Indian Journal of Pathology and Microbiology
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LETTER TO EDITOR  
Year : 2011  |  Volume : 54  |  Issue : 1  |  Page : 226-228
Intravascular papillary endothelial hyperplasia (Masson's tumor) of the parotid gland


1 Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
2 Department of Pathology, Fasa University of Medical Sciences, Iran

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Date of Web Publication7-Mar-2011
 

How to cite this article:
Mokhtari M, Azarpira N, Rasolmali R. Intravascular papillary endothelial hyperplasia (Masson's tumor) of the parotid gland. Indian J Pathol Microbiol 2011;54:226-8

How to cite this URL:
Mokhtari M, Azarpira N, Rasolmali R. Intravascular papillary endothelial hyperplasia (Masson's tumor) of the parotid gland. Indian J Pathol Microbiol [serial online] 2011 [cited 2014 Sep 2];54:226-8. Available from: http://www.ijpmonline.org/text.asp?2011/54/1/226/77423


Sir,

Intravascular papillary endothelial hyperplasia (IPEH) is a benign reactive vascular endothelial lesion, characterized by intravascular papillary growth of endothelial cells. It was first described by Masson (1923) as vegetant intravascular hemangioendothelioma. [1] The most frequent site of this lesion is skin and subcutis in which it appears as a red blue nodule, but it also occurs in fingers, trunk, head and neck, heart, larynx, and hypopharynx. [1],[2] The presentation of this lesion in the salivary gland is rare. A 39-year-old man presented with painless enlargement of left parotid since one year ago. The clinical diagnosis was of pleomorphic adenoma. Partial resection of parotid gland was done. Gross examination showed a 2 × 2 × 1 cm fragment of parotid gland with a small area of fibrosis and hemorrhage on sectioning. No mass was grossly identified. On histologic examination, the parotid gland showed chronic sialadenitis. There was also a dilated vessel with a focal area of intravascular papillary formation, covered by a rim of flat to plump endothelial cells. The papillary stalks were hyalinized [Figure 1] and [Figure 2]. No necrosis, mitoses or significant pleomorphism could be identified. The vessel also showed atherosclerotic change evidenced by the collection of foamy macrophages in the wall [Figure 3], but no thrombosis was identified. The diagnosis based on histologic sections was IPEH.
Figure 1: Dilated blood vessel with intravascular papillary formation (H and E, ×400)

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Figure 2: The papilla with hyalinized stalks is covered with plump endothelial cells. (H and E, ×400)

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Figure 3: Cholesterol cleft formation with foamy histiocytes in the wall of vessel, located in parotid gland. (H and E, ×100)

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There are numerous synonyms for IPEH, such as intravenous atypical vascular proliferation, intravascular angiomatosis, intravascular endothelial proliferation, Masson's pseudo-angiosarcoma, and Masson's lesion [1],[2] ; however, its exact pathogenesis remains uncertain.

IPEH is generally considered to be an unusual form of thrombus organization with extensive papillary endothelial proliferation.[3] Gupta et al.[4] stated that the source of hyperplastic endothelial cells in IPEH is vascularized granulation tissue formed during the process of organization of thrombus.

In addition to thrombosis, some other processes, such as endothelial cell proliferation secondary to infarct, blood stasis, and perivascular inflammation, were thought to be responsible for IPEH pathogenesis. [1] In our case the lesion occurred in an atherosclerotic vessel without superimposed thrombus.

Three forms of IPEH are known: the primary form (ie, the pure form), the secondary form (ie, the mixed form), and the extravascular form. [2],[3] The primary form occurs in normal preexisting vessels and the secondary form occurs in pre-existing vascular lesions, such as hemangioma, arteriovenous malformation, or pyogenic granuloma. [2],[3] Elevated levels of fibroblast growth factor in these patients may contribute to endothelial hyperplasia. [5] The extravascular form is rare and occurs in extravascular organizing hematoma. [6] The pure form is usually found in the extremities (particularly fingers) and the head and neck region, whereas the mixed type tends to be seen on the trunk. [6]

Histologically, IPEH can simulate angiosarcoma, because of the presence of papillary formations, anastomosing vascular channels, and plump endothelial cells. Useful points in the differentiation are exclusively intravascular nature of IPEH, lack of necrosis, bizarre cells, and atypical mitosis. The presence of fibrohyaline papillary stalks and finding of residual thrombi are useful criteria for the diagnosis of IPEH. [2],[3],[4] In conclusion, histopathologic examination is required to confirm the diagnosis of IPEH because it mimics several other lesions. This lesion may occur in the atherosclerotic vessel without thrombus formation.

 
   References Top

1.Murugaraj V, Kingston GT, Patel M, Anand R. Intravascular papillary endothelial hyperplasia (Masson's tumour) of the oral mucosa. Br J Oral Maxillofac Surg 2010;48:e16-7.  Back to cited text no. 1
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2.Guvenc MG, Derekolylu L, Korkut N, Oz F, Oz B. Intravascular papillary endothelial hyperplasia (Masson lesion) of the hypopharynx and larynx. Ear Nose Throat J 2008;87:700-1.  Back to cited text no. 2
    
3.Tzeng YS, Tsai CS, Lin CY, Peng YJ, Hong GJ. Intravascular papillary endothelial hyperplasia on the thigh. J Med Sci 2003;23:303-6.  Back to cited text no. 3
    
4.Gupta S, Nigam S, Chaturvedi KU. Masson's tumor. A lesion of uncertain histogenesis. Indian J Dermatol 2005;50:77-9.  Back to cited text no. 4
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5.Modi A, Moorjani N, Pontefract D, Livesey S. Isolated papillary endothelial hyperplasia in the left atrial appendage. Interact Cardiovasc Thorac Surg 2008;7:1204-6.  Back to cited text no. 5
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6.Arai E, Shimizu M, Ogawa F, Hirose T, Ohbayashi H, Taguchi S, et al. Exteravascular papillary endothelial hyperplasia of the palm masquerading as an angiosarcoma. J Dermatol 2008;35:238-41.  Back to cited text no. 6
    

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Correspondence Address:
Negar Azarpira
Department of Pathology, Organ Transplant Research Center, Nemazi Hospital, Shiraz University of Medical Sciences, Shiraz
Iran
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DOI: 10.4103/0377-4929.77423

PMID: 21393933

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