Tufted Angioma Workup

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

Laboratory Studies

  • No specific laboratory study is useful in the diagnosis or treatment of tufted angioma.
  • Urinary levels of basic fibroblast growth factor are of no value in the diagnosis of this condition, unlike juvenile capillary angioma.
  • If the coexistence of Kasabach-Merritt syndrome is suspected, a CBC count with a determination of the platelet count, prothrombin time and/or activated partial thromboplastin time, and full disseminated intravascular coagulation profile is indicated.
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Imaging Studies

  • MRI studies have been proven useful in the examination of patients with deep and/or extensive tufted angiomas.
  • MRI has been successful in evaluating the depth of invasion and extent of growth of tufted angiomas that extend deep into the muscle and fascia.[5]
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Other Tests

  • No other tests are recommended for tufted angioma.
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Procedures

  • Other than biopsy for diagnosis and the surgical treatment described below, no other procedures are indicated for tufted angioma.
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Histologic Findings

Tufted angiomas have a specific histologic pattern. They are characterized by the lobular arrangement of densely cellular capillaries, which appear similar to cannonballs, that are distributed throughout the dermis.[25] The vascular tufts consist of tightly packed hypertrophic endothelial cells with scanty cytoplasm and nuclei that are round, ovoid, or fusiform.

Mitoses are abundant, but atypia and pleomorphism are rare. Occasionally, hemosiderin deposits may be observed within the endothelial cells. Capillary spaces are narrow and elongated, and they are more noticeable in the periphery of the lobules, where they have a characteristic half-moon shape.[26]

The capillary lobules are present throughout the dermis and subcutaneous tissue; the epidermis is uninvolved in most cases. Rare cases with fascial and muscular involvement are reported.[5] The surrounding appendageal structures of the dermis are unaffected, although hypertrophy of neighboring eccrine sweat glands is reported. No edema or inflammation surrounds the vascular lobules.

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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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  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].

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  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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  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].

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  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].

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  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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