Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2022;12(3):e2022122 1

Dermatology Practical & Conceptual

Retiform Hemagioendothelioma:  
Dermoscopic-pathological Correlation 

Saurabh Mittal1, Naimah Aljassem2

1 Department of Dermatology, NMC Royal Hospital

2 Department of Pathology, NMC Royal Hospital

Citation: Mittal S, Aljassem N. Retiform Hemagioendothelioma: Dermoscopic-pathological correlation.  
Dermatol Pract Concept. 2022;12(3):e2022122. DOI: https://doi.org/10.5826/dpc.1203a122

Accepted: October 29, 2021; Published: July 2022

Copyright: ©2022 Mittal et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non 
Commercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing interests: None.

Authorship: Both authors have contributed significantly to this publication

Corresponding author: Dr. Saurabh Mittal, MD, Department of Dermatology, NMC Royal Hospital, Abu Dhabi, UAE. E-mail: 
drsaurabh0811@gmail.com

Case Presentation 

A-31-year-old female presented with a single, asymptomatic, 

slowly growing, soft, cystic, dark-red nodule (with bluish 

periphery) of size 2 cm x1 on the medial aspect of left up-

per thigh, of 4-5 years duration (Figure 1A). Dermoscopy 

revealed multiple deep red-colored globules of variable sizes 

separated by grayish white septae (Figure 1B).

Histology showed a tumor composed of infiltrating vas-

cular channels, which was poorly circumscribed and was 

composed of partially compressed, anastomosing vessels 

lined by hobnail endothelial cells. The vessels were separated 

by attenuated fibrous walls. Immunohistochemistry was pos-

itive for CD34 highlighting the florid vascular proliferation. 

Based on the above features, a diagnosis of retiform heman-

gioendothelioma was made. 

Teaching point

Retiform hemangioendothelioma is a rarely infiltrative 

neoplasm, that mostly presents as an isolated growth, com-

monly involving the lower limbs [1,2]. Surgical excision has 

been used most commonly, although recurrences have been 

reported [2]. The unique feature observed was the grayish 

white septae separating the globules. Histologically, these 

septae conformed to the attenuated fibrous walls. To our 

knowledge, this is the first case describing the dermoscopic 

features for this entity.



2 Image Letter | Dermatol Pract Concept. 2022;12(3):e2022122

Figure 1. (A) Clinical picture showing dark-red nodule. (B) Dermoscopy (Dermlite 10x) revealing multiple deep red-colored globules of 

variable sizes separated by grayish white septae.

References

1. Requena L, Kutzner H. Hemangioendothelioma. Semin Diagn 

Pathol. 2013;30(1):29-44. DOI: 10.1053/j.semdp.2012.01.003. 

PMID: 23327728.

2. Nobeyama Y, Ishiuji Y, Nakagawa H. Retiform hemangioendo-

thelioma treated with conservative therapy: report of a case and 

review of the literature. Int J Dermatol. 2016;55(2):238-243. 

DOI: 10.1111/ijd.12908. PMID: 26267121.