Atypical florid vascular proliferation in appendix: a diagnostic dilemma

Joon Hyuk Choi,Mi Jin Gu,So Hyun Kim

doi:10.1186/1746-1596-8-12

Abstract

Vascular abnormality of the intestine is rare, except angiodysplasia. We report on an unusual case of atypical florid vascular proliferations of the appendix. A 41-year old male presented with melena. Adhesioned blood clots in the appendiceal orifice were observed by colonoscopy. He underwent laparoscopic appendectomy. Microscopically, a tiny exophytic polypoid mass was observed. The mass showed pyogenic granuloma-like features in the superficial portion and infiltrative florid vascular proliferations in the deeper portion. Endothelial cells showed minimal nuclear atypia, and mitotic figures were observed infrequently and showed positivity for CD31 and CD34 and negativity for HHV-8. Differential diagnoses include from benign vascular tumor to angiosarcoma or Kaposi's sarcoma, but this lesion does not fit the description of any defined vascular entity. We diagnosed atypical florid vascular proliferations and the patient has been well during the five-month postoperative follow-up. The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1386921325843104.

Highlights

Vascular proliferative lesions occurring in the gastrointestinal tract include tumors and tumor-like lesions of the vessels
In our review of the English literature, vascular tumors or vascular lesions occurring in the appendix have been rarely reported [4,5,6,7,8,9]
The florid benign vascular proliferations occurring in the gastrointestinal tract have been reported and may be confused with angiosarcoma [1,2,3]

Summary

Introduction

Background Vascular proliferative lesions occurring in the gastrointestinal tract include tumors and tumor-like lesions of the vessels. Seven cases of florid vascular proliferations occurring in the intestinal tract have been reported in English literature [1,2,3]. All reported cases were associated with intussusception or mucosal prolapse and showed microscopic features that overlap with those of angiosarcoma. Florid vascular proliferations are thought to be a secondary response to repeated mucosal trauma and ischemia and differential diagnosis from angiosarcoma is necessary [1].

Results

Conclusion