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Symplastic hemangioma: report of two cases
Seng Geok Nicholas Goh1, Johannes F Dayrit, Eduardo Calonje
1St John's Institute of Dermatology, St Thomas' Hospital, Lambeth Palace Road, London, UK.
Journal of Cutaneous Pathology
|November 7, 2006
Summary
Symplastic hemangioma, a rare vascular lesion, exhibits degenerative atypia in smooth muscle and interstitial cells. These findings, though concerning, are considered degenerative, not malignant, with no observed recurrence in studied cases.
Area of Science:
- Vascular Pathology
- Dermatopathology
- Surgical Pathology
Background:
- Symplastic hemangioma is a poorly recognized vascular lesion.
- It is characterized by degenerative atypia of vascular smooth muscle and interstitial cells.
Observation:
- Two cases presented with a cirsoid aneurysm-type appearance.
- Histology revealed thick-walled, dilated vessels with mild endothelial atypia.
- Atypical spindle or epithelioid cells showed pleomorphism, hyperchromasia, and multinucleation.
Findings:
- Lesions uniformly showed perivascular hemorrhage, thrombosis, and papillary endothelial hyperplasia.
- Stroma contained hemosiderin and inflammatory infiltrate; adipocytes were present.
- Immunohistochemistry confirmed focal smooth muscle actin positivity in atypical cells.
Implications:
- The bizarre cytologic changes are interpreted as degenerative, similar to ancient schwannoma or symplastic leiomyoma.
- This understanding aids in accurate diagnosis and avoids misclassification as malignancy.
- The absence of recurrence in these cases suggests a benign clinical course.