very little consensus, even among experts. I think benign, uncertain malignant potential, and malignant covers the gamut of classification schemes for vascular proliferations in general; a much more practical approach than the nomenclature based approach we use (and agonize over) currently.  We thought this was benign. HHV 8 is negative and the patient is not HIV positive.