Anastomosing Hemangioma of the Ovary: A Clinicopathological Study of Six Cases with Stromal Luteinization

Abstract

We report six cases of anastomosing hemangioma of the ovary. All lesions were unilateral and arose in 43 to 81 year old females. In all but one patient, the tumor was asymptomatic and represented incidental finding. The exception was a tumor associated with massive ascites and elevated CA 125. The tumors were, on cut section, spongy and dark violet in color. The size of tumors ranged from 0.5 to 3.5 cm. All lesions showed the same histological features and consisted of capillary sized anastomosing vessels with sinusoid-like pattern intermingled with sporadic medium sized vessels. Interestingly, in all cases there were areas of luteinized cells at the tumor periphery, which ranged from rare small nests to multiple and commonly confluent areas. In one tumor, components of mature adipose tissue were present. Immunohistochemically, all tumors were CD31 and CD34 positive. Other markers examined were negative, including; estrogen receptor, progesterone receptor, androgen receptor, and D2-40. Proliferative activity (Ki-67 index) was very low in all cases. Anastomosing hemangioma is a rare entity, only 8 lesions occurring in ovary has been described from its initial description in 2009. We report six additional cases with their clinicopathological correlation.

Anastomosing hemangioma of the ovary mimics metastatic ovarian cancer

“…Yet, out of the 6 cases the authors investigated, none were within the ovary. The morphological appearance is consistently described as non-lobular proliferation of anastomosing capillary sized vessels with sinusoidal-like arrangements resembling the red pulp of the spleen, with vessels lined by bland endothelial cells ( Dundr et al, 2017 ). Importantly, the lack of atypical endothelial cells and mitotic figures helps to differentiate AH from its malignant counterpart, angiosarcoma ( Bösmüller et al, 2011 ).…”

“…Since the definition of AH was established in 2009, 14 identifiable cases in the ovary have been described ( Table 1 ) ( Dundr et al, 2017 , Kryvenko et al, 2011 , Metodiev et al, 2015 , John and Folpe, 2016 , Gunduz et al, 2019 , Subbarayan et al, 2019 , Stewart and Salfinger, 2020 ). In these cases identified from the literature, ages at diagnosis ranged from 43 to 81 and size of tumors ranged from 1 mm to 11.2 cm.…”

Anastomosing Hemangioma: Short Review of a Benign Mimicker of Angiosarcoma

“…19,21 In the liver, any lobe may be involved, usually in a non-subcapsular location. 11,24 In the bowel, it may have polypoid appearance or involve the muscularis propria, mimicking a gastrointestinal stromal tumor. 11 In the ovary, it may involve both the cortex and the medulla.…”

“…11 In the ovary, it may involve both the cortex and the medulla. 3,24 In soft tissues, it usually involves paravertebral muscles and the fat in abdominal or mediastinal areas. 20 HISTOPATHOLOGY At low magnification, the tumor appears well circumscribed but rarely encapsulated and displays a diffuse or, less frequently, a vaguely lobulated growth pattern.…”

“…In cases of AH of the ovary with prominent stromal luteinization, the differential diagnosis includes steroidogenic tumors. 24 In such cases, the possibility of stromal luteinization should be considered in order to avoid misdiagnosis of a steroid cell tumor associated with pronounced stromal vascularization. Splenosis is another lesion that may simulate AH.…”