ANGIOMA SERPIGINOSUM¹

Synonyms.—Infective angioma or nævus lupus (Hutchinson); Sarcome angioplas-
tique réticulé (Darier).

Symptoms.—The seat of this rare malady has varied in the dif­
ferent cases reported. In the original case reported by Hutchinson,

¹ Literature: Hutchinson, Arch, of Surg., 1889-90, vol. i, p. 289, with colored plate;
ibid., 1890-91, vol. ii, p. 71 (Jamieson‘s case); ibid., p. 111 (Lassar‘s case); ibid., 1891-
92, vol. iii, p. 166 (Warren Tay‘s case); J. C. White, Jour. Cutan. Dis., 1894, p. 505
(report of a case, male, aged twelve, with illustration and excellent histologic cuts,
including reports on pathology by Darier, Councilman, and Bowen); Crocker, Brit.
Jour. Derm., 1894, p. 367 (case demonstration—woman, aged twenty-eight, with 3 or
4 rings on forehead, 1 on cheek, of two months’ duration; one on cheek, developed
two years previously, had almost disappeared, leaving a slight whitening of the surface);
Hyde and Montgomery, Diseases of the Skin, seventh edit., p. 644 (brief reference—
female infant, developing as a sequence of congenital nævus of the vulva); Sequeira‘s
(Brit. Jour. Derm., 1912, p. 355, with good colored plates) case was a young woman of
twenty, in whom the whole of the front and outer side of the right upper arm was the
seat of characteristic red patches with a distinct purplish tinge; around the periphery
were clusters of minute red spots recalling the ‘‘cayenne pepper grains” of Hutchin-
son‘s original description; the malady began when patient was two years old, as
small red spots.

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and also that described by Jamieson, the back of the arm was the begin­
ning site, from which it gradually extended downward, passing beyond
the elbow and upward to the shoulder, Jamieson‘s extending chiefly
downward to the base of the thumb. In the latter, too, there were some
lesions on the side of the chest on a line with the fifth rib. Tay‘s case
started on the right calf, finally involving both legs; Lassar‘s originated
on the cheeks, appearing later on the ears, and also downward on the
right side on the arm. In White‘s patient the disease first appeared
below the right scapula, and gradually extended anteriorly toward the
nipple; in Crocker‘s patient it was on the forehead and cheek. The
malady is insidious and slow, beginning usually early in life, and as mi­
nute, firmly seated, pin­point­ to pin-head-sized, elevated, bright red to
dull red or purplish points or papules. Gradually the lesions increase
in size, and when about the size of a pea usually tend to undergo centrally
involution changes, while still extending peripherally, so that an annular
or circinate configuration is assumed, and which, if coalescing, form
irregular serpiginous figures. During this time new papules—infective
satellites, as Hutchinson aptly designates them—are forming beyond the
main area, and these in turn undergo central absorption and spread in
an annular manner, fusing with other rings. The malady is steadily
progressive, although exceedingly slow, and probably with periods of at
least relative quiescence. No positive atrophic changes ensue, the
central involuting portion usually merely showing some discoloration.
As a rule there are no subjective symptoms, although in White‘s case,
slight itching and tenderness on pressure were present.

Etiology and Pathology.—Of the 8 cases now on record, 6
began in the first two years; 6 were females. Apparently there is no
assignable cause, although in 2 instances (Hutchinson, Hyde and Mont­
gomery) there seems to have been a preëxisting nævus. The pathologic
histology has been studied by Bowen, Darier, and Councilman—all from
tissue of the same (White‘s) case. According to Bowen,¹ who had also
observed White‘s case clinically, the microscopic findings by Darier and
Councilman practically agree with his, and are indicative of an angiosar-
comatous character. Sequeira found immediately beneath the epider­
mis some structureless oval bodies which lay in unlined spaces, but whose
significance could not be determined. The process seems to begin,
quoting from Bowen, by a proliferation of the endothelium of the vessels,
accompanied by a corresponding proliferation of the perithelium. The
epidermis and the papillary layer were filled with longitudinally shaped,
ribbon-like masses of cell, extending in their general arrangement parallel
to the surface. The cells had large oval nuclei, with a slight amount of
surrounding protoplasm, and the groups or clumps, concentrically ar­
ranged, usually presented a central lumen, indicating their intimate
connection with the vessels. Here and there, in the groups, granular
masses resulting from cell degeneration were observed. Histologically
the growth was comparable to angiosarcoma, and Bowen is inclined to
regard it as due to some anomalous congenital condition of the vessels.
Darier looks upon it as an anomalous type of sarcoma, of a disseminated,
¹ Bowen, Twentieth Century Practice, vol. v (Diseases of the Skin), p. 68o.

692

NEW GROWTHS

reticulated form, developing along the vessels, with a tendency here and
there toward true angiomatous characters. These findings would seem
to indicate, as Bowen states, the possibility of later malignant changes.
Prognosis and Treatment.—The malady is persistent and
progressive, and in the cases in which the growths were destroyed by
cauterization (Hutchinson, White) and excision, new lesions appeared
peripherally or in the resulting scar tissue. Possibly electrolysis along
the borders of the area, as Crocker suggests, with the object of causing
occlusion of the vessels, might stay its progress, but the failure of the
more active methods already tried would scarcely lend much hope to this
plan.

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