Cytologic Diagnosis of Intravascular Papillary Endothelial Hyperplasia: A Report of Two Cases and Review of Cytologic Literature

Abstract

Background: Intravascular papillary endothelial hyperplasia (IPEH), previously known as ‘Masson’s hemangioma’, is a reactive endothelial proliferation that occurs most commonly in the vessels of the head, neck, and extremities. The cytologic findings of the lesion are varied and depend on the age of the lesion. Cases: Case 1 is a 61-year-old man who presented with a swelling on the medial aspect of the forearm. The clinical diagnosis was lipoma. Cytologic smears showed spindle cells tagging onto a rich capillary network and smaller round cells arranged around hyaline cores. The cytologic diagnosis was benign vascular tumor. On histolopathogic examination a diagnosis of IPEH was given. Case 2 is a 45-year-old man who presented with swelling on the dorsal aspect of the wrist. The cytologic diagnosis of giant cell tumor was made based on the presence of scattered spindled cells and multinucleate giant cells. The giant cells had various shapes like round or crescent and had 10–25 nuclei. The lesion was excised and a diagnosis of IPEH was rendered. Conclusion: These two cases highlight the varied cytomorphology of IPEH making the pinpoint diagnosis of this lesion difficult on cytologic smears.

Intravascular Papillary Endothelial Hyperplasia of the Chest Wall Misdiagnosed as a Malignancy on Fine Needle Aspiration

“…The cytologic features of IPEH in the published literature show diverse morphologies, leading to frequent diagnostic error. 1 - 3 , 9 , 10 IPEH has been misdiagnosed as malignant vascular tumor, embryonal carcinoma, squamous cell carcinoma, adenoid cystic carcinoma, and giant cell tumor. Handa et al 10 suggested two types of cell populations that can assist in cytologic diagnosis of IPEH: spindle cells and round cells.…”

“…1 - 3 , 9 , 10 IPEH has been misdiagnosed as malignant vascular tumor, embryonal carcinoma, squamous cell carcinoma, adenoid cystic carcinoma, and giant cell tumor. Handa et al 10 suggested two types of cell populations that can assist in cytologic diagnosis of IPEH: spindle cells and round cells. The spindle cells in IPEH are scattered or tagged onto a capillary network and have fine granular chromatin, prominent nucleoli, and wispy cytoplasm.…”

Intravascular papillary endothelial hyperplasia (Masson tumor) mimicking a sarcoma and developing from an arteriovenous hemodialysis fistula

“…US is also important for guiding fine-needle aspiration, given the fact that in some cases a diagnosis is possible with cytologic evaluation, as was observed in the present report. However, in the majority of cases, a definite diagnosis of IPEH could not be made by cytology [13,14].…”

Extravascular papillary endothelial hyperplasia mimicking soft tissue sarcoma in 2 cats: a potential diagnostic pitfall

“…Cytologic features of our case paralleled those reported in human PEH and included moderate cellularity, hemorrhagic background, pleomorphic spindle-to-round cells, hyperchromatic nuclei, and prominent nucleoli. 5,9,11,14,17,22,24 In human medicine, these findings are nonspecific and have driven various interpretations including reactive-to-malignant vascular lesions or various types of carcinoma. 5,9,11,14,17,22,24 In our 2 cases, initial cytologic findings led to the erroneous but understandable diagnostic hypothesis of FISS because cytologic findings were consistent and because FISS represents a frequent sequela of injection in cats.…”

“…13 The diagnosis of PEH relies on the microscopic finding of a well-demarcated lesion composed of papillary projections of reactive endothelium supported by fibrovascular stalks and intimately associated with organized fibrin. 1,2,7,8,12,13 PEH represents a diagnostic challenge for pathologists because it is often misdiagnosed as malignancy and especially as angiosarcoma (AS) on both cytology 5,9,11,14,17,22,24 and histopathology. 8,12 Formerly known as "Masson tumor" from the name of the pathologist who first identified this entity, 20 PEH was originally considered a neoplastic lesion.…”