Intravascular papillary endothelial hyperplasia along the intrinsic muscle after hand contusion injury: Report of two cases

Intravascular Papillary Endothelial Hyperplasia Involving the Hand: A Case Report of a Rare Entity

Masson's tumor, also named intravascular papillary endothelial hyperplasia (IPEH), is a rare, benign vascular tumor. Evaluation by clinical features can be confused with other soft tissue tumors. Therefore, the diagnosis should be confirmed by histopathological examination. The patient reported here is 67 years old and came to us with a small painful lesion over the left thumb of about two months duration. Histopathological examination was consistent with Masson's tumor (IPEH) following excisional biopsy, with good functional outcomes. To the best of our knowledge, this is the first report of this entity from Kuwait. Dermatologists and surgeons should know about this rare entity and its unusual presentation, to be able to distinguish it from similar presenting serious conditions, especially angiosarcoma. Through this report, we purport to facilitate recognition of this condition apart from some other conditions it may mimic.

Intravascular Papillary Endothelial Hyperplasia (Masson Tumor) of the Right Thumb: A Case Report and Literature Review

The Masson tumor is a benign vascular tumor named after Pierre Masson, the French pathologist who originally described it in 1923, terming it "hémangio-endothéliome végétant intravasculaire." It is a rare tumor that can arise in any area throughout the body. However, the exact cause of Masson tumor remains poorly understood, and its diagnosis is challenging and difficult to distinguish from several other soft-tissue tumors. In this report, we report a case of Masson tumor arising in the right thumb that is only the second reported case in the hand in Saudi Arabia.

Masson's Lesion - A very rare cardiac mass

Masson's lesion is a rare type of vascular tumor usually found in the skin and soft tissues. Histological examination remains the gold-standard for diagnosis. Treatment involves complete surgical excision and correct diagnosis is essential to avoid unnecessary aggressive therapy. A unique case of Masson's lesion presenting as an asymptomatic pericardial mass is reported for the first time. Multimodality imaging was used for a comprehensive non-invasive mass characterization. Relevant imagiological and pathological findings for differential diagnosis are discussed. The importance of close coordination between different medical specialties for optimal care of this unusual clinical condition is highlighted.

Masson's tumor involving the hand: A case report

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Masson’s tumor or IPEH is a rare benign tumor composed of reactive endothelial cells in a thrombus.

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Angiosarcoma may mimick Masson’s tumor, thus ruling it out is imperative.

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Surgical resection conveys excellent outcome and prognosis, with handful of recurrence cases.

Introduction

Masson’s tumor or IPEH represents a rare exuberant endothelial proliferation within a thrombus through an uncomprehended phenomenon. Being reported for the 1st time in Saudi Arabia, plastic surgeons should keep it in the list of differential diagnosis.

Case

We report a case of 17-year-old-girl who presented with a 6-month-old, painful mass on the volar side of her left 4th MCP. Radiology was inconclusive. Histopathology reported Masson’s tumor following surgical excision with good functional outcome and no recurrence.

Discussion

Comprising 2%–4% of overall skin vascular tumor and with no identifying clinical or radiological feature, IPEH poses as a diagnostic challenge. The literature reports similar tumors in the hand with different locations and presentations. Surgical excision remains the cornerstone of management, yet the role of radiotherapy remains undefined. Incomplete excision may result in recurrence, which requires a consensus on the extend of marginal excision. Rare cases of recurrence were reported. Histopathology is the only reliable method of diagnosis.

Conclusion

We present the 1st reported case of IPEH involving the hand in Saudi Arabia. Plastic surgeons should be aware of such rare conditions and be able to differentiate them from relatively identical yet more sinister tumors, especially angiosarcoma.

Masson's Tumor of the Hand: An Uncommon Histopathological Entity

Masson's tumor or Masson's hemangioma, more precisely termed intravascular papillary endothelial hyperplasia (IPEH), is an uncommon benign vascular lesion of the skin and subcutaneous tissues which can be frequently confused with angiosarcoma. Although relatively rare, its accurate diagnosis is essential since it can clinically be similar to both benign and malignant lesions. We present a 39-year-old man with a round bulging arising from the left palm side of the hand with gradual growth in the last 5 months and on and off tenderness. The microscopic section demonstrated the papillary proliferation of endothelial cells in favor of Masson's hemangioma, which was sufficiently treated with excision alone.