Case Number : Case 3004 - 11 January 2022 Posted By: Uma Sundram

I am concerned that this might be a manifestation of a malignancy, perhaps haematological.  Not sure of the significance of the ERG stain - this doesn't look like a vascular tumour.  More relevant clinical details and IHC please.

I believe this is a vascular tumor that forms slit-like spaces and irregular vascular branches that dissects the colagen fibers. My first opinion this is a Kaposi sarcoma. I would do a HHV-8 stain.

Watching at low magnification my first spot was of a retiform hemangioendothelioma. But RHE usually shows hobnail cells. A weird RH which doesn’t read the books...or am’I already getting “weird”?  ( :-)

There are vessels with inconspicuous lumen and endothelial cells having plump pale banal looking nuclei, and dense lymphoid infiltrate.  Thought of epithelioid haemangioma but don't see any eosinophil. Epithelioid Kaposi sarcoma is a possibility, need HHV-8 stain. 

This was a difficult case but the final consensus was that of a hemangioendothelioma. Both retiform and composite hemangioendotheliomas were considered. HHV 8 is negative. Long standing lesion on the back, slowly growing over time. No other history and the patient is young.

Great comments!

Angiolymphoid hyperplasia/epithelioid hemangioma