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Presented by Jonathan Epstein, M.D. and prepared by Jospeh Kronz, M.D.
Case 1: 50-year-old male with a painful skin nodule
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Question 1 of 1
1. Question
Week 3: Case 1
50-year-old male with a painful skin nodule
Correct
Answer: Glomangioma
Histology: The lesion consists of a well circumscribed small nodule within the subcutaneous adipose tissue. Within the center of the lesion are dilated benign appearing vascular channels. Surrounding these ectatic vessels are nests and cords of extremely bland appearing cells. The cells have scant cytoplasm and small round nuclei without nucleoli, mitoses, or pleomorphism. These cells are typical of those found within glomus tumors. When combined with a more prominent vascular component these lesions are designated as “glomangiomas”.
Discussion: Hemangiomas have similar vessels yet lack the cellular component exterior to the vessels. Paragangliomas, when found near the jugulotympanic region are referred to as “glomus jugulare tumors”, although they are different tumors than glomus tumors. Paragangliomas have a very prominent thin-walled vascular component evenly distributed throughout the lesion as is typical of many endocrine type tumors. In paragangliomas, the cells between the vessels are not as uniform, round and bland as seen within a glomus tumor. Whereas glomus tumors consist of modified smooth muscle cells that stain with actin, paragangliomas are neuroendocrine tumors. Hemangiopericytomas usually lack the dilated vascular component seen in glomangiomas. As in glomus tumors, the cells in hemangiopericytoma lie exterior to the endothelial cells. However, the cells in hemangiopericytoma have a short spindled morphology.
Incorrect
Answer: Glomangioma
Histology: The lesion consists of a well circumscribed small nodule within the subcutaneous adipose tissue. Within the center of the lesion are dilated benign appearing vascular channels. Surrounding these ectatic vessels are nests and cords of extremely bland appearing cells. The cells have scant cytoplasm and small round nuclei without nucleoli, mitoses, or pleomorphism. These cells are typical of those found within glomus tumors. When combined with a more prominent vascular component these lesions are designated as “glomangiomas”.
Discussion: Hemangiomas have similar vessels yet lack the cellular component exterior to the vessels. Paragangliomas, when found near the jugulotympanic region are referred to as “glomus jugulare tumors”, although they are different tumors than glomus tumors. Paragangliomas have a very prominent thin-walled vascular component evenly distributed throughout the lesion as is typical of many endocrine type tumors. In paragangliomas, the cells between the vessels are not as uniform, round and bland as seen within a glomus tumor. Whereas glomus tumors consist of modified smooth muscle cells that stain with actin, paragangliomas are neuroendocrine tumors. Hemangiopericytomas usually lack the dilated vascular component seen in glomangiomas. As in glomus tumors, the cells in hemangiopericytoma lie exterior to the endothelial cells. However, the cells in hemangiopericytoma have a short spindled morphology.
