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Reprint Address: Fred Bernardes Filho, md, Dermatology Division, Department of Medical Clinics, Ribeirao Preto Medical School, University of São Paulo, Avenue Bandeirantes 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
Affiliations
Dermatology Division, Department of Medical Clinics, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
A 52-year-old female presented to emergency department (ED) with a 1-month history
of a recurrent painless bleeding lesion in her right hand. She recalled a bird biting
her right hand while she was feeding birds in a park 1 week before the onset of symptoms.
She was admitted with her right hand covered with blood (Figure 1A). After washing her hand, a bright red papule, without pulsation, surrounded by
a collar of epidermis was observed (Figure 1B). An ultrasound image, requested in another ED 10 days prior, revealed a well-vascularized
7-mm deep nodular lesion (Figure 2A and 2B). Saucerization excision of the lesion was performed, and histopathology
showed a lobular proliferation of small blood vessels, which erupted through a breach
in the epidermis to produce a globular pedunculated tumor (Figure 3A and 3B).
Figure 1(A) Right hand covered with blood at presentation to the emergency department. (B)
A bright red papule surrounded by a collar of epidermis.
Figure 2(A) Sonographic features of a friable vascular palmar lesion. (B) Color Doppler sonography
showed intense vascularization in the interior of the lesion.
Figure 3(A) Lobular proliferation of capillaries with epidermal collarette at the periphery
(yellow arrows). Presence of erythrocytes in the lumen of vascular channels and in
interstices, and intense inflammatory infiltrate (hematoxylin and eosin stain; 50×).
(B) Lobules of dilated (green arrows) and congested (black arrows) capillaries in
an edematous stroma (hematoxylin and eosin stain; 400×).
