Arteriovenous Tumor: Dermoscopic Clues
Abstract
Case Presentation A 78-year-old man consulted for an asymptomatic cutaneous lesion on the external aspect of his left arm that had first appeared 7 months earlier. The lesion, which was firm and measured 15?mm in diameter, was papulonodular, dome-shaped, and erythematous-violaceous in color (Fig. 1A). Figure 1. A, Firm erythematous-violaceous, papulonodular lesion on the external aspect of the left arm. B, Dermoscopic image showing whitish structures on an erythematous base, nonarborizing telangiectasias, vessels with a glomerular appearance, and a slight brown reticular pattern mainly on the periphery. What Is Your Diagnosis? Arteriovenous tumor. Comment Polarized light dermoscopy revealed the presence of whitish structures, a slightly brown reticular pattern mainly on the periphery, and vascular structures (nonarborizing telangiectasias in areas with a glomerular appearance), all on an erythematous base (Fig. 1A). Given the clinical and dermoscopic characteristics of the lesion, the differential diagnosis was made with a vascular lesion, including arteriovenous tumor, aneurysmal dermatofibroma, and hypomelanotic nodular melanoma. ... Álvarez-Salafranca, M.; Fuentelsaz, V.; Cebrián García, C.
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ARTICLE IN PRESS
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ACTAS
De mo-Sifiliog áficas
xxx
(xxxx)
xxx---xxx
PRACTICAL
DERMOSCOPY
Tumo
a e io enoso:
pis as
de ma oscópicas
pa a
su
sospecha夽
A e io enous
Tumo :
De moscopic
Clues
Case
P esen a ion
A
78-yea -old
man
consul ed
o
an
asymp oma ic
cu aneous
lesion
on
he
ex e nal
aspec
o
his
le
a m
ha
had
fi s
appea ed
7
mon hs
ea lie .
The
lesion,
which
was
fi m
and
measu ed
15
mm
in
diame e ,
was
papulonodula ,
dome-
shaped,
and
e y hema ous- iolaceous
in
colo
(Fig.
1A).
Wha
Is
You
Diagnosis?
A e io enous
umo .
Commen
Pola ized
ligh
de moscopy
e ealed
he
p esence
o
whi ish
s uc u es,
a
sligh ly
b own
e icula
pa e n
mainly
on
he
Figu e
1
A,
Fi m
e y hema ous- iolaceous,
papulonodula
lesion
on
he
ex e nal
aspec
o
he
le
a m.
B,
De moscopic
image
showing
whi ish
s uc u es
on
an
e y hema ous
base,
nona bo izing
elangiec asias,
essels
wi h
a
glome ula
appea ance,
and
a
sligh
b own
e icula
pa e n
mainly
on
he
pe iphe y.
夽Please
ci e
his
a icle
as:
Ál a ez-Sala anca
M,
Fuen el-
saz
V,
Ceb ián
Ga cía
C.
Tumo
a e io enoso:
pis as
de -
ma oscópicas
pa a
su
sospecha.
Ac as
De mosifiliog .
2020.
h ps://doi.o g/10.1016/j.ad.2019.05.019
Figu e
2
Well-ci cumsc ibed
ascula
p oli e a ion
in
he
de -
mis,
wi h
essels
co e ed
wi h
a
single
laye
o
endo helial
cells.
Some
essels
ha e
a
hick
fib omuscula
wall,
wi h
no
defini i e
p esence
o
elas ic
lamina,
whe eas
o he s
ha e
a
hinne
wall
(hema oxylin-eosin,
×40).
pe iphe y,
and
ascula
s uc u es
(nona bo izing
elangiec-
asias
in
a eas
wi h
a
glome ula
appea ance),
all
on
an
e y hema ous
base
(Fig.
1A).
Gi en
he
clinical
and
de moscopic
cha ac e is ics
o
he
lesion,
he
di e en ial
diagnosis
was
made
wi h
a
1578-2190/©
2020
AEDV.
Published
by
Else ie
Espa˜
na,
S.L.U.
This
is
an
open
access
a icle
unde
he
CC
BY-NC-ND
license
(h p://
c ea i ecommons.o g/licenses/by-nc-nd/4.0/).
ADENGL-2502;
No.
o
Pages
2
ARTICLE IN PRESS
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M.
Ál a ez-Sala anca,
V.
Fuen elsaz
and
C.
Ceb ián
Ga cía
ascula
lesion,
including
a e io enous
umo ,
aneu ysmal
de ma ofib oma,
and
hypomelano ic
nodula
melanoma.
The
lesion
was
emo ed
comple ely
(Fig.
2).
His opa hology
e ealed
a
well-ci cumsc ibed----bu
no
encapsula ed----p oli e a ion
comp ising
agg ega ed
essels
in
he
de mis
co e ed
by
a
single
laye
o
endo helial
cells
wi hou
a ypia.
Some
essels
had
a
hick
fib omuscula
wall,
wi h
no
defini i e
elas ic
lamina,
and
o he s
had
a
hinne
wall.
A e io enous
umo ,
o
ac al
a e io enous
umo ,
is
a
benign
ascula
umo
ha
is
clinically
di ficul
o
diagnose.
I
usually
mani es s
as
a
soli a y,
asymp oma ic
lesion
mainly
a
ac al
si es,
such
as
he
head
and
limbs.1I
has
been
epo ed
o
appea
on
pa ch-like
capilla y
mal o ma ions
such
as
po
wine
s ains.2
His opa hologically,
he
lesion
is
a
well-ci cumsc ibed
p oli e a ion
in
he
papilla y
de mis
composed
o
mul i-
ple
ascula
spaces
wi h
hick
walls
in e spe sed
wi h
o he
spaces
wi h
hin
walls.
I
has
been
sugges ed
ha
his
is
a
hama oma ous
p oli e a ion
o
he
subpapilla y
plexus.3,4
A
ecen
s udy
o
39
cases
summa ized
he
de moscopic
cha ac e is ics
o
hese
lesions.
The
de moscopic
pa e n
mos
commonly
associa ed
wi h
a e io enous
umo
was
nona bo izing
elangiec asias
on
a
eddish
backg ound
(72%
o
cases)
in
he
absence
o
he
lacunae
ha
a e
ypical
o
o he
ascula
umo s.
Fu he mo e,
whi ish
s uc u es
and
a
sligh ly
pigmen ed
pe iphe al
ne wo k
we e
de ec ed
in
49%
and
18%
o
cases,
espec i ely.4
While
i
is
ue
ha
de moscopy
can
e eal
ascu-
la
s uc u es
in
aneu ysmal
de ma ofib oma,
hese
a e
obse ed
a
he
edge
o
he
lesion,
p obably
in
associa ion
wi h
blood
essels
o
he
su ounding
s oma.
This
ype
o
umo
has
i egula
spaces
filled
wi h
ed
cells,
al hough
hey
lack
an
endo helial
laye
and,
he e o e,
a e
no
seen
as
cen al
elangiec asias
in
de moscopy,
bu
as
homogeneous
eddish
o
bluish
a eas.5
In
he
case
o
hypomelano ic
nodula
melanoma,
he
el-
e an
findings
include
a
clea ly
a ypical
ascula
pa e n,
mainly
wi h
i egula
linea
essels
and
hai pin
essels,
as
well
as
milky
ed
a eas.
In
his
con ex ,
pigmen
ne wo ks
a e
unusual.6
In
conclusion,
de moscopy
could
p o e
o
be
a
use ul
ool
o
he
diagnosis
o
a e io enous
umo .
Howe e ,
he
defini i e
diagnosis
o
his
ype
o
lesion
necessa ily
equi es
a
his opa hology
wo k-up.
Conflic s
o
In e es
The
au ho s
decla e
ha
hey
ha e
no
conflic s
o
in e es .
Re e ences
1.
Connelly
MG,
Winkelmann
RK.
Ac al
a e io enous
umo .
A
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icopa hologic
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Am
J
Su g
Pa hol.
1985;9(1):15---21.
2.
Yoon
NY,
Ahn
SK,
Hong
SP.
An
ac al
a e io enous
umo
a ising
wi hin
a
acial
po -wine
s ain.
In
J
De ma ol.
2014;53(3):e226---8.
3.
Kou las
IG,
Jessu un
J.
A e io enous
hemangioma:
a
clinico-
pa hological
and
immunohis ochemical
s udy.
J
Cu an
Pa hol.
1994;21(4):343---9.
4.
Zaballos
P,
Medina
C,
Del
Pozo
LJ,
Gómez-Ma ín
I,
Ba˜
nuls
J.
De -
moscopy
o
a e io enous
umo :
A
mo phological
s udy
o
39
cases.
Aus alas
J
De ma ol.
2018;59(4):e253---7.
5.
Zaballos
P,
Llamb ich
A,
A a
M,
Olaza án
Z,
Mal ehy
J,
Puig
S.
De moscopic
findings
o
haemoside o ic
and
aneu ys-
mal
de ma ofib oma:
epo
o
six
pa ien s.
B
J
De ma ol.
2006;154(2):244---50.
6.
Menzies
SW,
Moloney
FJ,
By h
K,
A amidis
M,
A genziano
G,
Zalaudek
I,
e
al.
De moscopic
e alua ion
o
nodula
melanoma.
JAMA
De ma ol.
2013;149(6):699---709.
M.
Ál a ez-Sala anca,a,∗V.
Fuen elsaza
aSe icio
de
De ma ología,
Hospi al
Royo
Villano a,
Za agoza,
Spain
C.
Ceb ián
Ga cía,b
bSe icio
de
Ana omía
Pa ológica,
Hospi al
Royo
Villano a,
Za agoza,
Spain
∗Co esponding
au ho .
E-mail
add ess:
[email p o ec ed]
(M.
Ál a ez-Sala anca).
7
Ap il
2019
13
May
2019
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