Acquired Elastotic Hemangioma With Smooth Muscle Hypertrophy: A Case Report and Brief Review of the Literature

Acquired elastotic hemangiomas (AEH) are benign, rare, vascular tumors which were first described in 2002 by Requena et al. as a variant of a hemangioma (1). They characteristically present in adults as a slow growing lesion in a chronically sun exposed area such as forearms. Histopathologic examination characteristically shows a proliferation of vascular channels within the superficial half of the dermis oriented in a parallel configuration to the overlying epidermis. There is a background of conspicuous solar elastosis between the vessels. The lesional vascular channels are often thin walled and thought to be of capillary origin (2). Here, we describe a case of acquired elastotic hemangioma on the left ventral forearm of a 65-year-old female in which the lesional vessels had a markedly thickened and hypertrophic medial layer. This unique histopathologic presentation, combined with the preexisting literature, raises the possibility that at least a subset of these lesions may derive from venules containing smooth muscle adaptable to underlying systemic diseases, such as chronic pulmonary disease.