|
 
 |
| CASE REPORT |
|
| Year : 2020 | Volume
: 4
| Issue : 2 | Page : 170-172 |
|
Segmental cherry angiomas with microtia and hepatomegaly: A case report
Niral K Sheth, Mohabat D Baria, Nilam K Damor, Rahul S Bhabhor
Department of Dermatology and Venereology, Zydus Medical College and Hospital, Dahod, Gujarat, India
| Date of Submission | 20-Apr-2019 |
| Date of Acceptance | 18-Nov-2019 |
| Date of Web Publication | 18-Aug-2020 |
Correspondence Address:
Mohabat D Baria
Department of Dermatology and Venereology, Zydus Medical College and Hospital, Dahod - 389 151, Gujarat
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/CDR.CDR_17_19
Cherry angioma or Campbell de Morgan spots or senile hemangioma is an acquired, well-circumscribed vascular lesion, occurring in adulthood and increasing in number with age. We report the case of a 60-year-old male patient with segmental cherry angioma, hepatomegaly, and ear abnormality.
Keywords: Cherry angioma, hepatomegaly, microtia, segmental
How to cite this article:
Sheth NK, Baria MD, Damor NK, Bhabhor RS. Segmental cherry angiomas with microtia and hepatomegaly: A case report. Clin Dermatol Rev 2020;4:170-2 |
| Introduction | |  |
Vascular anomalies represent a spectrum of disorders from a simple birthmark to life-threatening entities. There are multiple classification schemes for vascular anomalies, but most of them are far from satisfactory. Cherry hemangiomas are the most common cutaneous vascular proliferations[1] that are often widespread and may involve both the sun-exposed and nonexposed sites. They typically present in the third or fourth decades of life. Not much is known about its etiology and pathophysiology. However, in most of the cases, they occur in healthy individuals. On physical examination, lesions may have a variable appearance, ranging from a small red macule to a larger dome-topped or polypoid papule. The color of the lesions typically is described as bright cherry red, but the lesions may appear more violaceous over time. Accurate diagnosis in such cases is crucial for appropriate evaluation and management, often requiring multidisciplinary approach.
| Case Report | | |
A 60-year-old male patient came to the dermatology outpatient department with complaints of generalized pruritus with night aggravation and family history of itching suggestive of scabies. Cutaneous examination of the abdomen revealed asymptomatic well-circumscribed reddish to reddish-brown polygonal papules over the left side of the abdomen [Figure 1]a and [Figure 1]b, strikingly demarcated from the midline. According to the patient, the lesions were present for 10 years and were not associated with any cutaneous or systemic symptoms such as abdominal pain and bleeding per rectum. An incidental finding in this case was also the presence of microtia of the right ear [Figure 2] since birth. The patient did not have complaints of hearing loss, vertigo, or tinnitus. Further examination by the otorhinolaryngologist suggested no abnormality associated with the ear. On general examination, the patient was fairly built; well nourished; conscious; and oriented about time, place, and person. Systemic examination of the patient was normal. Blood counts, erythrocyte sedimentation, liver and kidney function tests, blood sugars, cholesterol fractions, and triglycerides were normal. Ultrasonography of the abdomen and pelvis revealed mild hepatomegaly, and ultrasonography of the local part revealed very tiny vascular cystic spaces on the left side of the abdominal wall without evidence of feeding vessels suggestive of hemangioma. The patient was further advised for a skin biopsy, but he did not consent for the same. Dermoscopic examination (Dino-Lite premier AM3013T nonpolarized contact type; ×50 magnification connected to a computer with inbuilt camera for taking photographs) of one of the papules revealed well–demarcated, round-to-oval tightly clustered reddish-brown lacunae [Figure 3]. The patient was counseled about the benign nature of the lesions and was referred to a physician for further systemic evaluation. | Figure 1: (a and b) Multiple reddish to reddish–brown, well-defined polygonal papules over the left side of the abdomen in segmental distribution with a striking demarcation from the midline
Click here to view |
 | Figure 3: Dermoscopy (Dino-Lite premier AM3013T nonpolarized contact type; ×50 magnification connected to a computer with inbuilt camera for taking photographs) of one of the lesions showing oval-to-round reddish lacunae (black arrow) in the background of brownish pigmentation (red arrow)
Click here to view |
| Discussion | | |
Vascular anomalies cover a wide spectrum of lesions predominantly affecting children but, in many cases, creating lifelong consequences with varying severities. This group of lesions range from benign to malignant, isolated to syndromic, and unifocal to multifocal and diffuse.
Cherry angiomas, also known as Campbell De Morgan spots or senile angiomas,[2] are the most common type of acquired vascular proliferation of the skin.[1] The etiology of cherry angiomas is not well-known, but because they tend to increase in number as the patient's age increases, the aging process may play a role in the pathogenesis of cherry angiomas. The exact actual prevalence of cherry angiomas is not clearly known, but Murison et al. reported that cherry angiomas were observed in 5% of adolescents and 75% of adults over 75 years of age.[1] They are benign in nature though they have been found to be associated with chemical exposures,[3],[4],[5] liver transplants,[6] graft-versus-host disease,[7] and in patients who are immunocompromised secondary to cyclosporine treatment.[8] On physical examination, the lesions may have a variable appearance, ranging from a small red macule to a larger dome-shaped or a polypoid papule. The lesions are usually asymptomatic, but may bleed with trauma. Cherry angiomas most commonly occur on the trunk or proximal extremities, but can be rarely seen on other body parts such as face, hands, and feet.[9] Histopathological examination of the lesions shows a sharply circumscribed vascular proliferation often embraced in part by a collarette of epithelium and adnexal structures. Higher magnification shows numerous venules in a thickened papillary dermis. Older lesions often display prominent collagen bundles, which is an appearance suggesting septa. The most important differential diagnosis of cherry angiomas in our case includes angiokeratoma (localized Fabry disease). Dermoscopy can be an important tool to differentiate these two entities. Dermoscopic diagnosis of hemangiomas (angiomas) and angiokeratomas is relatively straightforward. The important dermoscopic structures in angioma are lacunae, which can be red, red-white, red-blue, maroon, blue, blue-black, or even black in color. The lacunae can vary in size and color and are often separated by septae. Angiokeratomas have black lacunae in addition to other lacunae of varying colors including red and maroon. In addition to dark lacunae, angiokeratomas demonstrate a blue-whitish veil; these two structures, dark lacunae and blue-whitish veil, have a sensitivity of 84% and a specificity of 99% for angiokeratomas.[10] Other dermoscopic structures that can be seen in angiokeratomas include erythema and hemorrhagic crusts.
In our case, the patient had come with complaints of scabies and after detailed clinical examination was found to have multiple cherry angiomas on the left side of the lower abdomen in a segmental distribution for 10 years, and they were not associated with any symptoms. Incidentally, the patient was found to have microtia of the right ear since birth with no associated hearing loss. A striking feature was an association of these cherry angiomas with mild hepatomegaly evident on ultrasonography, while liver function tests and lipid profile of the patient were within normal limits. Ultrasonography of the local part was suggestive of hemangioma. Dermoscopy of the lesion in our case was suggestive of cherry angioma.
There have been studies reporting association of cherry angiomas with fatty liver disease[11] and segmental cherry hemangioma with extra genital lichen sclerosus et atrophicus.[12] Hepatomegaly in our case as well as the microtia was an incidental diagnosis, but the segmental distribution of lesions may indicate a genetic mosaicism. Hence, it becomes very necessary for dermatologists to examine each and every patient of cherry angiomas and to look for any systemic association of these lesions.
| Conclusion | | |
It becomes necessary for a practicing dermatologist to always consider a simple, common benign lesion such as cherry angioma as a marker of systemic association.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Acknowledgment
We are thankful to the radiology department for guiding us with the ultrasonography results of the lesions.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Murison AR, Sutherland JW, Williamson AM. De Morgan's spots. Br Med J 1947;1:634-6.  |
| 2. | James W, Berger T, Elston D. Andrews' Diseases of the Skin: Clinical Dermatology. 10 th ed. Philadelphia: Saunders; 2006. p. 595. |
| 3. | Cohen AD, Cagnano E, Vardy DA. Cherry angiomas associated with exposure to bromides. Dermatology 2001;202:52-3. |
| 4. | Raymond LW, Williford LS, Burke WA. Eruptive cherry angiomas and irritant symptoms after one acute exposure to the glycol ether solvent 2-butoxyethanol. J Occup Environ Med 1998;40:1059-64. |
| 5. | Firooz A, Komeili A, Dowlati Y. Eruptive melanocytic nevi and cherry angiomas secondary to exposure to sulfur mustard gas. J Am Acad Dermatol 1999;40:646-7. |
| 6. | Chu P, LeBoit PE. An eruptive vascular proliferation resembling acquired tufted angioma in the recipient of a liver transplant. J Am Acad Dermatol 1992;26:322-5. |
| 7. | Garnis S, Billick RC, Srolovitz H. Eruptive vascular tumors associated with chronic graft-versus-host disease. J Am Acad Dermatol 1984;10:918-21. |
| 8. | De Felipe I, Redondo P. Eruptive angiomas after treatment with cyclosporine in a patient with psoriasis. Arch Dermatol 1998;134:1487-8. |
| 9. | Odom RB, James WD, Berger TG. Andrews' Disease of the Skin. 9 th ed. Philadelphia, PA: WB Saunders; 2000. p. 733-99. |
| 10. | Jaimes N, Marghoon A. First step: Differnetiating melanocytic fromnon-melanocytic lesions. Pocket Guide to Dermoscopy. 1 st ed. New Delhi: Jaypee; 2017. p. 52. |
| 11. | Navabi J, Beiranvand B, Goudarzi M, Aznab M, Beiki O. Cherry angioma has acceptable diagnosticvalue for nonalcoholic fatty liver disease: Diagnosis of fatty liver by cherry angioma. Basic Clin Cancer Res 2015;7:18-23. |
| 12. | Ingram JR, Belgi G, Cook LJ, Hughes BR, Karim A, Finlay AY, et al. Segmental cherry angiomas associated with extragenital lichen sclerosus: A report of two cases. Clin Exp Dermatol 2013;38:386-9. |
[Figure 1], [Figure 2], [Figure 3]
|
Search Pubmed for