Solid Form of Epithelioid Hemangioma: A Case Report

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Epithelioid hemangioma (EH) is an uncommon benign vas-cular tumor, of controversial etiology that usually presents as a slowly growing nodule on the face or digit of a middle-aged woman. 1 Most lesions have a nonspecific nodular appearance with frequent secondary changes such as excoriation and bleeding. Multiplicity is also a common finding. Histopathologically, EH is characterized by a mixture of vascular proliferation and marked mixed inflammatory cell infiltration, and was first described by Wells and Whimster 2 as angiolymphoid hyperplasia with eosinophilia. The proliferation of vascular structures lined with prominent endothelial cells is a distinguishing feature of EH. The epithelioid endothelial cells that protrude into the vascular lumen create a characteristic " cobblestone " or " tombstone " appearance. A chronic inflammatory cell infiltration including lymphoplasma cells and eosinophils is a consistent finding. EH has a diverse range of microscopic features, depending on the composition and distribution of the vascular and inflam-matory cellular components. EH has been described in the literature as an inflammatory angiomatous nodule or, an atypical or pseudopyogenic granuloma, 3,4 when infiltration of various inflammatory cells is predominant, and a histiocytoid hemangi-oma 5 when cobble stone-like endothelial cells are conspicuous. Some cases of EH consist entirely of solid sheets of epitheli-oid to spindled cells without fully canalized vascular structures. The solid form of EH can be difficult to diagnose and is occasionally misdiagnosed as a malignant vascular tumor. EH is a benign neoplasm and surgical excision is sufficient for its treatment. Recently, we experienced a solid form of EH with no in-flammatory component, which showed a dramatic change into the typical morphology on the consecutive biopsy. This is the first reported Korean case of a solid form of EH, which pathologists should include in the differential diagnosis of epithelioid vascular lesions to avoid overdiagnosis of epithelioid vascular malignancies. A 35-year-old female patient presented with multiple consecutive dermal nodules in her left forearm. On the initial physical examination, there were approximately ten well-defined, er-ythematous, round nodules up to 0.6 cm in size. The lesions were nontender, nonpruritic, and without ulceration (Fig. 1). The lesions slowly grew in size over the course of 4 months. The patient was otherwise healthy with no …