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Journal of the American Academy of Dermatology
Volume 77, n° 5
page 920 (novembre 2017)
Doi : 10.1016/j.jaad.2017.03.045
accepted : 29 Mars 2017
Dermatopathology

Discrepancy between the clinical and histopathologic diagnosis of soft tissue vascular malformations
 

Sophie E.R. Horbach, MD a, , Amalia M. Utami, MD b, c, Lorine B. Meijer-Jorna, MD, PhD d, J.H. Sillevis Smitt, MD, PhD e, Phyllis I. Spuls, MD, PhD e, Chantal M.A.M. van der Horst, MD, PhD a, Allard C. van der Wal, MD, PhD b
a Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands 
b Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands 
c Department of Pathology, Hasanuddin University, Makassar, Indonesia 
d Department of Pathology, Symbiant, Pathology Expert Centre/Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands 
e Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands 

Correspondence to: Sophie E. R. Horbach, MD, Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.Department of Plastic, Reconstructive, and Hand SurgeryAcademic Medical CenterPO Box 22660, 1100 DDAmsterdamThe Netherlands
Abstract
Background

Soft tissue vascular malformations are generally diagnosed clinically, according to the International Society for the Study of Vascular Anomalies (ISSVA) classification. Diagnostic histopathologic examination is rarely performed.

Objective

We sought to evaluate the validity of the current diagnostic workup without routinely performed diagnostic histopathology.

Methods

We retrospectively determined whether there were discrepancies between clinical and histopathologic diagnoses of patients with clinically diagnosed vascular malformations undergoing therapeutic surgical resections in our center (2000-2015). Beforehand, a pathologist revised the histopathologic diagnoses according to the ISSVA classification.

Results

Clinical and histopathologic diagnoses were discrepant in 57% of 142 cases. In these cases, the pathologist indicated the diagnosis was not at all a vascular malformation (n = 24; 17%), a completely different type of vascular malformation (n = 26; 18%), or a partially different type with regard to the combination of vessel-types involved (n = 31; 22%). Possible factors associated with the discrepancies were both clinician-related (eg, diagnostic uncertainty) and pathology-related (eg, lack of immunostaining).

Limitations

Retrospective analysis of a subgroup of patients undergoing surgery.

Conclusion

The large discrepancy between clinical and histopathologic diagnoses raises doubt about the validity of the current diagnostic workup for vascular malformations. Clear clinical and histopathologic diagnostic criteria might be essential for a uniform diagnosis.

The full text of this article is available in PDF format.

Key words : clinical, dermatopathology, diagnosis, histology, histopathology, ISSVA, vascular anomalies, vascular malformations

Abbreviations used : AVM, CAVM, CI, CLAVM, CLM, CLVM, CM, CVM, ISSVA, LM, LVM, OR, VM



 Funding sources: None.
 Conflicts of interest: None declared.
 Reprints not available from the authors.



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