Osaki TH, Jakobiec FA, Mendoza PR, Lee Y, Fay A. Immunohistochemical investigations of orbital infantile hemangiomas and adult encapsulated cavernous venous lesions (malformation versus hemangioma). Ophthal Plast Reconstr Surg. 2013; 29(3):183-95.
Immunohistochemical studies have advanced knowledge regarding the pathogenesis of vascular anomalies in many anatomical regions. However, the immunohistochemical features of most orbital tumors have been overlooked. We reported a comparative immunohistochemical series of the two most common orbital vascular lesions – infantile hemangioma (IH) and encapsulated cavernous venous malformation (ECVM) also termed cavernous hemangioma. Twenty surgically excised orbital tumors diagnosed clinically and histopathologically as infantile hemangiomas (10 cases) or “cavernous hemangioma” (10 cases) were evaluated pathologically and immunohistochemically using hematoxylin and eosin, Alcian blue, Masson trichrome, GLUT-1, CD31, CD34, D2-40 and smooth muscle actin (SMA) stains. All cases reacted strongly with the traditional blood vessel endothelial markers CD31 and CD34 and were negative for D2-40, a selective marker for lymphatic endothelium. All IH were positive for GLUT-1 and all ECVM were negative for GLUT-1. In IH, SMA stained a monolayer of pericytes and in ECVM multilaminar smooth muscle vascular mural cells and intervascular (interstitial) stromal cells. Immunohistochemical staining definitively separated infantile hemangiomas from encapsulated cavernous venous malformations (so-called cavernous hemangiomas) based on their distinctive cytoarchitectures and excluded the participation of lymphatic endothelia in all cases of both kinds of lesion. This study was selected as the best published study in the field and was awarded with the ASOPRS Merrill Reeh Award.