Intravenous Lobular Capillary Hemangioma: A Case Report and Proposal for New Cutaneous Tender Tumor Differential Diagnosis Acronym

Abstract

Here, we report a case of a 70-year-old female who presented with a slowly enlarging tender nodule on the right forearm for several months. Physical examination showed a faintly blue-tinged freely mobile subcutaneous nodule. Excision was complicated by greater than expected bleeding and revealed an unexpected intravenous mass. Histopathology demonstrated capillary lobules separated by fibrous septae within a vein, consistent with intravenous lobular capillary hemangioma (IVLCH). IVLCH is a rare benign capillary proliferation of unclear etiology. Excision is typically curative and relieves any pain and discomfort the patient might be experiencing. With the addition of IVLCH, we respectfully propose a new acronym for the differential diagnosis of cutaneous tender tumors: intravenous lobular capillary hemangioma, foreign body (reaction), hidradenoma, osteoma cutis, glomus tumor, scar, fibromyxoma, leiomyosarcoma, eccrine angiomatous hamartoma, Dercum's disease (adiposis dolorosa), piezogenic pedal papule, eccrine spiradenoma, neurilemmoma (schwannoma), calcinosis cutis, angioendotheliomatosis, leiomyoma, metastases, angiolipoma, neuroma, dermatofibroma, granular cell tumor, endometriosis, thrombus, blue rubber bleb nevus, angioma, chondrodermatitis nodularis helicis, and keloid ("IF HOGS FLED PEN, CALM AND GET BACK"). Future additions to the cutaneous tender tumor differential diagnosis may require creative additions and rearrangements to this acronym. However, continual updates will allow it to serve both clinicians and pathologists alike as a comprehensive representation of etiologies to consider for cutaneous tender tumors.

Tender Cutaneous Neoplasms: Case Reports of Patients With a Symptomatic Dermatofibroma and a New Acrostic for Painful Tumors of the Skin

“…Several neoplasms are included in the differential diagnosis of painful dermal tumors (Table 1) [1][2][3][4][5][6]. The tender skin lesion typically presents as a cutaneous nodule that is either flesh-colored or maybe blue, brown, purple, or red.…”

“…The tender skin lesion typically presents as a cutaneous nodule that is either flesh-colored or maybe blue, brown, purple, or red. Microscopic evaluation of a tissue specimen --obtained during biopsy or excision of the lesion --is usually necessary to establish the diagnosis [1][2][3][4][5][6]. a Aids that can be used to assist a person in remembering something are referred to as mnemonic devices.…”

“…Dermatofibroma, also referred to as a fibrous histiocytoma, maybe a painful dermal tumor. However, this benign neoplasm was not included in the manuscript that summarized tender cutaneous lesions by Thompson in 1985 (Table 2) [1][2][3][4][5][6][7][8]. Subsequently, dermatofibroma was incorporated into the early acronyms (such as GLENDA and ENGLAND) for painful tumors of the skin (Table 1) [1][2][3][4][5][6].…”

“…However, this benign neoplasm was not included in the manuscript that summarized tender cutaneous lesions by Thompson in 1985 (Table 2) [1][2][3][4][5][6][7][8]. Subsequently, dermatofibroma was incorporated into the early acronyms (such as GLENDA and ENGLAND) for painful tumors of the skin (Table 1) [1][2][3][4][5][6]. Indeed, Naversen et al considered dermatofibroma to be the most common of the painful lesions when they included the tumor in their LEND AN EGG acronym [2].…”

“…They include adipose, bone, calcium, cartilage, eccrine, fibrous, infiltrative, lymphoproliferative, muscle, neural, and vascular tumors. Mnemonic devices --such as acronyms and acrostics --have been created to aid clinicians in remembering the differential diagnosis of painful skin tumors [1][2][3][4][5][6][7][8].…”