Case Number : Case 1761 - 27 February - Dr Limin Yu Posted By: Guest

Dr Limin Yu has got a whole host of images for today's Spot Diagnosis Case.

Geoff Cross - DermpathPRO Projects

Angiosarcoma. 

Clinical info would be helpful, but angiosarcoma favored. Considered acroangiodermatitis but looks like dissecting vessels and endothelial atypical are too much.

Angiosarc first thought.

This is a biopsy from a 8yo girl's lower lip. 

12 minutes ago, Limin Yu said:

This is a biopsy from a 8yo girl's lower lip. 

 

 

Oops !!! 

Then may be just a strawberry hemangioma or NICH ?? 

 :) Tricky case. I wasn't convinced of angiosarcoma in the images. 8 year old girl makes it even more unlikely I guess. The last but one image looks a bit retiform + there are a few inflammatory cells within the tumour. I am not so great with vascular tumours but DABSKA/PILA?

I know only another lesion able to simulate angiosarcoma so strictly: the meningothelial hamartoma of the scalp, but that should be "offside"...The Hobnail Hemangioma is a theoretical option, but I haven't any spot diagnosis now. I have a spot question instead: could be a paediatric angiosarcoma? 

For me this case is challenging too. I thought angiosarcoma could be a consideration but it did not convince me 100%. In my opinion the lesion looks retiform and infiltrative (as Sassi remarked), some of the cells have round nuclei with prominent nucleoli and they dissect collagen bundles. In other areas we see some sclerosis and a lymphocytic infiltrate is also evident. For me this tumor goes morphologically better with retiform haemangioendothelioma although as we know this tumor is more frequent in the adult population and can have significant overlap with Dabska's tumor

? angiosarcoma ? Kaposi's sarcoma

Wonder what Eduardo Calonje's opinion of this case would be...

A hard case, but I tend to interpret as something in the spectrum of hobnail (Dabska-retiform) hemangioendothelioma this vascular tumor with infiltrative growth pattern comprising vessels lined by cuboidal endothelium that are embedded in a hyaline stroma infiltrated by lymphocytes.

Agree, on the spectrum of hobnail haemangioendothelioma....retiform architecture is more noticeable than intravascular papillae, so would favour retiform haemangioenothelioma (although completely agree that the 2 are related entities).

Would go for a retiform haemangioendothelioma. However, this occurs more on limbs. 

I favour kaposi's sarcoma. One of the images shoe promontary sign.

On 27/02/2017 at 21:36, Limin Yu said:

This is a biopsy from a 8yo girl's lower lip. 

 

 

Eagerly waiting for the answer :)

Great case. Definitely not for mere mortals in soft tissues like me!  My thoughts were some type of haemangioendothelioma (composite of Dabska/PILA, retiform and even some slightly epithelioid cells). Also have to exclude KS - easily done with HHV8. Given clinical scenario likely to be benign behaviour I guess.

Thank you for the intense and insightful discussion. This is an indeed challenging case. The case was sent to Dr. Fletcher for consultation and his opinion was composite hemangioendothelioma.  His letter is attached. 

What a great case thank you dr. Yu