Quiz 26: What is your diagnosis?

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Diagnosis: Quiz 26

Quiz 26

Answer:  Cherry hemangioma

Criteria for diagnosis clinically:  A smooth-surfaced papule, violaceous in the center and rust-colored at the periphery, are typical of a cherry hemangioma, longstanding.

Differential diagnosis clinically: There is none.

Criteria for diagnosis histopathologically: Numerous, closely-set, erythrocyte-filled venules dilated widely in a well circumscribed locus in the upper part of the reticular dermis are findings of cherry hemangioma.

Differential diagnosis histopathologically: There is none.

Clinicopathologic correlation: The violaceous hue in the center of the papule is a result of the widely dilated venules being approximated close to one another in the upper part of the reticular dermis and being crammed with erythrocytes, whereas the rust cast at the periphery of it is attributable to red blood cells being present in large number in dilated venules that are fewer in number and situated more superficially in the reticular dermis than those in the center. The surface of the papule is smooth because the stratum corneum is normal.

Options for therapy predicated on knowledge of histopathologic findings: A hemangioma is benign and therefore need not be extirpated.

1) Scrutiny of the close-up photograph of the lesions clinical reveals that some tiny papules of cherry hemangioma actually are bright red, in contrast to the larger papules that are purple. The tiny papules represent a stage much earlier in the course biologic.

2) A hemangioma, a benign neoplasm, is different fundamentally and dramatically from telangiectases when viewed by microscopy conventional, as is illustrated by contrasting the changes here with those in Quiz 1671; the dilated vessels of this proliferation are much more numerous and in much closer proximity to one another than those of the vessels preexisting expanded exponentially of telangiectases.

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