Case Number : Case 1278 - 18 May Posted By: Guest

Thought of Glomeruloid Hemangioma ? with lots of esinophilic globules ?

Good possibility, Mona.
Another differential would be Tufted Angioma as there appear to be dilated lymphatic channels at periphery. (and one can get eosinophilic inclusions in this entity too). But the age is unusual, mostly occurs in children.

Glomeruloid haemangioma.

I thought this was a difficult case, so see my diagnosis note. Thanks for your comments!


[b]-- UNUSUAL HEMANGIOMA[/b]
(With features of glomeruloid hemangioma and papillary hemangioma)
[indent=1][b]COMMENT: [/b]Up until the last few years, the concept of papillary hemangioma had not been put out in the literature, and most of the lesions were classified under glomeruloid hemangioma. Both of the lesions contain PAS-positive hyaline globules in the endothelial cells, and it was thought initially that the lesions of glomeruloid hemangioma were pathognomonic of POEMS syndrome. Today, there is an argument that the papillary hemangiomas, albeit very similar to glomeruloid hemangiomas, are not associated with that syndrome but only the glomeruloid hemangiomas are. In this particular case, the evidence would seem to point toward this being a papillary hemangioma based on the fact that it contains thickened basement membranes with type IV collagen prominence and PAS-positive prominence around the vessels. Nonetheless, the structure of the lesion, to my eye, looks more like a glomeruloid hemangioma. It may just simply be that the small sample precludes the ability to differentiate the two very well. I think at this point, further clinical followup is warranted in order to determine whether the patient has any clinical manifestations of POEMS syndrome. There is some reason to believe that patients without that syndrome can produce papillary hemangiomas that can be very close in structure to the lesion I am seeing here. Usually they are solitary lesions opposed to the multiple ones in glomeruloid hemangiomas.[/indent]

[center]References:[/center]

Suurmeijer AJ, Fletcher CD. Papillary haemangioma. A distinctive cutaneous haemangioma of the head and neck area containing eosinophilic hyaline globules. Histopathology. 2007 Nov;51(5):638-48. PubMed PMID: 17927585.

Suurmeijer AJ. Papillary hemangiomas and glomeruloid hemangiomas are distinct clinicopathological entities. Int J Surg Pathol. 2010 Feb;18(1):48-54. doi:10.1177/1066896908323504. Epub 2008 Sep 19. PubMed PMID: 18805868.