Denisa Kacerovska1,2, Francesca Portelli3, Michal Michal1,2, Dmitry V Kazakov1,2. 1. Sikl's Department of Pathology, Charles University in Prague, Medical Faculty in Pilsen, Pilsen, Czech Republic. 2. Bioptical Laboratory, Pilsen, Czech Republic. 3. Department for Health Promotion and Mother and Child's Care G. D'Alessandro, Section of Pathology, University of Palermo, Palermo, Italy.
Abstract
BACKGROUND: The so-called acquired elastotic hemangioma (AEH) represents a peculiar vascular lesion affecting the sun-damaged skin of the extensor surface of the forearms or the lateral aspect of the neck of middle-aged or elderly women. METHODS: This is a clinicopathological and immunohistochemical study of a series of 6 lesions located on the knee or elbow showing epithelial features of lichen simplex chronicus (LSC)/prurigo nodularis (PN) with a marked subepidermal vascular proliferation closely resembling AEH. RESULTS: Microscopically, all cases of cutaneous lesions showed epithelial features of LSC/PN, that is compact hyperkeratosis with focal parakeratosis, irregular acanthosis, prominent hypergranulosis. Moreover, a marked subepidermal vascular proliferation arranged in a horizontal band closely resembling AEH was detected in these lesions. Another common histopathological finding was eccrine duct squamous metaplasia and/or hyperplasia. CONCLUSIONS: While AEH represents a distinctive clinicopathological variant of hemangioma characteristically appearing on sun-exposed areas of middle-aged or elderly patients, the herein described lesions seem to be non-neoplastic epithelial, vascular and eccrine sweat duct reactive changes which are likely to be associated with chronic pressure or repeated mechanical stimulation with a marked predilection for the knee and elbow.
BACKGROUND: The so-called acquired elastotic hemangioma (AEH) represents a peculiar vascular lesion affecting the sun-damaged skin of the extensor surface of the forearms or the lateral aspect of the neck of middle-aged or elderly women. METHODS: This is a clinicopathological and immunohistochemical study of a series of 6 lesions located on the knee or elbow showing epithelial features of lichen simplex chronicus (LSC)/prurigo nodularis (PN) with a marked subepidermal vascular proliferation closely resembling AEH. RESULTS: Microscopically, all cases of cutaneous lesions showed epithelial features of LSC/PN, that is compact hyperkeratosis with focal parakeratosis, irregular acanthosis, prominent hypergranulosis. Moreover, a marked subepidermal vascular proliferation arranged in a horizontal band closely resembling AEH was detected in these lesions. Another common histopathological finding was eccrine duct squamous metaplasia and/or hyperplasia. CONCLUSIONS: While AEH represents a distinctive clinicopathological variant of hemangioma characteristically appearing on sun-exposed areas of middle-aged or elderly patients, the herein described lesions seem to be non-neoplastic epithelial, vascular and eccrine sweat duct reactive changes which are likely to be associated with chronic pressure or repeated mechanical stimulation with a marked predilection for the knee and elbow.