Graft-versus-host disease-associated angiomatosis: A clinicopathologically distinct entity

Background: Chronic graft-versus-host disease (GVHD) may present with various cutaneous manifestations. Isolated case reports describe eruptive angiomas in this setting. Objective: We sought to provide a clinical and pathologic description of vascular proliferations in patients with GVHD. Methods: Cases of documented GVHD associated with vascular proliferations were collected from the National Institutes of Health, Ohio State University, and MD Anderson Cancer Center. Results: Eleven patients with a diagnosis of GVHD who developed vascular proliferations were identified. All patients manifested sclerotic type chronic GVHD of the skin. Vascular lesions were first documented a median of 44 months after transplantation and occurred primarily on the lower extremities or trunk. Histopathology revealed anastomosing networks of thin-walled vascular proliferations in a vague lobular growth pattern, with overlying epidermal acanthosis, peripheral collarette, ulceration, and disorganized fibroblast-rich and fibrotic stroma. Improvement was noted in 1 patient treated with propranolol and sirolimus and 1 patient with electrocautery. Limitations: Given the retrospective nature of the study, the overall incidence of vascular lesions in patients with GVHD is unknown. Histopathology was present for review on only 3 of 11 patients. Conclusion: The phenomenon of vascular lesions appears to be relatively specific for sclerotic type chronic GVHDwhencompared with other fibrosing diseases.We propose the term"graft-versus-host diseaseeassociated angiomatosis" to describe this entity.