Cutaneovisceral angiomatosis with thrombocytopenia.
We describe 10 children with multiple vascular lesions of the skin and gastrointestinal tract associated with sustained, minor thrombocytopenia. In some children, there was involvement of the lung (n = 5), bone (n = 2), liver (n = 1), spleen (n = 1), and muscle (n = 1). The cutaneous lesions were congenital, multifocal, discrete, red-brown and variably blue macules and papules; in 3 children, a large dominant plaque was also present. All children developed hematemesis and/or melena and endoscopic evaluation revealed several to numerous small mucosal lesions that involved all levels of the gastrointestinal tract. Three of 5 children with pulmonary nodules had cough and 1 also had hemoptysis. Biopsies of cutaneous, gastrointestinal, and pulmonary lesions showed thin-walled, blood-filled vascular channels and variable endothelial hyperplasia. The endothelial nuclei were elongated, round, crescentic, or hobnailed. Cytoplasmic and extracellular periodic acid-Schiff positive deposits were often present in the zones of endothelial hyperplasia. The platelets were small in some children, suggesting a primary defect, possibly accounting for the thrombocytopenia. Gastrointestinal hemorrhage and hemoptysis required antiangiogenic therapy. The constellation of findings defines a congenital proliferative disorder of blood vessels with a distinctive microscopic appearance. We have termed this relatively indolent or slowly progressive disorder cutaneovisceral angiomatosis with thrombocytopenia because this designation incorporates its major clinical and histopathologic features.
Prasad
Vinay
V
Department of Pathology, Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Fishman
Steven J
SJ
Mulliken
John B
JB
Fox
Victor L
VL
Liang
Marilyn G
MG
Klement
Giannoula
G
Kieran
Mark W
MW
Burrows
Patricia E
PE
Waltz
David A
DA
Powell
Julie
J
Dubois
Josée
J
Levy
Moise L
ML
Perez-Atayde
Antonio R
AR
Kozakewich
Harry P W
HP
D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000798:Angiomatosis / Q000150:complications / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology*; D015703:Antigens, CD / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology*; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007124:Immunoenzyme Techniques; D007223:Infant; D008297:Male; D012871:Skin Diseases / Q000150:complications / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology*; D013921:Thrombocytopenia / Q000150:complications / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology*
D020533:Angiogenesis Inhibitors; D015703:Antigens, CD; D015415:Biomarkers; D005938:Glucocorticoids