Updated: 2/1/2020

Vascular Tumors

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Topic
Snapshot
  • A 34-year-old man presents with a rash. He states he recently started feeling fatigued and a purple rash appeared a few weeks ago. On physical exam, there are dozens of purple papules and nodules on the skin and on the oral mucosa. A biopsy reveals lymphocytic infiltration. Additional viral testing is sent for further workup. (Kaposi sarcoma)
Introduction
  • Benign or malignant vascular proliferation
    • most commonly, these neoplasms manifest cutaneously
Benign Vascular Neoplasms
  • Strawberry hemangioma
    • clinical definition
      • benign capillary hemangioma of infancy
        • also known as infantile hemangioma
    • regresses spontaneously within a few years 
    • treatment is typically not necessarily
  • Cherry angioma
    • clinical definition
      • benign capillary hemangioma of adulthood
      • more frequent in elderly patients
    • does not regress spontaneously
    • treatment is typically not necessarily
  • Cavernous hemangioma
    • clinical definition
      • benign tumor of liver and spleen
        • risk of rupture with increasing size
    • associated conditions
      • von-Hippel-Lindau syndrome
    • treatment is typically not necessarily
  • Pyogenic granuloma
    • clinical definition
      • polypoid lobulated capillary hemangioma of the skin and mucosa
        • easily ulcerates and bleeds
        • often occurs on the gingiva
    • associated conditions
      • trauma
      • pregnancy
    • treatment
      • the lesion can be surgically removed if it causes excessive discomfort
Malignant Vascular Neoplasms
  • Kaposi sarcoma
    • clinical definition
      • endothelial malignancy that most commonly affects the skin, characterized by purple papules and nodules
      • can also affect the mouth, gut, and lungs
      • characterized by a lymphocytic infiltrate
    • associated conditions
      • human herpesvirus-8 infection
      • human immunodeficiency virus infection
    • treatment
      • antiretroviral therapy 
      • if refractory
        • adriamycin
        • vinblastine
  • Angiosarcoma
    • clinical definition
      • malignant vascular neoplasm affecting the head, neck, chest, and liver
      • more common in sun-exposed areas in the elderly population
      • very aggressive malignancy
    • associated conditions
      • radiation therapy
      • hepatic angiosarcoma is specifically associated with a "VAT of chemicals"
        • Vinyl chloride
        • Arsenic
        • Thorotrast
      • lymphangiosarcoma is associated with
        • chronic post-mastectomy lymphedema
    • treatment
      • surgical excision
Other Neoplasms
  • Glomus tumor
    • clinical definition
      • painful benign red-blue tumor of the glomus body
        • glomus body is a thermoregulatory agent, which can shunt blood towards or away from the skin surface
      • found under the fingernails
    • treatment
      • surgical excision
  • Cystic hygroma
    • clinical definition
      • cavernous lymphangioma of the neck
        • “webbed neck”
    • associated conditions
      • Turner syndrome
  • Bacillary angiomatosis 
    • clinical definition
      • benign capillary skin lesions caused by Bartonella henselae infections
      • characterized by neutrophilic infiltrate
    • associated conditions
      • acquired immunodeficiency disease syndrome (AIDS)
      • cat-scratch disease
    • treatment
      • antibiotic therapy

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Questions (5)
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(M1.CV.14.52) A 45-year-old woman presents to your clinic concerned about changes in her skin over the past few years as shown in Figure A. The lesions do not hurt or bleed and she is not bothered by their appearance but she is somewhat concerned that the lesions may be a sign of a more serious underlying medical condition. She is interested in reviewing a treatment plan that will prevent the lesions from causing adverse long-term effects. What treatment is required for this patient's skin lesions?

QID: 104263
FIGURES:
1

Immediate removal

2%

(2/98)

2

Biopsy

9%

(9/98)

3

Topical corticosteroids

4%

(4/98)

4

Regular follow-up to monitor regression of lesions

19%

(19/98)

5

No treatment required

64%

(63/98)

M 3 E

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(M1.CV.13.91) A 68-year-old female presents after noting the onset 3 months ago of an area of erythema on the anterior aspect of her left upper arm. Over the next several months, this lesion progressed to include numerous purple papules with areas of apparent necrosis as well as an enlarging underlying mass. Figure A depicts the patient's arm at her current presentation. She reports that her left arm has felt "heavy" and appeared swollen in the past. Which of the following elements of this patient's history would have most likely contributed to the development of her current condition?

QID: 100607
FIGURES:
1

Multiple recurrent staphylococcal skin abscesses treated with IV antibiotics and serial I&Ds

27%

(7/26)

2

Progressively debilitating polyarticular osteoarthritis

8%

(2/26)

3

Modified radical mastectomy with subsequent radiation therapy 12 years ago

50%

(13/26)

4

Remote anterior shoulder subluxation after an accidental injury 30 years ago

0%

(0/26)

5

Former 1 pack-per-day smoker, who quit 10 years ago

15%

(4/26)

M 2 D

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(M1.CV.13.67) A 51-year-old woman presents to the dermatologist with concern for a new skin lesion (Image A). You note two similar lesions on her back. Which of the following is a true statement about these lesions?

QID: 100583
FIGURES:
1

They will likely grow rapidly.

6%

(1/16)

2

They will likely regress spontaneously.

12%

(2/16)

3

They may be associated with von Hippel-Lindau disease.

6%

(1/16)

4

They will likely increase in number over time.

56%

(9/16)

5

They must be followed closely for concern of malignancy.

12%

(2/16)

M 2 E

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Evidence (6)
EXPERT COMMENTS (6)
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