Tennant Lucile B, Mulliken John B, Perez-Atayde Antonio R, Kozakewich Harry P W
Department of Pathology, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Pediatr Dermatol. 2006 May-Jun;23(3):208-15. doi: 10.1111/j.1525-1470.2006.00219.x.
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.
我们分析了疣状血管瘤的临床和组织病理学特征，将这些发现与诸如毛细血管-淋巴管畸形、毛细血管-静脉畸形和局限性血管角化瘤等角化过度的模仿者进行比较，并重新考虑在当前血管异常分类学中“疣状血管瘤”这一术语是否合适。一位外科医生将14个外观相似的局限性角化过度血管病变诊断为血管角化瘤、局限性血管角化瘤、毛细血管-静脉畸形、毛细血管-淋巴管畸形或疣状血管瘤。所有病变均位于四肢，除1例位于躯干，病变为单发或成群，直径2.6至8厘米。所有病变均隆起，呈红色至紫色，角化程度不一，边界不规则，部分病变表现为间歇性出血和渗血。手术切除年龄为4个月至16岁。经过组织学检查，3个病变被指定为由毛细血管、淋巴管和静脉组成的复合性血管畸形，无病变被诊断为血管角化瘤。14个标本中有11个符合疣状血管瘤的组织学标准：角化过度的表皮，有小的、厚壁的、充满血液的血管，多层基底膜累及整个真皮以及皮下组织。免疫染色显示局灶性GLUT1内皮阳性（7/11）和低水平MIB-1反应性（8/11）。疣状血管瘤具有公认的血管畸形临床特征，特别是出生时即存在且成比例生长。显微镜下特征，如厚的血管壁、多层基底膜、相对均匀的管腔大小和GLUT1免疫阳性，使人联想到婴儿血管瘤，特别是在其消退期。关于疣状血管瘤是一种畸形还是一种惰性肿瘤，似乎无法得出确凿结论，但临床证据支持前一种分类。
