Masson Tumor of the Heel Fat Pad

Abstract

Intravascular papillary endothelial hyperplasia (Masson tumor) is an uncommon benign vascular lesion characterized by a reactive proliferation of endothelial cells. This lesion commonly occurs in the head, neck, and upper extremities. Although it can be found anywhere in the body, the lesion has never affected the heel fat pad. This report presents a rare case of Masson tumor of the heel fat pad to facilitate the recognition of this uncommon lesion and also suggests other conditions to be considered when diagnosing heel lesions.

Intravascular Papillary Endothelial Hyperplasia Involving the Hand: A Case Report of a Rare Entity

“…A significant histopathological feature of IPEH is the appearance of hyperplastic endothelial cells covering papillary structures, intravascularly. A close association with the organizing thrombus contributes to the diagnosis [10]. Our case showed features consistent with these.…”

“…The pathophysiology of IPEH is not well understood, but the majority of current research suggests that it is caused by endothelial cells proliferating in blood vessels in response to post-traumatic thrombus formation, which is also linked to the organization and recanalization of thrombi. The order in which the disease advances is still debatable though; the primary process is either endothelial proliferation with subsequent thrombus development or the thrombus appears first and forges papillary proliferation [10].…”

“…The three differentiable IPEH subtypes are: (1) the primary type (56%) originates in dilated vascular spaces and presents with a small subcutaneous mass, frequently in fingers; (2) the secondary type (40%) develops in an antecedent vascular lesion like pyogenic granulomas, hemangiomas, or vascular malformations; and (3) the extravascular type (4%) evolves from a pre-existing hematoma, and these lesions are larger than the other-type lesions [10]. In our case, the lesion developed within a dilated vascular space, which is consistent with the primary subtype of IPEH.…”

“…The lesion frequently presents in the third and fourth decades of life with a predilection to females [10]. It often manifests as a small subcutaneous lump that may or may not be painful; the overlying skin may also become blue or reddish in color [10].…”

“…Other benign and malignant vascular tumors, such as glomus tumor, glomerulovenous hemangioma, venous lake, blue nevus, neurogenic tumor, and angiosarcoma, should be distinguished from IPEH [10]. Despite IPEH's benign nature, it is important to have an accurate histopathological diagnosis based on its similarity with angiosarcoma, a tumor of the blood vessels.…”