Department of Traumatology, Military Health Centre, Budapest, Hungary.
Department of Traumatology and Hand surgery, Saint John's Hospital, Budapest, Hungary.
Pathol Oncol Res. 2020 Oct;26(4):2083-2090. doi: 10.1007/s12253-020-00838-8. Epub 2020 Jul 15.
Although papillary endothelial hyperplasia may occur at almost any site, one of the most common sites is the hand. It is generally regarded as a reactive vascular proliferation i.e. exuberant form of organizing thrombus. Diagnosis of Masson tumor can be challenging due to its close clinical, radiological and even histopathological resemblance to angiosarcoma. We present seven cases of Masson tumor of the hand; wanting to reveal its nature using new vascular markers and discuss the treatment options and expected outcomes, present clinical and radiological features that may aid diagnosis and also offer treatment plans. A multicenter retrospective study was performed between January 2014 and November 2019. Immunohistochemical stains of Glut1, WT1, ERG, CD31 and alpha smooth muscle actin (ASMA) were performed on each cases. We found seven cases during the examined period. 4 out of 7 cases were women. All lesions occurred in the hands. 3 out of 7 cases appeared in a previously present vascular malformation. All cases were treated with surgical excision and the diagnosis of papillary endothelial hyperplasia was made by histology. Pre-operative testing (radiograph/MRI/US/fine needle aspiration biopsy) did not suggest the diagnosis of Masson tumor; however, aspiration cytology could rule out malignancy. The proliferative endothelial cells proved to be Glut1 negative and WT1 positive and the accompanying pericytic cells were ASMA positive in all cases. Though Masson tumor is a rare vascular lesion in the hand among other vascular tumors, it should be considered in the differential diagnostics even in the case of previously existing vascular malformation. WT1 positivity of the endothelial cells and the accompanying pericytic cells raises the question whether the initially reactive endothelial proliferation may transform into a true benign vascular tumor.
尽管乳头状内皮细胞增生症几乎可以发生在任何部位，但最常见的部位之一是手部。它通常被认为是一种反应性血管增生，即血栓形成的过度活跃形式。由于其在临床、放射学甚至组织病理学上与血管肉瘤非常相似，因此 Masson 肿瘤的诊断具有挑战性。我们展示了手部的 7 例 Masson 肿瘤病例；我们希望使用新的血管标志物揭示其性质，并讨论治疗方案和预期结果，提出有助于诊断的临床和放射学特征，并提供治疗计划。在 2014 年 1 月至 2019 年 11 月期间进行了一项多中心回顾性研究。对每个病例进行了 Glut1、WT1、ERG、CD31 和α平滑肌肌动蛋白 (ASMA) 的免疫组织化学染色。在检查期间发现了 7 例病例。7 例中有 4 例为女性。所有病变均发生在手。7 例中有 3 例出现在先前存在的血管畸形中。所有病例均采用手术切除治疗，组织学诊断为乳头状内皮细胞增生症。术前检查（X 线片/MRI/US/细针抽吸活检）并未提示 Masson 肿瘤的诊断；然而，抽吸细胞学检查可排除恶性肿瘤。所有病例的增生内皮细胞均为 Glut1 阴性和 WT1 阳性，伴随的周细胞为 ASMA 阳性。虽然 Masson 肿瘤在手部的其他血管肿瘤中是一种罕见的血管病变，但即使在先前存在的血管畸形的情况下，也应考虑在鉴别诊断中考虑该肿瘤。内皮细胞和伴随的周细胞的 WT1 阳性提出了这样一个问题，即最初的反应性内皮细胞增生是否可能转化为真正的良性血管肿瘤。
