Practical Dermoscopy
Tumor arteriovenoso: pistas dermatoscópicas para su sospecha
Arteriovenous Tumor: Dermoscopic Clues
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Álvarez-Salafranca, V. Fuentelsaz" "autores" => array:2 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Álvarez-Salafranca" "email" => array:1 [ 0 => "marcialaspn@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "V." "apellidos" => "Fuentelsaz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Royo Villanova, Zaragoza, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] 1 => array:3 [ "autoresLista" => "C. Cebrián García" "autores" => array:1 [ 0 => array:3 [ "nombre" => "C." "apellidos" => "Cebrián García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Royo Villanova, Zaragoza, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Arteriovenous Tumor: Dermoscopic Clues" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 563 "Ancho" => 750 "Tamanyo" => 199989 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Well-circumscribed vascular proliferation in the dermis, with vessels covered with a single layer of endothelial cells. Some vessels have a thick fibromuscular wall, with no definitive presence of elastic lamina, whereas others have a thinner wall (hematoxylin-eosin, ×40).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Presentation</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 78-year-old man consulted for an asymptomatic cutaneous lesion on the external aspect of his left arm that had first appeared 7 months earlier. The lesion, which was firm and measured 15 mm in diameter, was papulonodular, dome-shaped, and erythematous-violaceous in color (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">What Is Your Diagnosis?</span><p id="par0010" class="elsevierStylePara elsevierViewall">Arteriovenous tumor.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Comment</span><p id="par0015" class="elsevierStylePara elsevierViewall">Polarized light dermoscopy revealed the presence of whitish structures, a slightly brown reticular pattern mainly on the periphery, and vascular structures (nonarborizing telangiectasias in areas with a glomerular appearance), all on an erythematous base (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A).</p><p id="par0020" class="elsevierStylePara elsevierViewall">Given the clinical and dermoscopic characteristics of the lesion, the differential diagnosis was made with a vascular lesion, including arteriovenous tumor, aneurysmal dermatofibroma, and hypomelanotic nodular melanoma. The lesion was removed completely (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Histopathology revealed a well-circumscribed—but not encapsulated—proliferation comprising aggregated vessels in the dermis covered by a single layer of endothelial cells without atypia. Some vessels had a thick fibromuscular wall, with no definitive elastic lamina, and others had a thinner wall.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Arteriovenous tumor, or acral arteriovenous tumor, is a benign vascular tumor that is clinically difficult to diagnose. It usually manifests as a solitary, asymptomatic lesion mainly at acral sites, such as the head and limbs.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It has been reported to appear on patch-like capillary malformations such as port wine stains.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Histopathologically, the lesion is a well-circumscribed proliferation in the papillary dermis composed of multiple vascular spaces with thick walls interspersed with other spaces with thin walls. It has been suggested that this is a hamartomatous proliferation of the subpapillary plexus.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">A recent study of 39 cases summarized the dermoscopic characteristics of these lesions. The dermoscopic pattern most commonly associated with arteriovenous tumor was nonarborizing telangiectasias on a reddish background (72% of cases) in the absence of the lacunae that are typical of other vascular tumors. Furthermore, whitish structures and a slightly pigmented peripheral network were detected in 49% and 18% of cases, respectively.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">While it is true that dermoscopy can reveal vascular structures in aneurysmal dermatofibroma, these are observed at the edge of the lesion, probably in association with blood vessels of the surrounding stroma. This type of tumor has irregular spaces filled with red cells, although they lack an endothelial layer and, therefore, are not seen as central telangiectasias in dermoscopy, but as homogeneous reddish or bluish areas.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In the case of hypomelanotic nodular melanoma, the relevant findings include a clearly atypical vascular pattern, mainly with irregular linear vessels and hairpin vessels, as well as milky red areas. In this context, pigment networks are unusual.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In conclusion, dermoscopy could prove to be a useful tool for the diagnosis of arteriovenous tumor. However, the definitive diagnosis of this type of lesion necessarily requires a histopathology work-up.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">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:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case Presentation" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "What Is Your Diagnosis?" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Comment" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of Interest" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-04-07" "fechaAceptado" => "2019-05-13" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Álvarez-Salafranca M, Fuentelsaz V, Cebrián García C. Tumor arteriovenoso: pistas dermatoscópicas para su sospecha. Actas Dermosifiliogr. 2021;112:359–360.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 533 "Ancho" => 1500 "Tamanyo" => 108651 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Firm erythematous-violaceous, papulonodular lesion on the external aspect of the left arm. B, Dermoscopic image showing whitish structures on an erythematous base, nonarborizing telangiectasias, vessels with a glomerular appearance, and a slight brown reticular pattern mainly on the periphery.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 563 "Ancho" => 750 "Tamanyo" => 199989 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Well-circumscribed vascular proliferation in the dermis, with vessels covered with a single layer of endothelial cells. Some vessels have a thick fibromuscular wall, with no definitive presence of elastic lamina, whereas others have a thinner wall (hematoxylin-eosin, ×40).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acral arteriovenous tumor. A clinicopathologic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.G. Connelly" 1 => "R.K. Winkelmann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00000478-198501000-00005" "Revista" => array:7 [ "tituloSerie" => "Am J Surg Pathol." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 9 | 15 |
| 2024 October | 59 | 52 | 111 |
| 2024 September | 73 | 22 | 95 |
| 2024 August | 93 | 67 | 160 |
| 2024 July | 76 | 36 | 112 |
| 2024 June | 72 | 44 | 116 |
| 2024 May | 66 | 33 | 99 |
| 2024 April | 52 | 32 | 84 |
| 2024 March | 60 | 29 | 89 |
| 2024 February | 46 | 27 | 73 |
| 2024 January | 41 | 27 | 68 |
| 2023 December | 49 | 16 | 65 |
| 2023 November | 70 | 26 | 96 |
| 2023 October | 58 | 20 | 78 |
| 2023 September | 45 | 29 | 74 |
| 2023 August | 37 | 13 | 50 |
| 2023 July | 60 | 35 | 95 |
| 2023 June | 58 | 20 | 78 |
| 2023 May | 61 | 19 | 80 |
| 2023 April | 51 | 19 | 70 |
| 2023 March | 89 | 37 | 126 |
| 2023 February | 41 | 26 | 67 |
| 2023 January | 56 | 39 | 95 |
| 2022 December | 51 | 40 | 91 |
| 2022 November | 34 | 26 | 60 |
| 2022 October | 32 | 20 | 52 |
| 2022 September | 22 | 38 | 60 |
| 2022 August | 23 | 40 | 63 |
| 2022 July | 38 | 42 | 80 |
| 2022 June | 40 | 23 | 63 |
| 2022 May | 30 | 45 | 75 |
| 2022 April | 32 | 30 | 62 |
| 2022 March | 44 | 57 | 101 |
| 2022 February | 27 | 34 | 61 |
| 2022 January | 34 | 45 | 79 |
| 2021 December | 33 | 39 | 72 |
| 2021 November | 39 | 42 | 81 |
| 2021 October | 83 | 66 | 149 |
| 2021 September | 55 | 53 | 108 |
| 2021 August | 60 | 43 | 103 |
| 2021 July | 41 | 29 | 70 |
| 2021 June | 34 | 53 | 87 |
| 2021 May | 38 | 72 | 110 |
| 2021 April | 86 | 88 | 174 |
| 2021 March | 32 | 33 | 65 |
| 2021 February | 20 | 11 | 31 |
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