Diffuse Dermal Angiomatosis of the Breast

Abstract

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.

Diffuse dermal angiomatosis of the breast: Clinicopathologic study of 5 patients

“…2 Since it was first described in 1994 by Krell et al, 3 only 14 cases have been reported worldwide in the medical literature. 1,2,[4][5][6][7][8][9][10][11][12] The clinical presentation of patients varies, with skin conditions ranging from erythematous to violaceous patches and indurated plaques that may ulcerate; these are usually quite tender. Characteristic histopathologic findings include diffuse extravascular benign endothelial cells throughout the dermis that are both CD31 1 and CD34 1 .…”

“…The extremities have been thought to be most commonly involved; however, we identified 5 cases involving the breasts that have been reported. 2,7,8,10,11 We present an additional 5 women with DDA of the breast and review the existing literature.…”

Cutaneous Reactive Angiomatosis with Combined Histological Pattern Mimicking a Cellulitis

“…CRA has often been described in association with many different systemic or local diseases such as rheumatoid arthritis, bacterial endocarditis, cryoproteinemia, lymphoproliferative disorders, peripheral atherosclerosis, or an arteriovenous shunt [10,11] (table 1). …”

Schüsselförmiges schmerzhaftes Ulkus der Bauchwand

“…Häufig wird zudem ein Nikotinabusus angegeben. Es wurden auch Fälle mit Lokalisation der Hautverän-derungen an der Brust beschrieben, für die lokale Ischämievorgänge infolge physikalischer Belastung der Haut durch eine Makromastie verantwortlich gemacht wurden [3]. In der Mehrzahl der Fälle kommt es zu einer raschen Remission der Hautverände-rungen nach Beseitigung der Ischämie, z.…”

“…Die publizierten Fälle einer diffusen dermalen Angiomatose waren meist an den distalen Extremitäten lokalisiert und standen fast ausschließlich in Verbindung zu arteriovenösen Shunts bzw. arteriosklerotisch stenosierten und okkludierten Gefäßen [3]. Bisher wurde erst 1 Fall einer abdominal lokalisierten DDA beschrieben, bei dem weder arteriosklerotische noch gefäßstenosieren-de lokale Prozesse zugrunde lagen und eine mögliche Assoziation zu lokalen Immunglobulinablagerungen und zu einer monoklonalen Gammopathie gefunden wurde, sodass eine differenzialdiagnostische Abgrenzung zur reaktiven Angioendotheliomatose zu diskutieren wäre [5].…”