ONCOLOGY LETTERS 7: 275-277, 2014

Multiple microvenular hemangioma: A case report

1
Department of Dermatology, Cangzhou Central Hospital, Cangzhou, Hebei 061001; 2Department of Dermatology,
Tianjin Medical University, General Hospital; 3Tianjin Medical University, Tianjin 300052, P.R. China

Received April 20, 2013; Accepted October 25, 2013

DOI: 10.3892/ol.2013.1659

Abstract. The current study reports a case of multiple of their presence on the trunk and limbs for the past 5 years
microvenular hemangioma (MH). A 35‑year‑old male and with the absence of any precipitating factor. Initially,
presented with dark red maculopapules on the trunk and limbs the lesions were the size of rice granules, painless and itchy,
that had been apparent for 5 years. The number of lesions although not troublesome enough to persuade the patient to
exceeded 100 in total. A histological examination demon- attend a consultation. Thereafter, the size of the lesions gradu-
strated multiple, irregular, branching venules in the dermis, ally enlarged and also increased in number. Subsequently, the
without any endothelial atypia. On immunohistochemical individual sought medical advice at a local hospital and was
analysis of the vascular structures, the endothelial cells stained prescribed oral antihistamines and topical corticosteroids that
positive for CD31, CD34 and factor VIII, and the perivascular proved of no benefit. No other family member demonstrated
cells stained positive for SMA and HHF‑35. These observa- such lesions.
tions were consistent with a diagnosis of MH, and should be
differentiated from the most common differential diagnosis Lesion examination. Upon examination, numerous dark
of patch-stage Kaposi's sarcoma. There was no clear effect red, circular, non‑scaly maculopapules measuring 5 mm in
following topical application of recombinant human inter- diameter were noted on the chest, back, abdomen, buttocks
feron α-2b gel. and upper and lower extremities. The lesions had a diffuse
distribution with clear borders and were painless. An attempt
Introduction to count the number of lesions found >100. The lesions were
found in a greater concentration on the chest and back. The
Microvenular hemangioma (MH) is an acquired benign head, face, palms and soles were unaffected.
vascular tumor, occurring on the trunk and limbs in young
to middle‑aged adults without any gender predilection. MH Clinical and pathological analyses. Nothing abnormal was
usually presents as a solitary, purple-to-red papule/plaque found on chest X‑ray or abdominal B‑mode ultrasound scan.
measuring 5-20 mm in diameter. MH was first described by The patient's blood profile, urine and stool routine, liver func-
Bantel et al in 1989 (1). The etiology of MH is unknown. MH tion, renal function and electrolyte levels were also normal.
is rare, with <50 cases reported to date. Even in these reported
cases, accounts of multiple MH are extremely uncommon. The Patient diagnosis. Two lesions of the chest were removed
present study reports a case of multiple MH. Informed consent completely for diagnosis. The tumors were of the same
was obtained from the patient. histopathology and demonstrated proliferation of irregularly
branched, thin‑walled venules infiltrating the sclerotic dermal
Case report collagen and the presence of few blood vessels with inconspic-
uous lumina (Fig. 2A). A mixture of flat and plump endothelial
Patient presentation. A 35‑year‑old male presented cells was observed (Fig. 2B), however, there was an absence of
to Cangzhou Central Hospital (Cangzhou, China) in cellular atypia and mitotic figures. Perivascular infiltration of
September 2009 with multiple dark red maculopapules on few lymphocytes was noted.
the trunk and limbs (Fig. 1). The patient reported a history Immunohistochemically, the endothelial cells of the prolif-
erating vessels expressed CD31 (Fig. 3A), CD34 (Fig. 3B) and
factor VIII (Fig. 3C). The pericytes expressed SMA (Fig. 3D)
and HHF‑35 (Fig. 3E). The diagnosis was microvenular
Correspondence to: Dr Dong Fang Ai, Department of hemangioma. The patient was treated with recombinant
Dermatology, Cangzhou Central Hospital, No.16 West Xinhua Road, human interferon α-2b gel, twice a day. There was no clear
Cangzhou, Hebei 061001, P.R. China effect after a month.
E‑mail: faylcn@163.com
Discussion
Key words: microvenular hemangioma
MH is an acquired benign vascular tumor. MH was first
described by Bantel et al in 1989. At that time, the study
276 AI et al: MULTIPLE MICROVENULAR HEMANGIOMA

A B

Figure 1. (A) Dark red maculopapules on the chest. (B) Multiple dark‑red maculopapules on the lower extremities.

A B

Figure 2. Hematoxylin-eosin stain of small, irregularly branched blood vessels proliferating throughout the dermis and embedded in a desmoplastic stroma at
magnifications (A) x40 and (B) x200.

A B

C D E

Figure 3. Endothelial cells of the proliferative vessels expressed (A) CD31, (B) CD34 and (C) factor VIII. (D) The pericytes expressed SMA and (E) HHF‑35
(magnification, x400).

reported microcapillary angiomas in three female patients (1). to middle‑aged adults, but is also identified in children (4). It is
In 1991, similar cases were described by Hunt et al using most frequently located on the trunk and upper extremities, and
current terminology (2). MH is rare, with ≤50 cases reported less frequently on the toes (5). MH grows slowly and usually
to date. presents as a solitary, purple to red papule/plaque measuring
The etiology of MH is unknown, but in specific cases, MH 5‑20 mm in diameter. Alternatively, it can also present as a
has been observed following changes in hormonal contracep- pale red nodule, which clinically resembles cutaneous inflam-
tion or during pregnancy (1). Sex hormone imbalance may also mation (6). Generally, the lesion is asymptomatic, but slight
account for certain cases (3). MH shows a predilection for young tenderness has also been noted in specific cases (7). Multiple
 ONCOLOGY LETTERS 7: 275-277, 2014 277

MHs, as in the present case, are extremely rare. To date, thology, which include spreading and interdigitating epidermal
Xu et al has already reported four cases of patients from China processes and an increase in the basal lamina pigmentation.
who exhibited a rapidly progressive abrupt onset of numerous Furthermore, the course of this case was longer than usually
MHs numbering in the tens to hundreds (8). observed in MH.
Upon dermoscopic examination, multiple well‑demar- For cases of this disease with minor solitary lesions, exci-
cated red globules are observed with the presence of a fine sion has been associated with cure and usually no recurrence
pigmented network at the periphery (9). Histologically, MH is is observed. In cases with major or multiple skin eruptions,
composed of thin-walled, irregularly branching venules with regular follow‑ups should be performed, although the disease
inconspicuous vascular lumina. The collagen bundles in the is self‑limiting in nature. In the present case, some primary
dermis are thickened. The endothelial cells are surrounded by lesions disappeared without further treatment; however, a few
pericytes (10) and may present as a mixture of flat or plump new eruptions appeared on the patient's back and chest.
cells, but with a lack of cellular atypia, pleomorphism or
mitotic figures (11). Immunohistochemically, the endothelial Acknowledgements
cells of an MH are positive for CD31, CD34 and factor VIII,
and the pericytes are positive for SMA (9,12), but both stain This study was supported by a grant from the Tianjin
negative for podoplanin (13). Foundation of Natural Science (no. 09JCZDJC18300).
The tumor may exhibit infiltrative growth throughout the
dermis. Therefore, pathologists and clinicians must be aware References
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