Verrucous hemangioma and histopathological differential diagnosis with angiokeratoma circumscriptum neviforme

Abstract

Verrucous hemangioma is a rare vascular skin disorder with an immune profile similar to vascular neoplasms, but with behavior and evolution of vascular malformations. Its main differential diagnosis is angiokeratoma circumscriptum neviforme, with an almost indistinguishable clinical presentation because both diseases appear as erythematous patches that evolve to violaceous plaques, becoming scaly and even verrucous, most commonly affecting the lower limbs. Histopathology is crucial for the correct diagnosis: while in angiokeratoma the vascular alterations are limited to the papillary dermis, verrucous hemangioma extends deep into the dermis, reaching the subcutaneous tissue.

Angiokeratoma circumscriptum

“…The diagnosis of AKC can be usually suspected clinically and confirmed by histopathological study, which identifies characteristic ectatic thin-walled vascular channels in the papillary dermis with acanthosis and hyperkeratosis of the epidermis. The deep dermis and subcutaneous tissue are not affected and if they are involved the probable diagnosis is a verrucous hemangioma [1,2,9]. The differential diagnosis includes verrucous haemangioma, melanocytic nevus, melanoma, capillary aneurysm, pigmented basal cell carcinoma, and Spitz nevus [2].…”

Violaceous Papule With an Erythematous Rim

“…Verrucous hemangioma is a rare congenital vascular abnormality that is characterized by dilated vessels in the papillary dermis along with acanthosis, hyperkeratosis, and irregular papillomatosis, as seen in angiokeratoma. 4 However, the vascular proliferation composed of variably sized, thin-walled capillaries extends into the deep dermis as well as the subcutis (Figure 1). Verrucous hemangioma most commonly is reported on the legs and generally starts as a violaceous patch that progresses into a hyperkeratotic verrucous plaque or nodule.…”

Hemangioma Verukosa

“…30,31 Penegakan diagnosis VH dilakukan terutama dengan pemeriksaan histopatologi. 32,33 Menurut literatur, gambaran histopatologi VH dengan pewarnaan HE menunjukkan gambaran hiperkeratosis, akantosis epidermis yang bervariasi dan telangiektasis papiler yang menutupi hemangioma kavernosa atau kapiler profunda. 22 Gambaran histopatologi yang merupakan karakteristik VH adalah epidermis hiperplasia reaktif yang ditandai dengan akantosis irregular, hiperkeratosis dan papilomatosis.…”

“…Pada kasus ACN, perubahan vaskular terbatas pada papila dermis, sedangkan pada VH perubahan vaskular meluas, masuk jauh ke dalam dermis, bahkan dapat mencapai jaringan subkutan. 2,32 Pada ACN ditemukan akantosis, hiperkeratosis bahkan hipergranulosis pada epidermis, perubahan vaskular terbatas pada dermis papiler, sedangkan pada VH papilomatosis merupakan gambaran utama disertai proliferasi vaskular dalam papila dermis yang meluas ke dermis dalam dan jaringan subkutan. 13,32 Pada kasus ini, hasil pemeriksaan histopatologi menyokong diagnosis VH.…”