Journal of Clinical and Aesthetic Dermatology

MAY 2018

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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45 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY May 2018 • Volume 11 • Number 5 C A S E R E P O R T the staining intensity for CD34 in the lymphatics is usually lower than in the endothelium of angiomatous vessels and is very weak when compared to D2-40. Histopathologically, the lymphangiomatous lesions on our patient were localized only in the papillary dermis, with focal hyperkeratosis present on some of them. These lesions were positive for D2-40, but not for CD34. Therefore, we concluded that these lesions were related to lymphatic system. The second type of lesion clinically appeared to be HA, AC, or VH. Angiokeratomas are asymptomatic, 2- to 5mm, dark-red to blue-black hyperkeratotic papules that can be localized or generalized. Angiokeratoma circumscriptum naeviforme is the least common localized form of angiokeratoma. These types of lesions are typically multiple, hyperkeratotic, papules or plaque-like lesions usually found unilaterally on the lower leg, foot, or buttock. 6,14 They are typically seen at birth. Sometimes, the lesions are initially present as multiple reddish macules, clinically resembling nevus flammeus, and then develop into plaques with a hyperkeratotic verrucous surface a few years later. 14 Histologically, thin-walled ectatic vessels in the superficial dermis with overlying epidermal hyperplasia are found. 6 Initially, the angiomatous lesions of our patient were similar to HA and AC clinically, yet the ectatic vessels were extended from the papillary dermis into the reticular dermis. Because of the deep angiomatous component, the diagnosis of AC was ruled out. In the review article by Popadic, 7 the author reports that VH, another rare, congenital keratotic hemangiomatous lesion, was first described by Imperial and Helwing in 1967. This lesion might appear at birth as a reddish FIGURE 2. A) Hematoxylin and eosin stain samples—mild acanthosis and mild focal hyperkeratosis in the epidermis and dilated vessels and a slight perivascular lymphocytic infiltration in the papillary dermis in the first specimen taken from the border area of LA and LK (×100); B) Positive staining for D2-40 of the lymphangiomatous lesion (×100); C) Negative staining for CD34 of the lymphangiomatous lesion (×100); D) Papillomatosis, ectatic vessels in the papillary dermis and certain areas of the upper reticular dermis in the angiomatous lesion, epidermal hyperkeratosis in the left side of epidermis and mild acanthosis in the other side (×100); E) Positive staining of vascular endothelial cells for CD34 in the angiomatous lesion (×100); F) Slight irregular acanthosis and slight focal hyperkeratosis in the epidermis as well as ectatic vessels in the papillary dermis and upper reticular dermis in the punctate, macular lesion (×100); G) Positive staining of vascular endothelial cells for CD34 in the the punctate, macular lesion (HEX100); H) Positive staining of vascular endothelial cells for CD31 in the punctate, macular lesion (HEX100); I) Positive staining of vascular endothelial cells for D2-40 in the the punctate, macular lesion (HEX200)

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