Dermatopathology
Diffuse dermal angiomatosis of the breast: Clinicopathologic study of 5 patients

Presented at the American Society of Dermatopathology 45th Annual Meeting, San Francisco, California, October 16-19, 2008.
https://doi.org/10.1016/j.jaad.2014.08.015Get rights and content

Background

Diffuse dermal angiomatosis (DDA) is a rare skin condition considered to be a type of reactive angioendotheliomatosis. Histologic features are quite characteristic. It has been reported in association with vaso-occlusive disease, trauma, or underlying hypercoagulability. In the past, it was thought to be most common on the lower extremities.

Objective

The purpose of this study was to describe the clinical and histologic features of 5 patients with DDA.

Methods

The clinical and histologic features of 5 patients with DDA were evaluated.

Results

Five women (47-58 years old) had DDA of the breast. Histologic examination showed a diffuse proliferation of benign endothelial cells between the collagen bundles throughout the dermis.

Limitations

The main limitation of our study is the limited number of patients.

Conclusion

Involvement of the breast is much more common than previously reported. Smoking seems to be a strong risk factor for the disease. Revascularization, oral corticosteroids, and oral anticoagulation have all been reported to be somewhat successful in the treatment of DDA of the breast.

Section snippets

Methods

A 4-mm punch biopsy specimen of skin was obtained from an area of reticular erythema from 4 patients; the specimen from 1 patient (patient 2) was obtained elsewhere and reviewed at our institution. The specimens obtained internally were processed for routine histology. Immunohistochemical staining for CD31 was performed on specimens from 3 patients (patients 1, 4, and 5). Immunohistochemical staining for CD34 was performed on 1 specimen (patient 1). In situ hybridization for human herpesvirus

Results

The clinical characteristics and course of the 5 patients are summarized in Table I. Biopsy specimens were obtained from all patients. The findings from all patients were similar. There was diffuse proliferation of benign endothelial cells between collagen bundles in the reticular dermis, confirming DDA in all patients.

Discussion

DDA is a rare variant of reactive cutaneous angioendotheliomatosis characterized by erythematous to violaceous indurated and ulcerated plaques.3 Few cases have been reported. Affected persons are primarily female, with the most common site being the lower extremities (thighs), abdomen,1, 8 and forearm.12 Breast involvement has been thought rare; however, our review of the literature identified breast involvement in 5 of 14 previously reported cases.2, 7, 8, 10, 11 DDA is usually bilateral, most

References (12)

There are more references available in the full text version of this article.

Cited by (33)

  • Diffuse dermal angiomatosis of the thigh as the presenting sign of critical limb ischemia

    2023, Journal of Vascular Surgery Cases, Innovations and Techniques
  • Diffuse dermal angiomatosis of the breast: an emerging entity in the setting of cutaneous reactive angiomatoses

    2021, Clinics in Dermatology
    Citation Excerpt :

    It should be evaluated in all patients who fail conservative therapy, although DDAB developed in five previously reported women with macromastia after breast reduction surgery.18,19,23 In two patients in whom a subclavian artery occlusion was present, revascularization with stent placement resulted in substantial improvement.19,21 DDAB is more common than previously believed, the breast presumably being the most commonly involved site in DDA.

  • Calciphylaxis of the breast with associated diffuse dermal angiomatosis

    2017, Human Pathology: Case Reports
    Citation Excerpt :

    While the etiology of CPX is still somewhat uncertain, most investigators have found that hyperphosphatemia, combined with osteoblast-like changes in vascular smooth muscle cells and hypercoagulability are predisposing or causative factors in this vaso-occlusive phenomenon [3]. Diffuse dermal angiomatosis (DDA) is a rare skin condition, considered to be a reactive phenomenon related to hypoperfusion and presents as erythematous or violaceous, indurated plaques on the skin that may ulcerate [4]. We report a case of unilateral CPX of the breast in a 48-year-old woman with long-standing ESRD.

  • Primary Angiosarcoma of Breast: a Case Series of Rare Disease

    2024, Indian Journal of Surgical Oncology
  • A tale of a reticulated erythematous patch on the breast

    2023, Indian Journal of Dermatology, Venereology and Leprology
View all citing articles on Scopus

Funding sources: None.

Conflicts of interest: None declared.

View full text