Cutaneous epithelioid angiomatous noduleD18.-

Brenn T and Fletcher CD 2004

Cutaneous epithelioid angiomatous nodule (CEAN) is a rare (<100 published cases) benign vascular neoplasm of the skin that was first described in 2004. Its less spectacular clinical aspect makes it easy to confuse with other benign and malignant vascular tumors such as granuloma pyogenicum, epithelioid hemangioma, bacillary angiomatosis, Kaposi's sarcoma (especially in immunocompromised patients), epithelioid hemangioendothelioma and epithelioid angiosarcoma (Hua S et al. 2025).

In all cases described to date, minimal to mild cytologic atypia and the absence of invasion have been described as reliable features for distinguishing cutaneous epithelioid angiomatous nodules from malignant vascular tumors.

m:w=1:1

18 to 61 years (average age 38 years)

Preferably on the trunk, but also on the extremities, less frequently on the head, neck or genitals.

Clinically, the angiomatous neoplasm appears as a well-defined, solitary, deep red or blue-red, firm nodule or as a lump with an intact surface. If excision is incomplete, the tumor tends to recur. Satellite disease has also been described (Hua S et al.2025).

Histologically, they are non-encapsulated, well-demarcated, unilobular superficial skin nodules with intact or ulcerated overlying epidermis. They consist of a solid proliferation of plump epithelial cells and thin-walled vascular channels lined by similar cells with eosinophilic cytoplasm, vesicular nuclei and prominent nucleoli. Mitotic activity is usually present, but atypical forms of mitosis and necrosis do not occur. Cases with "abundant" mitotic activity have been described. An inflammatory cellular component consisting of lymphocytes, plasma cells and occasional eosinophils may be expressed within the stroma. The cytologic atypia ranges from mild to moderate. Mitotic activity is generally between 3 and 9/10 HPF.

Immunohistochemically, the tumor cells stain positive for the vascular markers CD31 and CD34. They are negative for human herpesvirus 8 (HHV-8) and cytomegalovirus (CMV). Warthin-Starry staining and EBER in situ hybridization are negative.

Pyogenic granuloma (history of trauma, very rapid initial growth)

Bacillary angiomatosis (characteristically occurs in immunocompromised patients and shows deep neutrophil infiltration with aggregates of eosinophilic granular substances representing clusters of Bartonella henselae organisms)

Epithelioid hemangioma (predominantly vasoformative architecture with extension into the subcutis, multilobular extension, involvement of small muscle vessels and the presence of lymphoid follicles)

Epithelioid hemangioendothelioma (infiltrative malignant neoplasm often occurring in solid organs and deep soft tissues, arranged in cords and strands embedded in myxohyaline stroma, characteristic blister cells detectable).

Angiosarcomas (CEAN cases show only moderate cytologic atypia, angiosarcomas are usually larger, show solid, sheet-like growth with widely infiltrative margins, dermal collagen dissection through vascular channels, necrosis, atypical mitoses)

There is a general consensus that CEAN is closely related to epithelioid hemangioma (syn: angiolymphoid hyperplasia with eosinophilia) or pyogenic granuloma and that distinguishing between these entities can sometimes be very difficult (Chetty R et al. 2018).

1. Alvarez-Argüelles-Cabrera H et al. (2008) Cutaneous epithelioid angiomatous nodule. J Eur Acad Dermatol Venereol 22:1383-1385)
2. Brenn T, Fletcher CD (2004) Cutaneous epithelioid angiomatous nodule: a distinct lesion in the morphologic spectrum of epithelioid vascular tumors. Am J Dermatopathol 26:14-21
3. Chetty R et al. (2018) Cutaneous epithelioid angiomatous nodule: a report of a series including a case with moderate cytologic atypia and immunosuppression. Diagn Pathol 13:50.
4. Hua S et al. (2025) Multiple cutaneous epithelioid angiomatous nodules. J Dtsch Dermatol Ges 23:90-92.
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6. Shiomi T et al. (2011) Cutaneous epithelioid angiomatous nodule arising in capillary malformation. J Cutan Pathol 38:372-375.
7. Wang A et al. (2015) Cutaneous epithelioid angiomatous nodule: a report of a series with marked cytologic atypia: potential diagnostic pitfall. USCAP 192:497A.