Pathology of Verrucous Hemangioma

Dr Sampurna Roy MD      

Verrucous hemangioma is a vascular malformation characterized by vascular spaces in the dermis and subcutaneous tissue with overlying hyperkeratotic, papillomatous epidermis.

Age:  Arise at birth or childhood.

Site: Occurs predominantly on the legs.

Clinical presentation:  

Presents as  blue-red, vascular papules, plaques or nodules, which later becomes warty in appearance.

Small satellite nodules may be present.

These lesions do not resolve spontaneously and have a tendency to recur after excision if margins are inadequate.

Microscopic features:

Histopathologic examination shows irregular papillomatosis, acanthosis and hyperkeratosis of the epidermis.

The superficial dermis shows multiple, thin-walled, dilated blood-filled spaces.

Similar spaces are present in the lower dermis and subcutaneous tissue.

Differential diagnosis-

Angiokeratoma:  Only  the superficial blood vessels are dilated. 

In verrucous hemangioma the vascular spaces are present in the dermis and subcutaneous tissue.

Further reading:

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A Somatic MAP3K3 Mutation Is Associated with Verrucous Venous Malformation. American Journal of Human Genetics. 2015;96(3):480-486.

An immunohistochemical study of verrucous hemangiomas.

Vascular tumours in infants. Part I: benign vascular tumours other than infantile haemangioma.

Verrucous hemangioma expresses primitive markers.

Verrucous hyperpigmented plaque in a 15-month-old boy. Eccrine angiomatous hamartoma (EAH) associated with verrucous hemangioma (VH).

Evolution of verrucous hemangioma.

Verrucous hemangioma: a report of two cases and review of the literature.

A case of eccrine angiomatous hamartoma associated with verrucous hemangioma.

Verrucous hemangioma: a challenging vascular lesion.

An unusual vascular tumor: verrucous hemangioma.

Maffucci syndrome and extensive verrucous epidermal nevi in the same leg.