A 53-year-old woman was presented to our clinic to evaluate an asymptomatic skin lesion on the right ear that had developed two years before. Her past medical history was contributory to uticaria pig- mentosa since childhood which had been treated by PUVA (Fig. 1). Bone marrow biopsy, which was performed before the skin lesion developed, re­vealed hypercellularity (90%) and hyperplasia (50%) of mast cells. Mast cells in bone marrow were positive for specific esterase, c-kit (CD117). Com­plete blood count and blood chemistry studies were normal ranged except for a slight thrombocytopenia. There was no family history for skin cancer or mastocytosis. On the physical examination, there was a 0.5×0.7 cm reddish to purplish soft papule on the posterior part of right ear (Fig. 2). But the Darier’s sign was unsuspicious. Excisional biopsy was performed, and the specimen was fixed in 10% formalin and routinely embedded into paraffin for H&E and Giemsa staining.

Fig. 1. Biopsy specimen

Fig. 1. Biopsy specimen of the skin lesion of urticaria pigmentosa before hemangioma developed. Hyperpig- mented basal layer and scattered cuboidal mast cells in the dermis, especially at the perivascular area (Hema­toxylin-Eosin stain; original magnification, x400).

The H&E stained sec­tion revealed flattened rete ridge without basal hyperpigmentation in the epidermis. In the upper dermis, multiple dilated endothelial cell-lined vas¬cular structures containing red blood cells were shown, and mast cells were densely infiltrated throughout the whole dermis including the inter- capillary stroma (Fig. 3A). At the higher magnification view, the infiltrated mast cells were shown as round to cuboidal cytoplasm with central ovoid nuclei. They also had basophilic granules in the cytoplasm (Fig. 3B). In Giemsa staining, mast cells with abundant fine purple metachromatic cyto­plasmic granules were observed (Fig. 4). The clini- copathologic features suggested a synchronous development of mastocytoma and hemangioma and we diagnosed this lesion as combined mastocy- toma-hemangioma. During one year follow-up after excision, there was no evidence of recurrence. kamagra soft tablets

Fig. 2. A 0.5×0.7 cm sized reddish

Fig. 2. A 0.5×0.7 cm sized reddish to purplish soft papule on the posterior part of the right ear.

Fig. 3. Excisional biopsy specimens

Fig. 3. Excisional biopsy specimens of the skin lesion showed (A) flattened rete ridge without basal hyperpigmentation, multiple dilated endothelial cell-lined vascular structures containing red blood cells in the upper dermis, and densely infiltrated mast cells throughout the whole dermis including the intercapillary stroma (Hematoxylin-Eosin staining; original magnification, x100). (B) At the higher magnification view, the infiltrated mast cells were shown as round to cuboidal cytoplasm with central ovoid nuclei (Hematoxylin-eosin stain; original magnification, x400).

Fig. 4. Mast cells with abundant

Fig. 4. Mast cells with abundant fine purple metachro­matic cytoplasmic granules were observed (Giemsa stain; original magnification, x400).