Requena L, Sangueza O P
Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain.
J Am Acad Dermatol. 1997 Oct;37(4):523-49; quiz 549-52. doi: 10.1016/s0190-9622(97)70169-5.
Classification of cutaneous vascular anomalies is difficult because conceptual confusion persists between vascular neoplasms and malformations. However, hemangiomas of the infancy fulfill criteria both for hyperplasia and neoplasm because they result from proliferation of endothelial cells, but often undergo complete regression. Despite these pitfalls we have classified cutaneous vascular anomalies into the following categories: hamartomas, malformations, dilatations of preexisting vessels, hyperplasias, benign neoplasms, and malignant neoplasms. In this first part of our clinicopathologic review of vascular anomalies, hamartomas, malformations, and dilatation of preexisting vessels are covered. Hamartomas include several combined vascular and melanocytic proliferations grouped as phakomatosis pigmentovascularis and the so-called eccrine angiomatous hamartoma that consists of proliferations of both eccrine glands and blood vessels. Vascular malformations result from anomalies of embryologic development, and in some of them the abnormalities of the involved vessels are more functional than anatomic, as is the case of nevus anemicus. In contrast, other cutaneous vascular malformations show striking morphologic abnormalities of the vascular structures. These anatomic vascular malformations are subdivided into the following groups: capillary, venous, arterial, lymphatic, and combined anomalies. Spider angioma, capillary aneurysm-venous lake, and telangiectases are not vascular proliferations at all, but dilations of preexisting vessels. In our opinion, most of the lesions described with the generic term of "angiokeratoma" are not authentic vascular neoplasms, but hyperkeratotic malformations of capillaries and venules or acquired telangiectases of preexisting blood vessels of the papillary dermis. Therefore the first group of these "angiokeratomas" are included in the vascular malformations section, and the second group are covered in the section of dilation of preexisting vessels. Lymphangiectases are considered the lymphatic counterpart of angiokeratomas because they result from ectasia of preexisting lymphatic vessels of the papillary dermis.
皮肤血管异常的分类很困难，因为血管肿瘤和畸形之间仍然存在概念上的混淆。然而，婴儿期血管瘤符合增生和肿瘤的标准，因为它们是由内皮细胞增殖引起的，但通常会完全消退。尽管存在这些问题，我们还是将皮肤血管异常分为以下几类：错构瘤、畸形、原有血管扩张、增生、良性肿瘤和恶性肿瘤。在我们关于血管异常的临床病理综述的第一部分中，涵盖了错构瘤、畸形和原有血管扩张。错构瘤包括几种血管和黑素细胞联合增殖，归类为色素血管性错构瘤病，以及所谓的小汗腺血管瘤性错构瘤，它由小汗腺和血管的增殖组成。血管畸形是胚胎发育异常的结果，其中一些受累血管的异常更多是功能性的而非解剖学上的，如贫血痣的情况。相比之下，其他皮肤血管畸形则显示出血管结构明显的形态学异常。这些解剖学上的血管畸形可细分为以下几组：毛细血管型、静脉型、动脉型、淋巴管型和混合型异常。蜘蛛痣、毛细血管动脉瘤 - 静脉湖和毛细血管扩张根本不是血管增殖，而是原有血管的扩张。我们认为，大多数用“血管角化瘤”这一通用术语描述的病变并非真正的血管肿瘤，而是毛细血管和小静脉的角化过度畸形或乳头真皮中原有血管的后天性毛细血管扩张。因此，这些“血管角化瘤”的第一组被归入血管畸形部分，第二组则在原有血管扩张部分进行阐述。淋巴管扩张被认为是血管角化瘤的淋巴管对应物，因为它们是由乳头真皮中原有淋巴管的扩张引起的。
