A Rare Case of Arteriovenous Hemangioma Clinically Mimicking Pigmented Nevus

Abstract

Abstrak Arteriovenous hemangioma (AH) adalah lesi jinak pembuluh darah kulit yang jarang, biasanya muncul pada kulit wajah berupa lesi tunggal, meninggi, papul merah, atau keunguan; kadang-kadang papul coklat. Dilaporkan satu kasus AH dengan gambaran klinis menyerupai nevus pada pasien perempuan yang berusia 19 tahun. Ini adalahkasus pertama di Bagian Ilmu Kesehatan Kulit dan Kelamin RS. Dr. M. Djamil Padang. Pasien datang dengan keluhan bintik hitam di lengan kanan bawah sejak satu bulan lalu. Pada pemeriksaan fisik, terdapat papul hitam soliter, dengan ukuran 0,3 x 0, 4 mm, bentuk bulat, skuama halus, berbatas tegas, pinggir reguler dengan permukaan tidak rata.Berdasarkan pemeriksaan histopatologi, lesi terdiri dari pembuluh darah yang berdinding tebal dan berdinding tipis yang sangat melebar, penuh dengan eritrosit dan dilapisi oleh selapis endotel yang sesuai untuk AH. Arteriovenous hemangioma adalah tumor yang dijumpai pada usia pertengahan hingga dewasa lanjut dengan puncak insiden pada dekade keempat dan kelima kehidupan. Pada kasus ini, umur pasien tergolong dewasa muda dengan gambaran klinis lesi menyerupai nevus pigmentosus. Kata kunci: arteriovenous hemangioma, kasus jarang, nevus pigmentosus Abstract Arteriovenous hemangioma (AH) is a rare benign vascular skin lesion, which typically appears in the skin of the face and extremities and most commonly occurring on the head and neck region with appearances as single, raised, red, or violaceous papules; sometime tan papule. A case of AH clinically mimicking pigmented nevus in 19year-old womanwas reported. This is the first case in Dermatology Department of Dr.M. Djamil Padang Hospital. She complained about a black pimple on the right lower arm since one month. Physical examination: there is a solitare black papule, with 0,3x0,4 mm, round shape, fine scales, well defined, regular border with irreguler surface.Histopathology findings: the lesions consist of thicked-walled and very dilated thin-walled vessels that full-filled with erythrocytes and are lined by an endothelial layer that suitable for AH. Arteriovenous hemangioma is a tumor of middle-age to elderly adults with a peak incidence in the fourth and fifth decades of life. In this case, the patient was young adult and clinically the lesion mimicking pigmented nevus.Keywords: arteriovenous hemangioma, rare case, pigmented nevus

Acquired arteriovenous hemangioma on the nose of a middle‐aged man: A case report

“…It was the first case of arteriovenous hemangioma with this clinical picture. 2 Akiyama et al reported four cases of arteriovenous hemangioma in patients with chronic liver disease and suggested the possible association of chronic liver dysfunction with the occurrence of arteriovenous hemangioma. 7 The case presented in this article is a 53-year-old man who presented with a skin colored, 1 × 1.3 cm nodular lesion on his nose for 15 years.…”

“…Arteriovenous hemangioma is a benign vascular lesion which can be either congenital or acquired. Although the etiology is unknown, trauma, inflammation, and chronic irritation may be its predisposing factors 2,4 . Clinically it is a red or violaceous papule which is frequently asymptomatic but pruritus, pain and enlargement may be seen in some patients 2 .…”

“…Although the etiology is unknown, trauma, inflammation, and chronic irritation may be its predisposing factors 2,4 . Clinically it is a red or violaceous papule which is frequently asymptomatic but pruritus, pain and enlargement may be seen in some patients 2 . It mostly occurs in the fourth and fifth decade of life with no sex predilection 2,6 .…”

“…Enzinger and Weiss, classified hemangiomas into capillary, cavernous, and miscellaneous forms like verrucous, venous and, arteriovenous hemangiomas. Arteriovenous hemangioma was first reported by Biberstein and Jessner but later, Enzinger and Weiss divided it into superficial and deep 2,3 . Superficial arteriovenous hemangiomas most commonly develop in the head and neck region, including the lips, the oral cavity, the perioral skin, the nasal cavity, and the eyelids 4,5 .…”

“…2 It mostly occurs in the fourth and fifth decade of life with no sex predilection. 2,6 In histology it is composed of thick-walled and thin-walled blood vessels distributed in superficial and mid dermis. 6 In this article we describe an acquired form of arteriovenous hemangioma on the nose of a middle-aged man.…”