DOCSLIB.ORG

Cavernous Hepatic Hemangioma

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Cavernous Hepatic Hemangioma Scintigraphic Evaluation of Liver Masses: Cavernous Hepatic Hemangioma Guest Editor: Abass Alavi Case Presentation and Discussion: Raymond A. Rubin and Gary R. Lichtenstein Gastrointestinal Section, Hospital ofthe University ofPennsylvania, Philadelphia, Pennsylvania tive, consistent with the diagnoses of pernicious anemia J NucIMed1993;34:849—852 and Hashimoto's thyroiditis. Esophagogastroduodenoscopy demonstrated achlo rhydria and several hyperplastic gastric polyps. Biopsy of CASE PRESENTATION thickened folds within the gastric fundus revealed a mod A 54-yr-old female was referred for evaluation of a erately dense infiltrate of small, slightly irregular mature mass in the right lobe of the liver noted on abdominal lymphocytesinvolvingthemucosaandextendingthrough ultrasound. She had been in her usual state of health until the muscularis. Although immunohistochemistry and 1 wk prior to admission to this institution when she noted gene rearrangement studies were not diagnostic, these episodic cramping right flank pain. She denied jaundice, findings raised the concern for a possible low-grade non pruritus, constitutional symptoms or change in bowel Hodgkin's lymphoma. Lymph node and thyroid biopsies habits. Microhematuria was noted on urinalysis. An in demonstrated nonspecific inflammation. travenous pyelogram demonstrated a nonobstructmg ure The initial differential diagnosis for the hepatic mass teral stone. While the kidneys appeared normal on ab included primary hepatic neoplasm, metastatic disease or dominal ultrasound, a large complex echogenic mass of cavernous hemangioma. Magnetic resonance imaging the right lobe of the liver was detected. (MRI) with intravenous gadolinium-DTPA demonstrated The patient's medical history was notable only for a an 8-cm lesion in the posterior segment of the right lobe total abdominal hysterectomy with bilateral salpingo-oo of the liver, which was dark on Ti and bright on T2 phorectomy performed for uterine leiomyomata. She images (Fig. 1). The borders of the mass were slightly took no medications. She neither drank alcohol nor used irregular. The first postcontrast image was not obtained intravenous drugs. There was no family history of liver until 4 mm aftergadoliniumwas injected.The massdid disease. Physical examination revealed a healthy appear not enhance peripherally. The enhancement pattern de ing black female without stigmata of chronic liver dis creased on the more delayed images. Whereas this was ease. There were numerous rubbery cervical and sub interpreted to be consistent with hemangioma, adenoma mandibular lymph nodes as well as a 5—6-cmor focal nodular hyperplasia, hepatocellular carcinoma or multinodular goiter. By percussion, the liver span was 10 hypervascular endocrine tumor were not ruled out. cm in the mid-clavicular line. No tenderness, hepatic or Images of the liver were obtained following the intra abdominal masses, splenomegaly or ascites were noted. venous administration of 20 mCi of @Tc-labeled red The remainder of the examination was within normal blood cells (RBCs). Sequential images revealed a rela limits. tively photopenic area in the inferoposterior aspect of the Laboratory values revealed normocytic anemia with right lobe of the liver (Fig. 2). Delayed images subse hyperlobulated polymorphonuclear leukocytes on pe quently demonstrated increased activity within the le ripheral blood smear. Liver function tests, electrolytes, sion.SPEC].'imagingconfirmedthe presenceof a focal coagulation studies, a-fetoprotein and the remainder of area of increased activity (Fig. 3). These findings were the complete blood count were within normal limits. Se believed to be diagnostic of hepatic cavernous hemangi rum gastrin was 262 pg/mI (nl 0—100),cyanocobalamin oma (HCH). level was < 100 ngfliter (nl 200—1200)and anti-parietal cell anti-thyroid microsomal antibodies were markedly posi DISCUSSION Hepatic cavernous hemangioma is the most common benign neoplasm of the liver (1). Focal lesions suggestive ReceivedAug.26, 1992;revisionacceptedSept.15,1992. of HCH are often incidentally discovered on sonography, Forcorrespondenceorreprintscontact:GaryA. Uchtenstein,MD,Hospital of the Universityof Pennsylvania,GastrointestinalSection,3rd Floor,Dulles Cr or radionuclidescintigraphy.DistinguishingHCH Building,3400SpruceSt.,Philadelphia,PA19104-4283. from other hepatic masses, especially primary or meta Cavernous Hepatic Hemangioma •Rubin and Uchtenstein 849 @ 4' @ ) .4' t@7 @, ; @t 4 ‘@ 1@ FIGURE 3. CoronalSPECT imagesof the liver demonstrate intense concentrationof activity in the inferoposterioraspect of the right lobe of the liver. With SPECT imaging,the lesion (be tween arrows) is clearly distinguishedfrom the adjacent normal liver. FIGURE 1. T2-weighted transverse magnetic resonance im age of the abdomen demonstrates an 8-cm high intensity mass (triangle)intheposterioraspectoftherightlobeoftheliver. Pathologically, HCH consists of large, thin-walled, blood-filled vascular spaces lined by flattened epithelium and separated by fibrous septae (1). In giant hemangio static malignancy, is a relatively common clinical chal mas, the increased endothelial surface may sequester lenge. As this particular case illustrates, specific imaging platelets, resulting in a thrombocytopenic coagulopathy studiesmay be diagnosticof HCH. The appropriateuti known as the Kassabach-Meritt syndrome (5). lization of available radiologic techniques may expedite Imaging of Hemanglomas establishingthe specificdiagnosisof HCH andavertex Radionucide Scintigraphy. The routine @Tc-sulfur pensive and potentially harmful testing. colloid liver scan offers little help in differentiating HCH As demonstrated by this case, HCH is generally de from other space-occupying lesions of the liver (3). On tected incidentally during radiologic studies, laparotomy the liver-spleen scan, HCH typically appears as a non or autopsy. It is found in all age groups and 60%—80%are specific cold defect in an otherwise normal liver (4). seen in females (2), in whom estrogens may contribute to Serial planar blood-pool scintigraphy with [@Tc]per the growth of these lesions (1). Similar to hepatic adeno technetate labeled RBCs is very specific, if not diagnos mas, the majority of HCHs are located in the right lobe of tic, for the noninvasive diagnosis of hemangioma. Slug the liver (3,4). Lesions are typically solitary, although gish blood flow through the tortuous vascular pathways li%—33% of the time they are multiple. The majority of produces a “perfusion/blood-pool mismatch― of initial patientswith HCH havenormalliver functiontestsand hypoperfusion with gradually increasing RBC accumula are asymptomatic. Patients with “giant―HCH (exceed tion on serial delayed imaging, which peaks within 30 to ing 4 cm in size) more commonly describe abdominal 50 mm after injection (3,6, 7). fullness, belching, weight loss and pain. Morbidity may Isolated cases of HCH have been reported in which be attributed to bleeding, infarction, necrosis and, rarely, increased arterial blood supply demonstrated not only red rupture (Table i). cell accumulation in the delayed images, but also on early perfusion and blood-pool images (8). Alternatively, some hemangiomas will be largely fibrotic and will not show the expected increased blood pool (6). .@ The specificity and positive predictive value of labeled RBC scanning approaches 100% (9,10). No lesions other than HCHs have been described as showing red cell TABLE 1 Clinicopathologic Classification of Cavernous Hemangioma 1. Solitaryor multiplewithoutsymptoms 2. Solitaryor multiplewith symptoms FIGURE 2. Anterior (Left)and posterior(Right)planarblood 3. Gianthemangiomas pool images demonstrate intense concentration (arrows) of @‘Tc-labeIedRBCsin the inferoposterioraspectof the right 4. Hemangiomatosis, exclusive of hepatic involvement 5. Hemangiomatosis, hepatic and extrahepatic involvement lobe of the liver. 850 The Journal of Nuclear Medicine •Vol. 34 •No. 5 •May 1993 accumulationon delayedimages,except for three re Magnetic Resonance Imaging. MRI has emerged as an ported cases of hepatocellular carcinomas (HCCs), a re accurate and safe, though expensive, method for diagnos ported case of an angiosarcoma and possibly hypervas ing hemangiomas (23). HCH usually appears as a smooth, cular metastases (7,11). homogenous mass of high signal intensity on T2-weighted While planar studies may not demonstrate small (<3 images (24). Other features, such as a lobulated contour cm) hemangiomas, smaller lesions may be detected with and peripheral location may be helpful in the MR diag the use of SPEC!' (12—15).SPECT is also superior to nosis of HCH (25). HCHs larger than 4 cm may demon planar imaging for detecting hemangiomas adjacent to the strate atypical features, such as an irregular outline or spleen and kidney (16). Since labeled RBC activity per inhomogenous internal architecture (26). MRI has greater sistsin the heartandmajorintrahepaticbloodvesselson sensitivity than labeled RBC SPEC].' scanning in detect delayed SPEC].' blood-pool images, it may be difficult to ing small (<2—2.5cm) HCHs. It is also superior in iden identify small hemangiomas when they are adjacent to tifying lesions adjacent to the heart and major intrahe these structures (9). Large (>4 cm) cavernous hemangi patic vessels (9). omas have been missed by both planar and SPECT The ability of MRI to distinguish HCH from metastases @“Tc-RBCimaging (14). False-negative labeled RBC is dependent in part on the histology
Load more

Recommended publications
  • Recurrent Targetoid Hemosiderotic Hemangioma in a 26-Year-Old Man
    CASE REPORT Recurrent Targetoid Hemosiderotic Hemangioma in a 26-Year-Old Man LT Sarah Broski Gendernalik, DO, MC (FS), USN LT James D. Gendernalik, DO, MC (FS), USN A 26-year-old previously healthy man presented with a 6-mm violaceous papule that had a surrounding 1.5-cm annular, nonblanching, erythematous halo on the right-sided flank. The man reported the lesion had been recurring for 4 to 5 years, flaring every 4 to 5 months and then slowly disap - pearing until the cycle recurred. Targetoid hemosiderotic hemangioma was clinically diagnosed. The lesion was removed by means of elliptical excision and the condition resolved. The authors discuss the clinical appearance, his - tology, and etiology of targetoid hemosiderotic heman - giomas. J Am Osteopath Assoc . 2011;111(2);117-118 argetoid hemosiderotic hemangiomas (THHs) are a com - Tmonly misdiagnosed presentation encountered in the primary care setting. In the present case report, we aim to pro - Figure. A 6-mm violaceous papule with a surrounding 1.5-cm annular, nonblanching, erythematous halo in a 26-year-old man. vide general practitioners with an understanding of the clin - ical appearance, pathology, and prognosis of THH. Report of Case A 26-year-old previously healthy man presented to our primary around it and itched and burned each time it developed. The care clinic with a 6-mm violaceous papule with a surrounding lesion faded completely to normal-appearing skin between 1.5-cm annular, nonblanching, erythematous halo on the right- episodes, without evidence of a papule or postinflammatory sided flank ( Figure ). The patient stated that the lesion had hyperpigmentation.
    [Show full text]
  • Tumors and Tumor-Like Lesions of Blood Vessels 16 F.Ramon
    16_DeSchepper_Tumors_and 15.09.2005 13:27 Uhr Seite 263 Chapter Tumors and Tumor-like Lesions of Blood Vessels 16 F.Ramon Contents 42]. There are two major classification schemes for vas- cular tumors. That of Enzinger et al. [12] relies on 16.1 Introduction . 263 pathological criteria and includes clinical and radiolog- 16.2 Definition and Classification . 264 ical features when appropriate. On the other hand, the 16.2.1 Benign Vascular Tumors . 264 classification of Mulliken and Glowacki [42] is based on 16.2.1.1 Classification of Mulliken . 264 endothelial growth characteristics and distinguishes 16.2.1.2 Classification of Enzinger . 264 16.2.1.3 WHO Classification . 265 hemangiomas from vascular malformations. The latter 16.2.2 Vascular Tumors of Borderline classification shows good correlation with the clinical or Intermediate Malignancy . 265 picture and imaging findings. 16.2.3 Malignant Vascular Tumors . 265 Hemangiomas are characterized by a phase of prolif- 16.2.4 Glomus Tumor . 266 eration and a stationary period, followed by involution. 16.2.5 Hemangiopericytoma . 266 Vascular malformations are no real tumors and can be 16.3 Incidence and Clinical Behavior . 266 divided into low- or high-flow lesions [65]. 16.3.1 Benign Vascular Tumors . 266 Cutaneous and subcutaneous lesions are usually 16.3.2 Angiomatous Syndromes . 267 easily diagnosed and present no significant diagnostic 16.3.3 Hemangioendothelioma . 267 problems. On the other hand, hemangiomas or vascular 16.3.4 Angiosarcomas . 268 16.3.5 Glomus Tumor . 268 malformations that arise in deep soft tissue must be dif- 16.3.6 Hemangiopericytoma .
    [Show full text]
  • Cavernous Hemangioma of the Gallbladder: a Case Report
    pISSN 2384-1095 iMRI 2019;23:264-269 https://doi.org/10.13104/imri.2019.23.3.264 eISSN 2384-1109 Cavernous Hemangioma of the Gallbladder: a Case Report Jae Hwi Park1, Jeong Sub Lee1, Guk Myung Choi1, Bong Soo Kim1, Seung Hyoung Kim1, JeongJae Kim1, Doo Ri Kim1, Chang Lim Hyun2, Kyu Hee Her3 1Department of Radiology, Jeju National University Hospital, Jeju National University School of Magnetic resonance imaging Medicine, Jeju, Korea 2Department of Pathology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea 3Department of Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea Case Report Cavernous hemangioma of the gallbladder is an extremely rare benign tumor. The tumor has only a few cases being reported in literature. However, to the best of our knowledge, no reports focusing on the MRI findings of cavernous hemangioma of the Received: April 23, 2019 gallbladder have been published. This study reports a case of gallbladder hemangioma Revised: June 10, 2019 with pathologic and radiologic reviews, including MRI findings. Accepted: July 2, 2019 Correspondence to: Keywords: Cavernous hemangioma; Gallbladder; Magnetic resonance imaging Jeong Sub Lee, M.D. Department of Radiology, Jeju National University Hospital, Jeju National University School of Medicine, 15 Aran 13-gil, INTRODUCTION Jeju-si, Jeju-do 63241, Korea. Tel. +82-64-717-1371 Cavernous hemangioma of the gallbladder is an extremely rare benign tumor (1). Fax. +82-64-717-1370 Hemangioma occurs in several organs, including the liver, brain, lungs and skeletal E-mail: [email protected] muscle. It is the most common benign tumor in the liver, in which cavernous hemangioma represents the majority of tumors (2, 3).
    [Show full text]
  • Benign Hemangiomas
    TUMORS OF BLOOD VESSELS CHARLES F. GESCHICKTER, M.D. (From tke Surgical Palkological Laboratory, Department of Surgery, Johns Hopkins Hospital and University) AND LOUISA E. KEASBEY, M.D. (Lancaster Gcaeral Hospital, Lancuster, Pennsylvania) Tumors of the blood vessels are perhaps as common as any form of neoplasm occurring in the human body. The greatest number of these lesions are benign angiomas of the body surfaces, small elevated red areas which remain without symptoms throughout life and are not subjected to treatment. Larger tumors of this type which undergb active growth after birth or which are situated about the face or oral cavity, where they constitute cosmetic defects, are more often the object of surgical removal. The majority of the vascular tumors clinically or pathologically studied fall into this latter group. Benign angiomas of similar pathologic nature occur in all of the internal viscera but are most common in the liver, where they are disclosed usually at autopsy. Angiomas of the bone, muscle, and the central nervous system are of less common occurrence, but, because of the symptoms produced, a higher percentage are available for study. Malignant lesions of the blood vessels are far more rare than was formerly supposed. An occasional angioma may metastasize following trauma or after repeated recurrences, but less than 1per cent of benign angiomas subjected to treatment fall into this group. I Primarily ma- lignant tumors of the vascular system-angiosarcomas-are equally rare. The pathological criteria for these growths have never been ade- quately established, and there is no general agreement as to this par- ticular form of tumor.
    [Show full text]
  • Cavernous Hemangiomas of the Orbit: Value of CT, Angiography, and Phlebography
    741 Cavernous Hemangiomas of the Orbit: Value of CT, Angiography, and Phlebography Mario Savoiardo 1, Liliana Strada, and Angelo Passerini Neuroradiologic studies performed in 18 cases of surgically magnified x 2 in nine cases. In four cases selective extern al carotid verified intraorbital cavernous hemangioma are reported. Skull injection was performed. CT was available in the last 14 cases. It films usually showed enlargement of the orbit and evidence of was usually performed with an EMI 1010 scanner with 5 mm cuts, soft-tissue mass. Phlebography rarely demonstrated filling of the a 320 x 320 matrix, and , when feasible, with coronal cu ts. The cavernous hemangioma or enlarged draining veins. On angiog­ radiologic findings were compared with the description of the sur­ raphy, in addition to displacement of vessels, pooling of contrast gical intervention. medium in the cavities of the hemangioma was observed in more than half the cases. Computed tomography (CT) demonstrated a rounded, hyperdense, enhancing lesion usually in the superior Results segment of the intraconal space. Although CT may be sufficient Skull films were completely normal in three cases, and in two for planning the surgical approach, in most cases a combination of CT and angiography will give better, more specific preopera­ others only minimal enlargement of the involved orbit was observed. Definite en largement was found in 11 , often with evid ence of tive diagnosis. increased soft-tissue density. In two cases, enlargement and poor definition of the margin of the optic canal were observed. In one of Cavernous hemangiomas are by far the most common vascular these the cavernous hemangioma, 4 mm in diameter, had grown malformation of the orbit and are among the most common of all the within the optic nerve at the apex of the orbit.
    [Show full text]
  • View Open Access Histological Variants of Cutaneous Kaposi Sarcoma Wayne Grayson1 and Liron Pantanowitz*2
    Diagnostic Pathology BioMed Central Review Open Access Histological variants of cutaneous Kaposi sarcoma Wayne Grayson1 and Liron Pantanowitz*2 Address: 1Histopathology Department, Ampath National Laboratory Support Services, Johannesburg, South Africa and 2Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts, USA Email: Wayne Grayson - [email protected]; Liron Pantanowitz* - [email protected] * Corresponding author Published: 25 July 2008 Received: 23 July 2008 Accepted: 25 July 2008 Diagnostic Pathology 2008, 3:31 doi:10.1186/1746-1596-3-31 This article is available from: http://www.diagnosticpathology.org/content/3/1/31 © 2008 Grayson and Pantanowitz; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract This review provides a comprehensive overview of the broad clinicopathologic spectrum of cutaneous Kaposi sarcoma (KS) lesions. Variants discussed include: usual KS lesions associated with disease progression (i.e. patch, plaque and nodular stage); morphologic subtypes alluded to in the older literature such as anaplastic and telangiectatic KS, as well as several lymphedematous variants; and numerous recently described variants including hyperkeratotic, keloidal, micronodular, pyogenic granuloma-like, ecchymotic, and intravascular KS. Involuting lesions as a result of treatment related regression are also presented. Introduction progression, (2) KS variants alluded to in the older litera- Kaposi sarcoma (KS) is a vascular lesion of low-grade ture, (3) more recently described KS variants, and (4) KS malignant potential that presents most frequently with lesions as a consequence of therapy.
    [Show full text]
  • Massive Cavernous Lymphangioma of the Breast and Thoracic Wall: Case Report and Literature Review
    147 Lymphology 39 (2006) 147-151 MASSIVE CAVERNOUS LYMPHANGIOMA OF THE BREAST AND THORACIC WALL: CASE REPORT AND LITERATURE REVIEW U. Krainick-Strobel, B. Krämer, R. Walz-Mattmüller, E. Kaiserling, C. Röhm, A. Bergmann, M. Hahn, D. Wallwiener, S. Brucker University of Tübingen Medical School, Department of Obstetrics and Gynecology (UK S,BK,CR, AB,MH,DW,SB), Breast Center and Pathology Institute (RW-M,EK), Tübingen, Germany ABSTRACT logical examination reveals multiple protrusions lined with thin endothelium. Lymphangiomas are benign lesions but They are generally located in the head, neck are associated with high morbidity when they area (dorsally or laterally; 75%), the axilla become very large, occur in critical locations, (25%), mediastinum or, more rarely, in the or when surgically removed, develop secondary retroperitoneum, abdominal organs, skeleton wound infections. Almost all lesions require or scrotum. Cystic lymphangiomas are most surgical treatment. Complete excision is commonly diagnosed in young children. curative; however, relapses must be anticipated 50–65% of lymphangiomas are present clini- with incomplete excision. We report the case cally in the newborn, and 90% are apparent of a patient with a long history of massive by the age of 2 years (2). Lymphangiomas are cavernous lymphangioma of the breast and generally cavernous lesions and are very rare thoracic wall extending into the axilla in in the breast, especially in adults. Secondary whom complete excision was not possible. lymphangiomas after mastectomy and subsequent irradiation of the thoracic wall Keywords: breast, cavernous lymphangioma, have been described (3) and only isolated hemangioma, cystic lesions, vascular cases have been reported in the literature (4-7).
    [Show full text]
  • Dermatologic Aspects of Fabry Disease ª the Author(S) 2016 DOI: 10.1177/2326409816661353 Iem.Sagepub.Com
    Original Article Journal of Inborn Errors of Metabolism & Screening 2016, Volume 4: 1–7 Dermatologic Aspects of Fabry Disease ª The Author(s) 2016 DOI: 10.1177/2326409816661353 iem.sagepub.com Paula C. Luna, MD1,2, Paula Boggio, MD2, and Margarita Larralde, MD, PhD1,2 Abstract Isolated angiokeratomas (AKs) are common cutaneous lesions, generally deemed unworthy of further investigation. In contrast, diffuse AKs should alert the physician to a possible diagnosis of Fabry disease (FD). Angiokeratomas often do not appear until adolescence or young adulthood. The number of lesions and the extension over the body increase progressively with time, so that generalization and mucosal involvement are frequent. Although rare, FD remains an important diagnosis to consider in patients with AKs, with or without familial history. Dermatologists must have a high index of suspicion, especially when skin features are associated with other earlier symptoms such as acroparesthesia, hypohidrosis, or heat intolerance. Once the diagnosis is established, prompt screening of family members should be performed. In all cases, a multidisciplinary team is necessary for the long-term follow-up and treatment. Keywords Fabry disease, angiokeratomas, lysosomal storage disorders Introduction Diffuse AKs are characterized by the presence of multiple lesions that affect more than 1 area of the skin. Although any Fabry disease (FD, also known as Anderson-Fabry disease or region of the skin can be affected, lesions usually localize to the angiokeratoma corporis diffusum [ACD]) is a rare X-linked bathing suit area (from the umbilicus to the upper thighs); this disease caused by the partial or complete deficiency of a lyso- phenotype is known as ACD.
    [Show full text]
  • Giant Cavernous Hepatic Hemangioma Diagnosed Incidentally in a Perimenopausal Obese Female with Endometrial Adenocarcinoma: a Case Report
    ANTICANCER RESEARCH 36: 769-772 (2016) Giant Cavernous Hepatic Hemangioma Diagnosed Incidentally in a Perimenopausal Obese Female with Endometrial Adenocarcinoma: A Case Report TIVADAR BARA JR.1, SIMONA GURZU2, IOAN JUNG2, MIRCEA MURESAN2, JANOS SZEDERJESI3 and TIVADAR BARA1 Departments of 1Surgery, 2Pathology, and 3Intensive Care, University of Medicine and Pharmacy of Tirgu-Mures, Tirgu-Mures, Romania Abstract. Hemangiomas are the most common benign Macroscopically, LHs are hypervascular poorly tumors of the liver, considered giant when they exceed 50- circumscribed lesions. Microscopically, they consist of large 100 mm in diameter. In the present report, we present a case cavities filled with venous blood coming from the hepatic of a 5.2-kg hemangioma of the right hepatic lobe, with artery, lined by endothelial cells and separated by fibrous septa hemangiomatous foci in the left lobe, which was incidentally (1). Due to unreported malignant transformation of LHs, their diagnosed in a 53-year-old obese female hospitalized for slow growth and low risk for bleeding, simple observation of uterine bleeding. The computed tomographic scan and asymptomatic lesions is usually recommended (1). physical examination revealed a giant abdominal tumor and LHs can be single or multiple and their size can vary from hepatic hemangioma of the right hepatic lobe was suspected. a few millimeters to over 20 cm (5). The term 'giant Right hepatectomy and total hysterectomy with bilateral hemangioma' is commonly used for lesions larger than 4 cm ovariectomy was performed. The histological examination of in diameter (1-5). LHs over 10 cm are considered extremely the surgical specimens confirmed the extremely giant large or massive, and only occasional cases over 30 cm or cavernous hepatic hemangioma, and a synchronous pT1a weighing more than 2 to 3 kg have been reported (3, 4).
    [Show full text]
  • Malignant Vascular Tumors&Mdash
    Modern Pathology (2014) 27, S30–S38 S30 & 2014 USCAP, Inc All rights reserved 0893-3952/14 $32.00 Malignant vascular tumors—an update Cristina Antonescu Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA Although benign hemangiomas are among the most common diagnoses amid connective tissue tumors, sarcomas showing endothelial differentiation (ie, angiosarcoma and epithelioid hemangioendothelioma) represent under 1% of all sarcoma diagnoses, and thus it is likely that fewer than 500 people in the United States are affected each year. Differential diagnosis of malignant vascular tumors can be often quite challenging, either at the low end of the spectrum, distinguishing an epithelioid hemangioendothelioma from an epithelioid hemangioma, or at the high-grade end of the spectrum, between an angiosarcoma and a malignant epithelioid hemangioendothelioma. Within this differential diagnosis both clinico-radiological features (ie, size and multifocality) and immunohistochemical markers (ie, expression of endothelial markers) are often similar and cannot distinguish between benign and malignant vascular lesions. Molecular ancillary tests have long been needed for a more objective diagnosis and classification of malignant vascular tumors, particularly within the epithelioid phenotype. As significant advances have been recently made in understanding the genetic signatures of vascular tumors, this review will take the opportunity to provide a detailed update on these findings. Specifically, this article will focus on
    [Show full text]
  • Hepatic Angiosarcoma Masquerading As Hemangioma
    Hepatic Angiosarcoma Masquerading as Hemangioma: A CASO CLÍNICO Challenging Differential Diagnosis Angiosarcoma Hepático e Hemangioma: Um Diagnóstico Diferencial Desafiante Ana Rita GARCIA1, João RIBEIRO1, Helena GERVÁSIO1, Francisco Castro e SOUSA2,3 Acta Med Port 2017 Oct;30(10):750-753 ▪ https://doi.org/10.20344/amp.8593 ABSTRACT Hemangiomas are usually diagnosed based on ultrasound findings. The presence of symptoms, rapid growth or atipical imagiological findings should make us consider other diagnoses, including malignant tumors such as angiosarcomas. We describe the case of a previously healthy 46-year-old female without a history of exposure to carcinogens who presented with abdominal pain for two months. Diagnostic work-up revealed elevated gamma-glutamyl transferase and lactate dehydrogenase levels. Abdominal ultrasound described a large nodular lesion in the right lobe of the liver described as a hemangioma. One month later, a computed tomography-scan was made and revealed the same lesion, which had grown from 13.5 to 20 cm, maintaining typical imaging characteristics of a hemangioma. A right hepatectomy was performed and pathology revealed an angiosarcoma. After surgery, a positron emission tomography-com- puted tomography scan showed hepatic and bone metastasis. The patient started taxane-based chemotherapy and lumbar palliative radiotherapy, but died 10 months after surgery. This case shows how difficult it is to diagnose hepatic angiosarcoma relying only on imaging findings. Two abdominal computed tomography -scans were performed and none suggested this diagnosis. Angiosarcoma is a very aggressive tumour with an adverse prognosis. Surgery is the only curative treatment available. However, it is rarely feasible due to unresectable disease or distant metastasis.
    [Show full text]
  • Tumor-Associated Protein Profiles in Kaposi Sarcoma and Mimicking
    International Journal of Molecular Sciences Article Tumor-Associated Protein Profiles in Kaposi Sarcoma and Mimicking Vascular Tumors, and Their Pathological Implications Kyoung Bun Lee 1, Kyu Sang Lee 2 and Hye Seung Lee 2,* 1 Department of Pathology, Seoul National University Hospital, Seoul 110-799, Korea 2 Department of Pathology, Seoul National University Bundang Hospital, Seongnam 463-707, Korea * Correspondence: [email protected]; Tel.: +82-31-787-7714; Fax: +82-31-787-4012 Received: 14 May 2019; Accepted: 26 June 2019; Published: 27 June 2019 Abstract: We investigated protein profiles specific to vascular lesions mimicking Kaposi sarcoma (KS), based on stepwise morphogenesis progression of KS. We surveyed 26 tumor-associated proteins in 130 cases, comprising 39 benign vascular lesions (BG), 14 hemangioendotheliomas (HE), 37 KS, and 40 angiosarcomas (AS), by immunohistochemistry. The dominant proteins in KS were HHV8, lymphatic markers, Rb, phosphorylated Rb, VEGF, and galectin-3. Aberrant expression of p53, inactivation of cell cycle inhibitors, loss of beta-catenin, and increased VEGFR1 were more frequent in AS. HE had the lowest Ki-67 index, and the inactivation rates of cell cycle inhibitors in HE were between those of AS and BG/KS. Protein expression patterns in BG and KS were similar. Clustering analysis showed that the 130 cases were divided into three clusters: AS-rich, BG-rich, and KS-rich clusters. The AS-rich cluster was characterized by high caveolin-1 positivity, abnormal p53, high Ki-67 index, and inactivated p27. The KS-rich cluster shared the features of KS, and the BG-rich group had high positive expression rates of galectin-3 and low bcl2 expression.
    [Show full text]