Indian Journal of Dermatology
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E-IJD CASE REPORT
Year : 2015  |  Volume : 60  |  Issue : 4  |  Page : 423
Vascular tumor on the forehead of an HIV patient


1 Department of Dermatology, La Paz Hospital, Madrid, Spain
2 Department of Anatomopathology, La Paz Hospital, Madrid, Spain

Date of Web Publication10-Jul-2015

Correspondence Address:
Dr. Ander Mayor Ibarguren
Department of Dermatology, La Paz Hospital, Madrid,
Spain
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.160536

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   Abstract 

Cirsoid aneurysm is a small vascular proliferation characterized by small to medium-sized channels with features of arteries and veins, that present as small, blue or red asymptomatic papule. We report a case of a crisoid aneurysm on the forhead of an HIV patient that suggested a Kaposi sarcoma as a differential diagnosis.


Keywords: Arteriovenous hemangioma, cirsoid aneurysm, Kaposi′s sarcoma


How to cite this article:
Ibarguren AM, Ramos JG, Merino MB, Pedrero RM, Fernández CG, Pinto PH. Vascular tumor on the forehead of an HIV patient. Indian J Dermatol 2015;60:423

How to cite this URL:
Ibarguren AM, Ramos JG, Merino MB, Pedrero RM, Fernández CG, Pinto PH. Vascular tumor on the forehead of an HIV patient. Indian J Dermatol [serial online] 2015 [cited 2019 Sep 24];60:423. Available from: http://www.e-ijd.org/text.asp?2015/60/4/423/160536

What was known?
Arteriovenous hemangioma is a benign cutaneous vessel proliferation that presents as a red papule that can mimic other vascular tumors.


Arteriovenous hemangioma or cirsoid aneurism is a benign tumor that appears usually in middle-aged adults as a lonely red or bluish papule on the face or acral locations. We report the case of a 44-year-old male with a history of HIV infection presenting with an angiomatous tumor in the frontal region. The lesion remained stable and asymptomatic since the onset a few months ago. The patient was diagnosed with HIV infection 14 years ago and had a history of primary syphilis, which was treated properly. Since then, the patient has remained asymptomatic with no opportunistic infections and a good immunological situation thanks to antiretroviral treatment (HIV viral load: 73 copies/ml, CD4 lymphocyte count: 576/μl. Recent serology studies were negative for HBV and HCV. On physical examination, he showed a solid tumor located in the frontal region [Figure 1], with a smooth surface, elastic consistency, non-pulsatile and asymptomatic upon palpation. The characteristics of the lesion, its location and the patient's medical history obligated ruling out HIV-related Kaposi's sarcoma versus other vascular lesions. Given the small size of the lesion, informed consent was given and the lesion was extirpated.
Figure 1: Solid red tumoration of 1 ¡¿ 0.5 cm, located the forehead. Note the vascular appearance of the lesion

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Pathology studies revealed vascular proliferation in the superficial dermis [Figure 2] with a thick-walled vessels predominating with a well-developed muscular layer [Figure 3]. Some smaller vessels and a thinner wall were observed in the periphery. These findings were compatible with cirsoid aneurism. Biberstein and Jessner first described arteriovenous hemangioma, also known as acral arteriovenous tumor, in 1956 under the name cirsoid aneurysm due to the spiral vessel that ascends toward the lesion from the hypodermis. [1] It is classified as a benign acquired neoplasm derived from capillaries and venules with endothelial differentiation. It usually presents in adulthood as a skin-colored papule that is erythematous or blue in color, located in the facial region, oral mucosa, posterior region of the neck and acral zones. The arteriovenous hemangioma is usually around 0.5 cm in size and solitary. However, multiple lesions have been observed and they usually present in groups. [2] The histopathology is characteristic, consisting of a proliferation of vessels in the dermis with a thick muscular wall intercalated with smaller arteriole-like vessels lacking an internal elastic layer. For this reason they are believed to derive from ectatic venules. Arteriovenous shunts in a single histological slice are uncommon. The absence of vascular gap junctions, fusiform cells, accompanying plasma cell infiltrates or changes in the availability of collagen fibers allow for the differential diagnosis of Kaposi's sarcoma.
Figure 2: A biopsy of the lesion shows a vascular proliferation predominately on the upper dermis (H and E stain, ¡¿20)

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Figure 3: A closer view reveals that the lesion is composed of unusual thick vessels for this localization, showing a well developed muscular layer. All around there are some smaller vessels (H and E stain, ¡¿10)

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This lesion has been described associated with HCV liver disease, [3] epidermal nevus syndrome and other hamartomas and vascular malformations. The clinical differential diagnosis primarily includes other vascular malformations such as spider nevus and occasionally other cutaneous lesions such as annular granuloma and basal cell carcinoma. [4]

AIDS-related Kaposi's Sarcoma is considered unlikely in seropositive patients with a good immunological situation such as our patient. Nevertheless, we propose that arteriovenous hemangioma should be ruled out when faced with any cutaneous lesion with an angiomatous appearance within the context of HIV infection, as should other benign vascular lesions.



 
   References Top

1.
Biberstein HH, Jessner M. A cirsoid aneurysm in the skin; A case report. Dermatologica 1956;113:129-41.  Back to cited text no. 1
    
2.
Requena L, Sangueza OP. Cutaneous vascular proliferation. Part II. Hyperplasias and benign neoplasms. J Am Acad Dermatol 1997;37:887-922.  Back to cited text no. 2
    
3.
Montalli VA, Martinez EF, Thomaz LA, Furuse C, de Araújo VC. Oral arteriovenous hemangioma in patient with hepatitis C. J Cutan Pathol 2012;39:471-3.  Back to cited text no. 3
    
4.
Franco GN, de Peña J, Ramírez MV, del Carmen Cruz Pérez DM. Hemangioma arteriovenoso. Comunicación de un caso. Dermatología Rev Mex 2010;54:159-62.  Back to cited text no. 4
    

What is new?
We report a case of an arteriovenous hemangioma on a patient with HIV infection. This type of vascular tumor might present as a differential diagnosis of Kaposi′s Sarcoma.


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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