Tufted Angioma 

  • Author: Mitchel P Goldman, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 23, 2012
 

Background

Tufted angiomas are rare vascular tumors most commonly localized to the skin and subcutaneous tissues and characterized by slow angiomatous proliferation. Although adult-onset cases have been described, tufted angiomas occur far more frequently in children. Tufted angiomas have a benign course, with no reported cases of aggressive behavior or metastases. However, tufted angiomas seldom self-involute.[1]

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Epidemiology

Frequency

United States

The incidence of tufted angiomas is low. As of the year 2000, only 54 cases are described in the English-language literature in the United States and Europe.

International

The international incidence of tufted angioma is also low. However, after Nakagawa identified the condition, angioblastoma, in 1949, more cases have been described in Japan. By 2000, 157 cases had been reported.[2, 3, 4]

Mortality/Morbidity

Tufted angioma is a benign entity. No deaths directly or indirectly attributable to complications have been reported. However, pain and tenderness are common associated symptoms, and hyperhidrosis is a frequent finding that occurs in 30% of patients.[5]

The growth pattern of tufted angioma tends to be slow and progressive (ie, occurring over 5 mo to 10 y). However, an occasional tufted angioma undergoes a rapid expansion phase that leads to localized swelling and a decreased range of motion of the structures in the affected area. One report described a patient with a painful tufted angioma on the lateral neck and jaw. The tumor also had deep extension into the underlying fascia and muscle, a rare finding.[6]

Kasabach-Merritt syndrome (KMS), also known as platelet-trapping syndrome (PTS), occurs in association with tufted angioma in some patients. Fortunately, most of these patients have a favorable response to the treatment of platelet-trapping syndrome with aspirin and/or ticlopidine, oral betamethasone, or vincristine, without further sequelae.

Race

No racial predilection is recognized for tufted angioma.

Sex

The prevalence of tufted angioma is equal in both sexes.

Age

Most series report that 60-70% of tufted angiomas develop before the patient is aged 5 years, and 25% of tumors appear by the time the patient is aged 1 year. The Japanese-language literature, however, reports that more than 50% of tufted angiomas appear in the patient's first year of life. Of these patients, 15% are believed to have had a blemish in the area where the tufted angioma later developed; this observation suggests a congenital mode of presentation.

Less than 10% of tufted angiomas develop in individuals older than 50 years, and tumors in persons older than 60-80 years are rare.[1, 4] One 81-year-old patient with a tufted angioma of 2 years' duration is reported in the French-language literature, and a case has been described in an 84-year-old man in Japan.[7, 8]

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Contributor Information and Disclosures
Author

Mitchel P Goldman, MD  Voluntary Clinical Professor, Department of Internal Medicine, Division of Dermatology, University of California, San Diego Medical Center

Mitchel P Goldman, MD is a member of the following medical societies: Aerospace Medical Association, American Academy of Cosmetic Surgery, American Academy of Dermatology, American College of Phlebology, American Dermatological Association, American Medical Association, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, American Society of Lipo-Suction Surgery, American Venous Forum, California Medical Association, Dermatology Foundation, International Society for Dermatologic Surgery, Noah Worcester Dermatological Society, Pacific Dermatologic Association, Phi Beta Kappa, San Diego County Medical Society, Society for Investigative Dermatology, and Women's Dermatologic Society

Disclosure: Lumenis Consulting fee Consulting; Syneron/Candela Grant/research funds Other; New Star Lasers Ownership interest Other; SkinMedica Grant/research funds Other

Coauthor(s)

Leyda E Bowes, MD  Cosmetic Surgery Fellow, Department of Dermatology, Cosmetic Laser Associates of San Diego County

Leyda E Bowes, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Florida Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Carrie L Kovarik, MD  Assistant Professor of Dermatology, Dermatopathology, and Infectious Diseases, University of Pennsylvania School of Medicine

Carrie L Kovarik, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

John G Albertini, MD  Consulting Staff, Dermatologic Surgery, The Skin Surgery Center; Program Director, ACGME Accredited Fellowship in Procedural Dermatology

John G Albertini, MD is a member of the following medical societies: American Academy of Dermatology and American College of Mohs Micrographic Surgery and Cutaneous Oncology

Disclosure: Nothing to disclose.

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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  2. Nakagawa K. Case report of angioblastoma of the skin. Jpn J Dermatol. 1949;59:92-4.

  3. Igarashi M, Oh-i T, Koga M. The relationship between angioblastoma (Nakagawa) and tufted angioma: report of four cases with angioblastoma and a literature-based comparison of the two conditions. J Dermatol. Aug 2000;27(8):537-42. [Medline].

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  7. Dewerdt S, Callens A, Machet L, Grangeponte MC, Vaillant L, Lorette G. [Acquired tufted angioma in an adult: failure of pulsed dye laser therapy]. Ann Dermatol Venereol. Jan 1998;125(1):47-9. [Medline].

  8. Murakami M, Nitta Y, Ikeya T, Hara K. Two cases of angioblastoma (Nakagawa): A one-month baby and an 84-year-old man (in Japanese). Rinsho Derma (Tokyo). 1997;39:925-9.

  9. Jang KA, Choi JH, Sung KJ, Moon KC, Koh JK. Congenital linear tufted angioma with spontaneous regression. Br J Dermatol. May 1998;138(5):912-3. [Medline].

  10. Ghosh SK, Bandyopadhyay D, Ghosh A, Biswas SK, Barma KD. Acquired multifocal tufted angiomas in an immunocompetent young adult. Indian J Dermatol. Jul 2011;56(4):412-4. [Medline]. [Full Text].

  11. Alberola FT, Betlloch I, Montero LC, Nortes IB, Martínez NL, Paz AM. Congenital tufted angioma: Case report and review of the literature. Dermatol Online J. May 15 2010;16(5):2. [Medline].

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  15. Miyamoto T, Mihara M, Mishima E, Hagari Y, Shimao S. Acquired tufted angioma showing spontaneous regression. Br J Dermatol. Dec 1992;127(6):645-8. [Medline].

  16. Fujita H, Asahina A, Tamaki K. Extensive tufted angioma of the left arm in a 47-year-old woman. Clin Exp Dermatol. Oct 2009;34(7):e216-7. [Medline].

  17. McAleer MA, Kirby B, Sheahan K, Collins P. An erythematous patch and plaque on the shoulder--quiz case. Acquired tufted angioma (TA). Arch Dermatol. Sep 2008;144(9):1217-22. [Medline].

  18. Enjolras O, Wassef M, Dosquet C, et al. [Kasabach-Merritt syndrome on a congenital tufted angioma]. Ann Dermatol Venereol. Apr 1998;125(4):257-60. [Medline].

  19. Swerlick RA, Cooper PH. Pyogenic granuloma (lobular capillary hemangioma) within port-wine stains. J Am Acad Dermatol. May 1983;8(5):627-30. [Medline].

  20. Alessi E, Bertani E, Sala F. Acquired tufted angioma. Am J Dermatopathol. Oct 1986;8(5):426-9. [Medline].

  21. Kim TH, Choi EH, Ahn SK, Lee SH. Vascular tumors arising in port-wine stains: two cases of pyogenic granuloma and a case of acquired tufted angioma. J Dermatol. Dec 1999;26(12):813-6. [Medline].

  22. Padilla RS, Orkin M, Rosai J. Acquired "tufted" angioma (progressive capillary hemangioma). A distinctive clinicopathologic entity related to lobular capillary hemangioma. Am J Dermatopathol. Aug 1987;9(4):292-300. [Medline].

  23. Kim YK, Kim HJ, Lee KG. Acquired tufted angioma associated with pregnancy. Clin Exp Dermatol. Nov 1992;17(6):458-9. [Medline].

  24. Schaffer JV, Fangman W, Bossenbroek NM, Meehan SA, Kamino H. Tufted angioma. Dermatol Online J. Oct 15 2008;14(10):20. [Medline].

  25. Jones EW. Dowling oration 1976. Malignant vascular tumours. Clin Exp Dermatol. Dec 1976;1(4):287-312. [Medline].

  26. Prieto VG, Shea CR. Selected cutaneous vascular neoplasms. A review. Dermatol Clin. Jul 1999;17(3):507-20, viii. [Medline].

  27. Barco D, Baselga E, Ribe A, Alomar A. [Congenital self-limiting tufted angioma]. Actas Dermosifiliogr. Jun 2008;99(5):423-5. [Medline].

  28. Descours H, Grézard P, Chouvet B, Labeille B. [Acquired tufted angioma in an adult]. Ann Dermatol Venereol. Jan 1998;125(1):44-6. [Medline].

  29. Munn SE, Jackson JE, Jones RR. Tufted haemangioma responding to high-dose systemic steroids: a case report and review of the literature. Clin Exp Dermatol. Nov 1994;19(6):511-4. [Medline].

  30. Bernstein EF, Kantor G, Howe N, Savit RM, Koblenzer PJ, Uitto J. Tufted angioma of the thigh. J Am Acad Dermatol. Aug 1994;31(2 Pt 2):307-11. [Medline].

  31. Leaute-Labreze C, Bioulac-Sage P, Labbe L, Meraud JP, Taieb A. Tufted angioma associated with platelet trapping syndrome: response to aspirin. Arch Dermatol. Sep 1997;133(9):1077-9. [Medline].

 
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This lesion is a tufted angioma in a 1-year-old girl. Present since birth, this bluish-red hemangioma-like plaque on the patient's right upper leg slowly enlarged and became tender during the month prior to presentation. The child was otherwise well. A skin biopsy specimen revealed dilated congested capillaries in the lower dermis and subcutis. Clusters of capillaries with hyperplastic endothelial cells were also scattered in the mid and upper parts of the dermis. The epidermis revealed a slight basket-weave orthokeratosis, with minimal acanthosis, and papillomatosis. The patient was treated conservatively with only observation. The lesion remained stable and did not progressed since presentation. Courtesy of National Skin Centre, Singapore.
 
 
 
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