Retroperitoneal cavernous hemangioma misdiagnosed as lymphatic cyst: A case report and review of the literature

Table 1 Clinical data of patients

No.	Gender	Age	Ultrasonic	CT	MRI	Positive sign	Preoperative diagnosis	Postoperative pathology	Ref.
1	Male	20	Small amount of low-velocity blood flow signal in the tumor with heterogeneous echogenicity	No	No	No	Retroperitoneal cavernous hemangioma	Cavernous hemangioma (lumbar major muscle origin)	[44]
2	Female	51	No	The edges of the mass are clear and smooth, with heterogeneous density, mild enhancement at the edge of enhancement, and nodular significant enhancement seen internally	The lesion shows delayed marked enhancement	Pain in the right lower abdomen, numbness and pain in the right lower extremity	Neurogenic tumor?	Cavernous hemangioma	[37]
3	Female	16	No	No	No	Fresh blood stools, black stools, severe anemia	Hemorrhoids? Colonic vasodilatation?	Cavernous hemangioma	[38]
4	Male	35	No	Uniform density mass. Homogeneous enhancement is seen	Smooth margins of the mass and uniform internal signal	Abdominal pain	Adrenal tumors; tumors of vascular origin; tumors of neurological origin; adrenal pheochromocytoma?	Cavernous hemangioma	[39]
5	Male	57	No	Isointense-slightly hypointense shadow of the right adrenal gland with clear margins, lobulated, heterogeneous density, nodular enhancement	No	Elevated blood pressure	Cortical cancer?	(Right adrenal gland) cavernous hemangioma	[19]
6	Male	14	Clearly defined mass with internal cystic mass and no significant blood flow signal	Hematoma in the right adrenal region	No	No	Tumor with hemorrhage	Hemangioma (left adrenal gland) with hemorrhagic necrosis	[20]
7	Male	57	No	Uneven density masses	No	Left upper abdominal pain	Left adrenocortical carcinoma, pheochromocytoma? Retroperitoneal mesenchymal-derived tumor?	Hemangioma (left adrenal gland) with hemorrhagic necrosis	[21]
8	Female	70	No	Clearly defined mass with heterogeneous density and scattered foci of speckled calcification at the margins; enhanced lesions with heterogeneous enhancement and multiple foci of nodular hyperenhancement at the periphery	No	Abdominal pain	Giant retroperitoneal occupancy with consideration of benign tumor of adrenal origin	(Left adrenal) cavernous hemangioma; immunohistochemistry: Vim (+)	[22]
9	Female	47	No	The density of the mass is uneven, and vascular shadow is seen in enhancement	T1W1 low signal, T2W1 heterogeneous high signal, lesion is heterogeneously reinforced, vascular shadow is seen	Abdominal distension, abdominal pain	Malignant tumors	Cavernous hemangioma with bleeding; Immunohistochemistry: CD31 (+); CD34 (+), CD2-40 (+), ERG (+), SMA (+)	[40]
10	Female	71	Irregular hypoechoic solid occupying lesion of the pancreas	Heterogeneous hypodense lesion in the pancreatic neck with clear borders and marked enhancement	No	Abdominal pain	No	Pancreatic cavernous hemangioma; immunohistochemistry: CD31 (+), CD34 (+), CD2-40 (-)	[25]
11	Female	37	Cystic solid mass	No	No	Abdominal pain	No	Pancreatic cavernous hemangioma	[26]
12	Female	63	Cystic solid mass	No	No	Abdominal pain	Pancreatic cancer	Pancreatic cavernous hemangioma with calcification and cyst formation	[26]
13	Male	79	Cystic solid mass in the head of the pancreas with clear borders, uneven internal echogenicity, scattered multiple echogenic areas, and poor blood flow signal	Occupation of the head of the pancreas with lamellar enhancement and increased delayed enhancement, with multiple microvascular shadows seen within	No	Abdominal pain, abdominal distension	No	Pancreatic cavernous hemangioma	[27]
14	Male	55	Cystic predominant mass in the tail of the pancreas with clear borders. Irregular shape, no obvious blood flow signal	Hypodense lesion in the body of the pancreas	Cystic occupying lesion in the body of the pancreas	Abdominal pain	Cystadenoma, cyst?	Pancreatic cavernous hemangioma	[28]
15	Male	49	No	A round-like hypodense lesion is seen in the neck of the pancreas, and enhancement is seen	Pancreatic neck occupancy with clear margins and homogeneous signal; enhancement is not obvious	Pain in the lower back and lower right abdomen	Pancreatic cancer?	Pancreatic cavernous Hemangioma	[29]
16	Female	58	No	Plain scan shows a round-like hypodense mass in the tail of the pancreas with well-defined borders, and moderate enhancement in the arterial phase and "thin thread-like" moderate enhancement in the venous and delayed phases	A round-like lesion was seen in the tail of the pancreas, with uniform low signal on T1WI and high signal on T2WI, and a little bit of slightly low signal was seen inside (DW1 showed slightly high signal, and mild to moderate patchy enhancement was seen inside the lesion)	Abdominal distension, abdominal pain, jaundice	Cystadenoma of the pancreas	Pancreatic cavernous hemangioma	[30]
17	Male	66	The envelope was intact and continuous, and multiple irregular echogenic areas were visible inside, separated by hyperechoic structures	A large round-like hypodense mass in the right upper abdomen with clear borders and nodular irregular enhancement around the mass in the arterial phase	A round abdominal abnormal signal shadow with well-defined borders, T1-weighted moderately low signal and nodular low signal in the periphery; T2-weighted mass is predominantly high signal, with striated low signal inside. After enhancement, T1-weighted nodular enhancement was seen in the periphery, and the enhancement became more obvious on delayed scan and expanded inward. There was no central enhancement on both scans	Symptomless	Cavernous hemangioma	Adrenal cavernous hemangioma	[31]
18	Female	54	Strongly echogenic mass in the right posterior lobe of the liver with clear boundaries and uneven internal echogenicity	A rounded hypointense shadow is seen in the right adrenal area, and a more hypointense area with clear borders is visible within it; the periphery of the lesion is mildly enhanced	The oval-shaped mass between the liver and the right kidney is hyposignal on T1WI, with an eccentric more hyposignal area within it; it is high-signal on T2WI, with a well-defined border and a non-enhancing hyposignal area within it	Abdominal pain	Retroperitoneal space-occupying lesions (malignant)	Primary retroperitoneal cavernous hemangioma	[34]
19	Female	60	Cystic	Slightly hypointense shadow with inconspicuous enhancement	No	Abdominal pain, fever	Cystic lesion of the tail of the pancreas. Cystic adenoma? Cystic adenocarcinoma?	Pancreatic cavernous hemangioma	[32]
20	Female	41	Cystic solid	No	No	Medical examination	Cystic dominant cystadenoma or islet cell carcinoma in the body of the pancreas	Pancreatic cavernous hemangioma	[32]
21	Female	30	Cystic solid	No	No	Abdominal pain, choking on food	Cystic solid occupancy of the head of the pancreas is likely to be benign	Pancreatic cavernous hemangioma	[32]
22	Female	57	Uneven hypoechoic	Uneven reinforcement	No	No	Gastrointestinal mesenchymal tumors (GISTs), carcinoid tumors, neurogenic tumors, metastatic lymphadenopathy, or other rare tumors	Retroperitoneal cavernous hemangioma	[41]
23	Male*	63	Mixed echogenicity within the indistinct contour of the head of the pancreas, CDFI shows hyperechoic and visible blood flow within the separation	A well-defined cystic mass in the head of the pancreas with foci of internal calcification	No	Abdominal pain, constipation		Pancreatic cavernous hemangioma	[33]
24	Male	36	Uneven echoes	Tumor between the dorsal head of the pancreas and right kidney without significant enhancement	Lower signal in the tumor, some relatively high intensity areas	Abdominal pain	Retroperitoneal sarcoma	Cavernous hemangioma; Immunohistochemistry: CD31 (+), CD34 (+), CD2-40 (partially +)	[42]
25	Male	35	No	Well-defined, cyst-like masses, no enhancement of the mass wall in the arterial and portal phases, persistent hypodensity of the mass	No	Abdominal pain	Benign tumors such as lymphangioma cysts, GISTs, or primitive retroperitoneal benign tumors	Primary retroperitoneal cavernous hemangioma; Immunohistochemistry: CD31 (+), CD34 (+), DOG1 (-), CD117 (-)	[35]
26	Female	71	No	Low density, no enhancement	No	Lower limb edema, dyspnea, abdominal distention, anemia		Retroperitoneal cavernous hemangioma; Immunohistochemistry: CD34 (+)	[43]
27	Male	70	No	Uniform density, surrounding calcification	(a) Molecular water diffusion limitation within the lesion on T2 fat-saturated weighted image; (b) high signal intensity intra-lesion region on T1 fat-saturated weighted image; (c) high signal region on enhanced T1 fat-saturated weighted image; (d) inhomogeneous enhancement	Physical examination		Adrenal cavernous hemangioma	[23]
28	Male	67	No	Clearly defined mass with significant peripheral enhancement in the early arterial phase	No	Back pain	Adrenal tumor, pheochromocytoma	Adrenal cavernous hemangioma	[24]
29	Male	38	No	Cyst-like, well-enveloped tumor with mildly enhancing walls in the portal phase	No	Abdominal pain		Primary retroperitoneal cavernous hemangioma; Immunohistochemistry: CD31 (+), Vim (+)	[36]

CT: Computed tomography; MRI: Magnetic resonance imaging.