This paper was partly presented in the most recent Annual Meeting of the American Society of Dermatopathology in October 2013 in Washington D.C., U.S.A. as a poster presentation.
Cutaneous collagenous vasculopathy associated with intravascular occlusive fibrin thrombi†
Article first published online: 24 JAN 2014
© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Journal of Cutaneous Pathology
Volume 41, Issue 4, pages 386–393, April 2014
How to Cite
Cutaneous collagenous vasculopathy associated with intravascular occlusive fibrin thrombi., , .
- Issue published online: 21 MAR 2014
- Article first published online: 24 JAN 2014
- Accepted manuscript online: 18 DEC 2013 08:25AM EST
- Manuscript Accepted: 2 NOV 2013
- Manuscript Revised: 6 OCT 2013
- Manuscript Received: 19 AUG 2013
- cutaneous blood vessels;
- intravascular fibrin thrombi;
Cutaneous collagenous vasculopathy (CCV) is a rare cutaneous microangiopathy that clinically resembles generalized essential telangiectasia with only 12 cases reported to date. The perivascular fibrosis is thought to be due to production of abnormal collagen by veil cells in the outer vessel walls as a result of unknown factors. This report is of an 84-year-old male with progressive telangiectasia. Biopsies showed characteristic features of CCV. In addition, there were multiple intravascular fibrin thrombi, some organizing and associated with endothelial cell hyperplasia with recanalization reminiscent of glomeruloid bodies and simulating reactive angioendotheliomatosis (RAE). Histochemically and ultrastructurally fibrin was noted within the vessel walls integrating into the fibrous tissue around the vessels; however, the patient had no evidence of coagulation disorder, cryoglobulinemia or cold agglutinemia. Immunofluorescence showed fibrinogen within the vessel walls but no immunoglobulins or C3. As well, there were minimal inflammatory cells. This suggests pauci-inflammatory injury to the endothelial cells by unknown angiogenic factors causing local intravascular fibrin thrombi with fibrin leaking and incorporating into the vessel walls, eventually leading to reparative perivascular fibrosis. This case suggests that some cases of CCV are related to a primary local intravascular occlusive thrombotic microangiopathy. However, the primary triggering factor causing the endothelial cell damage has yet to be elucidated.