Spindle Cell Hemangioma Reoccurrence in the Hand: Case Report

Spindle cell hemangioma (SCH) was first described by Weiss and Enzinger in 1986 [44]. They presented the initial 26 cases and at the time concluded that the vascular lesion was a vascular tumor of low-grade malignancy, and therefore, they termed the lesion a spindle cell hemangioendothelioma. Since then, various investigations have been conducted, including immunohistochemical studies, revealing they are benign lesions [4, 13, 14]. These lesions affect both sexes equally and have a predilection for the extremities. There are about 186 cases of SCH reported in the English literature, and 40 of the cases involved the hand [1–11, 13–26, 28–30, 32–47]. SCH can present as a solitary lesion (spindle cell hemangioma) or multifocal lesions (spindle cell hemangiomatosis) [33]; both types have been found in the hand. Lesions tend to develop during childhood or early adulthood. They most often have an indolent coarse [9, 13], but can become painful and disfiguring [8, 17]. Most lesions occur in the dermis and subcutaneous tissues, but have been found in the viscera, spinal cord, cervix, and oral cavity [26, 36, 40, 41, 43]. Spindle cell hemangiomas have features of both cavernous hemangiomas and Kaposi's sarcoma. Microscopically, this vascular lesion consists of vascular proliferations lined by a thin layer of endothelium within solid areas of mostly spindle cells [6]. There is minimal or no mitosis. The percentage of cavernous areas versus solid areas varies greatly [10, 14]. Thrombi or phleboliths can be found within these cavernous spaces [14, 40] and can be evident in radiographs [8]. The standard of care is wide local excision, but caution must be taken when there is multifocal disease not to cause further disability. Additionally, the reoccurrence rate is greater than 50% [33]. We present a case of a female patient who had a local reoccurrence of SCH in her hand 14 years after the original lesion was excised.