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27 August 2014 - Case of the Week #324

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Thanks to Dr. Govindaswamy Koteeswaran, Mahatma Gandhi Medical College and Research Institute (India), for contributing this case and discussion. To contribute a Case of the Week, follow the guidelines on our Case of the Week page.




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Case of the Week #324

Clinical History:
A 3 month old child presented with a painful nodule on the left little finger, present since birth, which was excised.

Gross examination showed a 2.0 x 1.5 cm skin covered nodule. The cut section showed a homogenous dark brown appearance.

Gross images:



Micro images:



What is your diagnosis?































Diagnosis:
Congenital eccrine angiomatous hamartoma

Discussion:
Microscopic examination showed an increased number of eccrine glands in the superficial dermis, with blood vessels between and around the glands and ducts. The vessels varied in size, but were predominantly small and lined by endothelial cells. Other areas of dermis showed smooth muscle bundles, fat cells and focal areas of myxoid change.

Congenital eccrine angiomatous hamartoma (EAH) is a rare benign hamartoma of eccrine glands and blood vessels that often occurs in the extremities (Ann Dermatol 2013;25:208). It may be present at birth or develop during childhood (Dermatology Online Journal 2009;15:10). It may be painful and be associated with hyperhidrosis, which can be helpful in diagnosis.

EAH must be differentiated from similar conditions including angiokeratoma, eccrine nevus, glomus tumor, hemorrhage (Ann Dermatol 2011;23 Suppl 1:S84), macular telangiectatic mastocytosis, nevus flammeus and smooth muscle hamartoma.

EAH is typically slow growing with benign behavior. Simple excision is usually curative, but is reserved for painful and cosmetically disfiguring lesions (Ann Dermatol Venereol 1997;124:623, Pediatr Dermatol 2009;26:316).


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