Two cases of atypical adult tufted angioma

Abstract

We report two cases of tufted angioma with atypical clinical presentations in adults. Patient 1 was a 41-year-old male with painful red plaques on his neck for 2 years. Cutaneous examination showed dark red papules distributed in clusters on the red plaques (7 cm×3.5 cm in size) of the neck, tough texture and some pseudo-vesicular lesions. Laboratory tests revealed a platelet (PLT) count of 83×109/L and abnormal coagulation. Histopathology revealed nodular endothelial cell hyperplasia arranged in tufts and looked like "cannonball" appearance in the dermis and subcutaneous tissue. Immunohistochemical stainings of CD31 and CD34 were positive, and D2-40 was focally positive.Diagnosis: Tufted angioma. The patient refused the treatment with oral propranolol, but was still under follow-up. Patient 2 was a 30-year-old female with a brown nodule on the left dorsal foot, accompanied by pruritus and pain for over two months. Dermatological examination showed a brown nodule in a diameter of about 0.8 cm, with a hard and rough surface. Laboratory tests were normal in routine blood test, liver, kidney and coagulation functions, except elevations in IgG (23.70 g/L) and C3 (0.888 g/L), and ANA 1∶640(+). Histopathological analysis revealed compact arrangement of endothelial cells with tuft proliferation in the dermis. Immunohistochemical stainings of CD31 and CD34 were positive, and D2-40 was focally positive. Diagnosis was tufted angioma. Surgical resection was given.

Keywords

• tufted angioma
• differential diagnosis
• kasabach-merritt phenomenon
• treatment