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Microvenular hemangioma (MVH) is a rare benign vascular tumor with a controversial etiology, but hormone receptor alterations might be involved. We report a case of MVH in a 41-year-old Taiwanese woman who presented with a 1.5 × 1 cm violaceous plaque on left thigh that had appeared 1 year previously. She had taken oral contraceptives for several years and stopped 1 year prior to presentation. Histologically, the tumor was composed of small and compressed venous structures infiltrating in the dermis and subcutis. Immunohistochemically, the tumor cells displayed negative immunoreactivity for human herpesvirus-8 and positive immunoreactivity for smooth muscle actin and progesterone receptor (PR). Taken together with the patient's medical hormone therapy history and the evidence of PR immunoreactivity, our findings support that progesterone may be associated with the tumorigenesis of MVH.

Microvenular hemangioma (MVH) is an acquired, benign type of hemangioma that usually manifests itself as a solitary, slowly growing, red to violaceous, asymptomatic papule, plaque or nodule. It is typically located on the trunk or extremities of young adults. It can be difficult to differentiate MVH from other types of hemangioma and Kaposi sarcoma. Herein we report a case of MVH unusual for its location, age of onset, and morphologic features. A 62-year-old man complained of an asymptomatic, bluish-red discoloration on the tip of his nose that had been present for two years. Dermatologic examination showed a violaceous patch 2 x 2 cm in diameter with indistinct borders. Incisional biopsy revealed irregularly branched small or medium-sized vascular spaces lined with benign endothelial cells, positive for CD34 and negative for HHV-8. MVH is a rare lesion, and less than 70 cases have been published to date. A review of 40 reported cases revealed that 15% of MVH patients were over 40 years of age and only 3% of the cases showed macules or patches. A literature survey showed only two cases of MVH located on the facial region, one on the chin and the other on the cheek. Our case was unique for its location and interesting for other rarely encountered features. MVH should be considered in the differential diagnoses of vascular lesions on nasal skin.

Background: Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare vascular proliferative disorder mainly located in the periauricular region. The etiopathogenesis of ALHE is unknown, and it is still controversial as to whether the entity represents a benign vascular neoplasm or an inflammatory process. Aim: Recently, the intracytoplasmic staining pattern of Wilms tumor 1 (WT1) on immunohistochemistry has highlighted true vascular neoplasms, such as microvenular hemangioma, tufted angioma, and spindle cell hemangioma, which has made it helpful to distinguish ALHE from vascular malformations, as there is a negative staining pattern in the other entities. We aimed to investigate the immunoreactivity of ALHE specimens for WT1 as well as glucose transporter protein 1 (GLUT1) immunohistochemistry, an important and sensitive marker for the diagnosis of infantile hemangioma, which recently has been described to label other hemangiomas, such as verrucous hemangioma. Material and methods: Clinical data and histopathological specimens from patients diagnosed with ALHE were reviewed, and immunohistochemical staining and microscopic analysis for WT-1 and GLUT1 were performed. Results: Intracytoplasmic endothelial staining of WT1 was detected in 19 of 20 ALHE specimens. GLUT1 was not detected in any ALHE specimen. Conclusions: We conclude that ALHE may represent a true hemangioma (i.e., benign vascular neoplasia) characterized by an eosinophil- and lymphocyte-rich inflammatory component as opposed to the reactive inflammatory dermatosis with a positive intracytoplasmic staining pattern for WT1. As far as we are aware, WT1 staining for ALHE has not been described to date.

A 75-year-old man presented to the dermatology clinic with an asymptomatic lesion on his right plantar surface. The lesion had progressively grown for two months. Physical examination revealed an erythematous and slightly scaly nodule measuring 10x10 mm. Dermoscopy examination showed central diffuse erythema with small red globules. A punch-biopsy revealed a proliferation of irregularly branched small vessels with collapsed lumen, extending in an infiltrative pattern in the superficial and deep dermis. Although this is a rare location, a diagnosis of microvenular hemangioma was made.

Background Microvenular hemangioma is an uncommon benign vascular tumor that can potentially be mistaken for malignancy. Methods We reviewed the histopathologic and clinical features of 13 microvenular hemangiomas, which represents the largest series reported to date. Results The patients [female (F) = 8 and male (M) = 5] had a mean age of 39 years (range: 16 months–69 years). All presented with a similar history of a new, asymptomatic, stable or slow-growing, red to purple plaque or nodule. The lesions were located on the extremities, chest, back or abdomen. Two patients had multiple lesions. In six, a vascular tumor was not suspected clinically. Histologically, all were composed of a dermal proliferation of thin-walled, often branching, vascular channels dissecting through collagen fibers. The vessels were surrounded by a conspicuous layer of pericytes. Immunohistochemistry showed that all were positive for a vascular marker. Stains for WT-1 were positive in 9 of 10. None of the lesions tested (0/12) were positive for podoplanin or human herpesvirus-8 (HHV-8) (0/9). Follow-up available on six patients showed no recurrences. Conclusion The histomorphology of microvenular hemangioma frequently raises concern for a malignant vascular lesion, especially Kaposi sarcoma. Identification of characteristic features, particularly the pericyte layer in routinely stained sections or with an SMA immunostain, allows an accurate diagnosis.

The current study reports a case of multiple microvenular hemangioma (MH). A 35-year-old male presented with dark red maculopapules on the trunk and limbs that had been apparent for 5 years. The number of lesions exceeded 100 in total. A histological examination demonstrated multiple, irregular, branching venules in the dermis, without any endothelial atypia. On immunohistochemical analysis of the vascular structures, the endothelial cells stained positive for CD31, CD34 and factor VIII, and the perivascular cells stained positive for SMA and HHF-35. These observations were consistent with a diagnosis of MH, and should be differentiated from the most common differential diagnosis of patch-stage Kaposi's sarcoma. There was no clear effect following topical application of recombinant human interferon α-2b gel.

Microvenular hemangioma (MH) is a rare benign acquired vascular neoplasm, which can be clinically and histologically misdiagnosed with other vascular lesions. Immunohistochemistry studies in MH are lacking. The aim of this study is to investigate the immunoprofile of MH and gain further insight in its histogenesis. We evaluated 9 cases of MH. Immunohistochemical expression of WT1, GLUT-1, and D2-40 was performed in all cases. All 9 MHs resulted completely positive for WT1 immunostaining. Immunohistochemistry performed in all 9 MH cases showed negative staining for GLUT-1 and D2-40. We added further support to the importance of WT1 as a useful tool in the diagnosis of vascular neoplasms. D2-40 negativity in all tested lesions implied that MH does not exhibit a lymphatic differentiation. GLUT-1, which is characteristically positive in infantile hemangioma and verrucous hemangioma, showed to be negative in MHs.

Microvenular hemangioma (MVH) is a rare, slowly growing, benign vascular tumor that typically presents as a solitary enlarging plaque or nodule on the trunk or the extremities of young to middle-aged adults. A minority of MVH present with multiple lesions that are either gradually or suddenly acquired (eruptive MVH). Herein, we report a case of a 53-year-old woman who progressively developed numerous bilateral MVHs presenting as enlarging, blanching, erythematous to violaceous macules, patches, and plaques over the proximal thighs and axillae. Two biopsies exhibited the irregular branching venules with inconspicuous lumina lacking endothelial atypia and associated with dermal fibrosis characteristic of MVH. Immunophenotypically, the endothelium expressed Wilms Tumor 1, CD31, CD34, and erythrocyte-type glucose transporter protein (GLUT-1) GLUT-1 focally and was negative for Human herpes virus 8 and the lymphatic marker D2-40. In addition, numerous dermal spindle cells expressing CD34 and procollagen, putative fibrocytes, surrounded the thickened dermal collagen bundles and small vessels of MVH implicating a reactive/reparative (proliferative) process due to an unrecognized cutaneous injury. A review of MVH summarizing its clinicopathologic findings and its natural history is presented.

Microvenular hemangioma (MVH) is an uncommon benign vascular neoplasm that usually occurs as a solitary asymptomatic red or purple papule, nodule, or plaque with a predilection for the upper extremities. Patients with more than 1 lesion, that is, multiple MVHs, are extremely rare. We describe the clinicopathologic features of 4 Chinese patients who had a rapidly progressive abrupt onset of numerous MVHs numbering in the tens to hundreds. Clinically, the correct diagnosis of MVH could not be made in any of our patients; however, histologic examination revealed the characteristic features of MVH. Immunohistochemical stains were performed in all cases and showed the vessel lining cells to be positive for CD34, CD31, and factor VIII-related antigen. Polymerase chain reaction for human herpesvirus-8 was negative in all cases. The differential diagnosis and review of the literature of patients with multiple MVHs are presented.

In recent years, the classification of vascular lesions has been expanded and modified with the addition of several newly described entities, the redefinition of others, the recognition of lesions of borderline biologic behavior, and the need to avoid misdiagnosis with early Kaposi's sarcoma. This review clarifies the nomenclature, updates information on previously known lesions, and summarizes data on several recently discovered, lesser-known entities such as glomeruloid hemangioma, microvenular hemangioma, and multinucleate cell angiohistiocytoma. Clinicopathologic features and differential diagnosis are emphasized.

Microvenular hemangioma (MH) is not a very common type of hemangioma, and it can occasionally be difficult to distinguish it from other benign vascular tumors and malignant tumors such as Kaposi's sarcoma. The latter has been shown to be negative for the marker D2-40. Nevertheless, the status of MH for D2-40 has not been established yet. We therefore studied the expression of podoplanin in three cases of MH using D2-40 antibody. No expression was seen, while the dermal lymphatics were clearly immunostained. Nevertheless, the vessels of the MHs were positive for CD34, CD31, and von Willebrand Factor. This study adds MH to the list of vascular lesions that fail to express the allegedly lymphatic marker podoplanin.

We describe a 31-year-old woman with an asymptomatic solitary red plaque on the back which measured 2 × 1 cm. The patient reported that it had been growing for a few months. Upon dermoscopic examination, multiple well-demarcated red globules were seen. At the periphery a fine pigment network was present. The lesion was excised and examined histopathologically. The specimen showed proliferation of irregular branching venules with inconspicuous lumina. The tumor cells lacked cellular atypia. Microvenular hemangioma is a rare, slowly growing, benign vascular tumor. It usually presents on the trunk or the extremities of young to middle-aged adults. Microvenular hemangioma is a benign vascular tumor with distinct dermoscopic and histopathological features which enable it to be distinguished from other vascular neoplasms.

This second part of our review about vascular proliferations summarizes the clinicopathologic features of the cutaneous vascular hyperplasias and benign neoplasms. Hyperplasias comprise a heterogeneous group of vascular proliferations that eventually show a tendency to regression. Angiolymphoid hyperplasia with eosinophilia is included within the group of hyperplasias because of its historical denomination and its reactive nature, probably as a consequence of an arteriovenous shunt, although usually the lesions do not regress. Pyogenic granuloma, bacillary angiomatosis, intravascular papillary endothelial hyperplasia, and pseudo-Kaposi's sarcoma qualify as vascular hyperplasias because they regress when the stimulus that initiated them is removed. Benign neoplasms form a large group of hemangiomas with distinctive clinicopathologic characteristics, although some of them are of recent description and may produce diagnostic difficulties. We classified cutaneous benign vascular neoplasms according to their cell lineage of differentiation, for example, endothelial, glomus cell, and pericytic differentiation. Subsequent categories are established according to the size of the involved vessels (capillaries, venules and arterioles, or veins and arteries) or the nature of the proliferating vessels (blood or lymphatic vessels). Capillary and cavernous hemangiomas have been the terms classically used to name the most common variants of benign vascular neoplasms (i.e., infantile hemangiomas), but they are not the most appropriate denominations for these lesions. First, these names are not contrasting terms. Furthermore, most of the socalled "cavernous" hemangiomas are not hemangiomas (neoplasms) at all, but venous malformations. The most important conceptual issue is that, at any point in time, a particular hemangioma has its own histopathologic pattern throughout the depth of the lesion. For these reasons, we classified hemangiomas into superficial and deep categories. Some of the lesions reviewed have been recently described in the literature, and they may histopathologically mimic lesions of Kaposi's sarcoma; these include targetoid hemosiderotic hemangioma, microvenular hemangioma, tufted hemangioma, glomeruloid hemangioma, kaposiform hemangioendothelioma, spindle-cell hemangioendothelioma, and benign lymphangioendothelioma. In each of these lesions, we update and emphasize those clinical and histopathologic features that are helpful for differential diagnosis with lesions of authentic Kaposi's sarcoma in any of its three stages of development (patch, plaque, or nodule).

Microvenular hemangioma (MVH) is a rare, benign, acquired vascular tumor. We report a case that shows the characteristic histopathologic features of this disorder in a boy with acute myelogenous leukemia (AML), suggesting an association with systemic immunosuppression.