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LETTER TO EDITOR  
Year : 2021  |  Volume : 64  |  Issue : 1  |  Page : 216-217
Primary nodal hemangioma of axillary lymph node: A rare encounter


Department of Pathology, Government Medical College, Kollam, Kerala, India

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Date of Submission16-Dec-2019
Date of Decision18-Feb-2020
Date of Acceptance17-Mar-2020
Date of Web Publication8-Jan-2021
 

How to cite this article:
Varughese AA, Raji N L. Primary nodal hemangioma of axillary lymph node: A rare encounter. Indian J Pathol Microbiol 2021;64:216-7

How to cite this URL:
Varughese AA, Raji N L. Primary nodal hemangioma of axillary lymph node: A rare encounter. Indian J Pathol Microbiol [serial online] 2021 [cited 2021 Jan 28];64:216-7. Available from: https://www.ijpmonline.org/text.asp?2021/64/1/216/306546




Dear Editor,

Primary benign vascular tumors of lymph node are very rare. Less than 60 cases are reported in literature.[1],[2] We report case of primary lymph node hemangioma in a 67-year-old lady who presented with an asymptomatic axillary swelling.

She visited our hospital for evaluation of left axillary swelling which she had noticed about 2 weeks back. Clinical examination revealed a firm, non-tender mobile swelling in the left axilla. Ultrasound of the left breast detected an isoechoic well-circumscribed mobile lesion in the left axillary region measuring 2.8 × 2.3 cm. The left breast was normal. CT thorax with contrast also showed an enlarged left axillary lymph node [Figure 1]a. No abnormalities were detected elsewhere in the chest. Fine-needle aspiration cytology attempted yielded only blood. Excision of the axillary swelling was done. The gross specimen was an encapsulated nodular mass measuring 2 × 1.5 × 1 cm. The surface showed attached fatty tissue. Cut section of mass had a grey-brown appearance [Figure 1]b. Microscopic evaluation revealed a well-encapsulated nodular mass composed of capillary vessels [Figure 2]a. Most of the nodal parenchyma was replaced by the vascular neoplasm except for little residual lymphoid tissue beneath the capsule [Figure 2]b. The capillaries showed hob nailing of endothelial cells in some areas [Figure 2]c. There was no increase in mitosis or nuclear atypia. The endothelial cells lining the capillaries are positive for CD34 [Figure 2]d.
Figure 1: (a). CT chest showing left axillary lymphadenopathy. (b). Gross specimen of excised axillary lymph node

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Figure 2: (a). Hemangioma lymph node showing capillary sized vessels, H and E, ×100 (b). Residual lymphoid tissue seen in the periphery of the hemangioma, H and E, ×40. (c). Endothelial cells show hob nailing of nuclei, H and E, ×400. (d). Endothelial cells are positive for CD34, ×400

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Hemangiomas of lymph nodes may be capillary, cavernous, or mixed.[3] There appears to be a female predominance, and usually, only a single node tends to be involved.[2],[4] Some are detected incidentally along with radical resection specimens or present as mass lesions.[4],[5] Differential diagnoses are other types of vascular tumors, benign ones including angiomyomatous hamartoma and lymphangioma, and malignant ones including hemangioendothelioma, Kaposi sarcoma, and angiosarcoma. Angiomyomatous hamartoma is seen only in inguinal lymph nodes. The parenchyma is replaced by blood vessels, fat, smooth muscle, and fibrous tissue without cellular fascicle formation. Lymphangioma consists of uncircumscribed small spaces filled with a proteinaceous material and floating lymphocytes and lined by a flat endothelial layer. The absence of atypia and mitosis rule out malignant vascular tumors. Vascular transformation of the sinus shows vascular proliferation restricted to sinuses, occasionally associated with obstruction.[3],[4] Benign vascular tumors of lymph nodes are less common than either non-neoplastic vascular hyperplasia or malignant lesions. They are usually incidental findings with no clinical significance. Surgical excision is curative in primary nodal hemangioma. Some cases that have been followed-up did not show any recurrences.[4] However, it is important to recognize them to avoid a misdiagnosis of malignant lesions or metastasis. To conclude, the authors present an extremely rare vascular lesion of the lymph node.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Chan JK, Frizzera G, Fletcher CD, Rosai J. Primary vascular tumors of lymph nodes other than Kaposi's sarcoma. Analysis of 39 cases and delineation of two new entities. Am J Surg Pathol 1992;16:335-50.  Back to cited text no. 1
    
2.
Sheikh U, Danforth R. Seven cases of primary intranodal hemangioma exclusively in females: Incidence in 2,461 consecutive hemangiomas examined by light microscopy. Am J Clin Pathol 2014;142:A096.  Back to cited text no. 2
    
3.
Ioachim HL, Medeiros LJ. Hemangiomas/hemangioendotheliomas. In: Ioachim HL, Medeiros LJ, editors. Ioachim's Lymph Node Pathology. 4th ed. Philadelphia, PA: JB Lippincott; 2008. p. 578-87.  Back to cited text no. 3
    
4.
Elgoweini M, Chetty R. Primary nodal hemangioma. Arch Pathol Lab Med 2012;136:110-2.  Back to cited text no. 4
    
5.
Terada T. Capillary cavernous hemangioma of the lymph node. Int J Clin Exp Pathol 2013;6:1200-1.  Back to cited text no. 5
    

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Correspondence Address:
Ashley Ann Varughese
Department of Pathology, Government Medical College, Kollam, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_979_19

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