Targetoid hemosiderotic hemangioma D18.01

Author: Prof. Dr. med. Peter Altmeyer

Co-Autor: Dr. Michael Hambardzumyan

All authors of this article

Last updated on: 25.05.2024

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Synonym(s)

Hobnail hemangioma; Targetoid hemosiderotic hemangioma

History
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Santa Cruz and Aronberg, 1988

Definition
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Rare, solitary hemangioma occurring at any age (preferably in adolescence) with a characteristic, shooting-disk-like clinical aspect.

Localization
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Legs, arms, buttocks, hips, chest area. Rarely tongue and gingiva.

Clinical features
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Mostly solitary, 0.2-0.5 cm in Ø, red to brown-red papule/plaque, which in some cases (about 20%) is surrounded by a narrow pale halo and a larger brownish ring (shooting disc aspect). This halo may fade or recede with time. Spontaneous regression of the hemangioma is not uncommon. 'Target-like' hemangioma.

Shallow dark brown variants may lack cocard stratification, causing them to be misrecognized as melanocytic neoplasms.

Histology
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Biphasic growth:

  • Superficial dermis: dilated, lacunar, thin-walled vessels lined by prominent "hobnail" endothelia, few intraluminal erythrocytes. Erythrocyte extravasations and hemosiderin deposits are frequently present (see clinic below).
  • Deep dermis: slit-like vascular spaces with hemosiderin deposits between compacted collagen bundles. Smooth muscle actin-positive pericytes are absent (indication of lymphatic differentiation). No mitoses or nuclear atypia.

Differential diagnosis
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Therapy
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Excision, no risk of recurrence.

Note(s)
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The skin change with a characteristic cockade pattern was initially regarded as a hemosiderotic hemangioma. In fact, it is neither a hemangioma nor a proliferating tumor, but rather a superficial lymphatic malformation. In this respect, it is listed under lymphatic mal formations in the classification of vascular malformations.

Literature
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  1. Al Dhaybi R et al. (2012) Targetoid hemosiderotic hemangiomas (hobnail hemangiomas) are vascular lymphatic malformations: a study of 12 pediatric cases. J Am Acad Dermatol 66:116-120.
  2. Christenson LJ et al. Trauma-induced simulator of targetoid hemosiderotic hemangioma. Am J Dermatopathol 23: 221-223
  3. Cotell S et al. (2003) What is your diagnosis? Targetoid hemosiderotic hemangioma. Cutis 72: 51-52
  4. Guillou L et al. (1999) Hobnail hemangioma: A pseudomalignant vascular lesion with a reappraisal of targetoid hemosiderotic hemangioma. Am J Surg Pathol 23: 97-105
  5. Gutte RM et al (2014) Targetoid hemosiderotic hemangioma. Indian Dermatol Online J 5: 559-560.
  6. Kakizaki P et al. (2014) Targetoid hemosiderotic hemangioma - Case report. An Bras Dermatol 89:956-959.
  7. Panigrahi A et al (2020) Targetoid hemosiderotic hemangioma. Indian Pediatr 57:983.

  8. Rapini RP, Golitz LE (1990) Targetoid hemosiderotic hemangioma. J Cutan Pathol 17: 233-235
  9. Santa Cruz DJ, Aronberg J (1988) Targetoid hemosiderotic hemangioma. J Am Acad Dermatol 19: 550-558
  10. Zaballos P et al. (2015) Dermoscopy of Targetoid Hemosiderotic Hemangioma: A Morphological Study of 35 Cases. Dermatology 231:339-344.

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Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 25.05.2024