Vascular fleshy tumor, also known as malignant hemangioendothelioma, is a rare malignant tumor originating from vascular endothelial cells or mesenchymal cells differentiating toward vascular endothelial cells.

bubble_chart Pathological Changes

1. Gross appearance: The vascular fleshy tumor of the skin is often located within the dermis, presenting as a round or oval purplish-red nodule, averaging 3 cm in size. Occasionally, satellite small tumor nodules can be seen around the tumor. When it invades the epidermis, it may form an ulcer accompanied by bleeding. Tumors occurring in deep muscles are larger in size. The tumor boundary is indistinct, without a capsule, and exhibits infiltrative growth. The cut surface mostly shows a mixture of gray-white necrotic foci and blood-containing spongy areas.

2. Microscopic appearance: The tumor cells are spindle-shaped or oval, forming irregular, anastomosing, slit-like, or branching vascular lumens. Except for a few rapidly growing tumor cells that may break through the basement membrane, all tumor cells are located within the membrane, which is a characteristic feature of this tumor.

bubble_chart Clinical Manifestations

The common sites of occurrence are the skin of the head and face, the breast, and the deep muscles of the thigh, followed by the retroperitoneum, the skin of the trunk, and the limbs. This tumor is highly malignant and often metastasizes early via the bloodstream to the liver, lungs, and bones, and via the lymphatic system to the regional lymph nodes.

bubble_chart Treatment Measures

Perform a wide local excision of the tumor whenever possible. If the local excision is incomplete, adjuvant radiotherapy can be supplemented, with literature reporting its effectiveness. Nevertheless, the tumor recurrence rate remains relatively high, with approximately half of the patients presenting with enlarged lymph nodes in the drainage area. Surgery often requires simultaneous lymph node dissection. The incidence of this tumor is low, and the efficacy of chemotherapy remains uncertain.

Histologically, some myxoid liposarcomas are highly vascular with newly formed blood vessels and require differential diagnosis from angiosarcomas, but lipoblasts can be observed in liposarcomas.