Haemangioendothelioma in an infant's wrist

Papillary endothelial hyperplasia (Masson's tumor) in children

The intravascular papillary endothelial hyperplasia (IPEH/Masson's tumor) is a rare benign tumor of the skin and subcutaneous vessels. We report, in four pediatric cases, clinical presentation, care (diagnostic and surgical) of Masson's tumor in children. Two boys (two years) and two girls (four and six years) showed a pain subcutaneous tumor (one to five centimeters). They were in the transverse abdominal muscle, between two metatarsals, at the front of thigh and in the axilla. Imaging performed (MRI, Doppler ultrasound) evoked either a hematoma, a lymphangioma or hemangioma. The indication for removal was selected from pain and/or parental concern. The diagnosis was histologically. A lesion persisted in residual form (incomplete initial resection), and is currently not scalable for eleven years.

DISCUSSION

This tumor is characterized by excessive proliferation and papillary endothelial cells in the vessels, following a thrombotic event. It is found mainly in adults (no specific age), and preferentially localizes in the face and limbs. The clinical differential diagnosis of this tumor is angiosarcoma. The imagery has not allowed in our series to diagnose but still essential to eliminate differential diagnoses. Only surgical excision with histological examination can differentiate. Our study emphasizes the possibility of pediatric cases with two cases of unusual locations (abdominal and axilla). Clinical presentations we met, now lead us to direct our histologist looking for a Masson tumor in any child with a subcutaneous tumor and/or intramuscular pain, sudden onset, and vascular appearance (after excluding an arteriovenous malformation).

Epitheloid hemangioendothelioma of the subcutaneous tissues of a finger

Epithelioid hemangioendotheliomas (EHEs) are known to have a variable malignant potential. EHEs are rarely seen in the hand and there is no consensus about their management. The options include excision, excision followed by adjuvant radiotherapy and amputation. In this paper, we report a case of EHE of a finger that was treated by excision. Although the tumor had ill-defined borders and there was histological evidence of tumor extension to all resection margins, no local recurrence or metastasis were noted during the 3 years of followup. The literature is reviewed and an argument is made that EHEs of the hand may have a more benign behavior compared with EHEs of the lower limbs and viscera.