Vascular Masquerade: A Case of Segmental Infantile Hemangioma With Minimal or Arrested Growth and Ulceration

Infantile hemangiomas (IHs) are the most common vascular tumors in pediatric patients. Infantile hemangiomas with minimal or arrested growth (IH-MAG) have a more atypical clinical appearance and are often misdiagnosed as capillary or other vascular malformations. Moreover, the histopathologic appearance of IH-MAG and ulcerated IH are not well characterized. A 5-month-old female presented with an asymptomatic blanchable vascular patch on the right thigh and lower leg and was diagnosed with a capillary malformation. At 8 months of age, the lesion developed spontaneous black eschars, concerning for a thrombo-occlusive process. Histologic examination revealed necrosis of the epidermis and superficial dermis overlying superficial dermal vessels with intravascular fibrinous thrombi and stained positive for glucose transporter protein-1. The patient was diagnosed with an IH-MAG and improved following initiation of propranolol therapy. This case highlights the ability of IH-MAG to masquerade as other vascular anomalies and offers rare insight into the pathophysiologic etiology of ulcerated IH.