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  • Controversy exists regarding the pathogenesis of intravascul

    2018-11-15

    Controversy exists regarding the pathogenesis of intravascular fasciitis. Pre-existing trauma, venous thrombosis formation, and viral infection-related myofibroblastic proliferation have all been implicated in the etiology of intravascular fasciitis. Amarjit et al reported intravascular fasciitis in a 16-week pregnant female, suggesting that the estrogen-related hormonal changes associated with pregnancy may be a contributing factor. There was no history of those events in our case. The reporting of similar cases will better define the epidemiology and pathogenesis of these extremely rare tumors. The clinical diagnosis of intravascular fasciitis is difficult, and surgical excision is usually required to obtain a definite answer. The major pathological differential diagnosis of intravascular fasciitis includes intravascular fibroangiomatous proliferations: Masson\'s tumor, angioleiomyoma, intravascular pyogenic granuloma, and intravascular myopericytoma. Masson\'s tumor, also known as intravascular papillary endothelial hyperplasia, is characterized by unusual endothelial proliferation in an organizing thrombus usually on the extremities. The histopathological features of Masson\'s tumor usually present with a mass of anastomosing vessel channels and a varying degree of intraluminal papillary projection. Angioleiomyoma, a relatively common neoplasm, usually presents as painful subcutaneous nodules on the lower legs of middle-aged women. It originates from the tunica media of a vessel wall and is composed of monomorphic mature smooth muscle cells that are distributed and intersected between numerous vascular channels. Intravascular pyogenic granuloma is characteristic of asymptomatic polypoid masses of angiomatous tissue, with typical lobular growth of the capillaries lined by flattened or rounded endothelial cells. It usually involves veins of the neck and upper extremities, and has a slight female predominance. Intravascular myopericytoma, a recently identified vascular tumor, is characterized by myoid-like spindle cells arranged in a concentric pattern around the blood vessels. In addition,immunohistochemical staining supports the notion that the proliferative spindle cells in intravascular fasciitis are of myofibroblastic differentiation by positive smooth muscle meclofenamate staining and negative CD31 expression, whereas CD31 markers are often observed in angiomyofibroblastic neoplasms. Due to rich cellularity and vascular invasion, intravascular fasciitis should also be differentiated from vascular leiomyosarcoma. Vascular leiomyosarcoma, a very rare malignant neoplasm, differentiates from the tunica media of the vessels. Compared with intravascular fasciitis, intravascular leiomyosarcoma is usually located in the large veins, e.g., the inferior vena cava or the external iliac vein, and presents with an ill-defined infiltrative pattern, significant cytological pleomorphism, and marked mitotic activity histologically. Cranial fasciitis should be considered in the differential diagnosis in our case, which presented lesions with nodular fasciitis-like histological features on the scalp. However, cranial fasciitis is a benign fibroblastic proliferation of the scalp that occurs almost exclusively in children younger than 6 years. Treatment is surgical excision and the general prognosis is good without a tendency for recurrence or hematogenous spread. Only rare cases of local recurrence following surgical excision have been reported.
    Introduction Tattooing has been practiced for thousands of years in many parts of the world and it is increasingly popular in today\'s society, particularly among the young people. Decorative tattooing involves the introduction of tattoo pigments into the dermis. Cutaneous reactions to tattoos are common and are generally due to the salts or metals in the pigments and may occur from weeks to years after the procedure. Welander first described reactions to tattoos in 1893. Different reactions to the different pigments in tattoos have been described, among which a reaction to mercury in red tattoo ink is the most well known. Various types of histopathologic patterns have been reported, including lichenoid, granulomatous, eczematous, and pseudolymphomatous reactions, most of which are confined to the areas of the tattoo. Generalized tissue reactions are infrequent, and only one case of spontaneous resolution of a granulomatous reaction to a cosmetic lip tattoo has been recorded. Herein, we present the case of a generalized lichenoid reaction to black tattoos that resolved spontaneously. Based on a review of the literature, we believe that this is the first case of such a finding.