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K. U. Loeffler, F. G. Holz, P. Meyer; Clinical and Histologic Evaluation of Eruptive Lobular Hemangioma of the Eyelid. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5694.
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Eruptive lobular hemangioma (ELH) of the eyelid is a rare tumor and therefore is often misdiagnosed clinically. In this study we report on the clinical, histologic, and immunohistochemical features of this entity to alert the clinician with regard to an accurate diagnosis. Furthermore, ELH was compared to other eyelid lesions of vascular origin.
All specimens diagnosed with ELH after surgical removal in the time period 2004 to 2007 were investigated by routine paraffin histopathology. In addition, immunoreactivity (IR) was investigated using antibodies to Herpes virus type 8 (HHV8), to macrophages (CD68), to endothelial cells (F8) and to cell proliferation markers CAS/CSE1L and Ki67. Patient data were collected, and the preoperative clinical findings as well as the follow-up data were evaluated. For comparison, one congenital capillary hemangioma (CCH), one cavernous hemangioma (CH), one vascular malformation (VM), and one Kaposi sarcoma (KS) were used.
14 specimens with typical histologic features of ELH could be evaluated. The mean age of the affected patients was 35 years, with a median of 32 years and an age range of 6 to 68 years. There were 4 female and 10 male patients. The clinical picture was extremely variable; it ranged from a (deep) subcutaneous nodule over a cyst-like lesion to the more typical hemorrhagic appearance, developing over a rather short time period. Histology always showed numerous capillaries/small-sized vessels arranged in lobules and usually surrounded by a moderate inflammatory cell infiltrate. There was distinct IR with F8 (similar in all lesions, and more prominent in larger vascular channels), with CD68 (less obvious in CCH and CH) and prominent labeling with Ki67 and CAS/CSE1L (much more pronounced in ELH and CCH compared to CH and VM). Staining with anti-HHV8 was only positive in KS. - No recurrence of ELH was seen after surgical removal apart from one particular case that will be illustrated.
ELH can exhibit an extremely variable clinical picture with a "vascular" or "hemorrhagic" appearance not always being a key feature. In cases of a doubtful diagnosis, the negative reaction with anti-HHV8 is helpful to distinguish it from Kaposi sarcoma.
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