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Hoxhaj I, Piccino M, Grossi U, Maffeis V, Beleù A, Baciorri F, Morana G, Zanatta P, Zanus G. Systematic Review and Case Report of a Left Gonadal Vein Anastomosing Hemangioma. J Clin Med 2025; 14:3108. [PMID: 40364141 PMCID: PMC12072553 DOI: 10.3390/jcm14093108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2025] [Revised: 04/22/2025] [Accepted: 04/26/2025] [Indexed: 05/15/2025] Open
Abstract
Background/Objectives: Anastomosing hemangioma (AH) is a rare, benign vascular tumor predominantly found in the genitourinary tract and often associated with impaired renal function. Due to its nonspecific radiological features, AH is frequently misinterpreted as a malignant vascular neoplasm, particularly angiosarcoma (AS), leading to potentially unnecessary surgical interventions. This study presents a systematic review of AH cases and describes a rare instance of retroperitoneal AH arising from the left gonadal vein, which was resected due to diagnostic uncertainty. Methods: A 68-year-old man underwent imaging for benign prostatic hyperplasia, incidentally revealing a 15-mm hypervascular retroperitoneal nodule adjacent to the left psoas muscle. Imaging findings, including moderate metabolic uptake on 18FDG-PET/CT, raised suspicion for AS. Given the diagnostic uncertainty and high-risk location, the multidisciplinary team (MDT) recommended surgical resection. Laparoscopic excision was performed, and histopathological analysis confirmed AH. The patient remained asymptomatic at a 22 month follow-up. In addition, a systematic review of 159 cases from 64 studies (2009-2024) was conducted to analyze radiological features, treatment approaches, and outcomes. Results: Among the reviewed cases, 68% were incidentally diagnosed, with AH occurring predominantly in the genitourinary system (70%), especially in the kidney, adrenal gland, and ovary. Chronic kidney disease (CKD) was present in 23.3% of cases, while 19.5% had a history of malignancy. Imaging was inconclusive in differentiating AH from malignancies: CT (71.9%) and MRI (6.1%) were the most used modalities, but none could reliably exclude AS. Management strategies included upfront surgical resection in 85%, while a growing proportion (9%) of cases underwent biopsy-based observation rather than immediate surgery. No cases were followed with imaging alone. Conclusions: AH remains a diagnostic challenge due to its overlap with malignant vascular tumors. While surgical excision is often performed, our review highlights an increasing trend toward conservative management with biopsy-based diagnosis. Improved awareness and the integration of histopathology, molecular markers, and MDT-based decision-making are crucial to prevent overtreatment in cases of suspected AH.
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Affiliation(s)
- Ilda Hoxhaj
- Surgery Unit 2, Department of Surgery, Regional Hospital Treviso AULSS 2 Marca Trevigiana, 31100 Treviso, Italy; (I.H.); (M.P.); (G.Z.)
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00168 Rome, Italy
| | - Marco Piccino
- Surgery Unit 2, Department of Surgery, Regional Hospital Treviso AULSS 2 Marca Trevigiana, 31100 Treviso, Italy; (I.H.); (M.P.); (G.Z.)
| | - Ugo Grossi
- Surgery Unit 2, Department of Surgery, Regional Hospital Treviso AULSS 2 Marca Trevigiana, 31100 Treviso, Italy; (I.H.); (M.P.); (G.Z.)
| | - Valeria Maffeis
- Department of Pathology, “Ca’ Foncello” Regional Hospital, 31100 Treviso, Italy; (V.M.); (F.B.)
| | - Alessandro Beleù
- Department of Radiology, Regional Hospital Treviso AULSS 2 Marca Trevigiana, 31100 Treviso, Italy; (A.B.); (G.M.)
| | - Francesca Baciorri
- Department of Pathology, “Ca’ Foncello” Regional Hospital, 31100 Treviso, Italy; (V.M.); (F.B.)
| | - Giovanni Morana
- Department of Radiology, Regional Hospital Treviso AULSS 2 Marca Trevigiana, 31100 Treviso, Italy; (A.B.); (G.M.)
| | - Paolo Zanatta
- Department of Anesthesiology and Critical Care, Regional Hospital Treviso AULSS 2 Marca Trevigiana, 31100 Treviso, Italy;
| | - Giacomo Zanus
- Surgery Unit 2, Department of Surgery, Regional Hospital Treviso AULSS 2 Marca Trevigiana, 31100 Treviso, Italy; (I.H.); (M.P.); (G.Z.)
- Department of Surgery, Oncology and Gastroenterology—DiSCOG, University of Padova, 35121 Padua, Italy
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Zhao T, Hung YP, Devins KM, Young RH, Oliva E. The Spectrum of Vascular Lesions of the Upper Female Genital Tract: A Report of 55 Cases. Int J Gynecol Pathol 2025:00004347-990000000-00236. [PMID: 40372932 DOI: 10.1097/pgp.0000000000001109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2025]
Abstract
Upper female genital tract vascular proliferations are rare and generally not well characterized. We evaluated types, differences in distribution, and associations of such lesions. Fifty-five vascular lesions were identified: 42 benign (ovary 24; uterine corpus 11; para-adnexal 4; fallopian tube 1; ovaries, fallopian tubes, and corpus 1; ovary and fallopian tube 1) and 13 angiosarcomas. Patients with benign vascular lesions had a mean age of 55 (range: 13-82) yr. Twenty-six lesions were incidental findings, and 11 were associated with clinical manifestations. They had a mean size of 2.0 (range: <1-13) cm, and often were grossly cystic and hemorrhagic. Uterine benign vascular lesions included 6 arteriovenous malformations, 3 venous hemangiomas/malformations, 2 cavernous hemangiomas, and 1 mixed venous-cavernous hemangioma. In the ovary, there were 10 anastomosing hemangiomas, 8 arteriovenous malformations, 6 venous (2 in mature cystic teratomas, 1 bilateral in a patient with Klippel-Trenaunay syndrome), and 2 cavernous hemangiomas. Anastomosing hemangiomas were frequently associated with peripheral stromal luteinization/hilar cell hyperplasia; intravascular growth, extramedullary hematopoiesis, and one with adipocytic metaplasia. Venous hemangiomas/malformations were noted at a younger age in the ovary when compared to the uterine corpus. Patients with angiosarcomas had a mean age of 32 (range: 12-58) yr and a mean tumor size of 9.7 (range: 1.5-23) cm. Eight presented with a pelvic mass. Most angiosarcomas were grossly hemorrhagic and/or necrotic. Eleven arose in the ovary, 4 of them were associated with mature cystic teratoma, 1 with adenosarcoma with sarcomatous overgrowth, and 1 was part of a malignant mesenchymoma. Five were predominantly spindled, 3 epithelioid, 2 spindled and epithelioid, and one pleomorphic. Both uterine angiosarcomas were epithelioid. Follow-up was available for 8 patients: 7 died of disease between 6 and 43 mo, and 1 was alive and well at 106 mo. Vascular lesions in the upper female genital tract are uncommon, morphologically heterogeneous, and more frequent and clinically evident in the adnexa. Anastomosing hemangioma is the most common benign vascular lesion in the ovary and may be misdiagnosed as a steroid cell tumor due to associated stromal luteinization/hilar cell hyperplasia. Arteriovenous malformation is the most common benign vascular lesion in the uterine corpus. Angiosarcomas may be associated with another neoplasm, more commonly mature cystic teratoma, and have a poor prognosis.
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Affiliation(s)
- Ting Zhao
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Aravind A, Ahuja S, Malik S, Zaheer S. Anastomosing hemangioma of the kidney: A rare case report. Int J Surg Case Rep 2025; 126:110659. [PMID: 39608330 PMCID: PMC11636329 DOI: 10.1016/j.ijscr.2024.110659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Revised: 11/20/2024] [Accepted: 11/22/2024] [Indexed: 11/30/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Hemangiomas are benign vascular neoplasms primarily affecting the skin and soft tissues but can also occur in visceral organs, with the liver being the most common site. Renal hemangiomas are exceedingly rare, with fewer than 300 cases reported. Various subtypes, including cavernous, capillary, and anastomosing hemangiomas, have been identified. Anastomosing hemangioma (AH), a histological subtype of capillary hemangioma, was first described in 2009. AH has a distinctive histological architecture of anastomosing sinusoidal-like vascular spaces and often mimics angiosarcoma. CASE PRESENTATION A 28-year-old male presented with an incidentally detected left renal mass found during an evaluation for abdominal pain and dyspepsia. The patient was asymptomatic with no history of hematuria or dysuria. Physical examination was unremarkable. Contrast computed tomography revealed a heterogeneously enhancing solid mass in the left kidney, suggesting a neoplastic etiology. Laparoscopic enucleation of the tumor was performed, and histopathological examination revealed a well-circumscribed tumor composed of irregular capillary-sized vascular spaces lined by plump endothelial cells with mild atypia. Immunohistochemical analysis showed positivity for CD34, CD31, and Factor VIII, confirming the diagnosis of anastomosing hemangioma. The patient has been under follow-up with no evidence of recurrence. CLINICAL DISCUSSION Anastomosing hemangioma of the kidney, although rare, is an important benign entity that can mimic malignant vascular tumors like angiosarcoma. Accurate diagnosis relies on histopathological examination and immunohistochemistry. CONCLUSION Despite its benign nature, AH often leads to overtreatment due to its diagnostic challenges. Increased awareness and reporting of AH cases are essential to improve diagnostic accuracy and management strategies.
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Affiliation(s)
- Amrutha Aravind
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sana Ahuja
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Shaivy Malik
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sufian Zaheer
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
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Merlo S, Vivod G, Gazic B, Kovacevic N. Anastomosing hemangioma of the ovary - a comprehensive review of this rare ovarian entity. Radiol Oncol 2024; 58:320-325. [PMID: 39287168 PMCID: PMC11406934 DOI: 10.2478/raon-2024-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 08/14/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND Anastomosing hemangioma of the ovary is a rare vascular tumor that predominantly affects middle-aged women. Despite its benign nature, its histological appearance can mimic aggressive vascular lesions, posing diagnostic challenges. This review aims to provide an overview of this uncommon entity. METHODS The PubMed and Scopus databases were searched for relevant articles published in English. Information on all retrieved cases was extracted and reviewed in detail. RESULTS We found 33 cases with relevant details of anastomosing heamangioma of the ovary. Despite the small number of cases we found, our study demonstrated the importance of an accurate hystopathological evaluation. CONCLUSIONS Although the preliminary imaging and initial microscopic features may appear alarming, careful microscopic examination reveals benign behavior. There is a need to raise awareness of this unusual and rare entity to improve morphologic recognition and avoid misdiagnosis that could lead to unnecessary treatment or patient anxiety.
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Affiliation(s)
- Sebastjan Merlo
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Faculty of Health Care Angele Boskin, Jesenice, Slovenia
| | - Gregor Vivod
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Barbara Gazic
- Department of Pathology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Nina Kovacevic
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Faculty of Health Care Angele Boskin, Jesenice, Slovenia
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Patrichi AI, Gurzu S. Pathogenetic and molecular classifications of soft tissue and bone tumors: A 2024 update. Pathol Res Pract 2024; 260:155406. [PMID: 38878666 DOI: 10.1016/j.prp.2024.155406] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/06/2024] [Accepted: 06/12/2024] [Indexed: 08/09/2024]
Abstract
Soft tissue and bone tumors comprise a wide category of neoplasms. Their diversity frequently raises diagnostic challenges, and therapeutic options are continuously developing. The therapeutic success rate and long-term prognosis of patients have improved substantially due to new advances in immunohistochemical and molecular biology techniques. A fundamental contribution to these achievements has been the study of the tumor microenvironment and the reclassification of new entities with the updating of the molecular pathogenesis in the revised 5th edition of the Classification of Soft Tissue Tumors, edited by the World Health Organization. The proposed molecular diagnostic techniques include the well-known in situ hybridization and polymerase chain reaction methods, but new techniques such as copy-number arrays, multiplex probes, single-nucleotide polymorphism, and sequencing are also proposed. This review aims to synthesize the most recent pathogenetic and molecular classifications of soft tissue and bone tumors, considering the major impact of these diagnostic tools, which are becoming indispensable in clinicopathological practice.
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Affiliation(s)
- Andrei Ionut Patrichi
- Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Targu-Mures, Romania; Research Center of Oncopathology and Translational Medicine (CCOMT), Targu-Mures, Romania
| | - Simona Gurzu
- Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Targu-Mures, Romania; Research Center of Oncopathology and Translational Medicine (CCOMT), Targu-Mures, Romania; Romanian Academy of Medical Sciences, Romania.
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Semash K, Dzhanbekov T, Abduazizov M, Tashmatov S. Anastomosing hemangioma of the liver in infant: A case report. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2024; 107:102838. [DOI: 10.1016/j.epsc.2024.102838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024] Open
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Ishido H, Tajima H, Meguro S, Takada M, Tatsuoka T, Kawasaki K, Ono Y, Ban S, Okuyama T, Yoshitomi H. Primary anastomosing hemangioma as a preoperative diagnostic mimicker of retroperitoneal cavernous hemangioma: A case report. Oncol Lett 2024; 27:254. [PMID: 38646490 PMCID: PMC11027107 DOI: 10.3892/ol.2024.14386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/30/2024] [Indexed: 04/23/2024] Open
Abstract
Anastomosing hemangioma (AH) is rare and a newly recognized variant of capillary hemangioma that is mostly found in the genitourinary tract. Additionally, AH is sometimes difficult to diagnose without pathological specimens. It is difficult to diagnose preoperatively due to the lack of specific clinical and radiologic appearance. The present report describes the imaging features from a radiological perspective and outlines the clinicopathologic features and treatment options. A 67-year-old woman was referred to Dokkyo Medical University Saitama Medical Center (Koshigaya, Japan) for a retroperitoneal tumor that was identified at a medical checkup 4 years prior. The patient had no symptoms, no abnormal physical signs and no past medical or specific family history. Routine blood tests were all within the normal ranges. A nonenhanced CT scan showed a circular, homogenous, well-circumscribed retroperitoneal tumor that was ~32×23 mm in size, between the abdominal aorta and the inferior vena cava, and just below the left renal vein. On a contrast-enhanced multidetector CT scan, the tumor showed heterogeneous septal enhancement in the arterial phase and persistent enhancement in the portal phase. The tumor was diagnosed as a benign neurogenic tumor or a retroperitoneal cavernous hemangioma at the time, and the patient was intended to be followed up at the outpatient clinic. However, it gradually increased to a maximum diameter of 35 mm over 4 years. Finally, it was completely resected by open laparotomy and pathologically diagnosed as AH. Retroperitoneal hemangioma is extremely rare in adulthood and has been confirmed in only 1-3% of all retroperitoneal tumors. To the best of our knowledge, only 6 cases of para-aortic AH have been reported. The incidence of this variant is very low. However, AH may be included in the differential diagnosis when a slowly progressing heterogeneous mass appears in the para-aortic region that exhibits a CT-enhanced pattern similar to a typical cavernous hemangioma.
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Affiliation(s)
- Hirotaka Ishido
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama 343-8555, Japan
| | - Hidehiro Tajima
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama 343-8555, Japan
| | - Soya Meguro
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama 343-8555, Japan
| | - Musashi Takada
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama 343-8555, Japan
| | - Teppei Tatsuoka
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama 343-8555, Japan
| | - Keishi Kawasaki
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama 343-8555, Japan
| | - Yuko Ono
- Department of Nephrology and Hypertension, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama 350-8550, Japan
- Department of Diagnostic Pathology, Dokkyo Medical University, Mibu, Tochigi 321-0293, Japan
| | - Shinichi Ban
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama 343-8555, Japan
| | - Takashi Okuyama
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama 343-8555, Japan
| | - Hideyuki Yoshitomi
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama 343-8555, Japan
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Rewari H, Wadhwa P, Talwar H, Taneja D. Anastomosing haemangioma of adrenal gland: an unusual vascular tumour. BMJ Case Rep 2024; 17:e259092. [PMID: 38670570 PMCID: PMC11057196 DOI: 10.1136/bcr-2023-259092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
With only 15 reported cases, anastomosing haemangioma of adrenal is a rare entity and usually presents as adrenal incidentaloma. A hypertensive, diabetic, non-smoker man in his late 60s presented with irritative voiding symptoms. On evaluation, he was found to have a urinary bladder mass and left adrenal incidentaloma measuring 8 cm. Metabolic evaluation confirmed it to be non-functional.The patient underwent transurethral resection of bladder tumour with left laparoscopic adrenalectomy. Intraoperatively, the adrenal tumour was highly vascular with multiple feeder vessels. Grossly it was soft, encapsulated with focal grey-brown areas. Microscopically, most of adrenal gland was replaced by anastomosing proliferating capillary vessels within framework of non-endothelial supporting cells reminiscent of splenic sinusoids. The tumour was positive for CD-31, CD-34, Glut-1 and SMA.Anastomosing haemangioma is a benign entity but it must be differentiated from angiosarcoma. Characteristic imaging features are not yet defined and is, therefore, difficult to diagnose preoperatively.
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Affiliation(s)
- Harshit Rewari
- Kidney and Urology Institute, Medanta - The Medicity, Gurugram, Haryana, India
| | - Pankaj Wadhwa
- Kidney and Urology Institute, Medanta - The Medicity, Gurugram, Haryana, India
| | | | - Divya Taneja
- Department of Histopathology, Medanta - The Medicity, Gurugram, Haryana, India
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Muñoz-Caicedo B, García-Gómez V, Gutiérrez C, Noreña-Rengifo B, Muñoz-Caicedo J. Unraveling Anastomosing Hemangioma: A Case Report. Cureus 2024; 16:e55351. [PMID: 38559534 PMCID: PMC10981951 DOI: 10.7759/cureus.55351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Anastomosing hemangioma is a rare and benign subtype of capillary hemangioma, a soft tissue tumor. It tends to be asymptomatic, causes abdominal pain and hematuria, and is more common in the genitourinary tract. It can be confused with paragangliomas or ectopic pheochromocytomas. Pathology shares characteristics with angiosarcoma, particularly in well-differentiated areas. Diagnosis without a surgical specimen is difficult and is based on clinical characteristics, laboratories, and imaging behavior similar to hemangiomas in other locations. When in doubt, a diagnosis can be supported by a percutaneous biopsy. The prognosis is good, without relapses or metastases. Early identification with follow-up can avoid surgical interventions.
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Caldwell NJ, Ackman JB, Chebib I, Mino-Kenudson M, Nielsen GP, Hung YP. Anastomosing haemangioma of the mediastinum: Clinicopathological series with radiological and genetic characterisation. Histopathology 2024; 84:463-472. [PMID: 37936489 DOI: 10.1111/his.15085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/12/2023] [Accepted: 10/14/2023] [Indexed: 11/09/2023]
Abstract
AIMS Anastomosing haemangiomas are benign tumours with anastomosing vascular channels that may mimic angiosarcoma. While anastomosing haemangiomas have been described in diverse locations, particularly the abdominal/paraspinal region, data on anastomosing haemangiomas in the mediastinum remain limited. We report the clinicopathological, radiological and molecular characteristics of the largest single-institutional series of mediastinal anastomosing haemangiomas. METHODS AND RESULTS In our pathology archives in 2011-23, we reviewed all vascular lesions involving the mediastinum and identified seven anastomosing haemangiomas. Clinical information was abstracted from medical charts; available radiological imaging was reviewed. Targeted DNA-based next-generation sequencing (447 genes, including GNAQ and GNA11) was performed on five cases. The seven patients included five women and two men, with an age range of 55-77 (median = 72) years. Of the six tumours with available radiology, two each were in the prevascular, visceral and paravertebral mediastinum, with lobulated peripheral enhancement in all tumours examined with contrast enhancement. Six patients underwent tumour resection; one patient received proton radiotherapy. Microscopically, each tumour was solitary and characterised by anastomosing capillary-sized vessels lined by hobnail endothelial cells. Fibrin microthrombi, hyaline globules and extramedullary haematopoiesis were common. In the five tumours analysed by next-generation sequencing, GNAQ p.Q209P was identified in one tumour; no additional reportable alterations were identified in the remaining cases. No recurrence was noted in the four patients with available follow-up of 3-58 (median = 9.5) months after resection. CONCLUSION While mediastinal anastomosing haemangiomas can microscopically mimic angiosarcoma, awareness of this entity and radiological correlation may help to circumvent this diagnostic pitfall.
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Affiliation(s)
- Nicholas J Caldwell
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeanne B Ackman
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ivan Chebib
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - G Petur Nielsen
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yin P Hung
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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11
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Kazemimood R, Eliaszadeh S, Wind K. Incidental Vascular Lesion in Explanted Liver: A Rare Case Report and Review of the Literature. Case Reports Hepatol 2023; 2023:8864977. [PMID: 37965500 PMCID: PMC10643026 DOI: 10.1155/2023/8864977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/16/2023] Open
Abstract
Hepatic small vessel neoplasm (HSVN) is a rare vascular hepatic lesion that is usually an asymptomatic incidental finding. Here we present a case of a 66-year-old male with HSVN who was discovered to have a lesion presenting as a small nodule in an explanted liver. HSVN is a recently described hepatic vascular lesion that has been previously underdiagnosed. It has an uncertain long-term malignant potential, so close follow-up is recommended.
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Affiliation(s)
- Rossana Kazemimood
- The University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Kenneth Wind
- Froedtert South Hospital, Pleasant Prairie, WI, USA
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12
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Alaghehbandan R, Remer EM, Berber E, McKenney JK. Anastomosing haemangioma of the adrenal gland: A clinicopathological series of seven cases. Histopathology 2023; 83:791-797. [PMID: 37553871 DOI: 10.1111/his.15022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023]
Abstract
AIMS Anastomosing haemangioma is a rare benign vascular neoplasm that may histologically mimic angiosarcoma. We report the largest single institution series of anastomosing haemangioma in the adrenal gland with emphasis on clinical and radiological features. METHODS AND RESULTS Our laboratory information system was searched for a 25-year period (1999-2023), yielding seven cases confirmed as anastomosing haemangioma of the adrenal gland after pathological re-review. Clinical, radiological and pathological information was obtained from medical charts and submitting pathologists. Of a total of seven patients, four (57.1%) were men and three women, ranging in age from 37 to 75 years (mean = 61). Six of seven patients underwent adrenalectomies and one had radical nephrectomy. Tumours ranged from 0.7 to 6.4 cm (mean = 2.1 cm) and five of seven (71%) were grossly well-circumscribed. Five of seven lesions were found incidentally at imaging for other indications. All tumours were unifocal except one, which presented with multifocal disease with a concurrent adjacent retroperitoneal anastomosing haemangioma. Three of five tumours imaged with contrast enhancement were almost completely hyperenhancing with a small central non-enhancing portion, features overlapping with pheochromocytoma. One of seven tumours involved the peri-adrenal adipose tissue with a focally infiltrative pattern. There were no recurrences or metastases in six patients with available follow-up data (median = 95 months). CONCLUSIONS Benign anastomosing haemangiomas of the adrenal gland tend to occur in older patients, may mimic pheochromocytoma on imaging and must be distinguished from angiosarcoma pathologically. Better awareness of this entity by pathologists, radiologists and surgeons is crucial to appropriate work-up, diagnosis and management.
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Affiliation(s)
- Reza Alaghehbandan
- Department of Anatomic Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Erick M Remer
- Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eren Berber
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Jesse K McKenney
- Department of Anatomic Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
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Zhang L, Wu J. Multimodal imaging features of retroperitoneal anastomosing hemangioma: a case report and literature review. Front Oncol 2023; 13:1269631. [PMID: 37954079 PMCID: PMC10634416 DOI: 10.3389/fonc.2023.1269631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/02/2023] [Indexed: 11/14/2023] Open
Abstract
Background Anastomotic hemangioma is a rare subtype of capillary hemangioma primarily found in the genitourinary tract. We present a case of a patient with an anastomotic hemangioma located in the retroperitoneal space; then, we explore and summarize the imaging features from previously reported cases for accurate diagnosis. Case presentation A 57-year-old woman complained of left lower back pain. Contrast-enhanced ultrasound revealed a hypoechoic mass with "slow-in and slow-out" enhancement. Abdominal CT scan displayed a well-defined, round soft tissue mass in the right retroperitoneal region with obvious enhancement. MRI indicated low signal on T1-weighted imaging, high signal on T2-weighted imaging and diffusion-weighted imaging, and progressive enhancement after enhancement. Surgical removal of the tumor was performed. Histopathological examination exhibited a distinct tumor border with interconnected blood vessels and a cavity lined by a single layer of cubic endothelial cells. Immunohistochemistry confirmed the presence of CD31[+] and CD34[+]. The final pathological diagnosis was anastomotic hemangioma. No recurrence was observed during a 40-month follow-up. Conclusion Retroperitoneal anastomotic hemangioma is a rare and benign neoplasm that may be misdiagnosed as ectopic pheochromocytoma or angiosarcoma. This case report presents and analyzes the imaging characteristics of a series of retroperitoneal anastomotic hemangiomas, which can be valuable for future diagnoses and help prevent unnecessary surgeries.
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Affiliation(s)
- Liqing Zhang
- Department of Radiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian Wu
- Department of Pathology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Paparo AJ, Hillery S, Gan E, Chai S, Khor TS. Anastomosing haemangioma of the colon. Pathology 2023; 55:892-894. [PMID: 37393147 DOI: 10.1016/j.pathol.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/03/2023] [Accepted: 03/19/2023] [Indexed: 07/03/2023]
Affiliation(s)
| | | | - Eng Gan
- GI Clinic, Myaree, WA, Australia; Wexford Gastroenterology, St John of God Murdoch Hospital, Murdoch, WA, Australia
| | - Siaw Chai
- Department of Anatomical Pathology, PathWest Murdoch, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Tze S Khor
- Department of Anatomical Pathology, PathWest QEII Site, Nedlands, WA, Australia
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15
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Miranda M, Howell D, Jabbour TE. Hepatic small vessel neoplasm: not totally benign, not yet malignant. J Pathol Transl Med 2023; 57:273-277. [PMID: 37608553 PMCID: PMC10518243 DOI: 10.4132/jptm.2023.06.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 08/24/2023] Open
Abstract
Hepatic small vessel neoplasm (HSVN) is a rare vascular tumor with few reports in the literature. While imaging findings may show characteristic enhancement patterns, limited available literature may not reveal the full potential for image-based diagnosis. Histologically, HSVN mimics other entities, though certain morphologic and immunohistochemical findings provide clues for diagnosis. However, HSVN still provides diagnostic challenges, especially on core biopsies with limited material for morphologic and molecular evaluation. While current recommendations are surgical resection and close observation, the long-term course of the tumor is unknown. We report a case of HSVN in a liver with additional feature of organized lymphoid aggregates necessitating additional hematopathology consultation and workup to rule out concurrent entities.
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Affiliation(s)
- Madison Miranda
- Department of Pathology, Anatomy, and Laboratory Medicine, West Virginia University, Morgantown, WV, USA
| | - David Howell
- Department of Pathology, Anatomy, and Laboratory Medicine, West Virginia University, Morgantown, WV, USA
| | - Tony El Jabbour
- Department of Pathology, Anatomy, and Laboratory Medicine, West Virginia University, Morgantown, WV, USA
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16
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Ye TW, Huang DS. Hepatic anastomosing hemangioma: A case report. Shijie Huaren Xiaohua Zazhi 2023; 31:655-658. [DOI: 10.11569/wcjd.v31.i15.655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/19/2023] [Accepted: 08/04/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Anastomosing hemangioma (AH) is a rare benign vascular tumor, which is often discovered in the genitourinary system and paravertebral region and rarely occurs in the liver. AH lacks specific clinical manifestations and is prone to overtreatment.
CASE SUMMARY A 29-year-old male patient sought medical attention due to the discovery of a liver tumor for 2 years and tumor enlargement for 7 mo. The preoperative diagnosis suggested the possibility of focal nodular hyperplasia. However, due to the rapid increase in the volume of the liver tumor, the possibility of malignancy cannot be ruled out. After surgical treatment, the diagnosis was confirmed as liver AH, and there was no recurrence during long-term follow-up after surgery.
CONCLUSION Hepatic AH, as a benign tumor of blood vessels, lacks specific clinical manifestations. It can manifest as a stable tumor in the liver with a rapid increase in the volume in a short period of time, similar to a malignancy. Therefore, for cases with short-term progressive enlargement of intrahepatic masses, clinicians should broaden the scope of diagnosis and treatment, reduce misdiagnosis rates, and avoid overtreatment.
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Affiliation(s)
- Tai-Wei Ye
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Dong-Sheng Huang
- Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou 310059, Zhejiang Province, China
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17
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McHenry A, Buza N. Anastomosing Hemangioma of the Ovary With Leydig Cell Hyperplasia: A Clinicopathologic Study of 12 Cases. Int J Gynecol Pathol 2023; 42:167-175. [PMID: 35512214 DOI: 10.1097/pgp.0000000000000887] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Anastomosing hemangioma is a recently described vascular neoplasm, initially identified in the male genitourinary tract. Since its first description, it has been reported at multiple anatomic sites, including rare cases in the female genital tract, most in the ovary. Herein we report the largest series to date of 12 ovarian anastomosing hemangiomas identified at our institution over a 15-yr period. The patients' age at the time of resection ranged from 50 to 76 yr (median: 62 yr), 3 patients presented with symptomatic pelvic masses, 3 tumors were identified by imaging studies, and the remaining 6 were incidentally discovered in ovaries removed for other indications. All tumors were unilateral, occurred at the ovarian hilum, and contained a vaguely lobulated architecture with sinusoidal-like vessels lined by hobnail endothelial cells with minimal to no cytologic atypia. A rim of luteinized/Leydig cells with abundant, eosinophilic cytoplasm and round, centrally placed nuclei surrounding the hemangioma was present in 9/12 tumors. Reinke crystals were observed in 3 of these 9 tumors. The volume of luteinized cells relative to the vascular proliferation ranged from 2% to 30%. All tumors with luteinized/Leydig cells also displayed numerous small eosinophilic, globular intracytoplasmic inclusions within the endothelial cells. The 3 tumors without luteinized/Leydig cells were exclusively intravascular lesions. Despite the frequent presence of luteinization/Leydig cells none of the patients experienced hormonal manifestations. Awareness of this rare benign ovarian entity is important, as its association with luteinized cells/Leydig cell hyperplasia (often exuberant) may be misinterpreted as a steroid cell tumor, Leydig-cell tumor, or as a mixed stromal-vascular tumor.
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Affiliation(s)
- Austin McHenry
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
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18
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Anastomosing hemangioma of the liver: An unusual variant in abdominal MRI imaging. Radiol Case Rep 2022; 17:4889-4892. [PMID: 36276658 PMCID: PMC9579299 DOI: 10.1016/j.radcr.2022.09.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 09/14/2022] [Indexed: 11/05/2022] Open
Abstract
The liver is a rare site for anastomosing hemangiomas with only a few cases reported that characterize the lesions on magnetic resonance imaging (MRI). These lesions may be underreported due to overlapping features with classic hemangiomas. Anastomosing hemangiomas have a well-defined histological profile and are often diagnosed by biopsy in the setting of atypical imaging features. We report a case of biopsy-proven hepatic anastomosing hemangioma found on a screening MRI for hepatocellular carcinoma in a 52-year-old female with cirrhosis. This lesion initially demonstrated interval growth but has shown no local recurrence in the 2-year surveillance period following microwave ablation.
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19
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Nishikimi T, Mizuno H, Kashima A, Morikami H, Ishiguro S, Ohashi T, Yamada H. A case of robot‐assisted adrenalectomy performed for an adrenal tumor (anastomosing hemangioma) exceeding 7 cm. IJU Case Rep 2022; 5:469-473. [PMID: 36341203 PMCID: PMC9626352 DOI: 10.1002/iju5.12517] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/24/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Anastomosing hemangioma in the adrenal area is extremely rare. We report a large anastomosing hemangioma in the adrenal area that underwent robot‐assisted adrenalectomy. Case presentation A 49‐year‐old man with left back pain underwent magnetic resonance imaging (MRI) that revealed a tumor in the left adrenal area; it was diagnosed as nonfunctional endocrinologically. However, the major axis of the tumor increased from 64 to 72 mm during the 4‐month period. Robot‐assisted left adrenalectomy was performed. Although the large tumor adhered to the surrounding tissues, it was safely resected by the effective use of an extra robotic arm. An anastomosing hemangioma was diagnosed since there were no malignant findings. Conclusion Robotic surgical systems may serve as an effective treatment option for large adrenal tumors, and our report is the first robot‐assisted adrenalectomy performed on an anastomosing hemangioma.
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Affiliation(s)
- Toshinori Nishikimi
- Department of UrologyJapanese Red Cross Aichi Medical Center Nagoya Daini HospitalJapan
| | - Hideki Mizuno
- Department of UrologyJapanese Red Cross Aichi Medical Center Nagoya Daini HospitalJapan
| | - Ayano Kashima
- Department of UrologyJapanese Red Cross Aichi Medical Center Nagoya Daini HospitalJapan
| | - Hiroko Morikami
- Department of UrologyJapanese Red Cross Aichi Medical Center Nagoya Daini HospitalJapan
| | - Shigeki Ishiguro
- Department of UrologyJapanese Red Cross Aichi Medical Center Nagoya Daini HospitalJapan
| | - Tomoyoshi Ohashi
- Department of UrologyJapanese Red Cross Aichi Medical Center Nagoya Daini HospitalJapan
| | - Hiroshi Yamada
- Department of UrologyJapanese Red Cross Aichi Medical Center Nagoya Daini HospitalJapan
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20
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Zhang ZY, Hong P, Deng SH, Tang SY, Liu Z, He HY, Ma LL, Zhang SD, Tian XJ. Spermatic cord anastomosing hemangioma mimicking a malignant inguinal tumor: A case report and literature review. Front Surg 2022; 9:930160. [PMID: 35937604 PMCID: PMC9354528 DOI: 10.3389/fsurg.2022.930160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background Anastomosing hemangioma (AH) is a rare vascular tumor and occurs in various organs. It is difficult to distinguish AH from malignant tumors even through multimodal imaging examination. AH located in the inguinal region is even rare. We present the diagnosis and treatment of a patient with spermatic cord AH in detail and conduct a literature review. Case Report An 84-year-old Chinese man had swelling pain in his right scrotum. A hard and fixed mass was palpable in the right inguinal region. Preoperative radiological examination considered it a neurogenic or vascular tumor. Malignant soft tissue sarcoma could not be excluded. He underwent radical inguinal right orchiectomy under intraspinal anesthesia. The diagnosis of spermatic cord AH was confirmed by pathological examination. The patient recovered uneventfully and remained disease-free during an 18-month follow-up. Conclusion Spermatic cord AH is quite rare and could be misdiagnosed as a malignant tumor. Pathological evidence might be necessary. The optimal choice of treatment should be determined through a comprehensive assessment of both tumor and patient factors.
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Affiliation(s)
- Zhan-yi Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Peng Hong
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Shao-hui Deng
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Shi-ying Tang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Zhuo Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Hui-ying He
- Department of Pathology, Peking University Third Hospital, Beijing, China
| | - Lu-lin Ma
- Department of Urology, Peking University Third Hospital, Beijing, China
- Correspondence: Lulin Ma Shudong Zhang Xiaojun Tian
| | - Shu-dong Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China
- Correspondence: Lulin Ma Shudong Zhang Xiaojun Tian
| | - Xiao-jun Tian
- Department of Urology, Peking University Third Hospital, Beijing, China
- Correspondence: Lulin Ma Shudong Zhang Xiaojun Tian
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21
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Shanbhogue K, Khandelwal A, Hajdu C, Cao W, Surabhi VR, Prasad SR. Anastomosing hemangioma: a current update on clinical, pathological and imaging features. Abdom Radiol (NY) 2022; 47:2335-2346. [PMID: 35678844 DOI: 10.1007/s00261-022-03559-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022]
Abstract
Anastomosing hemangioma (AH) is a rare, benign vascular neoplasm with distinctive histopathology and characteristic tumor distribution. AHs show marked proclivity to involve the kidneys, gonads and the retroperitoneal soft tissues; kidney is the most common target site often in the context of end stage renal disease. Recent studies have identified activating mutations of GNA genes that drive the molecular pathogenesis of AHs. AH appears as a solitary, well-circumscribed, hypervascular tumor that charters a benign course with an excellent prognosis. The purpose of this article is to provide a current update on clinical, pathological and imaging features of anastomotic hemangioma.
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Affiliation(s)
- Krishna Shanbhogue
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA.
| | - Ashish Khandelwal
- Department of Radiology, Mayo Clinic, 200 First St, Rochester, MN, 55902, USA
| | - Cristina Hajdu
- Department of Pathology, NYU Langone Health, 550 1st Avenue, New York, NY, 10016, USA
| | - Wenqing Cao
- Department of Pathology, NYU Langone Health, 550 1st Avenue, New York, NY, 10016, USA
| | - Venkateswar R Surabhi
- Department of Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1473, Houston, TX, 77030, USA
| | - Srinivasa R Prasad
- Department of Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1473, Houston, TX, 77030, USA
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22
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Xue X, Song M, Xiao W, Chen F, Huang Q. Imaging findings of retroperitoneal anastomosing hemangioma: a case report and literature review. BMC Urol 2022; 22:77. [PMID: 35599311 PMCID: PMC9124386 DOI: 10.1186/s12894-022-01022-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 04/20/2022] [Indexed: 12/03/2022] Open
Abstract
Background Anastomosing hemangioma is an uncommon benign vascular tumor that may be mistaken for a malignancy. The imaging findings of anastomosing hemangioma are not well provided from the previous reports. Herein, in the study, we discuss the imaging findings for one case of retroperitoneal anastomosing hemangioma. Case presentation One 64-year-old female patient had a left retroperitoneal mass that was incidentally detected upon physical examination. A hypoechoic mass with abundant blood flow signals was found by US in the perirenal space. CT and MRI detected a large cystic and solid lesion in the left retroperitoneal space. Plain CT indicated that the internal density was uneven, and the pattern of enhancement was obvious and progressive. MRI-T2WI showed high intensity, DWI showed isointensity, and the mass also showed obvious progressive enhancement. Finally, anastomosing hemangioma was diagnosed via histopathological studies. Conclusion As a rare and benign tumour, anastomosing hemangioma is easily misinterpreted. We suggest that the observation of “genitourinary tract related, well defined, hyperintensity or isointensity on T2WI, isointensity on DWI, and obvious progressive enhancement patterns likely to the vascular enhancement” may consider the diagnosis of AH.
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23
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24
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Chua WM, Hoe KMJ, Dalan R, Too CW, Ong SYK, Tay TKY, Loke KSH. Anastomosing Hemangioma on 68Ga-DOTATATE PET/CT: A Potential Pitfall. Clin Nucl Med 2022; 47:321-323. [PMID: 35020655 DOI: 10.1097/rlu.0000000000003984] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
ABSTRACT Anastomosing hemangioma (AH) is a rare benign vascular lesion that primarily involves the genitourinary tract. Cases have also rarely been reported in other organs. AH is often discovered incidentally and resembles angiosarcoma histologically. On imaging, it may mimic other vascular lesions such as renal cell carcinoma and neuroendocrine tumors. We present a case of a 32-year-old woman with incidentally detected AH involving the kidneys, adrenal glands, liver, and retroperitoneum, initially presumed to be neuroendocrine tumors based on imaging findings on CT and 68Ga-DOTATATE PET scans.
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Affiliation(s)
- Wei Ming Chua
- From the Division of Radiological Sciences, Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital
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25
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Shaker N, Patel A, Tozbikian G, Parwani A. Anastomosing hemangioma: A case report of a benign tumor often misdiagnosed as a malignant epithelioid angiosarcoma. Urol Case Rep 2022; 42:102023. [PMID: 35530542 PMCID: PMC9073214 DOI: 10.1016/j.eucr.2022.102023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 01/29/2022] [Accepted: 01/31/2022] [Indexed: 11/26/2022] Open
Abstract
Anastomosing hemangioma (AH), a rare benign genitourinary tract hemangioma is subject to frequent misdiagnosis due to its rarity and clinical, histological, and immunohistochemical similarities it shares with several diagnoses, including well-differentiated angiosarcoma (AS). This is particularly true of angiosarcoma, nearly identical to AH when presented in tissue samples of limited size. Lack of specific clinical and radiologic manifestations on initial preoperative assessment, coupled with limited diagnostic experience or awareness, can lead to misinterpretation of this entity, potentially leading to unnecessary clinical management. We present an initial misdiagnosis of AS which, upon review of the entire lesion, was identified as AH.
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26
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Omiyale AO. Primary vascular tumours of the kidney. World J Clin Oncol 2021; 12:1157-1168. [PMID: 35070735 PMCID: PMC8716994 DOI: 10.5306/wjco.v12.i12.1157] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/01/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
Primary vascular tumours of the kidney are rare and may pose diagnostic difficulties because of their similar clinical, morphological, and immunohistochemical features. This article summarizes the clinical and pathological features of primary renal angiosarcoma and anastomosing haemangioma of the kidney including epidemiology, genetics, and prognosis. Renal anastomosing haemangiomas are benign neoplasms characterized by anastomosing capillary-sized vascular channels. These tumours are rare, with about 75 cases reported in the literature. Most anastomosing haemangiomas are found incidentally on ultrasound, computed tomography, or magnetic resonance imaging. Common symptoms include abdominal pain, haematuria, and abdominal mass. Renal anastomosing haemangiomas are characterized by recurrent mutations in GNAQ and GNA14 genes. The prognosis of anastomosing haemangioma is excellent. Primary renal angiosarcomas are malignant tumours showing endothelial differentiation. To date, 76 cases have been described in the literature. Primary renal angiosarcomas are frequently symptomatic. The clinical features of renal angiosarcomas are similar to those of renal anastomosing haemangiomas, including abdominal pain, haematuria, and abdominal mass. Angiogenesis-related genes and vascular-specific receptor tyrosine kinases such as KDR, TIE1, SNRK, TEK, and FLT1 are upregulated in angiosarcomas. Primary renal angiosarcomas are highly aggressive neoplasms with a poor prognosis despite surgical treatment, chemotherapy, radiotherapy, or targeted therapy.
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Affiliation(s)
- Ayo O Omiyale
- Department of Cellular Pathology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, United Kingdom
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27
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Bansal A, Goyal S, Goyal A, Jana M. WHO classification of soft tissue tumours 2020: An update and simplified approach for radiologists. Eur J Radiol 2021; 143:109937. [PMID: 34547634 DOI: 10.1016/j.ejrad.2021.109937] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/21/2021] [Accepted: 08/24/2021] [Indexed: 02/07/2023]
Abstract
The WHO classification of soft tissue tumours categorizes the lesions based on histological differentiation. In the recent fifth edition (2020), many new entities have been introduced, based on their distinct biological behaviour, genetics and morphology. With the recent advances and better understanding of molecular genetics, several novel recurrent genetic alterations have been incorporated in this edition. These may serve as reliable diagnostic and prognostic markers for various soft tissue tumours. Though predominantly a pathologist's game; the radiologists must be aware of the recent updates to contribute towards the optimal diagnosis and management of soft tissue tumours. The imaging features of the new entities have not yet been described but are expected to be explored in the coming years. We hereby present a concise review of the updates in the recent WHO classification of soft tissue tumours. We have tried to emphasize the novel molecular genetics and their surrogate immunohistochemical markers which have brought a paradigm shift in the diagnosis, therapeutics, and prognosis of soft tissue tumours. We also present simplified diagnostic algorithms to characterize soft tissue tumours based on the clinico-radiological features.
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Affiliation(s)
- Abhinav Bansal
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Surbhi Goyal
- Department of Pathology, GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Ankur Goyal
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Manisha Jana
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
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28
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Case Report on Anastomosing Haemangioma: An Unusual Vascular Tumor in Kidney. Case Rep Nephrol 2021; 2021:8847998. [PMID: 33505742 PMCID: PMC7810550 DOI: 10.1155/2021/8847998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/30/2020] [Accepted: 12/30/2020] [Indexed: 11/18/2022] Open
Abstract
Anastomosing haemangioma is a rare benign vascular neoplasm, which may mimic angiosarcoma histologically. We here present a case of anastomosing haemangioma arising from the kidney. This patient presented with a large kidney mass and adrenal mass. The clinical and radiological findings were suspicious for renal cell carcinoma with metastasis. Radical nephrectomy and adrenalectomy were thus performed. Histopathological examination and immunohistochemical studies concluded a diagnosis of anastomosing haemangioma of the kidney and concurrent adrenal cortical adenoma. It is important to differentiate this tumor from other borderline or malignant vascular neoplasms.
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29
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Choi JH, Ro JY. The 2020 WHO Classification of Tumors of Soft Tissue: Selected Changes and New Entities. Adv Anat Pathol 2021; 28:44-58. [PMID: 32960834 DOI: 10.1097/pap.0000000000000284] [Citation(s) in RCA: 244] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Soft tissue tumors are a relatively rare and diagnostically challenging group of neoplasms that can have varying lines of differentiation. Accurate diagnosis is important for appropriate treatment and prognostication. In the 8 years since the publication of the 4th Edition of World Health Organization (WHO) classification of soft tissue tumors, significant advances have been made in our understanding of soft tissue tumor molecular biology and diagnostic criteria. The 5th Edition of the 2020 WHO classification of tumors of soft tissue and bone incorporated these changes. Classification of tumors, in general, but particularly in soft tissue tumors, is increasingly based on the molecular characteristics of tumor types. Understanding tumor molecular genetics improves diagnostic accuracy for tumors that have been difficult to classify on the basis of morphology alone, or that have overlapping morphologic features. In many large hospitals in the United States and Europe, molecular tests on soft tissue tumors are a routine part of diagnosis. Therefore, surgical pathologists should be familiar with newly emerging molecular genetic techniques in clinical settings. In the near future, molecular tests, particularly in soft tissue tumor diagnosis, will become as routine during diagnosis as immunohistochemistry is currently. This new edition provides an updated classification scheme and essential diagnostic criteria for soft tissue tumors. Newly recognized entities and subtypes of existing tumor types, several reclassified tumors, and newly defined molecular and genetic data have been incorporated. Herein, we summarize the updates in the WHO 5th Edition, focusing on major changes in each category of soft tissue tumor, and the newly described tumor entities and subtypes.
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Affiliation(s)
- Joon Hyuk Choi
- Department of Pathology, Yeungnam University College of Medicine, Daegu, South Korea
| | - Jae Y Ro
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX
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30
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Zheng LP, Shen WA, Wang CH, Hu CD, Chen XJ, Shen YY, Wang J. Anastomosing hemangioma arising from the left renal vein: A case report. World J Clin Cases 2020; 8:4986-4992. [PMID: 33195671 PMCID: PMC7642539 DOI: 10.12998/wjcc.v8.i20.4986] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/14/2020] [Accepted: 09/09/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Anastomosing hemangioma (AH) is a rare subtype of benign hemangioma that is most commonly found in the genitourinary tract. Due to the lack of specific clinical and radiologic manifestations, it is easily misdiagnosed preoperatively. Here, we report a case of AH arising from the left renal vein that was discovered incidentally and confirmed pathologically, and then describe its imaging characteristics from a radiologic point of view and review its clinicopathologic features and treatment.
CASE SUMMARY A 74-year-old woman was admitted to our department for a left retroperitoneal neoplasm measuring 2.6 cm × 2.0 cm. Her laboratory data showed no significant abnormalities. A non-contrast-enhanced computed tomography (CT) scan showed a heterogeneous density in the neoplasm. Non-contrast-enhanced magnetic resonance imaging (MRI) revealed a heterogeneous hypointensity on T1-weighed images and a heterogeneous hyperintensity on T2-weighed images. On contrast-enhanced CT and MRI scans, the neoplasm presented marked septal enhancement in the arterial phase and persistent enhancement in the portal phase, and its boundary with the left renal vein was ill-defined. Based on these clinical and radiological manifestations, the neoplasm was initially considered to be a neurogenic neoplasm in the left retroperitoneum. Finally, the neoplasm was completely resected and pathologically diagnosed as AH.
CONCLUSION AH is an uncommon benign hemangioma. Preoperative misdiagnoses are common not only because of a lack of specific clinical and radiologic manifestations but also because clinicians lack vigilance and diagnostic experience in identifying AH. AH is not exclusive to the urogenital parenchyma. We report the first case of this neoplasm in the left renal vein. Recognition of this entity in the left renal vein can be helpful in its diagnosis and distinction from other neoplasms.
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Affiliation(s)
- Li-Ping Zheng
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Wei-Ai Shen
- University of Ningbo, Ningbo 315000, Zhejiang Province, China
| | - Chun-Hua Wang
- Department of Pathology, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Chun-Dong Hu
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Xu-Jian Chen
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Yi-Yu Shen
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Jing Wang
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
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Elbaset MA, Zahran MH, Badawy M, Abd Elhameed M, Osman Y. A Report of Three Cases of Cystic Adrenal Masses. Incidence, Presentation and Management. A Case Series with a Short Review of the Literature. HELLENIC JOURNAL OF SURGERY 2020; 92:133-137. [DOI: 10.1007/s13126-020-0561-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/10/2020] [Accepted: 04/15/2020] [Indexed: 09/02/2023]
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Johnstone KJ, Strutton GM, Perry-Keene JL, Hazratwala K, Delahunt B. Multifocal anastomosing haemangioma of the kidney with intravascular growth and sinus fat invasion: a rare benign mimic of angiosarcoma. Pathology 2020; 52:394-396. [PMID: 32111399 DOI: 10.1016/j.pathol.2020.01.681] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/22/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Kate J Johnstone
- Pathology Queensland, Princess Alexandra Hospital Laboratory, Woolloongabba, Qld, Australia; School of Medicine, The University of Queensland, Herston, Qld, Australia.
| | - Geoffrey M Strutton
- Pathology Queensland, Princess Alexandra Hospital Laboratory, Woolloongabba, Qld, Australia
| | - Joanna L Perry-Keene
- Aquesta Specialised Uropathology, Toowong, Qld, Australia; Pathology Queensland, Sunshine Coast University Hospital Laboratory, Birtinya, Qld, Australia
| | - Kiran Hazratwala
- Northern Urology Clinic, Mater Medical Centre, Pimlico, Qld, Australia
| | - Brett Delahunt
- Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
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Bodman A, Goodman A, Olson JJ. Intracranial thrombosed anastomosing hemangioma: Case report. Neuropathology 2019; 40:206-210. [PMID: 31788869 DOI: 10.1111/neup.12624] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/29/2019] [Accepted: 10/21/2019] [Indexed: 12/28/2022]
Abstract
An anastomosing hemangioma is a relatively new diagnosis of a benign vascular lesion that is typically found in the genitourinary tract. On imaging, anastomosing hemangiomas have a broad differential diagnosis and can resemble malignant lesions such as angiosarcoma. Here we present a case of a 33-year-old male with seizures who on imaging was found to have a presumed recurrent intracranial meningioma. After surgical resection of his lesion, this case was pathologically diagnosed as having anastomosing hemangioma. To our knowledge, this is the first report of a case of a thrombosed anastomosing hemangioma located at intracranial and intradural region.
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Affiliation(s)
- Alexa Bodman
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Abigail Goodman
- Department of Pathology, Emory University, Atlanta, Georgia, USA
| | - Jeffrey J Olson
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
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Lunn B, Yasir S, Lam-Himlin D, Menias CO, Torbenson MS, Venkatesh SK. Anastomosing hemangioma of the liver: a case series. Abdom Radiol (NY) 2019; 44:2781-2787. [PMID: 31069477 DOI: 10.1007/s00261-019-02043-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To report imaging and pathologic features of five pathologically proven anastomosing hemangiomas of the liver (AHL). METHODS A retrospective review for AHL was conducted using our institutional database from 6/2004 to 3/2018. Histology proven AHL with radiologic imaging available for review were included. A total of five patients who met our criteria were identified from our institutional database. Computed tomography, ultrasound, and magnetic resonance imaging findings, including location, size, attenuation/signal intensity, enhancement characteristics, and additional imaging data were reviewed. The clinical and pathological data were also reviewed. RESULTS The imaging characteristics of AHL are variable, but features such as peripheral or diffuse hyperintensity on diffusion weighted imaging, arterial hyperenhancement without globular interrupted enhancement, and persistent enhancement without complete filling in the delayed phases were more characteristic of AHL. Imaging also demonstrated a lack of aggressive features. CONCLUSIONS AHL present a diagnostic dilemma as they can mimic more malignant lesions, such as angiosarcoma, both on imaging and at pathology. While the imaging characteristics of AHL are variable, there are some features which can help distinguish AHL from other liver lesions. When the diagnosis of anastomosing hemangioma is known, the management of choice is primarily surveillance, as intervention can cause unnecessary morbidity, and no degeneration to malignancy has been identified to date.
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Affiliation(s)
- Brendan Lunn
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Saba Yasir
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Sudhakar K Venkatesh
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Abstract
Anastomosing hemangiomas are a rare subtype of benign vascular hemangioma which most commonly arise in the genitourinary tract and retroperitoneum. In only a small number of reports has this entity been shown originating within the liver parenchyma. Despite their benign behavior, on contrast-enhanced computer tomography and magnetic resonance imaging studies anastomosing hemangiomas can demonstrate enhancement characteristics similar to primary and metastatic liver lesions. This case report highlights the imaging features of this entity and provides a brief review of the limited literature that exists on this rare hepatic lesion.
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Affiliation(s)
- Bryce Merritt
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, USA
| | - Spencer Behr
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, USA
| | - Sarah E Umetsu
- Department of Pathology, University of California, San Francisco, USA
| | - John Roberts
- Department of General Surgery, University of California, San Francisco, USA
| | - Kanti P Kolli
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, USA
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36
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Huang ZY, Chen CC, Thingujam B. Anastomosing Hemangioma of the Nasal Cavity. Laryngoscope 2019; 130:354-357. [PMID: 30963589 DOI: 10.1002/lary.27998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/05/2019] [Accepted: 03/25/2019] [Indexed: 12/25/2022]
Abstract
Anastomosing hemangioma (AH) is an uncommon benign vascular neoplasm first described in the genitourinary tract. Symptomatically and histologically mimicking malignant angiosarcoma, a few rare cases have been described in the nonrenal genitourinary tract. Here, we report a 37-year-old man with a nasal AH and epistaxis. To the best of our knowledge, this is the first case of AH reported in the nasal cavity. Awareness of this entity in the nasal cavity can be helpful in diagnosis and distinction from angiosarcoma. Laryngoscope, 130:354-357, 2020.
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Affiliation(s)
- Zheng-Yi Huang
- Department of Pathology, Kaohsiung Armed Forces General Hospital, Kaohsiung
| | - Chien-Chin Chen
- Department of Pathology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi.,Department of Cosmetic Science, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
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Lappa E, Drakos E. Anastomosing Hemangioma: Short Review of a Benign Mimicker of Angiosarcoma. Arch Pathol Lab Med 2019; 144:240-244. [DOI: 10.5858/arpa.2018-0264-rs] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Anastomosing hemangioma is a rare neoplastic vascular lesion, histologically mimicking angiosarcoma. It is predominantly composed of irregularly anastomosing sinusoidal-like spaces lined by endothelial cells with minimal atypia, a frequently hobnail morphology, and minimally invasive margins. Since its original description in the genitourinary system, an increasing number of anastomosing hemangiomas have been reported, localized deep in the body in various organs, always with similar histologic features. It is more frequently asymptomatic, often discovered incidentally by imaging studies, owing to coexisting benign or malignant tumors. In renal cases, the most frequent clinical context is end-stage renal disease. There is overwhelming evidence of the benign nature of the lesion and an accurate diagnosis could prevent overtreatment. The differential diagnosis includes other benign vascular tumors, well-differentiated angiosarcoma, Kaposi sarcoma, and other vascular-rich neoplasms. We review the clinical and histopathologic characteristics of this peculiar lesion with an emphasis on the differential diagnosis.
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Affiliation(s)
- Eleni Lappa
- From the Department of Pathology, Medical School, University of Crete, Voutes, Heraklion, Crete, Greece
| | - Elias Drakos
- From the Department of Pathology, Medical School, University of Crete, Voutes, Heraklion, Crete, Greece
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38
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Gunduz M, Hurdogan O, Onder S, Yavuz E. Cystic Anastomosing Hemangioma of the Ovary: A Case Report With Immunohistochemical and Ultrastructural Analysis. Int J Surg Pathol 2018; 27:437-440. [PMID: 30522379 DOI: 10.1177/1066896918817148] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In this article, we present a case of anastomosing hemangioma that shows cystic change. The tumor was a unilocular cystic lesion consisting of 2 distinct layers. The inner layer was composed of a proliferation of capillary-sized blood vessels resembling red pulp of the spleen. The outer layer was composed of stromal cells that resembled Leydig or steroid cell tumor of the ovary. An immunohistochemical examination confirmed endothelial and stromal characteristics of the layers, respectively. An ultrastructural analysis revealed absence of Reinke crystalloids in the stromal cells. We conclude that anastomosing hemangioma may rarely arise from the ovary as a cystic tumor and may be accompanied with luteinization of stromal cells.
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39
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Cheon PM, Rebello R, Naqvi A, Popovic S, Bonert M, Kapoor A. Anastomosing hemangioma of the kidney: radiologic and pathologic distinctions of a kidney cancer mimic. ACTA ACUST UNITED AC 2018; 25:e220-e223. [PMID: 29962849 DOI: 10.3747/co.25.3927] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Anastomosing hemangioma (ah) is a rare subtype of primary vascular tumour that can, clinically and radiologically, present similarly to malignant renal tumours such as renal cell carcinoma (rcc) and angiosarcoma. Rarely seen in the genitourinary system, the ah we report here occurred in a 40-year-old male patient diagnosed initially with rcc based on imaging and successfully treated by laparoscopic left radical nephrectomy, with adrenal sparing and perihilar lymph node dissection. The pathologic diagnosis of ah can be challenging on small biopsy specimens; we therefore opine that it is appropriate to excise these lesions to facilitate diagnosis and definitively exclude common renal cancers. However, in this review, we describe some radiologic and pathologic distinctions between ah and malignant tumours.
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Affiliation(s)
| | | | - A Naqvi
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON
| | - S Popovic
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON
| | - M Bonert
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON
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40
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Kishida N, Sentani K, Terada H, Honda Y, Goto K, Hatanaka Y, Kohashi K, Oda Y, Iwata J, Yasui W, Shinmei S, Hayashi T, Teishima J, Matsubara A, Nakamura Y, Iida M, Awai K. Anastomosing haemangioma with fatty changes in the perirenal space: a lesion mimicking liposarcoma. BJR Case Rep 2017; 4:20170022. [PMID: 30363145 PMCID: PMC6159110 DOI: 10.1259/bjrcr.20170022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 10/01/2017] [Accepted: 10/03/2017] [Indexed: 11/20/2022] Open
Abstract
Anastomosing haemangioma is a rare subtype of capillary haemangioma. Pathologically, anastomosing haemangioma presents with anastomosing sinusoidal capillary-sized vessels in an architecture reminiscent of the splenic parenchyma. Its anastomosing architecture pathologically can lead to concern for angiosarcoma. Many cases of anastomosing haemangioma, which often occurred in the retroperitoneum, were well circumscribed, hyperdense on plain CT, revealed avid contrast enhancement and some of them exhibited fatty changes. In cases of tumours with fat of retroperitoneal occurrence, images frequently do not allow for easy differentiation from liposarcoma. Although anastomosing haemangioma with fatty changes and liposarcoma can be difficult to differentiate, no previous report has addressed this diagnostic difficulty. We have encountered a case of anastomosing haemangioma with fatty changes occurring in the perirenal space that was difficult to differentiate from liposarcoma. With retroperitoneal tumours accompanied by fatty changes and including a strongly enhanced area, the possibility of anastomosing haemangioma—which is a benign tumour—may also be considered. In such cases, biopsy is an effective means of diagnosis.
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Affiliation(s)
- Naotaka Kishida
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences,Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Kazuhiro Sentani
- Department of Molecular Pathology, Institute of Biomedical and Health Sciences,Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Hiroaki Terada
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences,Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Yukiko Honda
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences,Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Keisuke Goto
- Department of Molecular Pathology, Institute of Biomedical and Health Sciences,Hiroshima University, Minami-ku, Hiroshima, Japan.,Department of Urology, Institute of Biomedical and Health Sciences, HiroshimaUniversity, Minami-ku, Hiroshima, Japan
| | - Yui Hatanaka
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Higashi-Ku, Fukuoka, Japan
| | - Kenichi Kohashi
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Higashi-Ku, Fukuoka, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Higashi-Ku, Fukuoka, Japan
| | - Jun Iwata
- Department of Diagnostic Pathology, Kochi Health Sciences Center, Kochi, Japan
| | - Wataru Yasui
- Department of Molecular Pathology, Institute of Biomedical and Health Sciences,Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Shunsuke Shinmei
- Department of Urology, Institute of Biomedical and Health Sciences, HiroshimaUniversity, Minami-ku, Hiroshima, Japan
| | - Tetsutaro Hayashi
- Department of Urology, Institute of Biomedical and Health Sciences, HiroshimaUniversity, Minami-ku, Hiroshima, Japan
| | - Jun Teishima
- Department of Urology, Institute of Biomedical and Health Sciences, HiroshimaUniversity, Minami-ku, Hiroshima, Japan
| | - Akio Matsubara
- Department of Urology, Institute of Biomedical and Health Sciences, HiroshimaUniversity, Minami-ku, Hiroshima, Japan
| | - Yuko Nakamura
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences,Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Makoto Iida
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences,Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences,Hiroshima University, Minami-ku, Hiroshima, Japan
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41
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Burton KR, Jakate K, Pace KT, Vlachou PA. A case of recurrent, multifocal anastomosing haemangiomas. BMJ Case Rep 2017. [PMID: 28630244 DOI: 10.1136/bcr-2017-220076] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Anastomosing haemangiomas are relatively rare lesions, with a renal predilection, and which, given their imaging and pathologic appearance, mimic aggressive malignancies such as angiosarcoma. The imaging characteristics of this case are informative when evaluating a vascular lesion of the adrenal gland.
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Affiliation(s)
- Kirsteen R Burton
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Kiran Jakate
- Laboratory Medicine and Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Kenneth T Pace
- Division of Urology, Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Paraskevi A Vlachou
- Division of Abdominal Imaging, St. Michael's Hospital, Toronto, Ontario, Canada
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42
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Berker NK, Bayram A, Tas S, Bakir B, Caliskan Y, Ozcan F, Kilicaslan I, Ozluk Y. Comparison of Renal Anastomosing Hemangiomas in End-Stage and Non–End-Stage Kidneys: A Meta-Analysis With a Report of 2 Cases. Int J Surg Pathol 2017; 25:488-496. [DOI: 10.1177/1066896917706025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background. Renal anastomosing hemangioma (RAH) is a very rare distinct entity composed of anastomosing sinusoidal (spleen-like) capillary-sized vessels lined by flat or hobnail endothelial cells. Most of the published cases of RAH occurred in the setting of end-stage renal disease (ESRD). Methods. We present 2 cases of RAH in ESRD along with a literature review. We compared clinicopathologic features of RAHs in end-stage and non–end-stage kidneys. A meta-analysis was conducted with PubMed and a manual search through references of relevant publications. Individual patient data gathered from the literature were used in the analysis. Results. Our systematic review revealed 49 RAHs, including our 2 cases. Thirty-two (65.3%) cases were in ESRD, only 17 (34.7%) were in patients with non-ESRD. RAHs in ESRD were in younger patients, smaller in size, multifocal, and seen more with renal epithelial neoplasms when compared with RAHs in non-ESRD ( P < .05). Extramedullary hematopoiesis was seen mostly in RAHs in ESRD kidneys (85% vs 41.7%) ( P = .018). Follow-up data were available for 25 cases with a mean follow-up of 24.58 ± 38.54 months. Recurrence, metastasis, or death have never been described related to RAH in any patients. Conclusions. In conclusion, RAHs are rare and mostly arise in kidneys with end-stage damage. RAHs in ESRD and non-ESRD differ in terms of clinicopathologic features.
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Affiliation(s)
| | - Aysel Bayram
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Serap Tas
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Baris Bakir
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasar Caliskan
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Faruk Ozcan
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Isin Kilicaslan
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Ozluk
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Perdiki M, Datseri G, Liapis G, Chondros N, Anastasiou I, Tzardi M, Delladetsima JK, Drakos E. Anastomosing hemangioma: report of two renal cases and analysis of the literature. Diagn Pathol 2017; 12:14. [PMID: 28118845 PMCID: PMC5260082 DOI: 10.1186/s13000-017-0597-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/04/2017] [Indexed: 01/13/2023] Open
Abstract
Background Anastomosing hemangioma (AH) is a very rare vascular tumor mimicking angiosarcoma, predominately observed in kidney and less frequently in other organs. We present two new renal cases of AH at opposite ends of the clinical presentation spectrum, provide review of the literature and compare the epidemiological, clinical and pathological profiles of renal and non-renal cases. Case presentation The first occurred in a 64-year-old woman presented with back pain and the second, a multifocal lesion, in a 47-year-old man with end stage renal disease (ESRD). Histology disclosed a vascular tumor with striking anastomosing pattern, minimal nuclear atypia and locally infiltrative pattern, mimicking superficially angiosarcoma. Extramedullary hematopoiesis, extensive perirenal fat entrapment and increased number of mast cells were additional features in the second lesion. Both patients are well, without disease, 25 and 14 months after diagnosis. Conclusion Comprehensive review and analysis of the published literature show that the growing number of non-renal AHs exhibits similar epidemiologic, clinical, biologic and histologic characteristics with renal AHs and most mild differences vanish after exclusion of cases associated with ESRD. Better understanding of AH pathogenesis will contribute to optimal treatment choices.
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Affiliation(s)
- Marina Perdiki
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Goudi, Mikras Asias 75, 11527, Athens, Greece
| | - Galateia Datseri
- Department of Pathology, Medical School, University of Crete, Voutes, Heraklion, 71110, Greece
| | - George Liapis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Goudi, Mikras Asias 75, 11527, Athens, Greece
| | - Nikolaos Chondros
- Department of Urology-University Hospital of Heraklion, Medical School, University of Crete, Voutes, Heraklion, 71110, Greece
| | - Ioannis Anastasiou
- First Department of Urology, Medical School, National and Kapodistrian University of Athens, Goudi, Mikras Asias 75, 11527, Athens, Greece
| | - Maria Tzardi
- Department of Pathology, Medical School, University of Crete, Voutes, Heraklion, 71110, Greece
| | - Johanna K Delladetsima
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Goudi, Mikras Asias 75, 11527, Athens, Greece
| | - Elias Drakos
- Department of Pathology, Medical School, University of Crete, Voutes, Heraklion, 71110, Greece.
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Dundr P, Němejcová K, Laco J, Skálová H, Bauerová L, Matěj R, Fischerová D. Anastomosing Hemangioma of the Ovary: A Clinicopathological Study of Six Cases with Stromal Luteinization. Pathol Oncol Res 2017; 23:717-722. [DOI: 10.1007/s12253-016-0186-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 12/29/2016] [Indexed: 10/20/2022]
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