A new lipomatous entity: The cavernous angiolipoma of the subcutis

Angiolipoma is a benign soft-tissue tumor which combines the morphological features of lipoma with those of hemangioma. The ratio of lipomatous and vascular components is variable, reaching the latter the highest percentage in the cellular variant of the tumor. Microscopically, the tumor consists of mature adipocytes separated by a branching network of small vessels, which often contain fibrin thrombi. We present the first literary description of cavernous angiolipoma of the subcutis in a 75-year-old man, delivering a new lipomatous entity. This entity should be reserved to subcutaneous angiolipoma with very large vascular gaps, haphazardly arranged and engorged by blood. The differential diagnosis of this tumor depends on vascular density: the hypovascular tumor can be mistaken with a common lipoma, while the hypervascular lesion should be distinguished from cavernous hemangioma and related variants, intramuscular hemangioma, spindle cell hemangioma, arteriovenous and venous malformations and Kaposi's sarcoma. Histopathogenetic theories about cavernous angiolipoma of the subcutis include a possible differentiation from a pluripotent mesenchymal cell into both lipomatous and angiomatous counterparts, due to inflammation or trauma, and a progressive development from a congenital malformation / benign hamartoma. In support of the latter thesis, there is a 5-10% familial incidence of classic angiolipoma and the frequent presence of many mast cells inside the tumor. Moreover, about a third of all angiolipomas express androgen receptors and this datum leads to suspect a hormonal influence in the development of these subcutaneous tumors

New advances on placental hydrops and related villous lymphatics

Fetoplacental hydrops is the final stage of several pathological conditions in which the placenta and umbilical cord become edematous and the fetus develops an anasarcatic state characterized by an excessive accumulation of extravascular fluids in at least two serous cavities of the body. It is a common histological finding of stillbirth, characterized by the appearance of markedly edematous villi, suggesting an increased interstitial fluid accumulation. The recent improved knowledge of lymphangiogenesis and the availability of monoclonal antibodies selectively labeling lymphatic endothelium lead to the hypothesis that villous edema is essentially a lymphedema from defective lymphatic function following inadequate villous blood circulation. Lymphedema is a morphologic phenotype found by our research group in a 24-case series of stillbirths from different morbid conditions such as chromosomal aberrations, congenital malformations, inherited hemoglobinopathies, and prolonged perinatal severe anoxia. Unlike long-lived organs, the placenta is devoid of innervation by the autonomic nervous system; therefore, the vascular tone regulation and the peripheral perfusion are modulated by the expression of the angiotensin converting enzyme (ACE) in the vascular endothelia. This finding may suggest to the clinician to search for a more suitable therapy in case of mother's hypertension during pregnancy