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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 70-year-old woman with no relevant past history who presented 2 lesions on the dorsum of the right hand that had appeared 6 months earlier&#46; The lesions were asymptomatic and had developed gradually&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed 2 violaceous papules located close together on the dorsum of the right hand and that measured 1<span class="elsevierStyleHsp" style=""></span>cm and 0&#46;5<span class="elsevierStyleHsp" style=""></span>cm in diameter &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The lesions had a smooth surface and firm consistency and were not tender to palpation&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">A punch biopsy was taken from 1 of the lesions&#46; Histology showed a normal epidermis&#44; but in the middle and deep dermis there was a disorganized proliferation of mature eccrine glands and ducts with interspersed mature adipocytes &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; In addition&#44; there were numerous vascular structures with walls of varying thickness that were positive for CD31 on immunohistochemistry &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What Is Your Diagnosis&#63;</span></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Eccrine angiomatous hamartoma</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical Course and Treatment</span><p id="par0030" class="elsevierStylePara elsevierViewall">As the lesions showed persistent growth&#44; they were excised&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Eccrine angiomatous hamartoma &#40;EAH&#41; is a rare benign skin tumor combining eccrine and vascular elements&#46; The first case was described by Lotzbeck in 1859&#44; but the term EAH was later proposed by Hyman in 1968&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">EAH typically appears in early childhood&#44; often in congenital form&#44; and during later stages of childhood or even puberty&#46; While infrequent&#44; there have been reports of onset in adults&#44; as in our patient&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Clinically the lesions are usually single&#44; though multiple lesions are observed&#44; and they typically arise on the limbs &#40;80&#37;&#41;&#44; although they have been described on other areas of the body&#46; Morphologically&#44; the lesions may consist of papules&#44; nodules&#44; or plaques that can be erythematous&#44; violaceous&#44; bluish&#44; yellowish&#44; or even skin colored&#46; Although EAH is normally asymptomatic&#44; the 2 most common symptoms are pain &#40;42&#37;&#41; and hyperhidrosis &#40;34&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Histopathology of EAH reveals a proliferation of mature eccrine glands in the middle and deep dermis in close association with dilated or collapsed angiomatous channels with thin&#44; clearly differentiated walls&#46; Some histopathologic variants also include pilar structures&#44; apocrine glands&#44; lipomatous foci&#44; lymph vessels&#44; and&#44; rarely&#44; bone&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The clinical differential diagnosis must include vascular malformations&#44; smooth muscle hamartoma&#44; juvenile xanthogranuloma&#44; glomus tumor&#44; tufted angioma&#44; blue rubber bleb nevus syndrome&#44; and macular telangiectatic mastocytosis&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The most relevant disorders in the histologic differential diagnosis are sudoriparous angioma&#44; which involves dilation rather than proliferation of the eccrine glands&#44; and eccrine nevus&#44; in which angiomatous proliferation is absent&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">As EAH is benign and occasionally presents spontaneous involution&#44; it does not require aggressive measures&#46; 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Journal Information
Vol. 103. Issue 9.
Pages 825-826 (November 2012)
Visits
7361
Vol. 103. Issue 9.
Pages 825-826 (November 2012)
Case for Diagnosis
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Violaceous Papules on the Dorsum of the Hand
Pápulas violáceas en el dorso de la mano
Visits
7361
B. García-Garcíaa,
Corresponding author
begarciagarcia@gmail.com

Corresponding author.
, L. Palacios-Garcíaa, B. Vivanco-Allendeb
a Servicio de Dermatología, Hospital Universitario Central de Asturias, Oviedo, Spain
b Servicio de Anatomía Patológica, Hospital Universitario Central de Asturias, Oviedo, Spain
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Medical History

We report the case of a 70-year-old woman with no relevant past history who presented 2 lesions on the dorsum of the right hand that had appeared 6 months earlier. The lesions were asymptomatic and had developed gradually.

Physical Examination

Physical examination revealed 2 violaceous papules located close together on the dorsum of the right hand and that measured 1cm and 0.5cm in diameter (Fig. 1). The lesions had a smooth surface and firm consistency and were not tender to palpation.

Figure 1
(0.12MB).
Histopathology

A punch biopsy was taken from 1 of the lesions. Histology showed a normal epidermis, but in the middle and deep dermis there was a disorganized proliferation of mature eccrine glands and ducts with interspersed mature adipocytes (Fig. 2). In addition, there were numerous vascular structures with walls of varying thickness that were positive for CD31 on immunohistochemistry (Fig. 3).

Figure 2.

Hematoxylin-eosin, original magnification×10.

(0.24MB).
Figure 3.

CD31 immunohistochemical staining, original magnification×10.

(0.17MB).

What Is Your Diagnosis?

Diagnosis

Eccrine angiomatous hamartoma

Clinical Course and Treatment

As the lesions showed persistent growth, they were excised.

Comment

Eccrine angiomatous hamartoma (EAH) is a rare benign skin tumor combining eccrine and vascular elements. The first case was described by Lotzbeck in 1859, but the term EAH was later proposed by Hyman in 1968.1

EAH typically appears in early childhood, often in congenital form, and during later stages of childhood or even puberty. While infrequent, there have been reports of onset in adults, as in our patient.2,3

Clinically the lesions are usually single, though multiple lesions are observed, and they typically arise on the limbs (80%), although they have been described on other areas of the body. Morphologically, the lesions may consist of papules, nodules, or plaques that can be erythematous, violaceous, bluish, yellowish, or even skin colored. Although EAH is normally asymptomatic, the 2 most common symptoms are pain (42%) and hyperhidrosis (34%).4

Histopathology of EAH reveals a proliferation of mature eccrine glands in the middle and deep dermis in close association with dilated or collapsed angiomatous channels with thin, clearly differentiated walls. Some histopathologic variants also include pilar structures, apocrine glands, lipomatous foci, lymph vessels, and, rarely, bone.5

The clinical differential diagnosis must include vascular malformations, smooth muscle hamartoma, juvenile xanthogranuloma, glomus tumor, tufted angioma, blue rubber bleb nevus syndrome, and macular telangiectatic mastocytosis.4 The most relevant disorders in the histologic differential diagnosis are sudoriparous angioma, which involves dilation rather than proliferation of the eccrine glands, and eccrine nevus, in which angiomatous proliferation is absent.6

As EAH is benign and occasionally presents spontaneous involution, it does not require aggressive measures. However, in patients with painful lesions or cosmetic concerns, surgical excision is the only definitive treatment.

References
[1]
A.B. Hyman, H. Harris, M.H. Brownstein.
Eccrine angiomatous hamartoma.
N Y State J Med, 68 (1968), pp. 2803-2806
[2]
E. Jeong, H.J. Park, S.T. Oh, J.Y. Lee, B.K. Cho.
Late-onset eccrine angiomatous hamartoma on the forehead.
Int J Dermatol, 45 (2006), pp. 598-599
[3]
A. Batalla, E. Rosón, A. Flórez, A. Troncoso, C. de la Torre.
Hamartoma angiomatoso ecrino: presentación de dos casos.
Actas Dermosifiliogr, 102 (2011), pp. 289-292
[4]
M.T. Pelle, H.B. Pride, W.B. Tyler.
Eccrine angiomatous hamartoma.
J Am Acad Dermatol, 47 (2002), pp. 429-435
[5]
R.L. Sulica, G.F. Kao, V.I. Sulica, N.S. Penneys.
Eccrine angiomatous hamartoma (nevus): immunohistochemical findings and review of the literature.
J Cutan Pathol, 21 (1994), pp. 71-75
[6]
P.T. Martinelli, J.A. Tschen.
Eccrine angiomatous hamartoma: a case report and review of the literature.
Cutis, 71 (2003), pp. 449-455

Please cite this article as: García-García B, et al. Pápulas violáceas en el dorso de la mano. Actas Dermosifiliogr. 2012;103:825-6.

Copyright © 2011. Elsevier España, S.L. and AEDV
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