Soft Tissue Tumors Part 3 - Muscle, Vascular, Nerve, Other

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Soft Tissue Tumors Part 3 - Muscle, Vascular, Nerve, Other

Benign vascular tumors

Symplastic hemangioma

Author: Nat Pernick, M.D., PathologyOutlines.com, Inc.

Revised: 31 October 2009, last major update October 2009

Definition

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● Hemangioma with bizarre stromal cells in fibrinous material around vessels

Epidemiology

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● Limited published reports

Etiology

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● Due to degenerative atypia of vascular smooth muscle and interstitial cells, similar to symplastic leiomyoma of uterus or ancient schwannoma

Treatment

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● Excision, does not recur or metastasize (Hautarzt 2000;51:327)

Micro description (Histopathology)

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● Vascular lesion with thick walled and variably dilated vessels

● Degenerative atypia of vascular smooth muscle and interstitial cells within a pre-existing vascular lesion, with minimal endothelial cell atypia

● Atypical cells are spindled or epithelioid with variable hyperchromasia, nuclear enlargement, pleomorphism and multinucleation (J Cutan Pathol 2006;33:735)

● Perivascular hemorrhage, vascular thrombosis and focal papillary endothelial hyperplasia are common

● Stroma has hemosiderin and mononuclear inflammation

● May have fibrous tissue, stromal edema or fat cells within superficial dermis

● May have rare atypical mitotic figures or bizarre lipoblast-like stromal cells

● No endothelial cell multilayering

● No mitotic figures

Micro images

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Micro images: lower extremity #1; #2; #3

Virtual slides

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16 year old girl with calf lesion

Positive stains

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● Smooth muscle actin (pleomorphic cells)

Differential Diagnosis

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● Angiosarcoma: endothelial cells are atypical, there is frequent multilayering of cells and prominent mitotic activity

● Pleomorphic hyalinizing angiectatic tumor: infiltrative lesion of superficial soft tissue of distal extremities; shows heavily hyalinized, fibrin containing vessels, spindled and pleomorphic stromal cells with frequent intranuclear inclusions

End of Soft Tissue Tumors Part 3 - Muscle, Vascular, Nerve, Other > Symplastic hemangioma

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