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Dermpath-India Pathology of Cutaneous Epithelioid Angiomatous Nodule 2022 |
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Cutaneous Epithelioid Angiomatous Nodule (CEAN) was first described in
2004 by Brenn and Fletcher after a study of 15 cases.
In 2008, Sanguenza et al. described an additional 10 cases of CEAN and proposed that they should be classified as epithelioid hemangioma or angiolymphoid hyperplasia with eosinophilia. Some authors consider "CEAN" to be a type of pyogenic granuloma. Cutaneous Epithelioid Angiomatous Nodule is a rare benign vascular proliferation and a distinct entity. The lesion usually occurs in adults. There is a wide age range of presentation (15-80 years). Clinical presentation: Clinically, Cutaneous Epithelioid Angiomatous Nodule (CEAN) presents as a solitary rapidly growing reddish-blue nodule. The size ranges between 0.5 to 1.5 cm in maximum diameter. Site: It is usually located on the trunk and extremities. Cases have been reported on the face and nasal mucosa.
Differential Diagnosis: Differential diagnosis include all vascular lesions composed of epithelioid cells. Epithelioid hemangioma (angiolymphoid hyperplasia with eosinophilia) ; Epithelioid hemangioendothelioma ; Epithelioid Angiosarcoma ; Bacillary angiomatosis and pyogenic granuloma. 1) Epithelioid hemangioma (angiolymphoid hyperplasia with eosinophilia - ALHE) - ALHE is usually located on the head and neck region. These are multiple lesions. CEAN usually presents as a solitary lesion on the trunk and extremities. ALHE is a multilobular lesion located in the deep dermis and has a very prominent inflammatory infiltrate and higher number of eosinophils. No lymphoid follicles or germinal centers are present in CEAN. 2) Epithelioid Angiosarcoma - It is a poorly circumscribed aggressive tumour. The cells show nuclear pleomorphism, atypia, numerous atypical mitotic figures and patchy areas of necrosis. More than 50% cases are cytokeratin positive 3) Epithelioid hemangioendothelioma - This is a malignant tumour which is larger, deeper and less well-defined compared to CEAN. The tumour has a hyaline, myxoid, chondroid or collagenous stroma. Cytokeratin is positive in many cases. 4) Bacillary angiomatosis - Bacillary angiomatosis is an infectious disease causing proliferation of small blood vessels in the skin and visceral organs of patients with human immunodeficiency virus infection and other immunocompromised hosts. This vasoproliferative, pseudoneoplastic lesion is caused by small , gram-negative bacilli Bartonella henselae. 5) Pyogenic granuloma - Lobular proliferation of capillaries consisting of cytologically bland endothelial cells, surrounded by pericytes. These are usually post traumatic lesions and located on the face and mouth. It may extend into deep dermis, subcutis, or intravascular space.
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