Arteriovenous haemangioma in chronic liver diseases: case report and determination of oestrogen receptor status

Abstract

EditorArteriovenous haemangioma (AVH) is a rare, benign, acquired vascular lesion, usually presenting as a solitary bluish asymptomatic papule on the head or extremities. 1 The pathogenesis of AVH is unknown, but it may represent multicentric hamartomatous proliferation of the suprapapillary vascular plexus. Recently, several cases of AVH associated with chronic liver diseases have been described. [2][3][4] We report here a case of AVH in a 57-year-old man with liver cirrhosis and hepatocellular carcinoma associated with chronic hepatitis B. Immunohistochemical analysis showed that the endothelial cells in the tumour were negative for oestrogen receptor. To our knowledge, this is the first report describing oestrogen receptor status of AVH in a patient with chronic liver disease.A 57-year-old Korean man presented at the dermatology unit with a solitary, asymptomatic, progressively enlarging, violaceous nodule of 3 years' duration on his left anterior chest. Eight years previously, he had been diagnosed with chronic active hepatitis associated with hepatitis B virus infection. Six months previously, liver cirrhosis and hepatocellular carcinoma were detected by abdominal ultrasound and computed tomography and treated three times by transhepatic arterial chemoembolization. Laboratory findings, including liver function and coagulation tests, were typical of patients with liver cirrhosis.Physical examination showed a solitary, well-demarcated, round, violaceous nodule 7 mm in diameter on the left anterior chest ( fig. 1). Around the nodule were erythematous patches with radiating fine telangiectasias. Histopathological

Recognizing skin conditions in patients with cirrhosis: a narrative review

“…Arteriovenous haemangiomas (AVH) ( Figure 1(d) ) are benign and acquired vascular tumours characterized by bluish erythematous papules or nodules with a diameter of 0.5–1.0 cm. Lesions present as single erythematous plaques in the head and neck in most cases and are more prevalent in middle-aged men [ 19 ], which can regress as liver function improves ( Figure 1(e,f) ). Histopathological features include well-circumscribed dome-shaped lesions in the upper and mid-reticular dermis with dilated thick- and thin-walled endothelium-lined spaces resembling arteries and veins, respectively.…”

“…The mechanism of AVH is unclear and may be related to elevated oestrogen levels, though Lee et al. found no oestrogen receptors in the biopsy of AVH in patients with liver cirrhosis [ 19 ].…”

Multiple Arteriovenous Hemangiomas in a Patient with Chronic Liver Disease

“…The pathogenic mechanism of AVH in relation to chronic liver disease is still unclear. Patients with liver failure have relatively high blood estrogen levels4 and some think that estrogens may be involved in the occurrence of AVH in such patients. However, the association is still unclear4.…”

“…Clinically, AVH usually presents as an asymptomatic, solitary, 0.5~1.0-cm-sized bluish to erythematous papule or nodule on the head or extremities1 and only 7% of cases have been reported to be multiple4. Histopathologic findings of AVH are well-circumscribed proliferation of blood vessels with thick and thin walls, lined by a single layer of endothelial cells in the upper and mid-reticular dermis1.…”

“…The deep type of AVH is a vascular malformation associated with shunting1. Cases of AVH associated with chronic liver diseases have been rarely reported45. Spider angioma is the most representative and classic vascular lesion of chronic liver disease5.…”