Virchows Archiv

, Volume 447, Issue 1, pp 103–106 | Cite as

Hemosiderotic fibrohistiocytic lipomatous lesion: clinical correlation with venous stasis

Case Report

Abstract

Hemosiderotic fibrohistiocytic lipomatous lesion (HFLL) is a recently proposed lipomatous entity. HFLL was originally suggested to be a benign reactive lesion arising due to an antecedent trauma. We report two patients with HFLL who also suffered from chronic vein insufficiency due to varicose involving deep veins of the low limbs. Both patients were middle-aged women with solitary, poorly circumscribed subcutaneous lesions on the lower extremities. Histopathological examination revealed typical features of HFLL. We think that the consistent clinical features such as advanced age, female sex predilection, and specific location along with distinctive histopathological features allow the suggestion that impaired blood circulation, to wit, venous stasis is involved in the pathogenesis of HFLL. We hypothesize that the proliferation of spindled fibroblastic and myofibroblastic cells and capillaries, erythrocyte extravasation, and hemosiderin deposition with lipomatous tissue of HFLL may simply represent an exaggerated tissue response to venous stasis in which elevated venous and capillary pressures, oxygen saturation, and edema stimulate the proliferation of the abovementioned elements and lead to erythrocyte extravasation. A similar histopathological pattern is seen in acroangiodermatitis of Mali and vascular transformation of lymph node sinuses, and these conditions are also associated with impaired blood circulation.

Keywords

Adipose tissue Acroangiodermatitis Vascular sinus transformation of lymph nodes Vein insufficiency Stasis Varicose HUMARA 

References

  1. 1.
    Allen RC, Zoghbi HY, Moseley AB, Rosenblatt HM, Belmont JW (1992) Methylation of HpaII and HhaI sites near the polymorphic CAG repeat in the human androgen-receptor gene correlates with X chromosome inactivation. Am J Hum Genet 51:1229–1239PubMedGoogle Scholar
  2. 2.
    Bluefarb SM, Adams LA (1967) Arteriovenous malformation with angiodermatitis. Stasis dermatitis simulating Kaposi’s disease. Arch Dermatol 96:176–181CrossRefPubMedGoogle Scholar
  3. 3.
    Cook PD, Czerniak B, Chan JKC, Mackay B, Ordóňez NG, Ayala AG, Rosai J (1995) Nodular spindle cell vascular transformation of lymph nodes. A benign process occurring predominantly in retroperitoneal lymph nodes draining carcinomas that can simulate Kaposi’s sarcoma or metastatic disease. Am J Surg Pathol 19:1010–1020PubMedGoogle Scholar
  4. 4.
    Folpe AL, Weiss SW (2004) Pleomorphic hyalinizing angiectatic tumor: analysis of 41 cases supporting evolution from a distinctive precursor lesion. Am J Surg Pathol 28:1417–1425PubMedGoogle Scholar
  5. 5.
    Kim TH, Kim KH, Kang JS, Kim JH, Hwang IY (1997) Pseudo-Kaposi’s sarcoma associated with acquired arteriovenous fistula. J Dermatol 24:28–33PubMedGoogle Scholar
  6. 6.
    Mali JW, Kuiper JP, Hamers AA (1965) Acro-angiodermatitis of the foot. Arch Dermatol 92:515–518CrossRefPubMedGoogle Scholar
  7. 7.
    Marshall-Taylor C, Fanburg-Smith JC (2000) Hemosiderotic fibrohistiocytic lipomatous lesion: ten cases of a previously undescribed fatty lesion of the foot/ankle. Mod Pathol 13:1192–1199CrossRefPubMedGoogle Scholar
  8. 8.
    Michal M, Koza V, Fakan F (1992) Myoid differentiation in vascular transformation of lymph node sinuses due to venous obstruction. Immunohistochemical and ultrastructural study. Zentralbl Pathol 138:27–33PubMedGoogle Scholar
  9. 9.
    Michal M, Koza V (1989) Vascular transformation of lymph node sinuses—a diagnostic pitfall. Pathol Res Pract 185:441–445PubMedGoogle Scholar
  10. 10.
    Nakamura H, Hirota S, Adachi S, Ozaki K, Asada H, Kitamura Y (2001) Clonal nature of seborrheic keratosis demonstrated by using the polymorphism of the human androgen receptor locus as a marker. J Invest Dermatol 116:506–510CrossRefPubMedGoogle Scholar
  11. 11.
    Paradis V, Laurent A, Flejou JF, Vidaud M, Bedossa P (1997) Evidence for the polyclonal nature of focal nodular hyperplasia of the liver by the study of X-chromosome inactivation. Hepatology 26:891–895PubMedGoogle Scholar
  12. 12.
    Serfling U, Lukowsky A, Audring H, Sterry W (1997) Search for Kaposi’s sarcoma-associated virus DNA in hemangioproliferative disorders and cutaneous malignant lymphoma. J Cutan Pathol 24:298–304PubMedGoogle Scholar
  13. 13.
    Steinmann G, Foldi E, Foldi M, Racz P, Lennert K (1982) Morphologic findings in lymph nodes after occlusion of their efferent lymphatic vessels and veins. Lab Invest 47:43–50PubMedGoogle Scholar
  14. 14.
    Stewart WM (1967) Fausse angiosarcomatose de Kaposi par fistules arteriovenulaires multiples. Bull Soc Fr Dermatol Syphiligr 74:664–665PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  1. 1.Sikl’s Department of Pathology, Medical Faculty HospitalCharles UniversityPilsenCzech Republic

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