Kanik A B, Hall J D, Bhawan J
Department of Dermatology, Boston, University School of Medicine, Massachusetts, USA.
Am J Dermatopathol. 1995 Dec;17(6):612-7. doi: 10.1097/00000372-199512000-00016.
A 39-year-old white man presented with four discrete dermal nodules in his right upper arm. Biopsy revealed superficial dermal well-circumscribed nodules composed of solid areas and vascular spaces lined by epithelioid endothelial cells and a similar nodule composed of spindle and epithelioid cells. A moderate mitotic count of 3-4 mitoses/10 hpf was present. Multiple lesions erupted 1 month later distally and proximally to the original lesions. Magnetic resonance imaging of the right arm demonstrated a lesion in the humerus. Biopsy of the humerus showed a vascular tumor with similar histologic features to the overlying skin lesions. The differential diagnosis included epithelioid vascular tumors, bacillary angiomatosis, pyogenic granuloma, and Kaposi sarcoma. Vascular lesions containing epithelioid and spindle cells span a spectrum from benign to malignant. We believe these tumors belong in the category of hemangioendothelioma and propose the name eruptive epithelioid hemangioendothelioma with spindle cells. Our case emphasizes that eruptive cutaneous vascular lesions do not always suggest immunosuppression or malignancy. Additionally, it highlights the association between epithelioid vascular lesions of the skin and bone.
一名39岁的白人男性因右上臂出现4个孤立的皮肤结节前来就诊。活检显示真皮浅层有边界清楚的结节，由实性区域和血管腔隙组成，血管腔隙内衬上皮样内皮细胞，还有一个由梭形细胞和上皮样细胞组成的类似结节。有丝分裂计数中等，为3 - 4个有丝分裂/10高倍视野。1个月后，在原病灶的远端和近端又出现了多个病灶。右臂的磁共振成像显示肱骨有一个病灶。肱骨活检显示为血管肿瘤，其组织学特征与上方皮肤病变相似。鉴别诊断包括上皮样血管肿瘤、杆菌性血管瘤、化脓性肉芽肿和卡波西肉瘤。含有上皮样和梭形细胞的血管病变范围从良性到恶性。我们认为这些肿瘤属于血管内皮瘤范畴，并提出“伴梭形细胞的暴发性上皮样血管内皮瘤”这一名称。我们的病例强调暴发性皮肤血管病变并不总是提示免疫抑制或恶性肿瘤。此外，它还突出了皮肤和骨骼上皮样血管病变之间的关联。
