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Retiform Hemangioendothelioma Developed on the Site of an Earlier Cystic Lymphangioma in a Six-Year-Old Girl

Albertini, Anne-Fore MD; Brousse, Nicole MD, PhD; Bodemer, Christine MD, PhD; Calonje, Eduardo MD, PhD; Fraitag, Sylvie MD

The American Journal of Dermatopathology: October 2011 - Volume 33 - Issue 7 - p e84-e87
doi: 10.1097/DAD.0b013e31821b0a9f
Extraordinary Case Report

Retiform hemangioendothelioma (RH) is a rare low-grade malignancy angiosarcoma, with a high rate of local recurrence and a low metastatic risk. A 6 year-old girl with a large cervical cystic lymphangioma diagnosed by ultrasound and Doppler ultrasound, which showed a large multiloculated anechoic cyst with no flow. The lymphangioma was treated with injections of Picibanil (OK-432). The tumor regressed, but after a year, she developed a poorly limited infiltrated plaque spreading out regularly over her chest, back, and shoulder. The biopsy showed a poorly limited dermal and subcutaneous vascular proliferation composed of elongated arborising vessels lined with ovoid endothelial cells in a hobnail pattern. In addition, the deep part of the lesion showed typical features of a papillary intralymphatic angioendothelioma pattern (PILA) or Dabska tumor. The endothelial cells strongly expressed podoplanin (D2-40). A diagnosis of RH with focal areas of PILA was reached. The girl died 8 months after surgery of hypovolemic shock in a context of diffuse lymphangiomatosis with pulmonary localization. To our knowledge, RH has hardly ever been described in children. This entity exhibits a continuum with the PILA, sharing not only morphological and immunohistochemical similarities but also its ability to develop in a context of a vascular anomaly, particularly a lymphangioma. The role of Picibanil in the development of this tumor can be discussed.

From the *Department of Pathology, Necker-Enfants Malades Hospital, APHP, Université Paris Descartes, Paris, France; †Department of Dermatology, Necker-Enfants Malades Hospital, APHP, Université Paris Descartes, Paris, France; and ‡Department of Pathology, St Jones Institute, St Thomas Hospital, London, England.

The authors declare no conflicts of interest.

Reprints: Sylvie Fraitag, MD, Department of Pathology, Necker-Enfants Malades Hospital, APHP, Université Paris Descartes, 149 rue de Sèvres, 75015 Paris, France (e-mail: sylvie.fraitag@nck.aphp.fr).

Copyright © 2011 Wolters Kluwer Health, Inc. All rights reserved.