LOBULAR CAPILLARY HEMANGIOMA, OLDER LESION WITH PARTIAL REGRESSION AND INFILTRATIVE PATTERN
The lobular nature of older examples of lobular capillary hemangioma (LCH) often is not  apparent. Fibrosis of the papillary dermis component, which may represent partial regression, is common. A more diffuse pattern of infiltration of the reticular dermis is sometimes seen. Inasmuch as pericytes as well as endothelial cells are found within the infiltrating vascular elements, there should be no confusion with angiosarcomas that have this pattern.

The main discussion of LCH is ELSEWHERE.


From a 32 year old female:
 
 Fig. 1 Very low power (direct scan of glass slide) view. The surface is eroded and the denuded surface is lined by granulation tissue (not further illustrated). The expanded papillary dermis resembles the cap of a mushroom. Fibrosis of the superficial component is prominent, and the lobular nature of the lesion is not apparent.
Fig. 2      A high power view from within the expanded papillary dermis shown in Fig. 1.. Pericytes are seen between capillaries lined by endothelial cells. The background is delicately fibrillar. A few chronic inflammatory cells (lymphocytes and plasma cells) are seen in this example.
Fig. 3       A medium power view from an area of fibrosis within the expanded papillary dermis shown in Fig. 1.. Vascular channels having branching outlines can be found in earlier examples of LCH, but are particularly prominent in this example. 
Fig. 4       A composite low power view of the area in the black rectangle shown in Fig. 1. The blood vessel with the thick wall is abnormal for this location in the reticular dermis. The other vascular components infiltrate between reticular dermis collagen bundles in a manner that is somewhat diffuse.
Fig. 5       A high power view of the blood vessel in the black rectangle in Fig. 4.. Smooth muscle, perictyes, and delicately fibrillar subendothelial stroma are illustrated.
Fig. 6       A high power view of some of the vessels infiltrating between reticular dermis collagen bundles in the lower part of the composite low power view (Fig. 4). Pericytes (PC) are a component of the infiltrating vascular channels.

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