Verrucous hemangioma (VH) is a uncommon, congenital and localized vascular malformation,

Verrucous hemangioma (VH) is a uncommon, congenital and localized vascular malformation, which usually presents as warty, bluish, vascular papules, plaques, or nodules, mainly on the lower extremities. stain. Gradually with the growth of child, the lesions increase in size, spread locally and become verrucous. The lesions are usually scattered but linear, serpiginous and reticular patterns can be seen rarely [2]. The linear arrangement of these lesions usually reflects order NVP-AEW541 genetic mosaicism or dermatomal distribution [3]. Verrucous hemangioma does not involute spontaneously, rather, incomplete excision can order NVP-AEW541 result in regrowth [3]. Clinically, VH is a close mimicker of other vascular lesions like angiokeratoma, infantile hemangioma and venous or lymphatic malformations. Thus, dermoscopic and microscopic evaluation aids in confirming the clinical diagnosis. Case Report A 13-year-old female presented with purplish, warty skin lesions over the inner surface of the left foot. Her mother stated that these lesions were noticed in early infancy, and with age they enlarged, increased in number, and became irregular on the surface. There was no history of any trauma or bleeding from these lesions. Cutaneous inspection revealed well-defined erythematous to violaceous plaques and nodules with verrucous surfaces arranged in a linear array over the medial aspect of the left foot that were tender on palpation (Figure 1a, b). No limb length discrepancy was noted. Systemic examination did not reveal any abnormalities, nor did laboratory investigations. Open in a separate window Figure 1 (a) Erythematous to violaceous plaques with verrucous surface (black circle) arranged in a linear array over the medial aspect of the left foot. (b) Satellite plaques (black arrow) arranged linearly over the dorsum of foot. (c) Dermoscopy of verrucous lesions showing the prominent hyperkeratosis over bluish background (black order NVP-AEW541 circle) along with the reddish blue lacunae (black arrow) indicating the underlying dilated vascular channels. (d) Peripheral areas of the lesion showing the bluish lacunae (black arrow) characteristic of vascular lesions correlating with the vascular channels seen in histopathology. [Copyright: ?2018 Dhanta et al.] The dermoscopic features were different depending on the type and site of the lesions. The most striking feature was a prominent bluish background. Hyperkeratosis and bluish lacunae were observed in most of the lesions but they were most prominent in verrucous plaques (Figure 1c). The periphery of the plaque showed well-defined dark blue lacunae characteristic of vascular lesions(Figure 1d). Doppler sonography of the lower limb (arterial system) showed diffuse irregular echogenicity in the subcutaneous plane of the affected section of the still left feet. At some areas, minimum amount vascularity was noticed and these sonographic features had been suggestive of hemangioma. A 4 mm punch biopsy was order NVP-AEW541 used for histopathological evaluation. Microscopy uncovered elongation of rete ridges, heavy parakeratosis and dense infiltration of eosinophils in a parakeratotic epidermis. Little and thin-walled capillaries lined by flattened endothelial cellular material were noticed predominantly in the dermis (papillary and deep dermis) achieving up to the dermosubcutaneous junction. A few capillaries had been dilated and filled up with refreshing fibrin thrombi (Body 2aCc). These features, hence, confirmed the medical diagnosis of verrucous hemangioma. The individual was described cosmetic surgery, where serial excisions had been planned to eliminate the complete lesion. Open up in another window Figure 2 (a) Scanning watch displaying hyperkeratosis, elongation of rete ridges, and vascular dilatations in the papillary dermis extending to subcutaneous cells (H&E, 4x). (b) Hyperkeratosis, papillomatosis, acanthosis, and dilated arteries in the dermis IL5R (H&E, 10). (c) Little and thin-walled dilated capillaries observed in dermis lined by flattened endothelial cellular material (dark arrow) with fibrin thrombi within a number of the vessels (H&Electronic, 40). [Copyright: ?2018 Dhanta et al.] Discussion In 1937, Halter released the word verrucous haemangioma which can be an uncommon vascular malformation. It had been first referred order NVP-AEW541 to as another entity and distinguished from angiokeratoma and its own various other variants by Imperial and Helwig in 1967 [1]. VH generally presents at birth or in early childhood and steadily progresses in proportions with age group. The original presentation.