ArticlePDF Available

Usefulness of MRI in Delineation of Dermal and Subcutaneous Verrucous Hemangioma

Authors:
Krishnan Nagarajan at Jawaharlal Institute of Postgraduate Medical Education & Research
Krishnan Nagarajan
Banushree C Srinivasamurthy at Indira Gandhi Medical College and Research Institute
Banushree C Srinivasamurthy
Download full-text PDF
Read full-text
Download citation

Abstract

Magnetic resonance imaging (MRI) has established itself as diagnostic modality of choice of soft tissue and musculoskeletal lesions but dermatological lesions have been diagnosed mainly by clinical examination. We present MRI features of dermal and subcutaneous verrucous hemangioma involving the dorsum of foot in a 20-year-old male and its usefulness in differentiating it from angiokeratoma with similar clinical features.
Content uploaded by Banushree C Srinivasamurthy
Author content
All content in this area was uploaded by Banushree C Srinivasamurthy on Nov 24, 2015
Content may be subject to copyright.
Volume 60 Issue 5 September-October 2015
®
IJD Focus : Lichen planus
Plantar epithelioma cuniculatum
Issuehighlights
• Oxidative stress in toxic epidermal
necrolysis
• IL-1 gene polymorphisms in psoriasis
• Clinical study and quality of life in
melasma
• Skin manifestation of diabetes
mellitus
• Isotretinoin and depression in acne
• Treatment of vitiligo after allogeneic
BMT by surgery
• Efficacy of punch elevation in facial
atrophic acne scar
• Growth factor concentrate for
nasolabial folds
• A clinicobacteriological study of
pyoderma
• Pattern of childhood vitiligo
• X-linked ichthyosis presenting as
erythroderma
• MRI in the delineation of dermal and
subcutaneous verrucous
hemangioma
Indian Journal of Dermatology • Volume 60 • Issue 5 • September-October 2015 • Pages 427-***
Issuehighlights
• Etiopathogenesis of atopic dermatitis
• Spectrum of malassezia infections
• Novel stain for pityriasis versicolor
• Tumour necrosis factor-alpha
genetic polymorphisms
• TTC repeat base pair loss mutation in
pure neural leprosy
• Prolong remission of psoriasis with
azathioprine pulse therapy
• Suction blister epidermal grafting
done in stable and segmental vitiligo
• Fractionated carbon dioxide laser
with topical latanoprost in
hypopigmented scars
• Primary cutaneous CD8+ CD30+
anaplastic large cell lymphoma
• Amyloidosis cutis dyschromica
• O'Brien actinic granuloma
• Congenital tail
Indian Journal of Dermatology • Volume 60 • Issue 4 • July-August 2015 • Pages 327-426
®
IJD
www.e-ijd.org
Indian Journal of
Dermatology
ISSN: 0019-5154
ISSN: 0019-5154
Diamond Jubilee year
Abstract
Magnetic resonance imaging (MRI) has established itself as diagnostic modality of choice of
soft tissue and musculoskeletal lesions but dermatological lesions have been diagnosed mainly
by clinical examination. We present MRI features of dermal and subcutaneous verrucous
hemangioma involving the dorsum of foot in a 20‑year‑old male and its usefulness in
differentiating it from angiokeratoma with similar clinical features.
Key Words: Angiokeratoma, magnetic resonance imaging, soft tissue magnetic resonance
imaging, verrucous hemangioma
Usefulness of MRI in Delineation of Dermal and Subcutaneous
Verrucous Hemangioma
K Nagarajan, CS Banushree1
Access this article online
Quick Response Code:
Website: www.e‑ijd.org
DOI: 10.4103/0019‑5154.164453
Introduction
Verrucous hemangiomas are rare angiomatous nevi
that are present at birth and grow into adulthood.[1,2]
They usually involve the dermis with extension into
subcutaneous plane and deserve deep excision to avoid
recurrence.[3,4] Magnetic resonance imaging (MRI) has
been used in soft tissue and musculoskeletal lesions:
both benign and malignant, not just for diagnosis,
but also to delineate and characterize the extent and
plan the treatment.[5‑7] Recent reviews of superficial
soft‑tissue tumors including lesions involving the skin
and its appendages and subcutaneous plane using
ultrasonography or MRI have shown the usefulness
of these modalities in evaluating and assessing these
lesions.[8] Herein, we present a case of verrucous
hemangioma involving the epidermis, dermis and
subcutaneous plane thereby differentiating it from
similar appearing ‘angiokeratoma’.
Case Report
Twenty‑year‑old male presented with hyperpigmented
hyperkeratotic plaque with warty papules on the medial
dorsum of foot over the first metatarsal. The lesion
showed brownish red papules with purple margins. The
patient had another hyperpigmented macular lesion on
the plantar aspect of medial foot that was considered as
evolving or satellite lesion [Figure 1]. Clinical diagnosis
was that of angiokeratoma. The patient was referred
for MRI to look for deeper extent of the lesion. On
MRI, linear plaque‑like heterogenous T1 isointense/
T2‑STIR hyperintense lesion was noted on the medial
dorsum of foot involving the subcutaneous plane
with dermal warty surface, suggestive of a lesion with
dermal and subcutaneous components, looking similar
to hemangioma. The deeper part of the lesion is seen
extending upto the extensor hallucis longus/brevis
tendons. No bony involvement or signal changes noted in
the first metatarsal bone. The MRI sections also showed
the plantar lesion involving dermal and subcutaneous
planes without any deeper extension into plantar fascia
[Figures 2 and 3].
Deeper biopsy from the larger lesion on the medial
dorsum of foot showed verrucous hyperplasia of the
epidermis with hyperkeratosis, acanthosis, and irregular
papillomatosis. Papillary dermis showed markedly dilated
vessels partially enclosed by elongated rete ridges
with similar foci of dilated vessels in deep dermis and
subcutaneous tissue [Figure 4]. The histopathological
diagnosis was that of verrucous hemangioma.
Discussion
Verrucous hemangiomas clinically resemble
angiokeratomas, which are capillary telangiectasia
involving only the papillary dermis and suspected to
From the Departments
of Radiology, 1Pathology,
Sri Manakula Vinayagar Medical
College and Hospital, Pondicherry,
India
Address for correspondence:
Dr. K. Nagarajan,
Assistant Professor of
Radio‑Diagnosis, All India
Institute of Medical Sciences,
Bhubaneswar ‑ 751 019,
Orissa, India.
E‑mail: lknagarajan1@gmail.com
What was known?
Verrucous hemangioma can mimic angiokeratoma in superficial biopsy. MRI can delineate soft‑tissue lesions exquisitely.
E-IJD SHORT COMMUNICATION
Nagarajan and Banushree: MRI in the delineation of dermal and subcutaneous verrucous hemangioma with histopathological confirmation
Figure 4: Histopathological (H and E) section from the lesion (magnification ×10)
showing hyperkeratosis, acanthosis, and dilated vessels within papillary dermis
partially enclosed by elongated rete ridges (arrows) and similar vessels also in
deeper dermis
Figure 1: (a) and (b) Clinical photograph of the right foot showing larger dorsal and
satellite ventral hyperkeratotic lesions medially
b
a
Figure 2: (a‑c) MRI (T2‑weighted with fat suppression) of right foot sagittal (a),
coronal (b and c) planes showing heterogeneous hyperintense lesions involving the
dermal, epidermal, and subcutaneous planes with strands inside, extending upto the
extensor tendons dorsally
b
a
c
Figure 3: (a) and (b) MRI sections (T1 & T2 weighted) in coronal plane showing the
lesions to be isointense in T1 and hyperintense in T2‑weighted images
b
a
originate due to local trauma. Angiokeratomas respond
to local ablation by cryotherapy, laser, or electrocautery.
Verrucous hemangiomas need wide excision, although
combined approach of laser or ultrasound therapy with
surgical excision is now being more used.[9‑11] Though
verrucous hemangiomas have been reported long back in
dermatological literature,[2] they are easily confused with
angiokeratoma differing only in their deeper extent and
only deep tissue biopsy can resolve the two.[12] However,
MRI with its excellent delineation of superficial soft
tissue can be used to delineate the extent of the plane
of the lesion and differentiate both of them. If the
biopsy does not include sufficient deeper tissue, it may
lead to wrong diagnosis of superficial angiokeratoma.[12]
MRI has been used in superficial epidermal/dermal
lesions like neurofibromas, hemangiomas, myxomas,
granular cell tumor, giant‑cell tumor of soft tissue,
granuloma annulare, nodular fasciitis apart from
lesions arising from skin appendages like infundibular/
epidermal inclusion (known as sebaceous) cysts,
pilomatricoma, merkel cell carcinoma, eccrine and
apocrine‑gland tumors.[5‑7] Very few cases of MRI features
of purely cutaneous (epidermal/dermal) lesions have
been reported. Chung et al.,[13] reported one case of
angiokeratoma in their comparison of imaging features
of 164 benign and 102 malignant soft tissue lesions in
an attempt to differentiate the two groups using MR
features of size, depth and MR signal heterogeneity.
Garrido Rios et al.,[14] reported a 38‑year‑old woman with
right thigh lesion initially suspected as angiokeratoma
and subsequent MRI showed the deeper subcutaneous
extent confirming it to be verrucous hemangioma. Similar
cases have been reported without the use of imaging in
their evaluation and differentiation.[12] The differential
diagnosis in our country should also include tuberculosis
verrucousa cutis. However, long clinical history, absence
of any associated ulceration, normal chest radiograph
and above all histopathology have helped to differentiate
it from tuberculosis verrucosa cutis.
Recent reports have attempted to delineate the
origin of these lesions – whether vascular anomalies
or tumors.[15,16] Tennant et al.,[16] compared similarly
appearing localized hyperkeratotic lesions clinically
diagnosed as angiokeratomas, verrucous hemangiomas
and capillary‑venous/lymphatic malformations. They
found the following features: thick vascular walls,
multi‑lamellated basement membrane, relatively uniform
channel size, GLUT immunopositivity, and low MIB‑1
Nagarajan and Banushree: MRI in the delineation of dermal and subcutaneous verrucous hemangioma with histopathological confirmation
reactivity in verrucous hemangiomas. These features
resemble infantile hemangiomas in their involutive
phase.
In our case as well, the initial clinical diagnosis and even
a superficial biopsy were that of angiokeratoma, but
subsequent MRI done before planning surgery revealed
the deeper extent of the lesion and led to revision
of diagnosis. MRI with its fine soft tissue pathology
delineation and non‑invasive advantage can help in such
dermatological conditions to enable proper diagnosis
before planning appropriate definitive treatment.
What is new?
MRI can delineate the dermal and subcutaneous plane of the lesions and guide
biopsy for histopathological diagnosis.
References
1. Halter K. Verrucous hemangioma with osteoporosis. Dermatol
Z 1937;75:275‑9.
2. Imperial R, Helwig B. Verrucous hemangioma.
A clinicopathologic study of 21 cases. Arch Dermatol
1967;96:247‑53.
3. Chang JK, Tsang WY, Calonje E, Fletcher CD. Verrucous
hemangioma. A distinctive but neglected variant of cutaneous
hemangioma. Int J Surg Pathol 1995;2:171‑6.
4. Rossi A, Bozzi M, Barra E. Verrucous hemangioma and
angiokeratoma circumscriptum: Clinical and histologic
differential characteristics. J Dermatol Surg Oncol
1989;15:88‑91.
5. Laffan EE, Ngan BY, Navarro OM. Pediatric soft‑tissue tumors
and pseudotumors: MR imaging features with pathologic
correlation: Part 2. Tumors of fibroblastic/myo‑fibroblastic,
so‑called fibrohistiocytic, muscular, lymphomatous,
neurogenic, hair matrix, and uncertain origin. Radiographics
2009;29:e36.
6. Blacksin MF, Ha DH, Hameed M, Aisner S. Superficial soft‑tissue
masses of the extremities. Radiographics 2006;26:1289‑304.
7. Beaman FD, Kransdorf MJ, Andrews TR, Murphey MD,
Arcara LK, Keeling JH. Superficial soft‑tissue masses: Analysis,
diagnosis, and differential considerations. Radiographics
2007;27:509‑23.
8. Jin W, Kim GY, Park SY, Chun YS, Rhyu KH, Park JS, et al.
The spectrum of vascularized superficial soft‑tissue tumors
on sonography with a histopathologic correlation: Part 2,
malignant tumors and their look‑alikes. AJR Am J Roentgenol
2010;195:446‑53.
9. Yang CH, Ohara K. Successful surgical treatment of verrucous
hemangioma: A combined approach. Dermatol Surg
2002;28:913‑9.
10. Maejima H, Katsuoka K, Sakai N, Uchinuma E. Verrucous
hemangioma successfully treated using 13‑MHz
ultrasonography. Eur J Dermatol 2008;18:597.
11. Achar A, Biswas SK, Maity AK, Naskar B. Verrucous
hemangioma treated by electrocautery. Indian J Dermatol
2009;54:51‑2.
12. Pavithra S, Mallya H, Kini H, Pai GS. Verrucous hemangioma
or angiokeratoma? A missed diagnosis. Indian J Dermatol
2011;56:599‑600.
13. Chung WJ, Chung HW, Shin MJ, Lee SH, Lee MH, Lee JS,
et al. MRI to differentiate benign from malignant soft‑tissue
tumours of the extremities: A simplified systematic imaging
approach using depth, size and heterogeneity of signal
intensity. Br J Radiol 2012;85:e831‑6.
14. Garrido‑Ríos AA, Sánchez‑Velicia L, Marino‑Harrison JM,
Torrero‑Antón MV, Miranda‑Romero A. A histopathologic and
imaging study of verrucous hemangioma. Actas Dermosifiliogr
2008;99:723‑6.
15. Brown A, Warren S, Losken HW, Morrell DS. Verrucous
lymphovascular malformation versus verrucous hemangioma:
Controversial nomenclature. Cutis 2008;81:390‑6.
16. Tennant LB, Mulliken JB, Perez‑Atayde AR, Kozakewich HP.
Verrucous hemangioma revisited. Pediatr Dermatol
2006;23:208‑15.
How to cite this article: Nagarajan K, Banushree CS. Usefulness of
MRI in delineation of dermal and subcutaneous verrucous hemangioma.
Indian J Dermatol 2015;60:525.
Received: September, 2013. Accepted: November, 2013.
Source of support: Nil, Conflict of Interest: Nil.
... Pengambilan biopsi yang dalam hingga jaringan subkutan merupakan langkah diagnostik yang penting dan perlu ditekankan, karena pada biopsi superfisial gambaran lesi VH cenderung serupa dengan ACN. 32,36 Pemeriksaan histopatologi tetap menjadi baku emas dalam menegakkan diagnosis VH, di mana diagnosis HV ditandai dengan saluran ektatik yang meluas ke dermis yang lebih dalam dibandingkan dengan ACN. 32,34 Konfirmasi diagnosis VH pada kasus ini dilakukan berdasarkan pemeriksaan CD31 dan MRI. ...
... Magnetic resonance imaging digunakan untuk melihat lesi jaringan lunak dan muskuloskeletal, baik jinak maupun ganas yang digunakan untuk penegakan diagnosis, melihat kedalaman lesi dan merencanakan manajemen terapi. 36,38 Gambaran struktur vaskular berkelokkelok, serpiginosa atau tortuous yang menempati seluruh jaringan dermis dan subkutan pada pemeriksaan MRI merupakan gambaran VH. 15 Pemeriksaan MRI penting untuk menentukan luasnya eksisi, mengingat VH dan ACN memiliki penatalaksanaan yang berbeda. 32,39 Angiokeratoma sirkumskriptum nefivorme dapat diterapi dengan metode fisik seperti elektrokoagulasi, electrocauter, krioterapi dan laser argon, sedangkan VH membutuhkan eksisi luas dan dalam untuk menghindari kemungkinan kambuh kembali. ...
Hemangioma Verukosa
Article
Full-text available
  • Dec 2020
Hemangioma verukosa adalah malformasi vena verukosa terlokalisisasi berupa hemangioma kapiler atau kavernosa dengan reaksi proliferasi epidermis berupa hiperkeratosis, akantosis dan papilomatosis serta ditandai dengan proliferasi dan pelebaran vaskular pada dermis hingga subkutan. Kelainan ini biasanya ditemukan pada ekstremitas bawah dan unilateral. Hemangioma verukosa sering didiagnosis sebagai malformasi vena atau limfatik. Seorang anak laki-laki berusia 11 tahun datang dengan bercak merah kehitaman yang kasar dan berbenjol-benjol pada kaki kanan yang dimiliki sejak lahir. Empat bulan sebelumnya, bercak tersebut berdarah akibat terkena lemparan bola kemudian menjadi semakin kasar, tebal dan bertambah gelap. Diagnosis awal pasien adalah hemangioma dan dilakukan krioterapi, namun lesi tidak membaik setelah 6 kali krioterapi. Diagnosis VH harus dipertimbangkan terutama jika menemukan lesi papul, plak maupun nodul eritematosa hiperkeratotik, ada saat lahir, berlokasi di ekstremitas bawah dan menunjukkan pertumbuhan setelah trauma atau infeksi. Dari hasil anamnesis, pemeriksaan fisik, serta penunjang, pasien didiagnosis dengan hemangioma verukosa. Terapi eksisi dengan margin yang adekuat pada kasus hemangioma verukosa dapat memberikan prognosis yang baik dan tingkat kekambuhan yang rendah. Terapi pada pasien ini berupa kombinasi salep clobetasol propionate 0,05% dan salicylic acid 5% kemudian dilakukan eksisi.
View
... Although biopsy with immunohistochemistry is the gold standard in diagnosing VVMs, recently MRI has also been used to determine the depth of invasion and lend further support to the diagnosis, with an indeterminate T1 signal but hyperintense T2/STIR signal characteristic. 14,15 In our patient, MRI demonstrated T2-hyperintense signals in the subcutaneous component, consistent with prior studies. Another imaging modality used to further characterize VVMs is Doppler ultrasound, which can identify reduced flow. ...
Verrucous venous malformation with thrombocytopenia in a neonate
Article
  • Nov 2021
Verrucous venous malformations (VVM) are rare, congenital, slow‐flow vascular anomalies that have been historically difficult to characterize due to clinical mimics and unclear histological evaluation. A life‐threatening complication of VVMs is localized intravascular coagulation. Herein, we describe a male neonate who presented with a congenital VVM on the left lower extremity with associated severe thrombocytopenia. We discuss the multifaceted diagnostic approach used to identify this VVM, while highlighting the use of WT‐1 as a negative predictive marker; we additionally outline novel treatment options and management beyond cutaneous involvement.
View
... [5] MRI is the diagnostic modality of choice because it delineates the dermal and subcutaneous plane of these lesions and guides biopsy. [6] Histopathological examination remains the gold standard for diagnosis with presence of ectatic channels extending into the deeper dermis vis-à-vis angiokeratoma circumscriptum [ Table 1]. Immunohistochemical positivity of endothelial cells lining the vascular channels for CD 34 and CD 31 antibodies acts as an adjunct. ...
Multiple Verrucous Hemangiomas: A Case Report with New Therapeutic Insight
Article
Full-text available
  • Jul 2017
Verrucous hemangioma is an uncommon congenital vascular malformation, which may clinically masquerade angiokeratoma, lymphangioma circumscriptum, or malignant melanoma. Differentiation is essential owing to varied therapeutic and prognostic implications. We present a rare case of multiple verrucous hemangiomas in a teenage girl who presented with multiple warty lesions over the dorsal aspect of the left foot since birth. Magnetic resonance imaging (MRI) scan was suggestive of a vascular malformation, and skin biopsy showed ectatic blood vessels extending from the papillary dermis into the subcutaneous tissue, diagnostic of verrucous hemangioma. A combination of 0.05% halobetasol propionate with 3% salicylic acid ointment was advised. This therapeutic intervention resulted in significant resolution of the warty lesions over a period of 2 months, following which surgical excision was performed. The implication is that we can use a combination of super potent topical steroid with salicylic acid as an adjunct to surgical resection.
View
... The differential diagnosis includes angiokeratoma, Cobb syndrome, angioma serpiginosum, lymphangioma circumscriptum, cutaneous keratotic hemangioma, blue rubber bleb nevus, papillomas, tumors (including melanoma), and verrucae [5,8]. Dermal and subcutaneous verrucous hemangioma have specific MRI features, making MRI useful in differentiating such verrucous hemangioma from angiokeratoma with similar clinical features [14]. Furthermore, such dermoscopic features may be helpful in diagnosing diseases that differ by the type and area of their associated lesions [15]. ...
Verrucous Hemangioma Treated with Electrocautery
Article
Full-text available
  • May 2016
Verrucous hemangioma is a rare vascular malformation consisting of a proliferation of dilated blood vessels of different sizes that occupy the dermis and hypodermis. The epidermis of the affected area shows a strong proliferative reaction that presents as a warty appearance. Here, we report the case of a 17-year-old male who presented with an asymptomatic warty growth above the lateral malleolus on the right leg, which healed after electrocautery.
View
View
Vascular anomalies: diagnostic features and step-wise approach
Article
  • Mar 2022
  • ACTA RADIOL
The first part of this review article emphasized correct nomenclature, classification systems, and imaging algorithm of vascular anomalies. The second part of the review discusses the individual entities, highlighting the characteristic clinico-radiological features of the commonly encountered ones. A step-wise algorithmic approach is also proposed for the evaluation of a suspected case of vascular anomaly.
View
MRI in verrucous venous malformation: role in diagnosis and treatment
Article
  • Feb 2021
  • CLIN IMAG
Verrucous venous malformation (VVM), recently reclassified from verrucous hemangioma, is a rare congenital vascular anomaly that is traditionally diagnosed on histopathologic analysis of deep tissue biopsy. This case report documents the utility of magnetic resonance imaging in confirming VVM diagnosis, characterizing lesion extent and guiding therapy.
View
The Spectrum of Vascularized Superficial Soft-Tissue Tumors on Sonography With a Histopathologic Correlation: Part 2, Malignant Tumors and Their Look-Alikes
Article
Full-text available
  • Aug 2010
  • AM J ROENTGENOL
Objective: The objective of this article is to illustrate the sonographic findings of malignant, vascularized superficial soft-tissue masses and their look-alikes. Conclusion: Radiologists need to be aware of the sonographic findings of malignant, vascularized superficial soft-tissue tumor findings and their look-alikes for the differential diagnosis and determining an optimal treatment plan.
View
Verrucous HemangiomaA Distinct but Neglected Variant of Cutaneous Hemangioma
Article
  • Jan 1995
Verrucous hemangioma is an uncommon variant of cutaneous hemangioma, showing characteristic clinicopathologic features. Since its formal characterization in 1967, little has been written on this entity. This report describes 10 cases to draw wider attention to this distinct hemangioma. The patients, 5 males and 5 females, were aged 6-44 years at presentation. The lesions were usually noted at birth as flat or dome-shaped reddish or bluish lesions that enlarged slowly and became verrucous. All 10 cases were located in the lower extremities. Among the six cases with follow-up information, two have recurred. Histologically, beneath the warty epidermal surface, haphazardly distributed in the dermis were vascular spaces often of cavernous size, merging into capillaries in the subcutis. In the subcutaneous tissue, the lobules of capillaries com monly merged with the adipose cells in a pseudoinfiltrative pattern. The endothelial cells were flat and nondescript, and showed variable immunoreactivity for factor VIII related antigen but showed strong staining with CD34. All the vascular channels were surrounded by complete rims of muscle-specific actin-positive pericytes. The overlying epidermis lacked evidence of human papillomavirus infection either by immunohisto chemical studies or ultrastructural examination. Thus the warty change represented a reactive phenomenon rather than a result of human papillomavirus infection. Since the lateral and deep extent of the vascular proliferation is often greater than that of the exophytic epidermal component in verrucous hemangioma, the size of the lesion is often underestimated, leading to inadequate excision and recurrence. Awareness of this entity and obtaining a complete clinical history should permit recognition of the lesion as a vascular lesion and not a primary epidermal or melanocytic lesion. Int J Surg Pathol 2(3):171-176, 1995
View
MRI to differentiate benign from malignant soft-tissue tumours of the extremities: A simplified systematic imaging approach using depth, size and heterogeneity of signal intensity
Article
  • May 2012
  • BRIT J RADIOL
Objective: Differentiating between malignant and benign lesions on the basis of MR images depends on the experience of the radiologist. For non-experts, we aimed to develop a simplified systematic MRI approach that uses depth, size and heterogeneity on T(2) weighted MR images (T(2)WI) to differentiate between malignant and benign lesions, and evaluated its diagnostic accuracy. Methods: MR images of 266 patients with histologically proven soft-tissue tumours of the extremities (102 malignant, 164 benign) were analysed according to depth (superficial or deep), size (<50, ≥50 mm) and signal intensity (homogeneous or heterogeneous) on T(2)WI, to determine the ability of each to predict benign and malignant tumours. These three parameters were categorised into systematic combinations of different orders of application, and each combination was assessed for its ability to differentiate between benign and malignant lesions. Results: Univariate analysis showed that depth, size and heterogeneity on T(2)WI differed significantly between benign and malignant masses (p<0.0001 each). Multiple logistic regression analysis, however, showed that depth was not helpful in distinguishing benign from malignant lesions. The systematic combination of signal intensity, size and depth, in that order, was superior to other combinations, resulting in higher diagnostic values for malignancy, with a sensitivity of 64%, a specificity of 85%, a positive predictive value of 32%, a negative predictive value of 59% and an accuracy of 77%. Conclusion: A simplified systematic imaging approach, in the order signal intensity, size and depth, would be a reference to distinguish between benign and malignant soft-tissue tumours for non-experts.
View
View
Verrucous hemangioma treated with electrocautory
Article
  • Oct 2009
  • Indian J Dermatol
Verrucous hemangioma is a rare form of vascular malformation which is usually congenital. Most of the cases present as wart-like dark blue to erythematous papules, nodules and plaques with special predilection in lower extrimities. We are reporting here a 19-year-old Muslim patient with large Verrucous hemangioma in the left leg along with discending of right shoulder without any signs of neurological involvement. Patient was successfully treated with repeat serial Electrocautory.
View
Pediatric Soft-Tissue Tumors and Pseudotumors: MR Imaging Features with Pathologic Correlation: Part 2. Tumors of Fibroblastic/Myofibroblastic, So-called Fibrohistiocytic, Muscular, Lymphomatous, Neurogenic, Hair Matrix, and Uncertain Origin
Article
  • Jun 2009
  • RADIOGRAPHICS
In the final part of this two-part review article on soft-tissue masses in children, the magnetic resonance (MR) imaging features, clinical findings, and pathologic findings in a wide variety of tumors, including those of fibroblastic/myofibroblastic origin, so-called fibrohistiocytic tumors, smooth-muscle tumors, skeletal-muscle tumors, tumors of uncertain differentiation, and lymphoma, are described. Other neoplasms that are not included in the World Health Organization classification of soft-tissue tumors but may be seen clinically as soft-tissue masses, specifically dermatofibrosarcoma protuberans, neurogenic tumors and pilomatricoma, are also included. In contrast to the tumors reviewed in Part 1 of this review, the MR imaging features and clinical findings of the tumors included here are largely nonspecific. However, MR imaging is useful in determining site of tumor origin, extent of disease, and relation of tumor to adjacent anatomic structures, and for follow-up after therapy. In some of these entities, the combination of findings may aid in narrowing the differential diagnosis, such as persistent low signal intensity on T1- and T2-weighted images in some fibroblastic lesions, identification of hemosiderin and a synovial origin in pigmented villonodular synovitis, or the presence of multiple target signs on T2-weighted images in deep plexiform neurofibroma. In a large number of cases, however, tissue biopsy is required for final diagnosis.
View
A Histopathologic and Imaging Study of Verrucous Hemangioma
Article
  • Dec 2008
The terms verrucous hemangioma and angiokeratoma circumscriptum have been used interchangeably in the literature to define clinically similar lesions. From a histologic perspective, however, angiokeratoma circumscriptum is limited to the papillary dermis whereas verrucous hemangioma extends as far as the hypodermis. We describe the case of a 38-year-old woman who consulted for a lesion on the right thigh that was initially diagnosed as angiokeratoma; magnetic resonance imaging, however, led to a final diagnosis of verrucous hemangioma.
View
View
Verrucous Hemangioma and Angiokeratoma Circumscriptum: Clinical and Histologic Differential Characteristics
Article
  • Feb 1989
  • J Dermatol Surg Oncol
It is important, from a prognostic and therapeutic point of view, to make a correct diagnosis between verrucous hemangioma (VH) and angiokeratoma circumscriptum. The former needs a large and deep exeresis, while the latter responds to the common means of physical therapy. Two cases of verrucous hemangioma are reported that have allowed us to review the clinical and histologic differential characteristics of the two forms.
View
View