DOCSLIB.ORG

A Clinicopathological and Immunohistochemical Study of Lymphatic Differentiation in 49 Angiosarcomas

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
A Clinicopathological and Immunohistochemical Study of Lymphatic Differentiation in 49 Angiosarcomas Histopathology 2010, 56, 364–371. DOI: 10.1111/j.1365-2559.2010.03484.x Can lymphangiosarcoma be resurrected? A clinicopathological and immunohistochemical study of lymphatic differentiation in 49 angiosarcomas Cohra C Mankey, Jonathan B McHugh, Dafydd G Thomas & David R Lucas Department of Pathology, University of Michigan, Ann Arbor, MI, USA Date of submission 18 November 2008 Accepted for publication 12 June 2009 Mankey C C, McHugh J B, Thomas D G & Lucas D R (2010) Histopathology 56, 364–371 Can lymphangiosarcoma be resurrected? A clinicopathological and immunohistochemical study of lymphatic differentiation in 49 angiosarcomas Aims: The term lymphangiosarcoma has largely been as hobnail and kaposiform morphologies were more abandoned in the current classification of endothelial often positive with these markers, including a statistical neoplasms. Recently, a number of lymphatic-associated association between D2-40 and hobnailing. Ten antibodies have been developed for immunohistochem- tumours had features suggestive of lymphatic differen- istry, which frequently stain angiosarcomas, implying tiation, namely well-differentiated histology, interanas- lymphatic or mixed lymphatic and blood vascular tomosing channels devoid of red cells, prominent differentiation is common. The aim was to investigate hobnailing, lymphoid aggregates, and multi-antigen further lymphatic antigen expression, and to explore expression of D2-40 (100%), Prox-1 (100%) and the relation of immunohistochemistry to morphological VEGFR-3 (60%), which might be deserving of the and clinical findings. appellation lymphangiosarcoma. Nine were cutaneous Methods and results: Forty-nine angiosarcomas in scalp ⁄ facial tumours in elderly patients and one arose tissue microarrays were analysed with D2-40 and within chronic lymphoedema. antibodies to Prox-1 and vascular endothelial growth Conclusions: Lymphatic differentiation is common in factor receptor (VEGFR)-3. D2-40 was positive in 53%, angiosarcoma, certain subsets show greater lymphatic Prox-1 in 76%, and VEGFR-3 in 57%. Tumours with differentiation than others, and lymphangiosarcoma features attributable to lymphatic differentiation such may be defined pathologically, rather than clinically. Keywords: angiosarcoma, D2-40, immunohistochemistry, lymphangiosarcoma, podoplanin, Prox-1, VEGFR-3 Abbreviations: LYVE-1, lymphatic vessel hyaluronan receptor-1; TMA, tissue microarray; VEGFR, vascular endothelial growth factor receptor Introduction lymphatic vessels, thus having lymphatic endothelial differentiation. Today pathologists rarely make this The concept of lymphangiosarcoma originated in 1948 diagnosis, and distinguishing between lymphangiosar- when Stewart and Treves described six cases of a coma and haemangiosarcoma has essentially become malignant vascular neoplasm that arose in the upper an obsolete practice. This is summarized in Enzinger extremity many years after radical mastectomy.1 and Weiss’s Soft tissue tumors textbook: ‘Since it is Because the neoplasm arose in the setting of chronic usually impossible to determine which tumors display lymphoedema, it was presumed to have arisen from lymphatic versus vascular differentiation, all are referred to as angiosarcoma, even those that arise in the setting of lymphedema’.2 Address for correspondence: Dr David R. Lucas, Department of Recently, a number of antigens preferentially Pathology, University of Michigan, 2G332 UH, Ann Arbor, expressed by lymphatic endothelial cells have been MI 48109-0054, USA. e-mail: [email protected] discovered. Examples include podoplanin (recognized Ó 2010 The Authors. Journal compilation Ó 2010 Blackwell Publishing Limited. Lymphatic differentiation in angiosarcoma 365 by the monoclonal antibody D2-40), Prox-1, vascular The following features were evaluated: differentiation endothelial growth factor receptor (VEGFR)-3, and (well, moderate or poor, based upon criteria of the lymphatic vessel hyaluronan receptor-1 (LYVE-1), all French Federation of Cancer Centre Systems), archi- of which have been used to study vascular tumours by tecture (vasoformative, fascicular ⁄ kaposiform or solid), immunohistochemistry. These antigens are expressed in cytology (hobnail, epithelioid, spindled or pleomorphic) nearly all lymphangiomas,3–9 but in only a minority of and presence or absence of lymphoid aggregates within haemangiomas.4,5,7–12 They are also expressed in nearly the tumour. Cuboidal cells with scant cytoplasm and all Kaposi sarcomas,3–5,7,8,11,13 a tumour believed to apical hyperchromatic nuclei that protruded into the have at least partial lymphatic differentiation. Data vascular lumen were considered hobnail cells, whereas about expression of lymphatic antigens in angiosarco- cells with abundant eosinophilic cytoplasm and vesic- ma, however, are limited.3–5,8,11,14 For example, only ular nuclei with prominent nucleoli were considered one group has studied a large number of cases,4 only epithelioid cells. The series did not include any low- single antigens have been studied in all but one series,15 grade malignant vascular tumour such as retiform and Prox-1 has not been studied at all. Some studies haemangioendothelioma or Dabska tumour, tumours suggest that most angiosarcomas show some degree of with frequent hobnailing. lymphatic differentiation,3,4,8,14 whereas others suggest Tissue microarrays (TMAs) with three 1.0-mm that certain subsets show lymphatic differentiation and punches of each tumour were constructed and suggest a link between expression of lymphatic antigens immunostained with D2-40 and antibodies to Prox-1 and morphological features such as hobnail cytol- and VEGFR-3. Table 1 details the antibodies and ogy,5,11 non-epithelioid cytology,4,15 kaposiform archi- conditions. A variety of normal tissue samples and tecture,11 and lymphoid infiltrates or aggregates.5,11 neoplasms were included in the TMAs as controls. The purpose of our study was to analyse a large number TMAs were utilized to facilitate screening of multiple of angiosarcomas by immunohistochemistry with tumours with multiple antibodies. In tumours show- D2-40, and antibodies to Prox-1 and VEGFR-3 to ing cytoarchitectural heterogeneity, tissue cores were determine the extent of lymphatic antigen expression. selectively taken to sample for variation. In addition, In addition, we wanted to see if we could identify a whole block tissue sections were stained in 23 subgroup of angiosarcomas that might be considered tumours. These included nine tumours that were lymphangiosarcomas based upon morphological, underrepresented in the TMA, such as ones in which immunohistochemical and clinical features. the core sections were lost in processing. Cytoplasmic immunoreactivity was considered positive for D2-40 Materials and methods and VEGFR-3, whereas nuclear reactivity was consid- ered positive for Prox-1. For 14 tumours with mixed This study was conducted under approval of the well and poorly differentiated areas, selected whole Institutional Review Board of the University of Mich- blocks were stained to analyse for variation in igan. The pathology database was searched for all patterns of reactivity based upon histological grade. angiosarcomas diagnosed between 1986 and 2006. A separate TMA block containing five lymphangio- Forty-nine cases had sufficient tissue in paraffin blocks mas, four haemangiomas and six Kaposi sarcomas for immunohistochemical studies. Each case was was used for antibody validation. classified as sporadic cutaneous, sporadic visceral ⁄ Correlative analyses between tumours having hob- deep-seated, lymphoedema-associated or radiation- nail cytology and ⁄ or kaposiform architecture (mor- associated based upon information gleaned from the phological features often attributed to tumours with medical records. Haematoxylin and eosin-stained lymphatic differentiation) and immunopositivity with sections were re-examined to confirm the diagnosis. D2-40, Prox-1 and ⁄ or VEGFR-3 were performed using Table 1. Antibodies and procedures Antibody Species Manufacturer Address Dilution Pretreatment D2-40 Mouse Signet Dedham, MA, USA 1:50 None Prox-1 Rabbit Abcam Cambridge, MA, USA 1:100 HIER pH 6 VEGFR-3 Rabbit Abcam Cambridge 1:150 HIER pH 6 HIER, heat-induced epitope retrieval. Ó 2010 The Authors. Journal compilation Ó 2010 Blackwell Publishing Ltd, Histopathology, 56, 364–371. 366 C C Mankey et al. histograms and Fisher’s exact test. A P-value of <0.05 Table 2. Immunohistochemical results of validation samples was considered statistically significant. Kaposi’s Antibody Haemangioma Lymphangioma sarcoma Results D2-40 0 ⁄ 45⁄ 55⁄ 6 Among the 49 angiosarcomas, 22 were sporadic Prox-1 1 ⁄ 45⁄ 55⁄ 6 cutaneous tumours (18 of the scalp or face, and one each on the back, ante cubit, vulva and buttock), 15 VEGFR-3 0 ⁄ 44⁄ 55⁄ 6 were sporadic visceral ⁄ deep-seated tumours (five breast, three heart, and one each involving mediasti- num, thigh, adrenal gland, retroperitoneum, aorta, maxillary sinus, and femur), eight were radiation- With hobnailing (n = 19) 100 Without hobnailing (n = 30) associated (five breast, one scrotum, one suprapubic 89 skin, and one oral mucosa) and four were lymph- 90 79 oedema-associated (all involving the lower extremity). 80 Nineteen tumours had well-differentiated areas, 42 had 68 70 67 moderately or poorly differentiated areas. Fourteen tumours had both well and poorly differentiated areas 60 50 within the same tumour. Architectural features were % 50 vasoformative in 38, solid in 28, and kaposiform ⁄ fas- 40 37 cicular in 11. Cytological
Load more

Recommended publications
  • Tumors and Tumor-Like Lesions of Blood Vessels 16 F.Ramon
    16_DeSchepper_Tumors_and 15.09.2005 13:27 Uhr Seite 263 Chapter Tumors and Tumor-like Lesions of Blood Vessels 16 F.Ramon Contents 42]. There are two major classification schemes for vas- cular tumors. That of Enzinger et al. [12] relies on 16.1 Introduction . 263 pathological criteria and includes clinical and radiolog- 16.2 Definition and Classification . 264 ical features when appropriate. On the other hand, the 16.2.1 Benign Vascular Tumors . 264 classification of Mulliken and Glowacki [42] is based on 16.2.1.1 Classification of Mulliken . 264 endothelial growth characteristics and distinguishes 16.2.1.2 Classification of Enzinger . 264 16.2.1.3 WHO Classification . 265 hemangiomas from vascular malformations. The latter 16.2.2 Vascular Tumors of Borderline classification shows good correlation with the clinical or Intermediate Malignancy . 265 picture and imaging findings. 16.2.3 Malignant Vascular Tumors . 265 Hemangiomas are characterized by a phase of prolif- 16.2.4 Glomus Tumor . 266 eration and a stationary period, followed by involution. 16.2.5 Hemangiopericytoma . 266 Vascular malformations are no real tumors and can be 16.3 Incidence and Clinical Behavior . 266 divided into low- or high-flow lesions [65]. 16.3.1 Benign Vascular Tumors . 266 Cutaneous and subcutaneous lesions are usually 16.3.2 Angiomatous Syndromes . 267 easily diagnosed and present no significant diagnostic 16.3.3 Hemangioendothelioma . 267 problems. On the other hand, hemangiomas or vascular 16.3.4 Angiosarcomas . 268 16.3.5 Glomus Tumor . 268 malformations that arise in deep soft tissue must be dif- 16.3.6 Hemangiopericytoma .
    [Show full text]
  • Lymphangioma Circumscriptum of the Vulva- a Case Series Dermatology Section
    DOI: 10.7860/JCDR/2021/47435.14553 Case Series Lymphangioma Circumscriptum of the Vulva- A Case Series Dermatology Section RASHMI S MAHAJAN1, YOGESH S MARFATIA2, ATMAKALYANI R SHAH3, KISHAN R NINAMA4 ABSTRACT Vulval dermatoses pose a diagnostic and therapeutic challenge for the dermatologists. Lymphangioma Circumscriptum (LC) is a form of lymphangioma affecting the skin and subcutaneous tissues that is characterised by benign dilation of lymphatic channels. This uncommon condition is known to occur over the chest, mouth, axilla, tongue, and rarely in the vulva. In this series, authors present three cases of LC of vulva in women between the age group of 45 to 60 years with late-onset fluid-filled lesions over the vulva. The first case had history of hysterectomy prior to onset of lesions, the second case had a spontaneous onset of lesions while the third was a suspected case of pelvic tuberculosis with secondary lymphangioma. Keywords: Lymphangiectasia, Vulvar, Vulval epithelium INTRODUCTION Disorders of vulval epithelium are a confusing spectrum of disorders. They are broadly classified as-1) Inflammatory, 2) Ulcerative and Bullous, 3) Infections, 4) Benign tumours and 5) Malignancies. It is essential to know the exact aetiology to plan successful therapy. LC is a benign lymphatic malformation characterised by dilation of lymphatic vessels in the skin and subcutaneous tissue with lesions erupting locally as isolated or grouped translucid, thin-walled vesicles filled with a clear liquid [1]. These pathological lymphatic malformations have no communication with the normal lymphatics [2]. The precise cause of LC is not established. It could be congenital or acquired as a result of damage to the lymphatic vessels secondary to various aetiologies.
    [Show full text]
  • Two Cases of Lymphangioma Circumscriptum Successfully Treated
    Letters to the Editor REFERENCES 8. Kato N. Vertically growing ectopic nail. J Cutan Pathol 1992;19:445‑7. 9. Nath AK, Udayashankar C. Congenital onychogryphosis: Leaning Tower nail. Dermatol Online J 2011;17:9. 1. Barad P, Fernandes J, Ghodge R, Shukla P. Vertically growing Nail. 10. Zaias N. The Nail in Health and Disease. 2nd ed. Norwalk, CT: Appleton Indian Dermatol Online J 2015;6;288‑9. and Lange; 1990. p. 164. 2. Fleckman P. Structure and function of the nail unit. In: 3rd, editors. Nails: 11. Ohata C, Shirabe H, Takagi K. Onychogryphosis with granulation tissue Therapy, Diagnosis and Surgery :Saunders; 2005. p. 13‑26. of proximal nail fold. Skin Res 1996;38:626‑9. 3. Kligman AM. Why do nails grow out instead of up? Arch Dermatol 1961;84:313‑5. 4. Kikuchi I, Ogata K, Idemori M. Vertically growing ectopic nail: Nature’s Access this article online experiment on nail growth direction. J Am Acad Dermatol 1984;10:114‑6. Quick Response Code: 5. Baran R. Nail growth direction revisited. Why do nails grow out instead of up? J Am Acad Dermatol 1981;4:78‑84. 6. Grover C, Bansal S, Nanda S, Reddy BS, Kumar V. En bloc excision of Website: www.idoj.in proximal nail fold for treatment of chronic paronychia. Dermatol Surg 2006;32:393‑9. 7. Hashimoto K. Ultrastructure of the human toenail. I. Proximal nail matrix. J Invest Dermatol 1971;56:235‑46. Letter to the Editor twice per year. Nothing in particular was noted in her family Two cases of lymphangioma history or her laboratory tests.
    [Show full text]
  • Mesenchymal) Tissues E
    Bull. Org. mond. San 11974,) 50, 101-110 Bull. Wid Hith Org.j VIII. Tumours of the soft (mesenchymal) tissues E. WEISS 1 This is a classification oftumours offibrous tissue, fat, muscle, blood and lymph vessels, and mast cells, irrespective of the region of the body in which they arise. Tumours offibrous tissue are divided into fibroma, fibrosarcoma (including " canine haemangiopericytoma "), other sarcomas, equine sarcoid, and various tumour-like lesions. The histological appearance of the tamours is described and illustrated with photographs. For the purpose of this classification " soft tis- autonomic nervous system, the paraganglionic struc- sues" are defined as including all nonepithelial tures, and the mesothelial and synovial tissues. extraskeletal tissues of the body with the exception of This classification was developed together with the haematopoietic and lymphoid tissues, the glia, that of the skin (Part VII, page 79), and in describing the neuroectodermal tissues of the peripheral and some of the tumours reference is made to the skin. HISTOLOGICAL CLASSIFICATION AND NOMENCLATURE OF TUMOURS OF THE SOFT (MESENCHYMAL) TISSUES I. TUMOURS OF FIBROUS TISSUE C. RHABDOMYOMA A. FIBROMA D. RHABDOMYOSARCOMA 1. Fibroma durum IV. TUMOURS OF BLOOD AND 2. Fibroma molle LYMPH VESSELS 3. Myxoma (myxofibroma) A. CAVERNOUS HAEMANGIOMA B. FIBROSARCOMA B. MALIGNANT HAEMANGIOENDOTHELIOMA (ANGIO- 1. Fibrosarcoma SARCOMA) 2. " Canine haemangiopericytoma" C. GLOMUS TUMOUR C. OTHER SARCOMAS D. LYMPHANGIOMA D. EQUINE SARCOID E. LYMPHANGIOSARCOMA (MALIGNANT LYMPH- E. TUMOUR-LIKE LESIONS ANGIOMA) 1. Cutaneous fibrous polyp F. TUMOUR-LIKE LESIONS 2. Keloid and hyperplastic scar V. MESENCHYMAL TUMOURS OF 3. Calcinosis circumscripta PERIPHERAL NERVES II. TUMOURS OF FAT TISSUE VI.
    [Show full text]
  • Kaposi's Sarcoma: a Review of 136 Rhodesian African Cases John A
    Postgrad Med J: first published as 10.1136/pgmj.43.502.513 on 1 August 1967. Downloaded from Postgrad. med. J. (August 1967) 43, 513-519. Kaposi's sarcoma: A review of 136 Rhodesian African cases JoHN A. GORDON M.B., Ch.B.(Cape Town), F.R.C.S.(Edin.) Surgeon, Harari Central Hospital, Salisbury, Rhodesia; Cancer Association Fellow of the Cancer Association of Rhodesia to the Westminster Hospital, London KAPosi's syndrome was originally described by University of Chicago cancer registry from 1946 Moricz Kaposi, Professor of Dermatology in the to 1960 showed eight cases of Kaposi's sarcoma in University of Vienna in 1872. The condition was 13,700 malignancies. thought to be rare and virtually confined to Central European Jews, although later it was also Age described in Mediterranean peoples. There was The original and subsequent 'European' des- even evidence that amongst the Jews the con- cription stressed that the patient would be in the dition was confined to the Ashkenazic sect sixth or seventh decades. However, Oettle (1962) (Rothman, 1962). Early reports were often based found that the African patients were between 35 on small series of cases, rarely numbering more and 44 years. At Harari Hospital some difficulty than a dozen. has been experienced in establishing ages but none Since the original masterly description of the in the series was over 50 years and this seems to copyright. disease (Kaposi, 1872) there has been much con- correspond closely with Oettle's figures though at fused discussion on all aspects of the tumour. least one patient was 24 years of age.
    [Show full text]
  • 8.5 X12.5 Doublelines.P65
    Cambridge University Press 978-0-521-87409-0 - Modern Soft Tissue Pathology: Tumors and Non-Neoplastic Conditions Edited by Markku Miettinen Index More information Index abdominal ependymoma, 744 mucinous cystadenocarcinoma, 631 adult fibrosarcoma (AF), 364–365, 1026 abdominal extrauterine smooth muscle ovarian adenocarcinoma, 72, 79 adult granulosa cell tumor, 523–524 tumors, 79 pancreatic adenocarcinoma, 846 clinical features, 523 abdominal inflammatory myofibroblastic pulmonary adenocarcinoma, 51 genetics, 524 tumors, 297–298 renal adenocarcinoma, 67 pathology, 523–524 abdominal leiomyoma, 467, 477 serous cystadenocarcinoma, 631 adult rhabdomyoma, 548–549 abdominal leiomyosarcoma. See urinary bladder/urogenital tract clinical features, 548 gastrointestinal stromal tumor adenocarcinoma, 72, 401 differential diagnosis, 549 (GIST) uterine adenocarcinomas, 72 genetics, 549 abdominal perivascular epithelioid cell tumors adenofibroma, 523 pathology, 548–549 (PEComas), 542 adenoid cystic carcinoma, 1035 aggressive angiomyxoma (AAM), 514–518 abdominal wall desmoids, 244 adenomatoid tumor, 811–813 clinical features, 514–516 acquired elastotic hemangioma, 598 adenomatous polyposis coli (APC) gene, 143 differential diagnosis, 518 acquired tufted angioma, 590 adenosarcoma (mullerian¨ adenosarcoma), 523 genetics, 518 acral arteriovenous tumor, 583 adipocytic lesions (cytology), 1017–1022 pathology, 516 acral myxoinflammatory fibroblastic sarcoma atypical lipomatous tumor/well- aggressive digital papillary adenocarcinoma, (AMIFS), 365–370, 1026 differentiated
    [Show full text]
  • Lymphangioma Circumscriptum: Clinicopathological Spectrum of 29
    ORIGINAL ARTICLE Lymphangioma Circumscriptum: Clinicopathological Spectrum of 29 Cases Saira Fatima, Nasir Uddin, Romana Idrees, Khurram Minhas, Zubair Ahmad, Rashida Ahmad, Naila Kayani and Muhammad Arif ABSTRACT Objective: To describe the clinicopathological spectrum of Lymphangioma Circumscriptum (LC). Study Design: Observational case series. Place and Duration of Study: Department of Pathology and Microbiology, AKUH, Karachi, from 2002 to 2012. Methodology: All reported cases of LC were retrieved from medical record. Clinical and pathological features were noted. Frequency percentages were determined. Results: There were 29 cases of LC predominantly males (62%). The mean age was 27.17 ± 15.5 years. The commonest sites was anal/perianal region (24%) followed by extremities (17%) and tongue, (14%). Vulval LC was seen in 3 patients. Two cases were described on scrotum. The lesions were most commonly suspected as viral warts, mole or polyp (in anal region). Vesicles with erosions and bleeding and localized growth were the usual clinical presentations. Four of the patients presented with swelling since birth. All were treated with surgical excision. Microscopic examination revealed acanthotic squamous epithelium with papillomatosis. The subepithelial region had collections of lymphatic channels composed of ectatic dilated vessels with serum and inflammatory cells in their lumina. The lymphatic channels were seen in deeper layers along with lymphocytic aggregates. Conclusion: Lymphangioma circumscriptum is a malformation of abnormal lymphatic channels with feeding cisterns in subcutaneous tissue. It is a benign lesion usually occurring in anal/perianal region and confused with warts. Surgical excision is preferred mode of treatment. Key Words: Cutaneous lymphangioma circumscriptum. Warts. Lymphatic malformation. INTRODUCTION The term lymphangioma circumscriptum was first coined Lymphangiomas are malformations of lymphatic by Morris et al.
    [Show full text]
  • Malignant Vascular Tumors&Mdash
    Modern Pathology (2014) 27, S30–S38 S30 & 2014 USCAP, Inc All rights reserved 0893-3952/14 $32.00 Malignant vascular tumors—an update Cristina Antonescu Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA Although benign hemangiomas are among the most common diagnoses amid connective tissue tumors, sarcomas showing endothelial differentiation (ie, angiosarcoma and epithelioid hemangioendothelioma) represent under 1% of all sarcoma diagnoses, and thus it is likely that fewer than 500 people in the United States are affected each year. Differential diagnosis of malignant vascular tumors can be often quite challenging, either at the low end of the spectrum, distinguishing an epithelioid hemangioendothelioma from an epithelioid hemangioma, or at the high-grade end of the spectrum, between an angiosarcoma and a malignant epithelioid hemangioendothelioma. Within this differential diagnosis both clinico-radiological features (ie, size and multifocality) and immunohistochemical markers (ie, expression of endothelial markers) are often similar and cannot distinguish between benign and malignant vascular lesions. Molecular ancillary tests have long been needed for a more objective diagnosis and classification of malignant vascular tumors, particularly within the epithelioid phenotype. As significant advances have been recently made in understanding the genetic signatures of vascular tumors, this review will take the opportunity to provide a detailed update on these findings. Specifically, this article will focus on
    [Show full text]
  • Purpuric Macule of the Right Axilla
    DERMATOPATHOLOGY DIAGNOSIS Purpuric Macule of the Right Axilla Andrew L.J. Dunn, MD; Brett H. Keeling, MD; Justin P. Bandino, MD; Dirk M. Elston, MD; John S. Metcalf, MD Eligible for 1 MOC SA Credit From the ABD This Dermatopathology Diagnosis article in our print edition is eligible for 1 self-assessment credit for Maintenance of Certification from the American Board of Dermatology (ABD). After completing this activity, diplomates can visit the ABD website (http://www.abderm.org) to self-report the credits under the activity title “Cutis Dermatopathology Diagnosis.” You may report the credit after each activity is completed or after accumu- lating multiple credits. A 67-year-old woman presented with a lesion on the medial aspect of the right axilla of 2 weeks’ duration. The patientcopy had a history of cancer of the right breast treated with a mastectomy and adjuvant radiation. She denied pain, bleeding, pruritus, or rapid growth, as well as any changes in medicationnot or recent trauma. Physical examina- tion revealed a 5-mm purpuric macule of the right axilla. A punch biopsy was performed. Amplifica- tion for the C-MYC gene was negative by fluores- Docence in situ hybridization. THE BEST DIAGNOSIS IS: a. atypical vascular lesion H&E, original magnification ×100 (Ki-67 immunostain, original magnifi- cation ×100 [inset]). b. hobnail hemangioma (targetoid hemosiderotic hemangioma) c. Kaposi sarcoma CUTIS d. lymphangioma circumscriptum (superficial lymphangioma) e. radiation-induced angiosarcoma PLEASE TURN TO PAGE 29 FOR THE DIAGNOSIS Dr. Dunn is from the Department of Pathology and Laboratory Services, University of Arkansas for Medical Sciences, Little Rock.
    [Show full text]
  • What Is Your Diagnosis?
    PHOTO QUIZ What Is Your Diagnosis? Patients reported leakage of straw-colored fluid when the lesions were traumatized. PLEASE TURN TO PAGE 310 FOR DISCUSSION Dirk M. Elston, MD, Departments of Dermatology and Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania. LTC Richard Vinson, MC, USA, Department of Dermatology, Brooke Army Medical Center, Fort Sam Houston, Texas. The authors report no conflict of interest. The views expressed are those of the authors and are not to be construed as official or as representing those of the Army Medical Department or the Department of Defense. The authors were full-time federal employees at the time this work was completed. It is in the public domain. VOLUME 76, NOVEMBER 2005 301 Photo Quiz Discussion The Diagnosis: Lymphangioma Circumscriptum (Benign Lymphangiectasia) esions of lymphangioma circumscriptum and may be misdiagnosed as condylomata acu- look like clusters of clear fluid-filled vesicles minatum.7,8 Vulvar lesions may occur following resembling frog eggs. The lesions may surgery or radiation therapy, or they may arise L 1 9 occur in a zosteriform distribution. Verrucous spontaneously. The most common patient com- hyperplasia of the epidermis and associated tis- plaint relates to the clear fluid oozing from the sue edema may be noted. Some vesicles contain lesions. Pain and cellulitis also may occur as blood in addition to lymph and Kim et al2 complications.10 Squamous cell carcinoma has reported solitary nodular angiokeratoma in a been reported in long-standing lymphangioma
    [Show full text]
  • Osteopathic Journal Feb 2006 6
    Journal of the AMERICAN OSTEOPATHIC COLLEGE OF DERMATOLOGY 2005-2006 Officers Journal of the President: Richard A. Miller, DO President-Elect: Bill V. Way, DO American First Vice-President: Jay S. Gottlieb, DO Second Vice-President: Donald K. Tillman, DO Third Vice-President: Marc I. Epstein, DO Osteopathic Secretary-Treasurer: Jere J. Mammino, DO Immediate Past President: Ronald C. Miller, DO College Trustees: David W. Dorton, DO Bradley P. Glick, DO of Dermatology Daniel S. Hurd, DO Jeffrey N. Martin, DO Executive Director: Rebecca Mansfield, MA Editors Jay S. Gottlieb, D.O., F.O.C.O.O. Stanley E. Skopit, D.O., F.A.O.C.D. Associate Editor James Q. Del Rosso, D.O., F.A.O.C.D. Editorial Review Board Ronald Miller, D.O. Eugene Conte, D.O. Evangelos Poulos, M.D. Stephen Purcell, D.O. AOCD • 1501 E. Illinois • Kirksville, MO 63501 Darrel Rigel, M.D. 800-449-2623 • FAX: 660-627-2623 www.aocd.org Robert Schwarze, D.O. Andrew Hanly, M.D. COPYRIGHT AND PERMISSION: written permission must be Michael Scott, D.O. obtained from the Journal of the American Osteopathic College of Dermatology for copying or reprinting text of more than half page, Cindy Hoffman, D.O. tables or figures. Permissions are normally granted contingent upon Charles Hughes, D.O. similar permission from the author(s), inclusion of acknowledgement Bill Way, D.O. of the original source, and a payment of $15 per page, table or figure of reproduced material. Permission fees are waived for authors Daniel Hurd, D.O. wishing to reproduce their own articles.
    [Show full text]
  • Splenic Angiosarcoma: a Clinicopathologic and Immunophenotypic Study of 28 Cases Thomas S
    Splenic Angiosarcoma: A Clinicopathologic and Immunophenotypic Study of 28 Cases Thomas S. Neuhauser, M.D., Gregory A. Derringer, M.D., Lester D. R. Thompson, M.D., Julie C. Fanburg-Smith, M.D., Markku Miettinen, M.D., Anne Saaristo, M.B., Susan L. Abbondanzo, M.D. Departments of Hematopathology (TSN, GAD, SLA), Endocrine and Otorhinolaryngic-Head & Neck Pathology (LDRT), Soft Tissue Pathology (JCF-S, MM), Armed Forces Institute of Pathology, Washington, DC; Molecular/Cancer Biology Laboratory, Haartman Institute, University of Helsinki, Finland (AS); Wilford Hall Medical Center, Lackland AFB, Texas (TSN) entiation (CD34, FVIIIRAg, VEGFR3, and CD31) Primary angiosarcoma of the spleen is a rare neo- and at least one marker of histiocytic differen- plasm that has not been well characterized. We de- tiation (CD68 and/or lysozyme). Metastases de- scribe the clinical, morphologic, and immunophe- veloped in 100% of patients during the course of notypic findings of 28 cases of primary splenic their disease. Twenty-six patients died of dis- angiosarcoma, including one case that shares fea- ease despite aggressive therapy, whereas only tures of lymphangioma/lymphangiosarcoma. The two patients are alive at last follow-up, one with patients included 16 men and 12 women, aged 29 to disease at 8 years and the other without disease 85 years, with a mean of 59 years and median of 63 at 10 years. In conclusion, primary splenic an- years. The majority of patients (75%) complained of giosarcoma is an extremely aggressive neo- abdominal pain, and 25% presented with splenic plasm that is almost universally fatal. The ma- rupture. The most common physical finding was jority of splenic angiosarcomas coexpress splenomegaly (71%).
    [Show full text]