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Year : 2013  |  Volume : 4  |  Issue : 1  |  Page : 32-33

Cavernous hemangioma mimicking nevus sebaceous


Department of Dermatology, Father Muller Medical College, Mangalore, Karnataka, India

Date of Web Publication20-May-2013

Correspondence Address:
M Teena Ramesh
Department of Dermatology, Father Muller Medical College, Mangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-9727.112276

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  Abstract 

Cavernous hemangiomas are congenital vascular malformations that are now known as venous malformations. They can occur in any tissue but are especially common in the skin, where they usually are seen at birth or within the first several years of life. Nevus sebaceous is a benign tumor of the sebaceous gland presenting from birth to adolescence. A 34-year-old male patient presented with an asymptomatic raised lesion over the scalp that was present since birth and had been increasing in size over the past 3 years. Provisional diagnosis of nevus sebaceous was carried out due to the site, age of appearance and non-blanchability, but histopathology showed features suggestive of cavernous hemangioma. We report this case for its misleading form of presentation.

Keywords: Cavernous hemangiomas, nevus sebaceous, venous malformations


How to cite this article:
Ramesh M T, Bhat M R, Sukumar D, Srinath M K. Cavernous hemangioma mimicking nevus sebaceous. Muller J Med Sci Res 2013;4:32-3

How to cite this URL:
Ramesh M T, Bhat M R, Sukumar D, Srinath M K. Cavernous hemangioma mimicking nevus sebaceous. Muller J Med Sci Res [serial online] 2013 [cited 2022 Aug 16];4:32-3. Available from: https://www.mjmsr.net/text.asp?2013/4/1/32/112276


  Introduction Top


Cavernous hemangiomas are congenital vascular malformations that are now known as venous malformations (VM). They can occur in any tissue but are especially common in the skin, where they usually are seen at birth or within the first several years of life. [1] Cutaneous VMs are light-to-dark bluish lesions, they do not contain the tissue of the organ in which they are situated, can arise anywhere in the body and are considered benign neoplasms.

Nevus sebaceous also known as nevus sebaceous of Jadassohn/Organoid nevus is a benign tumor of the sebaceous gland. It appears more commonly on the scalp. It presents as a hairless waxy verrucous plaque presenting from birth to adolescence.


  Case Report Top


A 34-year-old male patient presented with an asymptomatic raised lesion over the scalp that was present since birth and had been increasing in size over the past 3 years [Figure 1]. There was no history of pain, itching or oozing from the lesion.
Figure 1: Solitary erythematous plaque showing hyperpigmentation

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On examination, there was a well-defined solitary erythematous plaque with hyperpigmentation and blanching was absent. Provisional diagnosis of nevus sebaceous was carried out due to the site, age of appearance and non-blanchability. Histopathological examination of the biopsy specimen showed numerous dilated and congested vascular spaces lined by flattened endothelial cells at the dermis and these features are suggestive of cavernous hemangioma [Figure 2]a and b.
Figure 2: Histopathology shows numerous dilated and congested vascular spaces lined by flattened endothelial cells at the dermis. (a) H and E, 10, (b) H and E, 40

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  Discussion Top


The subject of vascular malformations remains shrouded in mystery and confusion resulting from a lack of understanding of the nature of the pathology compounded by the confusing nomenclature still associated with these lesions. For example, the term "hemangioma" has been used to describe a variety of vascular lesions with different etiologies and natural histories. Names utilizing a mixture of descriptive and histologic terms, such as "strawberry angioma", "nevus flammus", or "cavernous hemangioma" still abound in current medical usage. [2]

VMs, often incorrectly termed cavernous hemangiomas are low-pressure, low-flow malformations. They are present at birth, although, not always visible at that stage, and undergo slow growth commensurate with the growth of the child. [3],[4] They are usually located in skin and mucosal membranes, but any organ can be affected. [5] They are composed of dilated, serpiginous vascular channels.

VMs are usually sporadic and solitary, but they can also be familial and typically are multifocal. Sudden enlargement can occur after trauma, hemorrhage, surgery, or with hormonal changes. VMs can become painful due to the development of thrombophlebitis or in cases with muscular or articular involvement. Calcified phleboliths may be present in the lesions. The pathogenesis of sporadic vascular malformation is unknown. However, identification of the defective gene for inherited VM could help to understand the cause.

VMs may be associated with other anomalies as a component of several complex syndromes such as: (i) Blue Rubber Bleb Nevus syndrome or Bean syndrome; (ii) Maffucci's syndrome; (iii) Klippel-Trenaunay syndrome; or (iv) Gorham's syndrome (Gorham-Stout syndrome).

Vikkula et al. conclude in their study that VM is caused by a mutation in the Tie-2 receptor tyrosine kinase and that Tie-2 signaling pathway is critical for endothelial cell-smooth muscle cell communication in venous morphogenesis. [6]

As many VMs are asymptomatic no treatment other than reassurance may be necessary in many cases. [2] Complications include bleeding, ulceration, thrombosis, infection and cosmetic disfigurement. These require treatment based on their site and size: Compression, embolization, surgery or abstention. [7] Rapidly progressing lesions demand pathological evaluation to rule out malignancy and excision is considered on a case-by-case basis.

 
  References Top

1.Resnick D, Kyriakos M, Greenway GD. Tumors and tumor-like lesions of soft tissues. In: Resnick D, Kransdorf NJ, editors. Bone and Joint Imaging. 3 rd ed. USA: Elsevier Saunders; 2005. p. 1219-20.  Back to cited text no. 1
    
2.Duncan IC, Fourie PA. Vascular Malformations Part 2-current classification of vascular malformations. SA J Radiol 2004;8:23-30.  Back to cited text no. 2
    
3.Mulliken JB, Glowacki J. Hemangiomas and vascular malformations in infants and children: A classification based on endothelial characteristics. Plast Reconstr Surg 1982;69:412-20.  Back to cited text no. 3
    
4.Dubois J, Garel L. Practical aspects of intervention in vascular anomalies in children. Semin Intervent Radiol 2002;19:73-87.  Back to cited text no. 4
    
5.Mulliken JB, Young AE. Vascular birthmarks. In: Mulliken JB, Young AE, editors. Hemangiomas and Malformations. Philadelphia: W.B. Saunders; 1988. p. 512-3.  Back to cited text no. 5
    
6.Vikkula M, Boon LM, Carraway KL 3 rd , Calvert JT, Diamonti AJ, Goumnerov B, et al. Vascular dysmorphogenesis caused by an activating mutation in the receptor tyrosine kinase TIE2. Cell 1996;87:1181-90.  Back to cited text no. 6
    
7.Lobato R, Martínez L, Leal N, Díaz M, Díez-Pascual R, Velasco B, et al. Hemangiomas and vascular malformations. Review and update. Cir Pediatr 1997;10:119-21.  Back to cited text no. 7
    


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