Diffuse dermal angiomatosis of the breast: Response to isotretinoin

McLaughlin, Elizabeth R.; Morris, Robert J.; Weiss, Sharon W.; Arbiser, Jack L.

doi:10.1067/mjd.2001.116344

Cited by 46 publications

(56 citation statements)

References 19 publications

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“…Die erst kürzlich beschriebene diffuse dermale Angiomatose (DDA) weist histologisch ein auffallendes infiltrierendes kapilläres Wachstumsmuster auf, das aufgrund der fehlenden Lobulierung Bösartigkeit suggeriert [1,2,3,4,7]. Der Nachweis organoid strukturierter kapillärer Gefäße sowie das Fehlen atypischer Endothelien und atypischer endothelialer Mitosen sind Zeichen einer gutartigen vaskulären Neubildung.…”

Section: Schlüsselwörterunclassified

“…Gegenwär-tig wird die DDA als reaktive, ischämie-bedingte kapilläre Proliferation interpretiert. Typisch ist das klinische Bild mit schmerzhaften, oft zentral exulzerierten bräunlich lividen Plaques, die rasche Rückbildung aufweisen können [1,2,3,4,7]. Operative Wiederherstellung der arteriellen Durchblutung sowie eine die Gefäßneubildung unterdrückende Medikation (Glukokortikosteroide, Retinoide) zählen zu den therapeutischen Möglichkeiten [5].…”

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Diffuse dermale Angiomatose

et al. 2002

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Diffuse dermal angiomatosis (DDA) is a benign, acquired vascular proliferation characterized by painful, poorly circumscribed, livid-erythematous plaques with frequent central ulceration. The clinical features are reminiscent of reactive angioendotheliomatosis or embolia cutis medicamentosa. Histologically, a dense diffuse network of regular capillary vessels throughout the dermis is seen. Endothelial atypia, atypical mitoses or signs of vasculitis are missing. A 43-year-old woman developed a bizarre brownish-livid rapidly growing lesion of DDA 8 centimeters above a surgical scar, shortly after removal of 20 kilograms of fatty tissue from the lower abdominal wall. DDA regressed spontaneously within 12 weeks, and has not recurred over 4 years of follow-up.

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Diffuse dermale Angiomatose

et al. 2002

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“…2 Our patient had noted improvement with isotretinoin therapy, which was reported to be effective in 1 patient, possibly because of its antiangiogenesis effect. 5 After the blockage of the subclavian artery was identified and treated with percutaneous stent placement in our patient, her skin lesions resolved entirely.…”

Section: Commentmentioning

confidence: 99%

“…Thus far, 2 cases have been described that demonstrated typical histologic features of DDA. 4,5 However, both of the patients involved lacked a relevant medical history, including a history of a vaso-occlusive disease process. It is possible, as suggested by some authors, that both patients had traumatic ulcerations of fat-rich areas in their large pendulous breasts and that subsequent angiogenesis was responsible for a DDA-like histologic picture.…”

Section: Commentmentioning

confidence: 99%

“…[1][2][3][4][5][6][7] Involvement of the breast is rare, having been reported in only 2 patients. 4,5 Neither of these patients had a relevant medical history or a vaso-occlusive disorder, but both had large pendulous breasts. Although the 2 cases demonstrated histologic features that are typical of DDA, it has been suggested that they may have resulted from traumatic ulceration of fat-rich areas, with subsequent angiogenesis.…”

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Diffuse Dermal Angiomatosis of the Breast

2006

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Background: Diffuse dermal angiomatosis is rare and usually considered a variant of reactive angioendotheliomatosis. It generally involves the extremities of patients with severe vascular disease and other comorbidities. Two patients with breast involvement have been described; however, neither had a relevant medical history or a vaso-occlusive disorder, but both had large pendulous breasts, and 1 was positive for IgM anticardiolipin and antinuclear antibodies.Observations: A 53-year-old woman had a reticulated, erythematous plaque with superficial ulceration and underlying tender nodules on her left breast. She had a history of cardiovascular disease and was a heavy smoker. Biopsy of the lesion showed diffuse proliferation of additional endothelial cells and small bland vessels within the pap-illary and upper reticular dermis. Angiography showed almost complete occlusion of the subclavian artery proximally. Diffuse dermal angiomatosis was diagnosed. With isotretinoin therapy, the lesions improved. One month later, after percutaneous subclavian arterial revascularization, the lesion resolved completely. A literature review suggested that a history of heavy smoking, in addition to a history of vascular disease, may be important in the pathogenesis of diffuse dermal angiomatosis.Conclusions: Clinical acumen is crucial to diagnose diffuse angiomatosis of the breast. Appropriate treatment to alleviate hypoxia may improve the patient's condition.

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