Promontory Sign in a Reactive Benign Vascular Proliferation

Abstract

The promontory sign was described 27 years ago and it was claimed to be useful in the diagnosis of early stages of Kaposi sarcoma. However, it is not pathognomonic, because it has also been described in angiosarcoma and in benign vascular tumors. Some authors claim that some reactive vascular lesions known as pseudo-Kaposi do not present the promontory sign. We report the case of a vascular cutaneous lesion on the breast of a 75-year-old woman, which had a benign clinical behavior, and presented with the promontory sign. The lesion was made of tortuous dilated lymphatic tissue, and small capillaries with a lobular distribution. It was characterized by CD31 and D240 immunostaining, although no immunostaining for human herpesvirus 8 (HHV8) was found. The lesion spontaneously improved and eventually disappeared. It was thought to be secondary to a chronic trauma to the area due to a prolonged stance in bed in the emergency room.

A rare case of iatrogenic gingival Kaposi’s sarcoma

“…The protrusion of the adnexal structures and pre-existing vessels into newly-formed vessels results in the characteristic promontory sign (Grayson and Pantanowitz, 2008). Despite its importance in the diagnosis of early stages of KS, promontory sign is not pathognomonic because it has also been described in angiosarcoma and in benign vascular tumours (Lazova et al, 2009;Fernandez-Flores and Rodriguez, 2010).…”

Delimiting CD34+ Stromal Cells/Telocytes Are Resident Mesenchymal Cells That Participate in Neovessel Formation in Skin Kaposi Sarcoma

“…This mechanism resembles that described for ECs and collagen as inverse sprouting [ 65 ]. When the intraluminal fold cores contain blood vessels, with or without perivascular inflammatory infiltrates, they appear as vessels within vessels, which can explain the promontory sign described in some types of KS lesions [ 18 , 19 , 75 , 76 ].…”