Masson's disease in hand surgery: a clinicopathologic study of four cases

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 Tumor of the Heel Fat Pad

ABSTRACT

Intravascular papillary endothelial hyperplasia (Masson tumor) is an uncommon benign vascular lesion characterized by a reactive proliferation of endothelial cells. This lesion commonly occurs in the head, neck, and upper extremities. Although it can be found anywhere in the body, the lesion has never affected the heel fat pad. This report presents a rare case of Masson tumor of the heel fat pad to facilitate the recognition of this uncommon lesion and also suggests other conditions to be considered when diagnosing heel lesions.

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

Intravascular papillary endothelial hyperplasia (IPEH), also known as Masson's tumor or vegetant intravascular hemangioendothelioma, is a reactive condition representing an exuberant organization and recanalization of a thrombus. It can occur in normal blood vessels or in vascular malformations, perhaps in response to blood vessel injury or thrombosis.

In this report, we present the diagnostic and therapeutic courses of a 55 year-old woman and an 18 year-old man, who had a progressive protruding hand mass following a hand contusion. The pathological examination confirmed the diagnosis of IPEH in both patients.

Imaging characteristics of intravascular papillary endothelial hyperplasia

PURPOSE

Intravascular papillary endothelial hyperplasia (IPEH) is a soft tissue, tumor-like, benign, reactive, vascular proliferation that, although not rare, is uncommonly imaged. We report the imaging findings of intravascular papillary endothelial hyperplasia in 13 patients, highlighting characteristic imaging features.

MATERIALS AND METHODS

We retrospectively reviewed 13 patients with IPEH who had corresponding MR and/or ultrasound imaging. MR imaging studies were evaluated for lesion location, shape, size, signal intensity, signal heterogeneity, and enhancement. Ultrasound studies were assessed for lesion shape, size, echogenicity, heterogeneity, and vascularity. Demographic data, including patient age, gender, and clinical history were also reviewed.

RESULTS

Most patients (11 of 13) presented with an enlarging mass. The age range was 10-72 years (mean 46) with ten females and three males. Eleven of the 13 lesions were primary IPEH without an associated preexisting vascular lesion. Ten of 13 lesions were in the superficial soft tissues, all of which were primary IPEH. Two of the three lesions in the deep tissues were secondary IPEH, arising within a preexisting vascular lesion. Lesions were small (mean 1.4 cm) and had a rounded shape. All of the primary lesions demonstrated high T2 signal peripherally and variable T2 signal centrally, with most demonstrating superficial location (91 %), peripheral enhancement (89 %) and associated dominant vessel (73 %). The five lesions evaluated by ultrasound were all hypoechoic with either scattered or peripheral vascularity on Doppler.

CONCLUSIONS

Primary papillary endothelial hyperplasia is commonly seen in the superficial soft tissues when captured on imaging and has a characteristic imaging appearance.

Case for diagnosis

Intravascular papillary endothelial hyperplasia is a benign vascular lesion caused by proliferation of endothelium. It is reactive to thrombotic or inflammatory stimuli in the vessel wall.We report the case of a 14-yearold male patient with a violet-colored erythematous tumoral lesion of progressive growth in the occipital region. The diagnosis of intravascular papillary endothelial hyperplasia (IPEH) was confirmed by clinical and histopathological findings. Total lesion exeresis was performed with no recurrence up to date. IPEH presents clinical importance due to its clinical and histological resemblance to angiosarcoma. In order to differentiate it from angiosarcoma, distinguishing features of the benign disease should be considered, such as lack of cellular atypia and rare mitotic activity.Prognosis is good.

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.

Masson's tumor in the ulnar artery

A healthy 30-year-old woman presented to the emergency department with a pulsatile right forearm mass and numbness of her fourth and fifth fingers. Duplex scan imaging revealed an ulnar artery aneurysm with intramural thrombus. After resection, histopathology revealed intravascular papillary endothelial hyperplasia, also known as Masson's tumor, a rare but benign vascular neoplasm. Local resection of the tumor with vascular reconstruction is curative and resulted in resolution of her neurologic symptoms. To our knowledge, this is the first reported case of a Masson's tumor occurring in an ulnar artery.