Adult-Onset Tufted Angiomas Associated With an Arteriovenous Malformation in a Renal Transplant Recipient

Abstract

Tufted angioma (TA) is a rare benign vascular neoplasm characterized histopathologically by the proliferation of endothelial cells arranged in lobules in the dermis and subcutaneous fat. To date, about 200 cases have been reported, most of which are of Japanese ethnicity. TA predominantly affects children and young adults, developing in 80% of patients younger than 10 years. A white 72-year-old renal transplant recipient presented with 2 asymptomatic dusky red papules on his right leg. The lesions appeared 5 years after the start of immunosuppressive treatment. Histopathologic examination showed a proliferation of poorly canalized capillary-sized vascular structures with typical "cannonball" pattern in the dermis and subcutaneous fat. Eccrine glands were also evident focally in the stroma of capillary lobules. On immunohistochemistry, endothelial cells in the vascular tufts stained positive for CD31 and CD34 but were negative for factor VIII-related antigen, human herpes virus 8, and podoplanin (clone D2-40); α-smooth muscle actin stained pericytes disposed in a single layer in capillary-sized vessels and in 2-3 or more layers in vessels of larger size, respectively. The microscopic findings were suggestive of TA. In the deep dermis, venules with smooth muscle wall and arterioles, as shown by Van Gieson staining, normally not found at that level, were present and appeared surrounded by capillary lobules. Onset of TA in adulthood is rare and may be associated with pregnancy, varicella zoster virus infection, and pharmacological immunosuppression. A case of acquired adult-onset TA associated with an arteriovenous malformation in an elderly transplanted patient is described.

Violaceous annular plaques on the abdomen in a middle‐aged woman

“…Tufted angioma is a benign cutaneous vascular tumor that may be congenital or present in infancy and early childhood. Onset in adulthood is uncommon, with less than 10% of cases developing after 5th decade and associated with pregnancy, immunosuppression, and varicella zoster virus infection 1 . The clinical presentation is diverse, most often being a solitary dusky red to purplish ill‐defined indurated plaque on the neck, upper trunk, or proximal limbs.…”

“…Onset in adulthood is uncommon, with less than 10% of cases developing after 5th decade and associated with pregnancy, immunosuppression, and varicella zoster virus infection. 1 The clinical presentation is diverse, most often being a solitary dusky red to purplish ill-defined indurated plaque on the neck, upper trunk, or proximal limbs. Lesions are usually asymptomatic or sometimes painful and may be associated with hypertrichosis and hyperhidrosis.…”

Virome Analysis Reveals No Association of Head and Neck Vascular Anomalies with an Active Viral Infection

“…In addition, CMV infection was found to inhibit lymphangiogenesis and vascular remodeling in a human placenta model (25) and resulted in impaired vascular function in a mouse model (26). Interestingly, varicella zoster virus infection was suspected to play a role in the development of tufted angiomas at a higher age (27).…”