Tufted angioma (TA) is an acquired, benign vascular neoplasia of the skin characterized by slow, painless growth. Children and young adults are most commonly affected. These angiomas develop primarily on the shoulder, chest, back and neck.
The typical appearance is an erythematous, bluish-reddish to brown macula or plaque with angiomatous appearance. Accompanying pain and hyperhidrosis are also described. Tufted angiomas may be associated with vascular malformations, pregnancy, non-regressive lipodystrophy and liver transplantation. An associated Kasabach-Merritt phenomenon has been described in some cases.
Microscopically, multiple vascular structures in a lobular arrangement can be seen in the dermis and subcutaneous fatty tissue. Each lobule consists of accumulations of endothelial cells that grow concentrically around a pre-existing vascular plexus. Some lobules protrude into the wall of dilated thin-walled blood vessels, creating a crescent-shaped or slit-like image. Immunohistochemically, there is a strong expression of CD31, CD34 and smooth muscle actin. Histologically, they can be very similar to a kaposiform hemangioendothelioma, although they are not as large.
Tufted angiomas rarely show spontaneous regression. Symptomatic lesions require treatment.