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RESIDENT RESOURCE CENTER POWERED by • Case Report: Masson’S Tumor • Top Resident Presentations from Cosmetic Surgery Forum 2014 • Ask an Expert: Molluscum

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RESIDENT RESOURCE CENTER POWERED by • Case Report: Masson’S Tumor • Top Resident Presentations from Cosmetic Surgery Forum 2014 • Ask an Expert: Molluscum RESIDENT RESOURCE CENTER POWERED BY • Case Report: Masson’s tumor • Top Resident Presentations from Cosmetic Surgery Forum 2014 • Ask an Expert: Molluscum CASE REPORT: EXCISION OF AN INTRAVASCULAR PAPILLARY ENDOTHELIAL HYPERPLASIA By Doug Richley, DO; Christine Sickles, DO, Stephen J Plumb, DO; Jonathan Cleaver, DO, FAOCD; and Lloyd Cleaver, DO, FAOCD 37-year-old Caucasian male presented for evalu- ation of a lesion located on his left superior mucosal lip (Fig. 1). He reported that the lesion was asymptomatic and had been enlarging over a Asix-month period. He admitted to mild pain with manipu- lation. He first noticed this lesion approximately two years Figure 1. before his visit. He presented to the office wanting to have the lesion removed, secondary to him being concerned due to the fact that it has been enlarging, as well as the mild pain he experiences with manipulation. Based on the clinical presentation and history, our ini- tial differential diagnosis included venous lake, dysplastic nevus, and blue nevus. The changing nature of the lesion, as well as it being mildly tender to palpation warranted that the lesion be removed. The decision was made to perform an excisional biopsy. The defect created by the excision was approximated using 5.0 Vicryl absorbable suture. A total of four interrupted sutures were used to close the defect (Fig. 2). We instructed the patient to follow-up with his primary physician five to seven days after excision for evaluation of the wound and Figure 2. to have the sutures removed. The lesion was sent for hemo- toxylin and eosin (H & E) staining and histologic review. The DISCUSSION dermatopathology report showed a proliferation of vessels Intravascular papillary endothelial hyperplasia (IPEH) or with papillary endothelial projections (Fig. 3), consistent Masson’s tumor was first described by Pierre Masson in 1923 with the diagnosis of intravascular papillary endothelial as a neoplastic process. This was due to the proliferation of hyperplasia (IPEH) or Masson’s tumor. The benign nature endothelial cells and fibrin deposition into the vessel of the of this entity did not warrant further treatment, and the lumen that lead to obstruction and degeneration. It was later patient was advised to follow-up in one year. described as a reactive process and is now regarded as a benign, FEBRUARY 2015 PRACTICAL DERMATOLOGY 27 RESIDENT RESOURCE CENTER non-neoplastic vascular lesion that can occur post-trauma.1,2 In 1976, Clearkin and Enzinger proposed the name intravascular papillary endothelial hyperplasia (IPEH).3 The lesion may also be referred to as Masson’s lesion, Masson’s tumor, Masson’s hemangio-endotheliome vegetant intravasculaire, Masson’s pseudoangiosarcoma, intravascular angiomatosis, intravascular or extravascular papillary endothelial hyperplasia.4 Masson’s tumor occurs in both males and females, show- ing a slight female predominance with a 1.0:1.2 male to female ratio. A possible hormonal role has been suggested based on this gender difference, and local angiogenic growth factors may contribute to endothelial proliferation.5 The average age of pre- sentation is 34 years old.3 Vascular lesions are common in the oral region, but Masson’s tumor is an uncommon lesion that comprises approximately two percent of vascular tumors.2 Clinically, a Masson’s tumor presents as a single firm, papule, nodule or mass. Patients may complain of pain or tenderness.1 The lesions are red or purple in color and ranges in size from 5mm to 5cm. It typically involves the fingers, head, neck, trunk, lower extremities, and upper extremities.5 Rarely these lesion arise on mucosal mem- branes, including the upper lip, lower lip, tongue, buccal mucosa, mandibular vestibule, and angle of the mouth.6 The pathogenesis of Masson’s tumor is not completely understood, but it is thought that these lesions develop as a Figure 3. reactive process during the organization and recanalization of a thrombus. This lesion is considered to be a result from trau- tures then develop within the irregular thrombus and anasto- ma or continuous stimulation.2 In the early stage of forma- mose with adjacent vascular structures. The anastomosis and tion, endothelial cells embed themselves into the thrombus. recanalization may convert the thrombus to a mass of vascu- The endothelial cells cause a separation within the thrombus larized connective tissue and cause subendothelial vascular leading to irregular digestion by collagenase. Papillary struc- wall swelling.7 TOP 10 RESIDENT PRESENTATIONS FROM THE 2014 COSMETIC SURGERY FORUM A significant point of emphasis at Cosmetic Surgery Forum (CSF), which was most recently held in December in Las Vegas, is the education future generations of dermatologists. Residents are given the opportunity to conduct and present case studies, and every year, CSF acknowledges the top 10 presentations. The winning presentations given by dermatology residents at the 2014 CSF meeting include: 1. Kerry Shaughnessy: “A Chronic Pruritic Plaque on the Left Shoulder” 2. Amy Thorne: “The Extracutaneous Effects of Benign Stigmata” 3. Divya Shokeen: “Rhabdomyolysis in Patients on Isotretinoin Therapy” 4. David Rayhan: “Bilateral Peri-Ocular Primary Mucinous Carcinoma Treated with Mohs Micrographic Surgery” 5. Tatyana Petukhiva: “Significant Inter-rater Variability in Acne Scarring” 6. Bonita Kozma: “Hidradenitis Suppurtiva” 7. Cerrene Giordano: “Ulcerations of Striae Distensae” 8. Michael Graves: “Defining the Absorption Spectrum of Dihydroxyacetone, a Popular Sunless Tanner, Using Reflectance Photospectrometry” 9. Conor Dolehide: “An Adolescent with Solid Facial Edema (Morbihan Disease) 10. Tanya Khan: “Retained Dermal Filler Masquerading as Periorbital Edema” 28 PRACTICAL DERMATOLOGY FEBRUARY 2015 RESIDENT RESOURCE CENTER ASK AN EXPERT: MANAGING MOLLUSCUM Sheila Fallon Friedlander, MD discussed her current POWERED BY approach to the management of molluscum with host Adam Friedman, MD in a recent issue of NewDermMD. Dr. Friedlander says the first step to treating molluscum is to find out how long the child has had it, if anyone else in the family also has it, and how much treatment they’ve already tried. Explaining that many patients who present to her with this condition are typically frustrated because they’ve already been to a pediatrician and maybe even another dermatologist, she says education about the disease and treatment options is very important. Treatment advice can range from watchful waiting to treatment with cantharidin, if the patient is the right candidate. To hear more about how and when she uses cantharidin, as well as how she treats molluscum on the face, visit http://newdermmd.com/2014/12/ask-an-expert There are three different types of lesions described. The Doug Richley, DO is a first type is the primary form and it arises within an isolated Dermatology Resident, dilated blood vessel, most commonly a vein and occurs on 2nd year, Northeast the fingers, head, and neck. The secondary type is found in a Regional Medical Center/ preexisting vascular malformation, such as pyogenic granulo- ATSU, Kirksville, Missouri. ma or cavernous hemangioma and arises intramuscularly. The Christine Sickles, DO is a Traditional third type is the least common and is found extravascularly, Intern, Lewis-Gale Medical Center, and usually arises in the setting of a hematoma.3,8 The differ- Blacksburg, VA. Stephen J Plumb, DO is a ential diagnosis of benign oral lesions includes hemangioma, Dermatopathologist, Cleaver Dermatology, mucocele, pyogenic granuloma, endothelioma, and the malig- Kirksville, Missouri. Jonathan Cleaver, DO, nant neoplasms diagnosis includes angiosarcoma.5 FAOCD, FAOCD is Attending Dermatologist, Northeast Regional Histologically, Masson’s tumor is characterized by papil- Medical Center/ATSU, Kirksville, Missouri. Lloyd Cleaver, DO, lary structures with a central hypocellular hyaline core lined FAOCD is Program Director, Northeast Regional Medical Center/ by endothelial cells and associated thrombi. The histology ATSU, Kirksville, Missouri is usually distinct enough to make the diagnosis, but immu- The authors have no relevant disclosures. nohistochemical confirmation may be needed to ensure the 1. Adeoye A, Akang E, Fasina O. Orbital intravascular papillary endothelial hyperplasia in a Nigerian child: a case report and lesion is endothelial in origin. Von Willebrand factor, CD review of literature. Journal of Medical Case Reports 2012, 6:300. 31, factor XIIIa, and CD 43 are markers that can be used to 2. Akdur et al. Intravascular papillary endothelial hyperplasia: histomorphological and immunohistochemical features. 9 Diagnostic Pathology. 2013,8:167. highlight the endothelial lining. The histologic features that 3. Bolognia J, Rapini R, Jorizzo J. Dermatology: 2 Volume Set. Spain: Elsevier – Health Sciences Division, 2003. Print. 4. Choi C, Han K, Park K, Won Y, Yang J. Intravascular Papillary Endothelial Hyperplasia (Masson tumor) of the Skull: Case distinguish Masson’s tumor from angiosarcoma are a well Report and Literature Review. Journal of Korean Neurosurgery 2012, 52-54. circumscribed intravascular papillary hyperplasia, a prolifera- 5. Chung H, Jang Y, Jun J, Kim J, Kim S, Kim D, Lee S, Lee W. HIF-1α and VEGF expression correlates with thrombus remodeling in cases of intravascular papillary endothelial hyperplasia. Int J Clin Exp Pathol 2013;6(12):2912-2918. tive process that is confined to the intravascular space, and 6. Hiraki A, Iyama K, Shinohara M, Yonezawa H. Intravascular Papillary
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