Related Experiment Video
Updated: Aug 8, 2026
Substernal Thyroid Biopsy Using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration
Published on: November 10, 2014
Fine needle aspiration cytology of papillary endothelial hyperplasia. A case report
J A Novak1, D J Ferguson, R A Komorowski
1Department of Pathology, Medical College of Wisconsin, Milwaukee, USA.
Insights
Papillary endothelial hyperplasia, a vascular lesion, can mimic squamous cell carcinoma in head and neck fine needle aspiration biopsies. Factor VIII-related antigen staining aids diagnosis.
Area of Science:
- Pathology
- Oncology
- Vascular Biology
Background:
- Papillary endothelial hyperplasia (PEH) is an endothelial cell proliferation.
- It is an unusual form of thrombus organization.
Observation:
- A 41-year-old male presented with a neck mass initially diagnosed as squamous cell carcinoma via fine needle aspiration.
- Histopathology revealed PEH associated with a hematoma.
- Immunocytochemistry confirmed endothelial cells using factor VIII-related antigen.
Findings:
- PEH can be misdiagnosed as malignancy in head and neck fine needle aspiration.
- Factor VIII-related antigen staining is crucial for identifying endothelial cells.
- Absence of cytoplasmic orangeophilia and factor VIII-related antigen can aid diagnosis.
Implications:
- Vascular lesions should be considered in head and neck masses with atypical presentations.
- Accurate diagnosis of PEH prevents unnecessary oncological treatment.
- Immunocytochemistry is vital for differentiating PEH from other neck masses.
Background:
Papillary endothelial hyperplasia is an intravascular or rarely extravascular proliferation of endothelial cells. It is considered an unusual form of thrombus organization.
Case:
A 41-year-old, healthy male presented with a neck mass, which was aspirated. The cytomorphologic features were interpreted as consistent with squamous cell carcinoma. Subsequent workup failed to reveal a primary lesion, and the mass was surgically excised. Histopathology showed papillary endothelial hyperplasia associated with a hematoma. Immunocytochemical staining for factor VIII-related antigen on a destained, alcohol-fixed smear from the fine needle aspirate confirmed the endothelial nature of the cells.
Conclusion:
A vascular lesion should be considered in a fine needle aspiration biopsy of a head and neck mass, in particular when the clinical features are not consistent with a metastatic malignancy. The absence of cytoplasmic orangeophilia and immunoreactivity for factor VIII-related antigen may be helpful in establishing the diagnosis.
