Indian Journal of Dermatology
E-IJD CASE REPORT
Year
: 2015  |  Volume : 60  |  Issue : 4  |  Page : 423-

Vascular tumor on the forehead of an HIV patient


Ander Mayor Ibarguren1, Jéssica González Ramos1, María Beato Merino2, Rocío Maseda Pedrero1, Cristina Gómez Fernández1, Pedro Herranz Pinto1,  
1 Department of Dermatology, La Paz Hospital, Madrid, Spain
2 Department of Anatomopathology, La Paz Hospital, Madrid, Spain

Correspondence Address:
Dr. Ander Mayor Ibarguren
Department of Dermatology, La Paz Hospital, Madrid,
Spain

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.



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;60:423-423


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 2021 Aug 1 ];60:423-423
Available from: https://www.e-ijd.org/text.asp?2015/60/4/423/160536


Full Text

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}

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}{Figure 3}

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

1Biberstein HH, Jessner M. A cirsoid aneurysm in the skin; A case report. Dermatologica 1956;113:129-41.
2Requena L, Sangueza OP. Cutaneous vascular proliferation. Part II. Hyperplasias and benign neoplasms. J Am Acad Dermatol 1997;37:887-922.
3Montalli 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.
4Franco GN, de Peña J, Ramírez MV, del Carmen Cruz Pérez DM. Hemangioma arteriovenoso. Comunicación de un caso. Dermatología Rev Mex 2010;54:159-62.