Id endothelial morphology, but with bland morphology without mitotic figures [7-14]. Clinically ehs form a cutaneous or subcutaneous entity that often appears in the head and neck. This predisposition for head and neck was only noted in the majority of cases described by sangueza et al. (2008), but not in brenn's cases and the current series in which trunk and extremities were mostly involved. Eh is more common (compared to cean) in middle aged and older women. It can be multiple, involving arterial walls, and is usually characterized by a more prominent vasoformative component (not seen in cean); it is rarely solidly cellular as is cean. In contrast to the presence of inflammatory cells (including eosinophils) in eh, no lymphoid follicles or germinal centers were present in any cean described here. Furthermore, the overlying epidermis is usually hyperplastic, hyperkeratotic, and acanthotic; the stroma (when encountered) in cean is usually in a perilesional distribution rather than within the lesion itself as in eh. Very recently in an update by goh and calonje [15], cean was considered as a distinct entity. However, they did not state why this was the case as detailed here. In conclusion, in my experience cean represents a distinct group of both clinically and morphologically distinct vascular lesions in the skin that defies classification according to current criteria and should be separated from pyg, eh, and other reactive vascular entities. Bz opinion the initial observation and description of brenn and fletcher is correct [2]; all three cases from innsbruck (and others from slide seminars and dermatopathology clubs as well as personal communications and discussions) fall into the setting of cean presented in the original presentation. My main point regards the teleological character of this lesion: what type of disease is cean? Again i agree with brenn and fletcher: a reactive process. In this sense cean is related to pyogenic granuloma (pyg) and epithelioid hemangioma (eh), the latter also known under a variety of different names such as histiocytoid hemangioma, angiolymphoid hyperplasia with eosinophilia (alhe), and many others [12, 13, 14, 16]. Pyogenic granuloma is reactive and occurs in easily traumatized areas, particularly around the mouth or acral, and frequently in children or young adults. But it can occur at any age, anywhere on the body, and not only superficially but in deep locations such as in subcutaneous or soft tissue or intravascularl. cheap viagra cheap generic viagra generic viagra cheap generic viagra buy cheap viagra buy viagra cheap viagra buy generic viagra buy real viagra online
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