Papillary endothelial hyperplasia first described by Masson as vegetant intravascular hemangioendothelioma, is a reactive endothelial proliferation that, in many respects, mimics an angiosarcoma. Such lesions are most commonly located within veins of the head, neck and fingers, and must be included in differential diagnosis of vascular lesions. The clinicopathologic features of an unusual hand case are reported because of the origin of such a lesion from the first common volar digital artery. Surgical excision was followed by end-to-end vascular reconstruction, adequate blood flow was confirmed by a second angiographic study three months later.