Intravascular papillary endothelial hyperplasia. Light and electron microscopic observations of a case

Abstract

CASE REPORTThe patient, a 33-year-old Caucasian male, initially presented at another hospital complaining of a mass in the anterior left leg which had been present for several years. There was no history of varicosities, pain, erythema, or antecedent trauma. The mass was opened, thought to be a hematoma, and evacuated without surgical pathological consultation. Over the next eight months the mass recurred and gradually increased in size.With the second presentation, physical examina- tion revealed a soft, nontender, pretibial mass of the left leg fixed to the tibia1 fascia approximately 10 cm below the knee. An incisional biopsy was performed, the diagnosis deferred, and outside consultation obtained. The patient was readmitted after several weeks for complete excision .of the mass. The physical examination was essentially unchanged. X-rays of the left leg including venography and arteriography were normal. A soft 4 x 5 cm mass was excised with adherent periosteum. MATERIALS AND METHODSTissues obtained from the incisional biopsy and the later excision were routinely examined and fixed in 10% neutral buffered formalin. Blocks were prepared for histopathology, and slides were stained with hematoxylin and eosin. Selected blocks were further examined with Wilder's reticulin stain, Verhoeff-van Gieson, aldehyde fuchsin alcian blue, Masson trichrome, phosphotungstic acid-hematoxylin (modified from Mallory), the Fraser-Lendrum stain, and Gomori's iron stain.Other tissue was minced and fixed in 5 % buffered glutaraldehyde. After a buffer rinse the tissue was osmicated, dehydrated, and embedded in plastic. Thick sections were cut on a Sorvall MT-1 Porter Blum microtome and stained with toluidine blue. Ultra-thin sections were cut with a diamond knife on a Sorvall MT-2 ultramicrotome, mounted on copper grids, and stained with lead citrate and uranyl acetate. These grids were examined with an Hitachi-12 electron microscope.

Intravascular papillary endothelial hyperplasia of the extremities: MR imaging findings with pathologic correlation

“…Intravascular papillary endothelial hyperplasia has been reported in previous studies [1,5] to comprise approximately 2-4% of the vascular tumors of the skin and soft tissue, and to have varying demographic features according to its sub-forms. The pure form of IPEH occurs most commonly on the fingers, followed by the head and neck, and the elbow to the hand; and it is exclusively found in the subcutis.…”

Intravascular Papillary Endothelial Hyperplasia of the Central Nervous System-Four Case Reports-

“…9,34) IPEH was originally regarded as neoplastic because of the histological similarity with hemangiosarcoma, but is currently believed to be an unusual form of intravascular organizing thrombi or a reactive process, although the exact histogenesis remains controversial. 3,5,10,13,18,33,35) Such endothelial proliferation was described as an unusual excessive reaction to the normal process of organization of a thrombus rather than a neoplasm in 1932. 16) However, some authors continue to consider IPEH as a true neoplasm.…”

“…12) The majority of these lesions are intimately associated with thromboembolic material. 1,2,[4][5][6]8,11,15,[17][18][19][20]22,[26][27][28][29][30]32,34,35,37,38,40) IPEH can generally be observed as an unusual pattern of organization of arterial and venous thrombi or a focal incidental microscopic finding in hemangioma rather than true neoplastic change. IPEH may be closely related to and probably is a peculiar form of organizing thrombi.…”

“…6,26) IPEH has since been described under many different names, including IPEH, intravascular angiomatosis, Masson's pseudoangiosarcoma, Masson's hemangioma, and Masson's vegetant intravascular hemangiendothelioma. 2,4,5,8,10,15,17,18,28,35,37,40) Today, the term IPEH is favored over the more traditional names 5,10,12,[17][18][19]22,28,34,36,37) because of the absence of assumptions about the pathogenesis of the lesion. 10,38) IPEH most commonly occurs in the skin and subcutaneous soft tissues, where it exhibits a benign clinical course, but has also occurred in the nasal cavity, pharynx, larynx, internal auditory canal, labyrinthine, heart valve, breast, digestive tract, liver, kidney, cervix, uterus, female urethra, and pelvic veins.…”

Intravascular Papillary Endothelial Hyperplasia Arising From the Upper Lip

“…It is characterized histologically by papillary fronds lined by proliferating endothelium 17) . IPEH in the oral area is relatively uncommon; it usually presents as a cutaneous lesion 2,3,9) . We report a relatively rare case of an IPEH in the upper lip.…”