Case for Diagnosis
Asymptomatic Erythematous-Purpuric Plaque on the Forearm
Placa eritematopurpúrica asintomática en antebrazo
F.J. Torres Gómez
, P. Fernández Machín, J. Neila Iglesias
Corresponding author
Unidad de Anatomía Patológica, Agencia Sanitaria Bajo Guadalquivir, Hospital de Alta Resolución de Utrera, Utrera, Sevilla, Spain
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Torres Gómez, P. Fernández Machín, J. Neila Iglesias" "autores" => array:3 [ 0 => array:4 [ "nombre" => "F.J." "apellidos" => "Torres Gómez" "email" => array:1 [ 0 => "javiertorresgomez@yahoo.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Fernández Machín" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Neila Iglesias" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Anatomía Patológica, Agencia Sanitaria Bajo Guadalquivir, Hospital de Alta Resolución de Utrera, Utrera, Sevilla, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Placa eritematopurpúrica asintomática en antebrazo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 501 "Ancho" => 667 "Tamanyo" => 136358 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×100.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Clinical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">The patient was an asymptomatic 58-year-old woman with no history of interest who consulted for an erythematous-purpuric plaque measuring 2<span class="elsevierStyleHsp" style=""></span>cm at its maximum diameter on the right forearm that had appeared 4 months previously.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed an erythematous-purpuric plaque with a rough surface, elastic consistency, and slightly irregular borders on the extensor aspect of the right forearm (<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">Examination of a biopsy specimen from the center of the lesion revealed an epidermis with no significant histologic abnormalities and hyperpigmentation in the stratum basale. Below the epidermis, a fibrous band of superficial dermis acted as a border against a proliferation of small-caliber venous vessels running parallel to the epidermis that occupied the upper third of the reticular dermis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The vessels had oval lumina (some of which were collapsed) covered by a simple endothelium without atypia, mitotic figures, or intraluminal projections. The dermis surrounding the vessels showed intense elastotic degeneration, and the elastic fibers took the form of irregular arabesques with pointed ends (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The adnexa were displaced by the vascular proliferation. All the vessels stained positive for the immunohistochemical marker CD34, thus facilitating visualization of some vascular walls, which were slightly collapsed, with respect to the degenerated elastic fibers.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What Is Your Diagnosis?</span></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Acquired elastotic hemangioma.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Clinical Course and Treatment</span><p id="par0030" class="elsevierStylePara elsevierViewall">The lesion was removed by simple excision, with no signs of recurrence at 1 year.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Comment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Acquired elastotic hemangioma was first reported by Requena et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> in 2002. This benign acquired vascular lesion grows in the form of a plaque that is not always angiomatous in appearance. Consequently, clinical opinions on the lesion are somewhat heterogeneous. Given the clinical characteristics of the lesion in the case we report, the various diagnoses proposed included neutrophilic dermatosis and granuloma annulare, although the lesion was angiomatous in appearance, thus indicating the possibility of Kaposi sarcoma or another type of hemangioma.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The lesion is found mainly on photoexposed areas and is composed of a proliferation of small-caliber vessels arranged in the form of a band running parallel to the epidermis, from which it is separated by a homogeneous collagen band. The vessels, whose lumina may be open or collapsed, can present a prominent endothelium, without atypia, mitosis, or intraluminal projections.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2–5</span></a> The dermis always shows intense actinic damage, and elastic fibers twisted in the form of arabesques are common. The vessels stain positive for endothelial markers such as CD34 and CD31. Positivity for podoplanin indicates that the vessels are lymphatic in origin, although in the case we report, there were, at least focally, vascular structures whose morphology was compatible with venous vessels (consistent with the observations of Tong and Beer<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a>).</p><p id="par0045" class="elsevierStylePara elsevierViewall">Once the vascular nature of the lesion has been confirmed, a differential diagnosis should be made with other conditions characterized by proliferation of small vessels. Histopathology rules out Kaposi sarcoma and other spindle-cell vascular tumors. In clinical terms, the lesion is not compatible with cherry hemangioma or hobnail hemangioma.</p><p id="par0050" class="elsevierStylePara elsevierViewall">There continues to be some debate as to whether the lesion is hyperplastic or neoplastic, and the low number of cases reported in the literature contributes to this situation.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The treatment of choice is simple excision, with no relapses reported to date.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of Interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Clinical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical Course and Treatment" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 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: Torres Gómez FJ, Fernández Machín P, Neila Iglesias J. Placa eritematopurpúrica asintomática en antebrazo. Actas Dermosifiliogr. 2016;107:771–772.</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" => 501 "Ancho" => 667 "Tamanyo" => 79231 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 502 "Ancho" => 667 "Tamanyo" => 140599 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×40.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 501 "Ancho" => 667 "Tamanyo" => 136358 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×100.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acquired elastotic hemangioma: A clinicopathologic variant of hemangioma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. 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Sangueza" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-0560.2009.01361.x" "Revista" => array:6 [ "tituloSerie" => "J Cutan Pathol" "fecha" => "2010" "volumen" => "37" "paginaInicial" => "460" "paginaFinal" => "464" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19615005" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acquired elastotic hemangioma: Ten cases with immunohistochemistry refuting a lymphatic origin in most lesions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. Tong" 1 => "T.W. Beer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Cut Pathol" "fecha" => "2010" "volumen" => "37" "paginaInicial" => "1259" "paginaFinal" => "1260" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010700000009/v1_201611010039/S1578219016302165/v1_201611010039/en/main.assets" "Apartado" => array:4 [ "identificador" => "6154" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case for Diagnosis" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010700000009/v1_201611010039/S1578219016302165/v1_201611010039/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016302165?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 16 | 22 |
| 2024 October | 68 | 51 | 119 |
| 2024 September | 83 | 32 | 115 |
| 2024 August | 87 | 56 | 143 |
| 2024 July | 66 | 44 | 110 |
| 2024 June | 68 | 37 | 105 |
| 2024 May | 62 | 36 | 98 |
| 2024 April | 58 | 21 | 79 |
| 2024 March | 71 | 35 | 106 |
| 2024 February | 53 | 31 | 84 |
| 2024 January | 40 | 22 | 62 |
| 2023 December | 48 | 20 | 68 |
| 2023 November | 43 | 27 | 70 |
| 2023 October | 61 | 21 | 82 |
| 2023 September | 44 | 32 | 76 |
| 2023 August | 35 | 15 | 50 |
| 2023 July | 39 | 41 | 80 |
| 2023 June | 31 | 20 | 51 |
| 2023 May | 42 | 24 | 66 |
| 2023 April | 43 | 20 | 63 |
| 2023 March | 48 | 24 | 72 |
| 2023 February | 33 | 26 | 59 |
| 2023 January | 40 | 32 | 72 |
| 2022 December | 50 | 63 | 113 |
| 2022 November | 35 | 28 | 63 |
| 2022 October | 48 | 15 | 63 |
| 2022 September | 56 | 30 | 86 |
| 2022 August | 57 | 28 | 85 |
| 2022 July | 46 | 38 | 84 |
| 2022 June | 27 | 24 | 51 |
| 2022 May | 24 | 40 | 64 |
| 2022 April | 35 | 32 | 67 |
| 2022 March | 27 | 41 | 68 |
| 2022 February | 24 | 21 | 45 |
| 2022 January | 34 | 32 | 66 |
| 2021 December | 41 | 35 | 76 |
| 2021 November | 50 | 42 | 92 |
| 2021 October | 41 | 62 | 103 |
| 2021 September | 20 | 40 | 60 |
| 2021 August | 50 | 25 | 75 |
| 2021 July | 52 | 27 | 79 |
| 2021 June | 21 | 25 | 46 |
| 2021 May | 33 | 43 | 76 |
| 2021 April | 74 | 80 | 154 |
| 2021 March | 42 | 21 | 63 |
| 2021 February | 54 | 35 | 89 |
| 2021 January | 26 | 29 | 55 |
| 2020 December | 35 | 24 | 59 |
| 2020 November | 25 | 23 | 48 |
| 2020 October | 22 | 17 | 39 |
| 2020 September | 23 | 14 | 37 |
| 2020 August | 34 | 20 | 54 |
| 2020 July | 28 | 22 | 50 |
| 2020 June | 49 | 30 | 79 |
| 2020 May | 20 | 18 | 38 |
| 2020 April | 31 | 19 | 50 |
| 2020 March | 34 | 13 | 47 |
| 2020 February | 8 | 1 | 9 |
| 2020 January | 4 | 0 | 4 |
| 2019 December | 4 | 0 | 4 |
| 2019 November | 2 | 0 | 2 |
| 2019 September | 4 | 0 | 4 |
| 2019 August | 4 | 0 | 4 |
| 2019 July | 4 | 0 | 4 |
| 2019 June | 4 | 0 | 4 |
| 2019 May | 2 | 1 | 3 |
| 2019 April | 6 | 3 | 9 |
| 2019 February | 2 | 0 | 2 |
| 2019 January | 2 | 0 | 2 |
| 2018 November | 4 | 0 | 4 |
| 2018 October | 1 | 0 | 1 |
| 2018 September | 4 | 0 | 4 |
| 2018 February | 18 | 2 | 20 |
| 2018 January | 53 | 12 | 65 |
| 2017 December | 46 | 8 | 54 |
| 2017 November | 29 | 5 | 34 |
| 2017 October | 26 | 8 | 34 |
| 2017 September | 23 | 5 | 28 |
| 2017 August | 24 | 4 | 28 |
| 2017 July | 34 | 6 | 40 |
| 2017 June | 32 | 16 | 48 |
| 2017 May | 24 | 6 | 30 |
| 2017 April | 24 | 7 | 31 |
| 2017 March | 22 | 12 | 34 |
| 2017 February | 24 | 6 | 30 |
| 2017 January | 15 | 8 | 23 |
| 2016 December | 28 | 20 | 48 |
| 2016 November | 42 | 43 | 85 |
| 2016 October | 3 | 23 | 26 |
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