Five cases of a distinctive benign soft tissue lesion of the scalp in patients ranging from 4 months to 40 years of age are described. Clinically, the lesions appeared as solitary, subcutaneous nodules suggestive of a cystic vascular malformation or other benign condition. Histologically, however, the lesions were characterized by a monotonous, pseudoinfiltrative proliferation of cuboidal epithelioid cells arranged in clusters within the dermis and subcutaneous tissue in intimate association with vessels, adipose tissue, and other connective tissue elements. A prominent feature in all cases was the presence of areas simulating freely anastomosing vascular channels lined by round to spindle-shaped, slightly hyperchromatic epithelioid cells reminiscent of angiosarcoma. Immunohistochemically, these cells were negative for factor VIII-related antigen and Ulex europaeus lectin but were strongly positive with vimentin and epithelial membrane antigen antibodies, this latter being in keeping with the immunohistochemical profile of meningothelial cells. The meningothelial nature of these cells was supported by the electron microscopic demonstration in one case of cells with complex, interdigitating cytoplasmic processes that were joined by scattered cell junctions and contained abundant intracytoplasmic intermediate filaments. The intimate admixture of meningothelial elements with haphazardly arranged connective tissue elements sets these lesions apart from cutaneous meningiomas and warrants their designation as hamartomas with an ectopic meningothelial component.
