Case for Diagnosis
Erythematous Abdominal Papule
Pápula eritematosa abdominal
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"apellidos" => "Fúnez-Liébana" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Costa del Sol, Marbella, Málaga, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Costa del Sol, Marbella, Málaga, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pápula eritematosa abdominal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 732 "Ancho" => 976 "Tamanyo" => 271174 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×<span class="elsevierStyleHsp" style=""></span>200.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">The patient was a 35-year-old woman with no past history of interest. She consulted for a skin lesion that had arisen on the abdomen 8 months earlier. The lesion was asymptomatic and had not changed.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">An erythematous papule with a whitish halo, measuring 1<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>0.5<span class="elsevierStyleHsp" style=""></span>cm diameter, was observed on the left side of the abdomen (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">A biopsy of the lesion revealed a proliferation of uniform, small branching vessels in the dermis. The vessels had a collapsed appearance, with a very small lumen and prominent endothelial cells. No cell atypia or mitotic figures were observed. Immunohistochemistry for herpesvirus<span class="elsevierStyleHsp" style=""></span>8 was negative (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Additional Tests</span><p id="par0020" class="elsevierStylePara elsevierViewall">On dermoscopy the lesion showed diffuse central erythema with desquamation and a delicate peripheral pigment network (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis?</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Microvenular hemangioma.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Course and Treatment</span><p id="par0035" class="elsevierStylePara elsevierViewall">The excision biopsy performed at the first visit completely removed the lesion. No further treatment was required.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Microvenular hemangioma is a slow-growing, acquired benign vascular tumor that usually presents as a single erythematous papule, plaque, or nodule on the trunk or limbs of a young adult. The pathogenesis is unknown. The differential diagnosis includes benign (capillary hemangioma, pyogenic granuloma, and angioblastoma) and malignant (angiosarcoma and Kaposi sarcoma) vascular tumors and other lesions that present as erythematous-violaceous nodules, macules, or plaques that can resemble microvenular hemangioma. When multiple lesions are present, the differential diagnosis should include tumors and inflammatory lesions, such as eruptive dermatofibromas and leiomyomas, pityriasis lichenoides et varioliformis acuta, and drug eruption.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The definitive diagnosis is histological, with the finding of a proliferation of small dermal vessels formed of capillaries and venules, with no atypia.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Recent studies have described the immunohistochemistry of microvenular hemangioma, which is positive for WT1 (and angiogenesis marker) and negative for D2-40 (a marker of lymphatic differentiation), GLUT-1 (specific to infantile hemangioma), and HHV-8 (positive in Kaposi sarcoma).<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Although dermoscopy can reveal certain peculiarities, there are few published descriptions because of the low frequency of the disease. The first description was provided by Scalvenzi et al.,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> who reported diffuse erythema with multiple red globules of variably small size, and the presence of a fine peripheral pigment network. The red globules are defined as round structures, larger than dots.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Based on the dermoscopic findings, the differential diagnosis should include Kaposi sarcoma, which presents a classic rainbow pattern in its papular and nodular phases.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> However, early lesions can be similar to microvenular hemangioma, with a fine peripheral pigment network and a homogeneous pinkish-red color or a homogeneous structure with reddish-blue areas; globules, characteristic of microvenular hemangioma, have not been reported. In the present case we did not observe globules, further increasing the difficulty of differentiation from Kaposi sarcoma.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The presence of erythema or small vessels, particularly when associated with a multicomponent pattern, increases the possibility of vascular tumors and malignant lesions.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The dermoscopic findings were similar to those of a variant of dermatofibroma, with a peripheral network and a homogeneously erythematous central area. To date there have been no descriptions of cases of microvenular hemangioma that mimic dermatofibroma on dermoscopy.</p><p id="par0070" class="elsevierStylePara elsevierViewall">We have presented a case of microvenular hemangioma, a rare vascular tumor with dermoscopic features that can mimic other tumors and that must be included in the differential diagnosis of vascular tumors and of nonmelanocytic lesions with a pigment network.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Additional Tests" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Diagnosis" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Clinical Course and Treatment" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Comment" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Fernández-Morano T, Fernández-Canedo I, Fúnez-Liébana R. Pápula eritematosa abdominal. Actas Dermosifiliogr. 2016;107:62–63.</p>" ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 731 "Ancho" => 975 "Tamanyo" => 135483 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 732 "Ancho" => 976 "Tamanyo" => 271174 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×<span class="elsevierStyleHsp" style=""></span>200.</p>" ] ] 2 => array:6 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 732 "Ancho" => 976 "Tamanyo" => 58849 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Microvenular hemangioma: A clinicopathologic review of 13 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K.M. 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Balato" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000102038" "Revista" => array:6 [ "tituloSerie" => "Dermatology" "fecha" => "2007" "volumen" => "215" "paginaInicial" => "69" "paginaFinal" => "71" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17587844" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vascularización en dermatoscopia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.M. Martin" 1 => "R. Bella-Navarro" 2 => "E. Jordá" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2011.11.005" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2012" "volumen" => "103" "paginaInicial" => "357" "paginaFinal" => "375" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22463770" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermoscopic rainbow pattern in Kaposi's sarcoma lesions: Our experience" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Satta" 1 => "L. Fresi" 2 => "F. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 22 | 6 | 28 |
| 2024 October | 179 | 55 | 234 |
| 2024 September | 213 | 24 | 237 |
| 2024 August | 206 | 74 | 280 |
| 2024 July | 189 | 52 | 241 |
| 2024 June | 129 | 43 | 172 |
| 2024 May | 124 | 43 | 167 |
| 2024 April | 144 | 30 | 174 |
| 2024 March | 196 | 20 | 216 |
| 2024 February | 194 | 33 | 227 |
| 2024 January | 177 | 32 | 209 |
| 2023 December | 144 | 18 | 162 |
| 2023 November | 138 | 33 | 171 |
| 2023 October | 111 | 22 | 133 |
| 2023 September | 128 | 26 | 154 |
| 2023 August | 121 | 19 | 140 |
| 2023 July | 119 | 27 | 146 |
| 2023 June | 118 | 22 | 140 |
| 2023 May | 84 | 23 | 107 |
| 2023 April | 103 | 23 | 126 |
| 2023 March | 101 | 25 | 126 |
| 2023 February | 110 | 32 | 142 |
| 2023 January | 110 | 44 | 154 |
| 2022 December | 94 | 51 | 145 |
| 2022 November | 39 | 26 | 65 |
| 2022 October | 29 | 22 | 51 |
| 2022 September | 22 | 40 | 62 |
| 2022 August | 19 | 22 | 41 |
| 2022 July | 47 | 29 | 76 |
| 2022 June | 33 | 24 | 57 |
| 2022 May | 111 | 34 | 145 |
| 2022 April | 115 | 34 | 149 |
| 2022 March | 93 | 45 | 138 |
| 2022 February | 117 | 27 | 144 |
| 2022 January | 117 | 43 | 160 |
| 2021 December | 102 | 30 | 132 |
| 2021 November | 104 | 42 | 146 |
| 2021 October | 90 | 47 | 137 |
| 2021 September | 79 | 39 | 118 |
| 2021 August | 85 | 35 | 120 |
| 2021 July | 69 | 32 | 101 |
| 2021 June | 81 | 36 | 117 |
| 2021 May | 83 | 33 | 116 |
| 2021 April | 265 | 63 | 328 |
| 2021 March | 190 | 16 | 206 |
| 2021 February | 158 | 28 | 186 |
| 2021 January | 69 | 15 | 84 |
| 2020 December | 68 | 20 | 88 |
| 2020 November | 59 | 34 | 93 |
| 2020 October | 57 | 21 | 78 |
| 2020 September | 50 | 21 | 71 |
| 2020 August | 40 | 17 | 57 |
| 2020 July | 48 | 18 | 66 |
| 2020 June | 33 | 32 | 65 |
| 2020 May | 31 | 23 | 54 |
| 2020 April | 42 | 21 | 63 |
| 2020 March | 30 | 21 | 51 |
| 2020 February | 7 | 1 | 8 |
| 2020 January | 4 | 0 | 4 |
| 2019 December | 10 | 1 | 11 |
| 2019 November | 4 | 0 | 4 |
| 2019 October | 0 | 3 | 3 |
| 2019 September | 4 | 0 | 4 |
| 2019 August | 4 | 0 | 4 |
| 2019 July | 4 | 0 | 4 |
| 2019 June | 4 | 0 | 4 |
| 2019 May | 6 | 1 | 7 |
| 2019 April | 2 | 3 | 5 |
| 2019 March | 4 | 1 | 5 |
| 2019 January | 2 | 0 | 2 |
| 2018 December | 3 | 0 | 3 |
| 2018 November | 3 | 0 | 3 |
| 2018 October | 18 | 0 | 18 |
| 2018 September | 7 | 0 | 7 |
| 2018 June | 0 | 5 | 5 |
| 2018 May | 0 | 14 | 14 |
| 2018 April | 0 | 8 | 8 |
| 2018 March | 8 | 6 | 14 |
| 2018 February | 62 | 5 | 67 |
| 2018 January | 52 | 6 | 58 |
| 2017 December | 92 | 8 | 100 |
| 2017 November | 20 | 4 | 24 |
| 2017 October | 33 | 6 | 39 |
| 2017 September | 32 | 4 | 36 |
| 2017 August | 30 | 8 | 38 |
| 2017 July | 28 | 9 | 37 |
| 2017 June | 35 | 10 | 45 |
| 2017 May | 39 | 9 | 48 |
| 2017 April | 39 | 15 | 54 |
| 2017 March | 18 | 8 | 26 |
| 2017 February | 17 | 18 | 35 |
| 2017 January | 25 | 10 | 35 |
| 2016 December | 40 | 11 | 51 |
| 2016 November | 36 | 13 | 49 |
| 2016 October | 22 | 28 | 50 |
| 2016 September | 0 | 2 | 2 |
| 2016 August | 0 | 2 | 2 |
| 2016 July | 0 | 1 | 1 |
| 2016 June | 0 | 1 | 1 |
| 2016 May | 0 | 4 | 4 |
| 2016 April | 0 | 2 | 2 |
| 2016 March | 0 | 14 | 14 |
| 2016 February | 0 | 1 | 1 |
| 2016 January | 0 | 4 | 4 |
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