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Langmaid T, Ellis S, Fisher L, Pilgrim C. Conservative management of adult pancreatic haemangioma: case study and literature review. BMJ Case Rep 2021; 14:14/1/e239147. [PMID: 33500307 PMCID: PMC7839894 DOI: 10.1136/bcr-2020-239147] [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: 01/28/2023] Open
Abstract
Pancreatic haemangiomas are a rare cause of pancreatic lesions in adults. Diagnosis is challenging as they are seldom suspected and difficult to differentiate on imaging. Historically, pancreatic haemangiomas have been managed surgically despite their benign nature, largely due to diagnostic uncertainty. We present the case of a 69-year-old woman who, through combination of radiological, biochemical and endoscopic investigations, was diagnosed with pancreatic haemangioma and managed conservatively, avoiding the morbidity and mortality associated with surgical resection of a benign lesion.
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Affiliation(s)
- Tess Langmaid
- Department of General Surgery, Hepato Pancreato Billiary Unit, Alfred Health, Melbourne, Victoria, Australia
| | - Samantha Ellis
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Leon Fisher
- Department of Gastroenterology, Cabrini Health, Malvern, Victoria, Australia
| | - Charles Pilgrim
- Department of General Surgery, Hepato Pancreato Billiary Unit, Alfred Health, Melbourne, Victoria, Australia
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Zhou J, Chen Z. Rare adult pancreatic hemangioma: review of the literature with a case report. Gland Surg 2020; 9:1596-1604. [PMID: 33224837 DOI: 10.21037/gs-20-281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Adult pancreatic hemangioma is an especially rare benign tumor that is hard to diagnose through imaging examinations, meanwhile its histopathological and immunohistochemical studies have rarely been reported. At this time, only 29 cases in 27 publications have been reported. We report a new case as well as review these literatures. A 71-year-old woman came to our hospital with slight pain on left upper abdomen for three days. But the results obtained from the physical or laboratory examination were all negative so that her symptoms could not be explained clearly. The imaging examinations including ultrasonography and computed tomography both showed a mixed mass in the neck of the pancreas. The preoperative diagnosis of cystadenoma or adenocarcinoma was made, with high suspicious of malignancy. The patient underwent a central pancreatectomy with pancreatojejunostomy, but the pathologic diagnosis was pancreatic hemangioma. The immunohistochemical examination found the positive benign vascular markers (CD31, CD34) and negative lymphocyte markers (D2-40). Moreover, Ki-67 negativity also revealed its benign nature. After 36 months of follow-up, the patient has no complaints for abdominal pain. In conclusion, adult pancreatic hemangioma is extremely rare without any specific clinical manifestations. It is usually diagnosed postoperatively by histological examination and immunohistochemical studies. Imaging examinations, including computed tomography and magnetic resonance imaging, can't give definite conclusion. Endoscopic-ultrasound guided fine needle aspiration is conditionally worth doing, which can give some hints and exclude the malignancy of the lesion. If malignancy can be safely ruled out, the surgical decision must be made according to risk-benefit analysist. Maybe close observation and regular follow-up are more beneficial options.
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Affiliation(s)
- Junfeng Zhou
- Department of Hepatobiliary Surgery, The 960th Hospital of PLA, Jinan, China
| | - Zhong Chen
- Department of Hepatobiliary Surgery, The 960th Hospital of PLA, Jinan, China
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Lianyuan T, Yafeng W, Haibo Y, Yadong D, Jiahao M, Yuanxiang L, Deyu L. Adult pancreatic cavernous hemangioma: case presentation of a benign tumor with a complex composition. BMC Gastroenterol 2019; 19:197. [PMID: 31771513 PMCID: PMC6880481 DOI: 10.1186/s12876-019-1119-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 11/15/2019] [Indexed: 12/31/2022] Open
Abstract
Background Pancreatic cavernous hemangioma is an extremely rare benign tumor that is difficult to diagnose on an imaging examination, and its histopathological examination has rarely been reported. Case presentation Herein, we present the case of a 63-year-old man who was admitted to the hospital due to left upper abdominal pain and defecation unformed for more than 2 years. None of the positive results obtained from the physical examination could explain his symptoms. The imaging examination indicated a multilocular cyst with septa in the head of the pancreas. The patient underwent a pancreaticoduodenectomy, and the pathologic diagnosis was pancreatic cavernous hemangioma. The histopathological examination showed that the lesion was positive for benign vascular markers, such as CD31, CD34 and F8, and negative for lymphocyte markers, such as D2–40. Moreover, it was also positive for ERG and cytokeratin markers, CAM5.2 and AE1/AE3, indicating the complexity of its components, and Ki-67 negativity revealed its benign nature. Conclusions Pancreatic cavernous hemangioma has a complex composition that may be reflected not only in the imaging examination but also in the immunohistochemical detection, and it may achieve a good outcome by surgical excision.
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Affiliation(s)
- Tao Lianyuan
- Department of Hepatobiliary Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, No. 7 Weiwu Road, Zhengzhou, 450003, China
| | - Wang Yafeng
- Department of Hepatobiliary Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, No. 7 Weiwu Road, Zhengzhou, 450003, China
| | - Yu Haibo
- Department of Hepatobiliary Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, No. 7 Weiwu Road, Zhengzhou, 450003, China
| | - Dong Yadong
- Department of Hepatobiliary Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, No. 7 Weiwu Road, Zhengzhou, 450003, China
| | - Ma Jiahao
- Department of Hepatobiliary Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, No. 7 Weiwu Road, Zhengzhou, 450003, China
| | - Lu Yuanxiang
- Department of Hepatobiliary Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, No. 7 Weiwu Road, Zhengzhou, 450003, China
| | - Li Deyu
- Department of Hepatobiliary Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, No. 7 Weiwu Road, Zhengzhou, 450003, China.
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Raymundo SRDO, Hussain KMK, Hussein KG, Kuga ML. Rare case of adult pancreatic haemangioma and literature review. BMJ Case Rep 2018; 2018:bcr-2018-226456. [PMID: 30297496 DOI: 10.1136/bcr-2018-226456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Pancreatic haemangiomas are benign vascular tumours very rare in adults. Twenty-two cases are described in the literature. The symptoms are non-specific, and therefore rarely clinically suspected, and the vast majority are incidental findings in imaging tests such as ultrasound, CT, angiography or MRI. They appear on CT as a cystic lesion with contrast enhancement in the arterial phase. We present the case of a 36-year-old male patient with no history of disease, referred with lumbar pain and suspected renal calculus after tomography showing hypervascular enhancement in the pancreatic body and infiltrative lesion (possible neuroendocrine neoplasia) on MRI and biliopancreatic echoendoscopy. He was submitted to laparotomy with subtotal pancreatectomy and splenectomy and satisfactory evolution.
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Affiliation(s)
- Selma Regina de Oliveira Raymundo
- Cardiologia e Cirugia Vascular, Faculdade de Medicina de Sao Jose do Rio Preto, São José do Rio Preto, Brazil.,Cirurgia Geral, Hospital Austa, Sao Jose Rio Preto, Brazil
| | - Kassim Mohamede Kassim Hussain
- Cirurgia Geral, Hospital Austa, Sao Jose Rio Preto, Brazil.,Cirurgia Geral, Faculdade de Medicina de Sao Jose do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | | | - Magali Lúcia Kuga
- Cirurgia Geral, Hospital Austa, Sao Jose Rio Preto, Brazil.,Cirurgia Geral, Faculdade de Medicina de Sao Jose do Rio Preto, São José do Rio Preto, São Paulo, Brazil
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Barral M, Faraoun S, Fishman E, Dohan A, Pozzessere C, Berthelin MA, Bazeries P, Barat M, Hoeffel C, Soyer P. Imaging features of rare pancreatic tumors. Diagn Interv Imaging 2016; 97:1259-1273. [DOI: 10.1016/j.diii.2016.07.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 07/11/2016] [Accepted: 07/18/2016] [Indexed: 02/07/2023]
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Lu T, Yang C. Rare case of adult pancreatic hemangioma and review of the literature. World J Gastroenterol 2015; 21:9228-9232. [PMID: 26290651 PMCID: PMC4533056 DOI: 10.3748/wjg.v21.i30.9228] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 03/29/2015] [Accepted: 05/04/2015] [Indexed: 02/06/2023] Open
Abstract
Pancreatic hemangiomas are a rare type of cystic tumor, with very few cases reported in the literature. Herein, we present the case of a 28-year-old woman who was admitted to our hospital for abdominal pain. A physical examination failed to reveal any abnormalities that could explain her symptoms. A contrast-enhanced computed tomography showed a multilocular cyst with moderately enhanced septa and fluid-fluid levels in the body and tail of the pancreas. A serous cystadenoma or pseudocyst of the pancreas was initially suspected, and the patient underwent a subtotal pancreatectomy and splenectomy. The pathologic diagnosis was a pancreatic hemangioma. This is the second case of pancreatic hemangioma with fluid-fluid levels reported in the literature. Upon imaging, the presentation of this tumor can resemble serous or mucinous cystadenomas, pseudocysts of the pancreas, and side-branch type intraductal papillary mucinous neoplasms. This report reviews the clinical symptoms, radiologic features, pathologic characteristics, differential diagnoses, and treatment of this rare lesion type.
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Naito Y, Nishida N, Nakamura Y, Torii Y, Yoshikai H, Kawano H, Akiyama T, Sakai T, Taniwaki S, Tanaka M, Kuroda H, Higaki K. Adult pancreatic hemangioma: A case report. Oncol Lett 2014; 8:642-644. [PMID: 25013478 PMCID: PMC4081133 DOI: 10.3892/ol.2014.2206] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 02/26/2014] [Indexed: 12/19/2022] Open
Abstract
Vascular neoplasms of the pancreas are extremely rare and usually manifest as symptomatic, cystic lesions. This study presents a case that includes the clinicopathologic information used to discriminate pancreatic hemangioma from other types of cystic lesion of the pancreas. A 40-year-old female visited hospital with a chief complaint of abdominal pain. The serum CEA and CA19-9 levels of the patient were within the normal limits. An abdominal computed tomography scan and magnetic resonance imaging showed a 100-mm mass lesion in the body and tail of the pancreas, and the tumor extended toward the retroperitoneum and surrounded the splenic vein. The lesion was subsequently resected. Macroscopically, it was a multiloculated cyst with intracystic hemorrhage. Microscopically, the lesion was composed of numerous, heterogeneous cysts lined by a flattened single layer of cells without significant atypia. Notably, numerous neoplastic vessels extended into the interlobular septa of the pancreas and surrounded the main pancreatic duct. Immunohistochemical analysis showed that the lining cells expressed CD31 and CD34. The lesion was diagnosed as adult pancreatic hemangioma. Surgical treatment may be required when a direct contact between the lesion and the pancreatic tissue is demonstrated using imaging.
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Affiliation(s)
- Yoshiki Naito
- Department of Pathology, St. Mary's Hospital, Kurume, Fukuoka 830-8543, Japan
| | - Naoyo Nishida
- Department of Pathology, St. Mary's Hospital, Kurume, Fukuoka 830-8543, Japan
| | - Yasuhiro Nakamura
- Department of Pathology, St. Mary's Hospital, Kurume, Fukuoka 830-8543, Japan
| | - Yoshikuni Torii
- Department of Radiology, St. Mary's Hospital, Kurume, Fukuoka 830-8543, Japan
| | - Hiroshi Yoshikai
- Department of Gastroenterology, St. Mary's Hospital, Kurume, Fukuoka 830-8543, Japan
| | - Hiroshi Kawano
- Department of Gastroenterology, St. Mary's Hospital, Kurume, Fukuoka 830-8543, Japan
| | - Tetsuji Akiyama
- Department of Gastroenterology, St. Mary's Hospital, Kurume, Fukuoka 830-8543, Japan
| | - Terufumi Sakai
- Department of Gastroenterology, St. Mary's Hospital, Kurume, Fukuoka 830-8543, Japan
| | - Satoru Taniwaki
- Department of Surgery, St. Mary's Hospital, Kurume, Fukuoka 830-8543, Japan
| | - Masaya Tanaka
- Department of Surgery, St. Mary's Hospital, Kurume, Fukuoka 830-8543, Japan
| | - Hisashi Kuroda
- Department of Surgery, St. Mary's Hospital, Kurume, Fukuoka 830-8543, Japan
| | - Koichi Higaki
- Department of Pathology, St. Mary's Hospital, Kurume, Fukuoka 830-8543, Japan
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Bursics A, Gyökeres T, Bély M, Pörneczi B. Adult hemangioma of the pancreas: difficult diagnosis of a rare disease. Clin J Gastroenterol 2013; 6:338-43. [DOI: 10.1007/s12328-013-0396-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 06/03/2013] [Indexed: 02/07/2023]
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Adult pancreatic hemangioma: case report and literature review. Gastroenterol Res Pract 2009; 2009:839730. [PMID: 19421421 PMCID: PMC2676326 DOI: 10.1155/2009/839730] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2008] [Accepted: 02/09/2009] [Indexed: 12/11/2022] Open
Abstract
We report an adult pancreatic hemangioma diagnosed on pathological specimen review following pylorus preserving pancreaticoduodenectomy for a symptomatic cystic mass in the head of the pancreas. Eight cases of adult pancreatic hemangioma have been reported in literature since 1939. Presenting symptoms, radiographic diagnosis, pathologic characteristics, and treatment of adult pancreatic hemagiomas are discussed following review of all published cases.
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Affiliation(s)
- Wen-Tsan Chang
- Department of Surgery; Kaohsiung Medical University Hospital; Kaohsiung, Taiwan
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