Vascular Lesions B&B

Question 1

sarcoma

Answer 1

tumor of mesenchyme origin (embryonic connective tissue)

Question 2

how do angiosarcomas appear, and where do they typically occur? (3)

Answer 2

rare tumors of blood/lymph vessels with poor prognosis - appear as purple nodules or plaques

1. dermis (most common) - head/neck (sun-exposed), usually older/white males
2. liver - associated with vinyl chloride exposure
3. breast - following radiation or lymphedema after mastectomy

Question 3

Pt is a 70yo white male presenting to their dermatologist with concern of a purple nodule on their bald head. Biopsy is taken from the dermis, which reveals cancerous cells of mesenchyme origin. It is a rare cancer with an unfortunately poor prognosis. What is the diagnosis?

Answer 3

angiosarcoma: rare tumors of blood/lymph vessels with poor prognosis - appear as purple nodules or plaques

1. dermis (most common) - head/neck (sun-exposed), usually older/white males
2. liver - associated with vinyl chloride exposure
3. breast - following radiation or lymphedema after mastectomy

Question 4

bacillary angiomatosis

Answer 4

zoonotic infection by bartonella bacteria which occurs in immunocompromised patients (HIV/AIDs)

systemic infection —> blood vessels in skin —> numerous red/purple nodules

appears similar to Kaposi sarcoma, but biopsy will show neutrophils because this is bacterial, while Kaposi biopsy will only show lymphocytes because it is viral (HHV-8)

Question 5

Pt is a 47yo M with end-stage HIV and AIDs presenting to their physician with numerous red/purple nodules on their skin. A biopsy is taken which reveals neutrophil and lymphocyte infiltration. What is the cause of their rash?

Answer 5

bacillary angiomatosis: zoonotic infection by bartonella bacteria which occurs in immunocompromised patients (HIV/AIDs)

systemic infection —> blood vessels in skin —> numerous red/purple nodules

appears similar to Kaposi sarcoma, but biopsy will show neutrophils because this is bacterial, while Kaposi biopsy will only show lymphocytes because it is viral (HHV-8)

Question 6

how can bacillary angiomatosis be distinguished from Kaposi sarcoma?

Answer 6

both appear similar as red/purple nodules and occur in HIV/AIDs patients

bacillary angiomatosis: zoonotic infection by bartonella bacteria, biopsy shows neutrophils and lymphocytes because it is bacterial infection

Kaposi sarcoma: angioproliferation due to HHV-8, biopsy shows lymphocytes only because it is viral infection

Question 7

pyogenic granuloma

Answer 7

aka lobular capillary hemangioma, benign vascular tumor - blood vessel hyperplasia due to growth stimuli (pregnancy, trauma)

most often on skin/mucosa, often bleed profusely (surgically removed)

Question 8

Pt is a 33yo W in her first pregnancy presenting to her dermatologist with concern of a blood blister on her arm which has been bleeding profusely. Biopsy shows benign vascular tissue, and the lesion is surgically removed. What is the diagnosis?

Answer 8

pyogenic granuloma: aka lobular capillary hemangioma, benign vascular tumor - blood vessel hyperplasia due to growth stimuli (pregnancy, trauma)

most often on skin/mucosa, often bleed profusely (surgically removed)

Question 9

cherry hemangioma

Answer 9

benign capillary proliferation, common in middle-aged/elderly patients (develop with aging)

usually multiple, classically on the trunk

Question 10

cystic hygromas are of concern for what reason?

Answer 10

cystic hygroma: congenital malformation, large benign cyst containing lymph (usually on neck)

identified on prenatal ultrasound, commonly found with fetal aneuploidy and malformations - Down syndrome (tri21) and Turner syndrome (XO)

increased risk of miscarriage or fetal death, often found together with nuchal translucency (sign of Down’s)

Question 11

glomus body

Answer 11

collection of modified smooth muscle cells in the dermis of fingers/toes which regulate skin temperature

shunt blood away from surface in the cold to preserve heat

Question 12

glomus tumor

Answer 12

benign growth of glomus body (modified smooth muscle cells in the dermis of fingers/toes which preserve heat by shutting blood away from surface)

present as pink/purple papule or nodule, painful especially when cold

Question 13

benign growth of modified smooth muscle cells in the dermis of fingertips/toes, which present as pink/purple papule or nodule, painful especially when cold - what is?

Answer 13

glomus tumor: benign growth of glomus body (modified smooth muscle cells in the dermis of fingers/toes which preserve heat by shutting blood away from surface)

Question 14

strawberry hemangioma

Answer 14

benign hemangioma (excess proliferation of blood vessels) which commonly appear in newborns as a single lesion that appears within first few days/months after birth

involute within a few years

appears as raised red/pink patch

Question 15

cherry vs strawberry hemangioma

Answer 15

cherry hemangioma: benign capillary proliferation, common in middle-aged/elderly patients - usually multiple, classically on the trunk

strawberry hemangioma: benign blood vessel proliferation, common in newborns shortly after birth - single lesion, involutes within a few years

Question 16

nevus simplex

Answer 16

aka “stork bite” or “salmon patch” - capillary malformation (not tumor) common on eyelids or nape of neck in infants

pink-red macule birthmark, fades within a few years

Question 17

nevus flammeus

Answer 17

aka “port-wine stain” - malformation of dermal capillaries/venules causing slow/low blood flow

appear as unilateral pink/red patches which blanch when pressed (due to cutting off blood supply)

do not regress but grow as the child grows

common in children with Sturge-Weber syndrome (abnormal blood vessels)

Question 18

nevus simplex vs nevus flammeus

Answer 18

nevus simplex: “stork bite”/“salmon patch” - capillary malformation, fades within a few years

nevus flammeus: “port wine stain”, dermal capillary malformation, do not regress but grow with child, common in children with Sturge-Weber syndrome