Verrucous Hemangioma

Abstract

Verrucous hemangioma is an uncommon variant of cutaneous hemangioma, showing characteristic clinicopathologic features. Since its formal characterization in 1967, little has been written on this entity. This report describes 10 cases to draw wider attention to this distinct hemangioma. The patients, 5 males and 5 females, were aged 6-44 years at presentation. The lesions were usually noted at birth as flat or dome-shaped reddish or bluish lesions that enlarged slowly and became verrucous. All 10 cases were located in the lower extremities. Among the six cases with follow-up information, two have recurred. Histologically, beneath the warty epidermal surface, haphazardly distributed in the dermis were vascular spaces often of cavernous size, merging into capillaries in the subcutis. In the subcutaneous tissue, the lobules of capillaries com monly merged with the adipose cells in a pseudoinfiltrative pattern. The endothelial cells were flat and nondescript, and showed variable immunoreactivity for factor VIII related antigen but showed strong staining with CD34. All the vascular channels were surrounded by complete rims of muscle-specific actin-positive pericytes. The overlying epidermis lacked evidence of human papillomavirus infection either by immunohisto chemical studies or ultrastructural examination. Thus the warty change represented a reactive phenomenon rather than a result of human papillomavirus infection. Since the lateral and deep extent of the vascular proliferation is often greater than that of the exophytic epidermal component in verrucous hemangioma, the size of the lesion is often underestimated, leading to inadequate excision and recurrence. Awareness of this entity and obtaining a complete clinical history should permit recognition of the lesion as a vascular lesion and not a primary epidermal or melanocytic lesion. Int J Surg Pathol 2(3):171-176, 1995