[Cutaneous epithelioid angiomatous nodule: a recently described vascular tumor].

Cutaneous epithelioid angiomatous nodule (CEAN) is a rare benign vascular proliferation recently described by Brenn and Fletcher.1 It typically develops in adults as a solitary, small, reddish, fast-growing nodular lesion most frequently located on the trunk or limbs.2 Histologically it consists of an infiltration of epithelioid cells, with abundant eosinophilic cytoplasm and vesicular nuclei with conspicuous nucleoli. Although the proliferation is predominantly solid, it is normal to encounter vascular lumens in scattered foci through the lesion. A peripheral lymphoplasmocytic infiltrate is observed in many cases.2,3 The differential diagnosis should include other tumors and vascular proliferations composed of epithelioid cells.2 We describe the case of a 47-year-old woman with no personal history of interest, who consulted with a nodular lesion measuring 5 mm that had developed on her back over the previous 7 months. Examination revealed a small, reddish nodule surrounded by an erythematous halo (Figure 1). The lesion was surgically excised and histology was compatible with a diagnosis of CEAN (Figures 2 and 3). Immunohistochemistry was positive for CD31 and CD34, and the lymph vessels of the tumor periphery stained intensely with D2-40.4-6 CAEN was first described in 2004 by Brenn and Fletcher following a study of 15 cases.1 A further 17 cases have since been reported. Clinically CAEN presents as a rapidly growing (over weeks or months), usually solitary erythematous or violaceous nodule or papule, with a diameter ranging between 0.3 cm and 1.5 cm.4 The lesion usually develops in adults, with a wide age range of presentation, and is typically located on the trunk or extremities.3 Histology shows a solid, well-delimited proliferation, generally affecting the superficial dermis, and composed of epithelioid endothelial cells. Well-developed vessels are found in scattered foci through the lesion, and a lymphoplasmocytic infiltrate is present in the tumor periphery. A consistent finding is reactive hyperplasia of the epidermis, frequently delimiting the lesion peripherally.2,3 Some authors consider CAEN to be a specific entity, whereas other authors consider it to be a variant of epithelioid hemangioma, also called angiolymphoid hyperplasia with eosinophilia (ALHE). Nonetheless, as will be seen below, the clinical and histologic characteristics are different. Clinically, CAEN can easily be confused with a pyogenic granuloma; however, the latter has vessels of varying sizes grouped in a lobular pattern, and no epithelioid cells. The differential diagnosis for CAEN should include all vascular proliferations composed of epithelioid cells, namely, ALHE, epithelioid angiosarcoma, epithelioid hemangioendothelioma, Figure 1 Reddish nodule about 5 mm in diameter and with an erythematous halo, located on the back.