Treatment

The lesion was completely excised under local anesthesia. The specimen was removed in one piece (Figures 2 & 3).

Figure 2 This photograph is of the gross specimen removed in one piece demonstrates a dark-brown, smooth soft tissue lesion.

Figure 3 This photograph is of the gross specimen removed in one piece and bisected to demonstrate a dark-brown, smooth soft tissue lesion simulating a section of a liver.

Excisional Biopsy

Histologic examination reveals a multisected piece of soft tissue embedded in four separate blocks. All specimens are made up of surface epithelium with an underlying mass of granulation tissue containing numerous giant cells (Figures 4-6). The granulation tissue mass occupies the bulk of the specimen and is loose and vascular with extravasated erythrocytes and clusters of hemosiderin pigment. The giant cells are of variable shapes and sizes and are haphazardly arranged (Figures 5 & 6).

Figure 4 Low power (x40) H & E stained histology shows an ulcerated mass of vascular granulation tissue containing numerous multinucleated giant cells.

Figure 5 Higher power (x200) H & E stained histology shows a mass of vascular granulation tissue with numerous multinucleated giant cells and extravasated erythrocytes.

Figure 6 High power (x200) H & E stained histology shows a closer look at the vascular granulation tissue with numerous multinucleated giant cells and extravasated erythrocytes.