Cavernous hemangioma of adult pancreas: A case report and literature review

Figure 1 Contrast computed tomography scan showed a non-enhancing cystic lesion in the head of the pancreas.

Figure 2 Magnetic resonance imaging. Variable intensity in T1 weighted (A) and T2 weighted (B) imaging. Overall, the hemangioma had hypo-intensity in T1W and hyper-intensity in T2W imaging. Peripheral enhancement after gadolinium injection with gradual centripetal filling-in (C, D: Arterial phase; E: Venous; and F: Delayed venous phase) was noticed. Intensity was parallel to that of aorta. A central cystic area remained hypo-intense.

Figure 3 Magnetic resonance cholangiopancreatography demonstrated no ductal dilation.

Figure 4 Endoscopic ultrasound: Complex cyst at the head of pancreas, devoid of Doppler signals, with normal surrounding parenchyma and without any ductal or vascular abnormality.

Figure 5 Fine needle aspiration cytology. Direct smear showed few clusters of cells without atypia (A, B) and increased lymphocytes (C); Cell block showed clusters of histiocytes, some of which had light brown material in their cytoplasm, suggestive of hemosiderin (D).

Figure 6 Gross pathology showing head of pancreas lesion (A) and cystic lesion with thick septa and recent hemorrhage evident on cross section (B).

Figure 7 Histopathology. A: The hemangioma displaced the exocrine pancreas; B: It had blood filled ectatic vessels with thin endothelium lining large cavernous spaces and aggregates of chronic inflammatory cells in the surrounding fibrous tissue; C: The lumina of the vessels contained macrophages, some containing hemosiderin; D: One vessel with organizing thrombus containing fibrin and foamy macrophages.