Verrucous Hemangioma Revisited

Abstract

We analyzed the clinical and histopathologic characteristics of verrucous hemangioma, compared these findings to hyperkeratotic mimickers such as capillary-lymphatic malformation or capillary-venous malformation and angiokeratoma circumscriptum, and reconsidered whether the term verrucous hemangioma is appropriate in the current nosology of vascular anomalies. Fourteen similar-appearing localized hyperkeratotic vascular lesions were identified by one surgeon as either angiokeratoma, angiokeratoma circumscriptum, capillary-venous malformation, capillary-lymphatic malformation, or verrucous hemangioma. All lesions were located on an extremity, except for one lesion on the trunk, and were single or grouped and 2.6 to 8 cm in diameter. All were raised, red-to-purple, variably keratotic with irregular borders, and several manifested intermittent bleeding and oozing. Excision was performed at 4 months to 16 years of age. After histologic review, three lesions were designated as combined vascular malformations composed of capillaries, lymphatics, and veins, and none was designated as angiokeratoma. Eleven of 14 specimens met the histologic criteria for verrucous hemangioma: a hyperkeratotic epidermis with small, thick-walled, blood-filled vessels with multilamellated basement membrane involving the entire dermis as well as the subcutis. Immunostaining showed focal GLUT1 endothelial positivity (7/11) and low-level MIB-1 reactivity (8/11). Verrucous hemangioma has the accepted clinical features of vascular malformation, specifically presence at birth and proportionate growth. Microscopic features, such as thick vascular walls, multilamellated basement membrane, relatively uniform channel size, and GLUT1 immunopositivity are reminiscent of infantile hemangioma, particularly in its involutive phase. No firm conclusion seems possible as to whether verrucous hemangioma is a malformation or an indolent tumor, but clinical evidence favors the former category.

A Case of Eccrine Angiomatous Hamartoma Associated with Verrucous Hemangioma

“…Histologically, verrucous hemangiomas appear initially as capillary hemangiomas concentrated in the dermis, and they adopt a verruciform pattern with papillomatosis, irregular acanthosis, and cavernous or mixed hemangiomas in the dermis and subcutaneous tissue 8 . Immunostaining shows focal glucose transporter-1 protein (GLUT-1) endothelial positivity 9 .…”

Laser treatment for verrucous hemangioma

“…VH require a large, deep excision because they extend into the subcutis, occasionally involving the fascia. Incomplete extirpation can lead to recurrence [8,9,11,14]. Yang and Ohara performed surgery in combination with PDL, CO 2 laser, or argon laser in 23 patients with VH and reported that a combination approach using surgical reconstruction and laser is necessary for large and extensive lesions [15].…”

“…The The differential diagnosis of VH includes angiokeratoma, lymphangioma circumscriptum, angioma serpiginosum, verrucous epidermal naevus, verrucous cancer, or even malignant melanoma [6-8, 10, 11]. Occasional venous malformations may also mimic VH, though there is usually minimal hyperkeratosis [9].…”

“…Inflammatory cells, hemosiderin, and fibrosis may be present in the upper dermis [7]. VH resemble angiokeratoma, although VH involve small, thick-walled, blood-filled vessels with a multilamellated basement membrane involving the dermis as well as fatty tissue [6,9].…”

Case of adult‐onset verrucous hemangioma developed after repeated trauma

“…The histological appearance closely resembles angiokeratoma, but the vascular lesions in VH further involve the lower dermis and subcutaneous tissue, and sometimes the fascia, in contrast to those in angiokeratoma. 2 Because VH does not regress spontaneously, total surgical excision is usually recommended before the verrucous lesion grows too large. A recurrence rate of 33% has been reported in cases where the lesion is larger than 2 cm in size.…”