ERUPTIVE EPITHELIOID HEMANGIOENDOTHELIOMA WITH SPINDLE CELLS

A 39-year-old white man presented with four discrete dermal nodules in his right upper arm. Biopsy revealed superficial dermal well-circumsc ribed nodules composed of solid areas and vascular spaces lined by epi thelioid endothelial cells and a similar nodule composed of spindle an d epithelioid cells. A moderate mitotic count of 3-4 mitoses/10 hpf wa s present. Multiple lesions erupted 1 month later distally and proxima lly to the original lesions. Magnetic resonance imaging of the right a rm demonstrated a lesion in the humerus. Biopsy of the humerus showed a vascular tumor with similar histologic features to the overlying ski n lesions. The differential diagnosis included epithelioid vascular tu mors, bacillary angiomatosis, pyogenic granuloma, and Kaposi sarcoma, Vascular lesions containing epithelioid and spindle cells span a spect rum from benign to malignant. We believe these tumors belong in the ca tegory of hemangioendothelioma and propose the name eruptive epithelio id hemangioendothelioma with spindle cells. Our case emphasizes that e ruptive cutaneous vascular lesions do not always suggest immunosuppres sion or malignancy. Additionally, it highlights the association betwee n epithelioid vascular lesions of the skin and bone.