A case report of a renal anastomosing hemangioma and a literature review: an unusual variant histologically mimicking angiosarcoma

Abstract

Anastomosing hemangioma, a benign vascular neoplasm histologically simulating angiosarcoma, is newly recognized and has been described primarily in the genitourinary tract. Here, we present a case of renal anastomosing hemangioma originating in the left kidney of a 32-year-old Chinese man with detailed computerized tomography (CT) and enhanced CT image information. The patient had no obvious signs and symptoms. The tumor was incidentally found by color Doppler imaging during a routine heath check-up. Subsequently, a detailed CT and an enhanced CT scan were performed. The tumor was well demarcated, and mahogany brown lesions, which measured 2.6 cm in maximum diameter, were observed. Microscopically, the tumor shows a lobular architecture with alternating cellular areas composed of anastomosing sinusoidal capillary-sized vessels lined by hobnail endothelial cells and edematous, hyaline paucicellular areas. Cytologically, the tumor cells were generally bland and exhibited positivity for CD31 and CD34 immunohistochemically. The patient had good status without evidence of tumor recurrence 21 months after the surgery. We suggest that more attention should be focused on this rare renal hemangioma variant and that it should not be over-diagnosed as a malignance, particularly an angiosarcoma.Virtual SlidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/13000_2014_159

Anastomosing Hemangioma Involving the Para-Aortic Region: A Case Report

“…Rare cases of AH in other locations, including the testes, ovaries, thigh, abdominal wall, adrenal gland, liver, gastrointestinal tract, and urinary bladder have been reported (2)(3)(4)(5). Generally, most renal lesions occur unilaterally, and range in size from 0.6 to 5.0 cm (average: 2.1 cm) (6). Although the reported clinical manifestations of renal AH were hematuria and flank pain, a significant proportion of cases were asymptomatic (3).…”

“…Although the reported clinical manifestations of renal AH were hematuria and flank pain, a significant proportion of cases were asymptomatic (3). AH showed no significant sex predilection, and many cases were associated with end stage renal disease (6). The literature describes a good prognosis for AH after surgical treatment (6).…”

“…To the best of our knowledge, AH involving the para-aortic region has not been reported. Reported cases of AH involving less common sites described CT findings, but did not focus on these imaging findings (4)(5)(6). Thus, we present CT findings of AH in the para-aortic region with a brief review of the relevant literature.…”

“…Anastomosing hemangioma (AH) is a subtype of capillary hemangioma that is characterized histologically by an anastomosing pattern of capillary sized vascular channels that are reminiscent of splenic sinusoids (2). Although AH is known to have a predilection for the kidney, it can also sporadically involve the ovary, liver, gastrointestinal tract, adrenal gland and urinary bladder (3)(4)(5)(6). To the best of our knowledge, AH involving the para-aortic region has not been reported.…”

Spontaneous rupture of the kidney in the patients with synchronous renal hemangioma and nephrogenic hypertension

“…In recent years, a few case with rarely seen types of hemangiomas, for instance, anastomosing subtype of hemangiomas have been reported. [14] Since diagnosis of renal hemangioma is very difficult, and can be made only during exploration, its treatment is generally surgical intervention. However in cases diagnosed following emergence of mild hematuria which does not effect the general status of the patient, can be kept under observance.…”