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Chen J, Cai DM. Renal anastomosing hemangioma following partial nephrectomy for renal cell carcinoma: A case report. World J Clin Cases 2024; 12:4010-4015. [PMID: 38994314 PMCID: PMC11235457 DOI: 10.12998/wjcc.v12.i19.4010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/25/2024] [Accepted: 05/10/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Renal anastomosing hemangioma (AH) is a rare benign vascular tumor characterized by unique histopathological features. CASE SUMMARY We report a highly unusual case of renal AH. A male patient had undergone partial nephrectomy for clear cell carcinoma of the kidney four years prior. A follow-up computed tomography scan in the third postoperative year revealed a new mass near the surgical site on the same side of the kidney, raising suspicions of tumor recurrence. However, the characteristics on contrast-enhanced magnetic resonance imaging and ultrasonography were more consistent with those of a benign lesion. The patient strongly insisted on undergoing surgery due to concerns about the possibility of renal cancer recurrence. Postoperative pathology confirmed the diagnosis of renal AH. CONCLUSION This case report presents the imaging features of a patient with rare renal AH and a history of renal clear cell carcinoma, providing broader insights into the differential diagnosis of new lesions after surgery for renal cell carcinoma.
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Affiliation(s)
- Juan Chen
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Di-Ming Cai
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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2
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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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Capinha MD, Carvalho-Dias E, Cerqueira-Alves M, Mota P. Renal anastomosing haemangioma. BMJ Case Rep 2023; 16:e254131. [PMID: 37723090 PMCID: PMC10510885 DOI: 10.1136/bcr-2022-254131] [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: 09/20/2023] Open
Abstract
Anastomosing haemangioma is a rare subtype of haemangioma, a benign vascular tumour. Its rarity stems from its low incidence and difficulty in obtaining an accurate diagnosis. In addition, its histological resemblance to malignant neoplasms may lead to unnecessary overtreatment. Here, we report the case of an asymptomatic male patient with a slight increase in kidney function who underwent an abdominal ultrasound and a CT scan for suspected renal cell carcinoma. Subsequently, the patient underwent laparoscopic left radical nephrectomy. Histological analysis revealed an anastomosing haemangioma. The patient is currently asymptomatic with no relapse or imaging progression. We also present a literature review on anastomosing haemangioma.
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Affiliation(s)
| | | | | | - Paulo Mota
- Urology, Hospital de Braga, Braga, Portugal
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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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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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6
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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: 0] [Impact Index Per Article: 0] [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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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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8
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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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9
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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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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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