The relationship between vaginal cavernous hemangiomas and late pregnancy. A case report and a review of the literature

Abstract

The occurrence of cavernous hemangiomas in the vagina is very rare. A 34-year-old woman at 33 weeks' gestation was admitted with a large reddish mass of approximately 5 cm in diameter in the vagina, with bleeding and a sensation of discomfort with walking. The vaginal mass was excised to confirm the pathological diagnosis. Histopathological analysis showed various dilated vessels lined by increased endothelial cells, and the final diagnosis was vaginal cavernous hemangioma. The immunohistochemical analysis showed positive expressions of vascular endothelial growth factor (VEGF), estrogen receptor (ER), and progesterone receptor (PgR) in perivascular stromal cells around the hemangioma. Additionally, the authors reviewed the relationship between genital hemangiomas and pregnancy from the literature. In the female genital tract, six (75%) of eight vaginal hemangiomas were associated with pregnancy, in particular, late pregnancy, in addition to the present case, and eight (32%) of 25 cervical hemangiomas were seen in late pregnancy. Taken together, the hormonal status in late pregnancy may affect the formation of vaginal hemangiomas.

A rare case report of cervical hemangioma and a comprehensive literature review of 137 cases of cervical and uterine hemangiomas

“…[7][8][9] Hemangiomas are slow-growing tumors, and their pathologic features are dilated vessels with increased endothelial cells. 6 The main pathophysiology remains unclear. Estrogen plays an important role in developing hemangiomas.…”

“…6,9 Estrogen increases endothelial progenitor cells and angiogenic factors such as matrix metalloproteinase, vascular endothelial growth factor, and nitric oxide. 6 Other angiogenic factors that increase with estrogen are the basic fibroblast growth factor, insulin-like growth factor, and transforming growth factorβ. 5 Cervical hemangiomas can be acquired or congenital.…”

A Case of a Refractory Bleeding Giant Vaginal Wall Cavernous Hemangioma Successfully Managed with Sclerotherapy

“…Hemangiomas rarely occur in female genital organs, such as the uterus, vagina, and perineum [ 2 ]. Most cases are congenital and are observed in childhood [ 1 ], but some are acquired due to trauma or infection, and the mechanism of their formation is unknown [ 3 ]. It is difficult to distinguish these lesions from varicose veins or vascular malformations macroscopically; therefore, they are diagnosed histologically [ 4 ].…”

“…Most hemangiomas in female genital organs are small and asymptomatic [ 1 ]; however, depending on the extent and location of the lesion, hemangiomas can cause irregular genital bleeding as well as infertility, miscarriage, intrauterine fetal death, and delivery failure due to obstruction of the ostium vaginae [ 4 ]. Vaginal wall hemangiomas in pregnant women often occur at the site of an episiotomy performed during a previous pregnancy [ 3 ]. Some cases in which hemangiomas grew during pregnancy and required treatment, especially in the last trimester, have been reported [ 5 ].…”

“…Hormonal dynamics have been identified as a possible mechanism for a growing hemangioma during pregnancy [ 1 ]. Yamashita confirmed the expression of estrogen receptors, progesterone receptors, and vascular endothelial growth factor (VEGF) in endothelial cells and perivascular cells of cervical and vaginal wall hemangiomas; moreover, the increased secretion of estrogen and progesterone during pregnancy promotes the secretion of angiogenic factors, such as VEGF [ 3 ]. Hemangiomas can induce severe bleeding even with minimal invasion [ 1 ]; therefore, assessment of lesion size using color Doppler ultrasound [ 6 ], magnetic resonance imaging (MRI) [ 7 ], or angiography [ 6 ] is recommended prior to biopsy and treatment [ 1 ].…”