Intravascular papillary endothelial hyperplasia: a pseudotumor presenting on the plantar foot

Intravascular Endothelial Hyperplasia of the Foot: A Case Series

Intravascular endothelial hyperplasia is a benign soft tissue mass rarely reported in the foot. Advanced imaging and confirming a benign diagnosis are critical for any soft tissue mass. This paper identifies 2 patients that developed intravascular endothelial hyperplasia tumors which required surgical excision. A 17-year-old male patient presented to clinic complaining of a painful bump to the arch of his right foot which he related to an injury 9 months prior. Magnetic resonance imaging of the right foot revealed a mass within the plantar subcutaneous fat that was serpiginous in nature similar to adjacent branching vessels favoring a low-flow vascular malformation. A 38-year-old female with Multiple Sclerosis presented with complaints of persistent symptoms of pain to the 1^st interspace, difficult ambulation and neuritis. Ultrasound and MRI observed solid, multilobulated mass, with internal vascular malformation, MRI describing intrinsic involvement along the abductor musculature and flexor tendons. Both lesions were surgically excised and sent for pathology. Pathology report indicated a diagnosis of intravascular papillary endothelial hyperplasia or Masson's tumor in both cases. Pathology diagnosis of intravascular papillary endothelial hyperplasia is generally good with wide resection leading to low recurrence rates. Both patients in the current study have progressed postoperatively with resolution of symptoms and without recurrence.

Intravascular papillary endothelial hyperplasia occurring in the foot: A case report and review of literature

RATIONALE

Intravascular papillary endothelial hyperplasia (IPEH; Masson tumor) is a type of vascular lesions composed of reactive proliferation of endothelial cells that occur in organizing thrombus. It commonly occurs on the head, neck, trunk, and upper extremities, but rarely in the foot.

PATIENT CONCERNS

A 38-year-old woman visited the hospital with a mass on the dorsum of right foot, which gradually increased in size 3 months ago.

DIAGNOSES

Ultrasonographic examination suggested angiomyolipoma or hemangioma.

INTERVENTIONS

The patient underwent excision under local anesthesia.

OUTCOMES

The lesion was confirmed to be IPEH by histological examination. There were no complications or recurrences after successful surgical excision.

LESSONS

IPEH presenting on the dorsum of the foot is vary uncommon. Radiologic diagnosis may be limited for diagnosis, and histologic confirmation should be made after surgical excision. There are some reports suggesting an association between trauma and IPEH occurrence, but this is not yet conclusive.

[Intravascular papillary endothelial hyperplasia (IPEH) : Masson's pseudoangiosarcoma on the forefoot]

Intravascular papillary endothelial hyperplasia (IPEH)/Masson's pseudoangiosarcoma is a rare (orphan) disease of the forefoot that has not yet been described in Europe. The pathoanatomic examination of a young patient with a vague interdigital space-consuming lesion revealed a intravascular papillary endothelial hyperplasia/Masson's pseudoangiosarcoma. The intravascular papillary endothelial hyperplasia can be mainly detected in the upper limbs as well as cervically. Heretofore, the intravascular papillary endothelial hyperplasia has only been described in Japan and the USA. For Europe, our case report is the first description of the clinical course of IPEH.

Intravascular papillary endothelial hyperplasia: magnetic resonance imaging of finger lesions

OBJECTIVE

To describe magnetic resonance imaging (MRI) features of intravascular papillary endothelial hyperplasia (IPEH), to identify findings differentiating IPEH of the finger from that of other locations, and to correlate these with pathology.

MATERIALS AND METHODS

Nineteen patients with 20 I.E. masses of the finger (n = 13) and other locations (n = 7) were evaluated. All patients underwent MRI, and the results were correlated with pathology.

RESULTS

Seventeen IPEHs, including all IPEHs of the finger, were located in the subcutis, the three other lesions in the muscle layer. On T1WI, all masses were isointense or slightly hyperintense. IPEHs of the finger (n = 13) revealed focal hyperintense nodules (n = 2) or central hypointensity (n = 2) on T1WI, hypointensity with a hyperintense rim (n = 7), hyperintensity with hypointense nodules (n = 5), or isointensity with a hypointense rim (n = 1) on T2WI, and rim enhancement (n = 5), heterogeneous enhancement with nodular nonenhanced areas (n = 6), peripheral nodular enhancement (n = 1), or no enhancement (n = 1) on gadolinium-enhanced T1WI. IPEHs of other locations (n = 7) demonstrated focal hyperintense nodules (n = 5) on T1WI, hyperintensity with hypointense nodules (n = 5) or heterogeneous signal intensity (n = 2) on T2WI, and rim or rim and septal enhancement (n = 6) or peripheral nodular enhancement (n = 1). Microscopically, IPEHs were composed of thrombi that were hypointense on T2WI and papillary endothelial proliferations that showed T2 hyperintensity and enhancement.

CONCLUSION

MRI of finger IPEH reveals well-demarcated subcutaneous masses with hypointensity or hypointense nodules with peripheral hyperintensity on T2WI, as well as peripheral enhancement. T1 hyperintense nodules, internal heterogeneity on T2WI, and septal enhancement are more common in IPEH of other locations.

Intravascular papillary endothelial hyperplasia of the digit: MRI features with histological correlation

To clarify the magnetic resonance (MR) features of the pure form of intravascular papillary endothelial hyperplasia, MR images (MRIs) from five patients were retrospectively reviewed and compared with histological findings. The images showed a heterogeneous, iso- to slightly high signal intensity mass on T1-weighted images and a mass with a central heterogeneous, iso- to slightly high signal intensity area completely or incompletely surrounded by peripheral high signal intensity areas on T2-weighted images. Heterogeneous enhancement was observed after gadolinium administration. Histological studies indicated that the central heterogeneous area on T2-weighted images corresponded to thrombi (organized and/or hyalinized) and/or papillary endothelial proliferation, and also that the peripheral high signal intensity area corresponded to vascular blood space and/or papillary endothelial proliferation. The pure form of intravascular papillary endothelial hyperplasia showed relatively characteristic features on MRIs.