Verrucous haemangioma: a diagnosis to consider.

To cite: Mestre T, Amaro C, Freitas I. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2014204612 DESCRIPTION The authors report a case of an 11-year-old boy with a congenital lesion on the left leg, initially described as a blue macule which progressed to a verrucous pigmented plaque (figure 1). MRI (figure 2) showed local infiltration of the lower dermis and subcutaneous tissue. Histopathological examination (figure 3) showed hyperkeratosis, irregular acanthosis, papillomatosis and vascular proliferation in the superficial dermis, deep dermis and subcutaneous fat tissue compatible with a verrucous haemangioma (VH). VH is a rare congenital vascular anomaly. The International Society for the study of vascular anomalies classifies vascular anomalies as vascular neoplasms or vascular malformations. In verrucous haemangiomas, categorisation as a neoplasm or malformation cannot be established definitely. Its classification is still unclear because it exhibits clinical features similar to those seen in vascular malformations, but expresses an immunoprofile similar to vascular neoplasms (WT1 and Glut-1 positivity).