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

Abstract

We report the MRI findings of three cases of intravascular papillary endothelial hyperplasia (IPEH) of the extremities with correlation of the pathologic findings. The IPEH is a non-neoplastic reactive lesion within the vessels and is commonly associated with thrombi. Signal intensity of the IPEH is complex due to the thrombi and the PEH itself. The thrombi are characterized by a slightly hyperintense signal on T1- and T2-weighted images compared with that of muscle when it comes at the medium stage of hemorrhage. Papillary endothelial hyperplastic tissue appears either as iso- or hyperintense to the muscle on T2- and T1-weighted images and shows variable enhancement on Gd-DTPA-enhanced images.

Intravascular papillary endothelial hyperplasia (Masson tumor) mimicking a sarcoma and developing from an arteriovenous hemodialysis fistula

“…A Medline Database search conducted in December 2013 using the terms "intravascular papillary endothelial hyperplasia," "MR imaging" and "extremities" identified 17 cases [7,12,[15][16][17]. With our case report, the number of cases in which MR imaging findings are described rose to 18.…”

“…It has varying demographic features according to its subtypes [7]. In its pure form IPEH occurs most commonly on the fingers, followed by the head and neck and the elbow.…”

“…The unenhancing, high T1WI signal foci and low T2WI signal foci correspond to thrombi and are hypoechoic on US. The peripheral/septal or central enhancing areas on gadolinium-enhanced T1W1 correspond to the hypertrophic papillary epithelium and a fibrovascular core, which are seen on US as hyperechoic septa and a central vascularized area [7,12].…”

Soft Tissue Masses Showing Low Signal Intensity on T2-weighted Images: Correlation with Pathologic Findings

“…Hyperintense region on T2WI corresponded to the ectatic blood-pool space in the hemangioma as well as to isointense central regions composed of thrombosis and endothelial papillary proliferative tissue (22). T2 sequences may show low SI areas reflecting thrombotic or hemorrhagic material and low signal internal septae have been described (23) (Fig.…”

Sonographic features of intravascular papillary endothelial hyperplasia (Masson's tumor) in the forearm

“…Since the lesion was first described by Masson in 1923, it has also been named ''vegetant intravascular hemangioendothelioma,'' ''intravascular angiomatosis,'' ''Masson's pseudoangiosarcoma,'' and ''Masson's tumor.'' 1,2 Although the lesion comprises 2-4% of vascular tumors of the skin and soft tissues, 3 reports of this entity are scarce in the imaging literature and only sporadic sonographic descriptions have been published. 2,4,5 We report a case of IPEH in an unusual location with a striking appearance on color Doppler sonography.…”