Retroperitoneal cavernous hemangioma resected by a pylorus preserving pancreaticoduodenectomy

Abstract

A retroperitoneal hemangioma is a rare disease. We report on the diagnosis and treatment of a retroperitoneal hemangioma which had uncommonly invaded into both the pancreas and duodenum, thus requiring a pylorus preserving pancreaticoduodenectomy (PpPD). A 36-year-old man presented to our hospital with abdominal pain. An enhanced computed tomography scan without contrast enhancement revealed a 12 cm × 9 cm mass between the pancreas head and right kidney. Given the high rate of malignancy associated with retroperitoneal tumors, surgical resection was performed. Intraoperatively, the tumor was inseparable from both the duodenum and pancreas and PpPD was performed due to the invasive behavior. Although malignancy was suspected, pathological diagnosis identified the tumor as a retroperitoneal cavernous hemangioma for which surgical resection was the proper diagnostic and therapeutic procedure. Reteoperitoneal cavernous hemangioma is unique in that it is typically separated from the surrounding organs. However, clinicians need to be aware of the possibility of a case, such as this, which has invaded into the surrounding organs despite its benign etiology. From this case, we recommend that combined resection of inseparable organs should be performed if the mass has invaded into other tissues due to the hazardous nature of local recurrence. In summary, this report is the first to describe a case of retroperitoneal hemangioma that had uniquely invaded into surrounding organs and was treated with PpPD.

Keywords: Retroperitoneal tumor, Retroperitoneal cavernous hemangioma, Cavernous hemangioma, Pancreaticoduodenectomy, Pylorus preserving pancreaticoduodenectomy

Core tip: A retroperitoneal cavernous hemangioma is a rare disease. This case of retroperitoneal hemangioma had uniquely invaded into the duodenum and pancreas head, and thus required treatment with pylorus preserving pancreaticoduodenectomy. Although hemangiomas are typically benign, clinicians should be aware of the possibility of invasion into the surrounding organs such as with this case. In the event of invasion, we recommend a combined resection of both the tumor and affected organs to reduce the chance of local recurrence that may be associated with inadequate resection.