A case of pedunculated hepatic hemangioma mimicking submucosal tumor of the stomach

Hepatic hemangioma is the most common benign tumor of the liver. Most such hemangiomas are small, asymptomatic, and have an excellent prognosis. Giant hepatic hemangioma has been reported in the literature, but the exophytic and pedunculated forms of hepatic hemangioma are rare. A 56-year-old woman was referred to our hospital under the suspicion of having a gastric submucosal tumor. Abdominal computer tomography (CT) scans showed a pedunculated mass from the left lateral segment of the liver into the gastric fundus, exhibiting the atypical CT findings of hepatic hemangioma. We therefore decided to perform laparoscopic resection based on the symptoms, relatively large diameter, inability to exclude malignancy, and risk of rupture of the exophytic lesion. The pathology indicated it to be a cavernous hemangioma of the liver. Herein we report a case of pedunculated hepatic hemangioma mimicking a submucosal tumor of the stomach due to extrinsic compression of the gastric fundus.     

Pathologic characteristics and treatment of lobular capillary hemangioma (pyogenic granuloma) in a Holstein calf

Lobular capillary hemangioma (LCH or pyogenic granuloma) is a benign vascular proliferation. It has features of a capillary hemangioma with a circumscribed aggregation of capillaries arranged in one or more lobules. It occurs in humans and rarely in animals. The present report describes pathologic findings of a pyogenic granuloma occurence on the mandibular gingiva of a Holstein calf. Grossly, the mass was polyploidy, reddish- to brown-colored, and pedunculated with an ulcerated surface that covered with a layer of white to yellow exudate. Histopathologic examination revealed characteristic lobular proliferation capillaries in a loose stroma. The stroma was formed from numerous fibroblasts, fibrocytes, and slender collagen fibers. It was edematous with scattered of mononuclear cells. Infiltration of neutrophils were visible adjust to the ulcerated area. Remarkable involution was seen after washing with povidone iodine 1%. This tumorlike lesion was diagnosed as LCH based on gross appearance, histopathologic features, and treatment by mouthwash povidone iodine.     

Pyogenic granuloma of the sigmoid colon

Pyogenic granuloma (PG) is a polypoid form of lobular capillary hemangioma that usually occurs in the skin and some mucosal surfaces. However, it is extremely rare in the intestinal tract and its preoperative diagnosis is difficult. We report on a case of PG of the sigmoid colon in a 62-year-old woman with a 6-month history of rectal bleeding. A pedunculated polypoid lesion was detected by colonoscopy and a polypectomy was performed. A microscopical study revealed a lobular arrangement proliferation of varying sizes of capillaries within an edematous stroma. A critical review of the English literature yielded only another well-documented case of PG in the large intestine. Diagnostic consideration includes inflammatory polyp and other vascular tumors such as bacillary angiomatosis and the angiomatous variant of Kaposi's sarcoma. Precise recognition of this distinctive vascular neoplasm in the gastrointestinal tract is essential to avoid misdiagnosis and inappropriate treatment.     

Parathyroid Hemangioma: A Report of Two Cases

Two cases of intraparathyroid hemangioma, associated with hyperparathyroidism, are reported. The first case showed a typical capillary hemangioma morphology with small branching vascular channels, almost completely replacing the gland’s architecture. The second case was a 2-mm cavernous hemangioma associated with glandular hyperplasia. This is, to our knowledge, the first time that this type of lesion is described.     

Capillary haemangioma of the cervix--a case report

A rare lesion, haemangioma of the cervix was found in a sixty-year-old female patient with prolapse of uterus. The patient had no complaints regarding the lesion and the haemangioma was detected incidentally during routine histopathological examination of the organ removed by surgery. Few cases of cervical hemangioma have been reported so far. Most of these are of the cavernous type morphologically, whereas the case reported here is a capillary hemangioma.     

Pyogenic granuloma of the oral cavity: comparative study of its clinicopathological and immunohistochemical features

There are two histological types of pyogenic granuloma (PG) of the oral cavity: the lobular capillary hemangioma (LCH) and non-LCH type. The aim of the present study was to examine and compare the clinical features, etiological factors, diameter of vascular elements and immunohistochemical features of LCH and non-LCH histological types of PG to determine whether they are two distinct entities. Thirty cases of LCH and 26 cases of non-LCH PG were retrieved and retrospectively studied. Clinically, LCH PG occurred more frequently (66.4%) as sessile lesion whereas non-LCH PG occurred as pedunculated (77%). Non-LCH PG was associated more frequently (86.4%) with etiological factors. The lobular area of the LCH PG contained a greater number of blood vessels with small luminal diameter than did the central area of non-LCH PG. In the central area of non-LCH PG a significantly greater number of vessels with perivascular mesenchymal cells non-reactive for alpha-smooth muscle actin and muscle-specific actin was present than in the lobular area of LCH PG. The differences found in the present study suggest that the two histological types of PG represent distinct entities.     

A rare neoplasm of the testis: capillary hemangioma

Intratesticular vascular neoplasms are extremely rare tumors and mostly seen in children or young adults. We reported a case of capillary hemangioma of the testis to attract attention to testicular hemangioma and also to prevent invasive surgery of the testis. The patient was an 18-year-old boy with a testicular mass. Scrotal sonography revealed a varicocele in the left testis and a simple cyst in the left epididymis. There was a solid hypoechoic neoplastic area 75 mm in diameter in the right testis. The laboratory findings including tumor markers and serum levels of alpha-fetoprotein and beta-human chorionic gonadotrophin were normal. The patient underwent right orchiectomy and the pathology diagnosis was capillary hemangioma. Testicular neoplasms derived from connective tissue, blood vessels and musculature are uncommon and intratesticular tumors of vascular origin are extremely rare. There are only 21 cases reported in the literature. The pathologists and the surgeon have to be aware of this entity as the prognosis of the neoplasm determines the method of surgery. Capillary hemangioma of the testis can be similar to malignant testicular tumors on clinical presentation, as well as on ultrasonography and magnetic resonance imaging. Although it is impossible to differentiate a hemangioma from a seminoma before the operation, intraoperative frozen study may be helpful in the differential diagnosis. Frozen section must be performed if the neoplasm has significant vascular proliferation identified by Doppler sonography. Because of the benign nature of this lesion, conservative surgical treatment by means of tumor enucleation with preservation of the testis is possible if intraoperative frozen section examination can be performed.     

Splenic hamartoma and capillary hemangioma are distinct entities: Immunohistochemical analysis of CD8 expression by endothelial cells

The histologic and immunohistologic features of two morphologically similar splenic tumors, a capillary hemangioma and a splenic hamartoma, are reported. The hemangioma was composed predominantly of small vascular channels lined by endothelium expressing factor VIII-related antigen and lacking T-subset antigen (CD8). In contrast, the splenic hamartoma was predominantly a spindle cell lesion with numerous vascular channels coursing through the tumor; these contained splenic-type endothelium expressing both CD8 and factor VIII-related antigen. Our results justify the concept that the splenic hamartoma is a tumor of splenic origin or a true hamartoma and is distinct from the splenic capillary hemangioma.     

Squamous cell carcinoma arising within verrucous carcinoma of the oral cavity: a case report

The author herein reports a case of squamous cell carcinoma (SCC) arising within verrucous carcinoma (VC) of the hard palate. An 84-year-old woman was admitted to our hospital complaining of oral discomfort. Oral examination revealed a pedunculated verrucous tumor (15 x 15 mm) in the hard palate. A biopsy revealed verrucous tumor. Resection of the lesion with wide margins was performed. Grossly, the palate tumor was pedunculated and verrucous, but a depressed area (8 x 7 mm) was recognized. Microscopically, the verrucous ares showed verrucous proliferation of squamous epithelium with little cellular atypia, and was interpreted as VC without invasion. The depressed lesion was obvious SCC with invasion. There were direct transitions between the VC and SCC. Immunohistochemically, the VC and SCC tumor cells were negative for human papilloma virus antigens. P53 protein was expressed in both VC and SCC, though the expression in SCC was much more strong and broad than that in VC. The Ki-67 antigen was also expressed in the VC and SCC, and Ki-67 labeling index ranged was 12% in VC and 64% in SCC. These findings indicate that SCC may arise within VC.     

Lobular capillary hemangioma of the oral mucosa: clinicopathological study of 43 cases with a special reference to immunohistochemical characterization of the vascular elements

Clinical and histopathological features were investigated in 43 cases of oral lobular capillary hemangiomas (LCH) with a special reference to characteristics of the vascular elements. The lesions affected females more than males by a ratio of 1:1.5. Average age of the patients was 52.7 years. The lesions involved the gingiva (n = 15), the tongue (n = 13), the labial mucosa (n = 10) and other sites. The lesions appeared usually as a pedunculated mass with ulceration; size of the lesions was up to 15 mm. Histologically, a lobular area and an ulcerative area were distinguished. The density of vessels was about 1045/mm2 and 160/mm2 in the lobular and ulcerative areas, respectively. The average diameter of the vascular lumen was 9.1 5.6 mm (range: 2.8-42.0 mm) and 18.8 20.9 mm (range: 5.6-139.7 mm) in the lobular and ulcerative areas, respectively. In the lobular area, most of the vessels had an inner layer of endothelial cells showing positive reaction for von Willebrand factor (vWF) and CD34, as well as an outer layer of mesenchymal cells showing positive reaction for alpha-smooth muscle actin (ASMA). However, in the ulcerative area, there was a variety of types of vessels consisting of various proportions of both endothelial and ASMA-positive perivascular mesenchymal cells. These results indicate that most of the vascular elements in the lobular area resemble more pericapillary microvascular segments than they do capillaries. Thus, the authors propose the term 'lobular pericapillary hemangioma' to represent this type of lesion.     

Solitary pulmonary capillary hemangioma: Clinicopathologic and radiologic characteristics of nine surgically resected cases

Background

Solitary pulmonary capillary hemangioma (SPCH) is an extraordinarily rare capillary derived mesenchymal neoplasm. Although routine morphology and immunohistochemistry are adequate for the diagnosis of classical SPCH in surgical specimens, true gross appearance identification of most tumor themselves and diagnosis for some exceptional cases are still very difficult. Furthermore, preoperative imaging and frozen diagnosis remain a challenge.

Hemangioma of the salivary gland: a study of ten cases of a rarely biopsied/excised lesion

Hemangioma is a common soft tissue tumor that frequently occurs in the oral and maxillofacial region including salivary glands, but is rarely biopsied and is therefore often unfamiliar to the surgical pathologist. Our study examined the subclassification and histologic features of salivary gland hemangioma (SGH). Consultative cases coded as hemangioma and located in salivary gland from 1970 to 2000 were retrieved from the Registry of Oral and Maxillofacial Pathology of the Armed Forces Institute of Pathology (Washington, DC). Only cases with histologic evidence of salivary gland involvement were included. Slide material and patient history for all cases were reviewed, subclassification assigned, and histologic features were noted. Ten cases coded as hemangioma with slides and history met our inclusion criteria. Seven cases were the "juvenile hemangioma" subtype in the parotid of infants, ranging in age from 3 to 10 months (mean age, 5.3 months) with a male predominance. These SGH had a distinctive histologic appearance of a cellular proliferation of capillary sized vessels around retained salivary gland ducts. Mitoses were easily identified. Three additional cases in females included an arteriovenous hemangioma of a lip minor salivary gland since birth in a 15-month-old infant and two parotid gland lesions: a lobular capillary hemangioma of a 10-year-old and a cavernous hemangioma in a 51-year-old. The latter three cases grew as replacing masses and lacked retained salivary gland ducts within the lesion, despite glandular tissue at the periphery of the tumor. No SGH cases in our series were identified in the submandibular or sublingual glands. Despite its common occurrence, SGH is relatively rare in our surgical pathology files. The parotid gland is the most common location (90%). Salivary gland hemangioma includes usual hemangioma subtypes, mainly in females, and a distinctive infantile subtype of capillary hemangioma (juvenile hemangioma), displaying distinctive histology and found predominately in males. The cellularity, mitotic activity, and retained salivary gland ducts in the latter lesion should not make one consider malignancy.     

Kaposiform hemangioendothelioma of the thymus

Kaposiform hemangioendothelioma is a rare pediatric neoplasm that presents most commonly in the soft tissues. We report the case of a 1-month-old infant who presented with stridor and was found to have a diffusely infiltrating tumor in the thymus that extended into the pericardium and up the carotid sheaths. Histologic examination revealed a vascular tumor infiltrating among the lobules of the lymphocyte-depleted thymus. The lesion had features of both a capillary hemangioma and Kaposi sarcoma. Immunoperoxidase studies on formalin-fixed, paraffin-embedded tissue demonstrated the neoplastic endothelial cells to be positive for vascular markers CD31 and CD34. Antibody to factor VIII-related antigen labeled feeding vessels, but failed to stain the lobules of tumor. Although these tumors have been treated in a fashion similar to capillary hemangiomas in the past, it may be important to differentiate Kaposiform hemangioendotheliomas because of their association with Kasabach-Merritt syndrome and recent success with more aggressive chemotherapy regimens.     

Visceral intravascular capillary hemangioma

In the course of routine pathologic examination of an ovarian serous cystadenoma excised from a 35-year-old woman, an intravascular mass in the cyst capsule was noted. Histologically, this was found to be an intravenous capillary hemangioma. To our knowledge, no such lesion has been previously reported. The relationship of this lesion to intravenous pyogenic granuloma and features by which the two may be distinguished are discussed. Other primary intravascular endothelial tumors are briefly reviewed.     

Exophytic cavernous hemangioma arising from the right ventricle: Report of a rare case

Cardiac hemangioma is relatively rare, accounting for approximately 1–3% of all primary heart tumors. This benign tumor may be an incidental lesion, but can also cause arrhythmias, pericardial effusion, congestive heart failure or outflow obstruction. We report a rare case with exophytic cardiac hemangioma arising from the right ventricle. Echocardiography showed an approximately 40 mm round protruding mass on the anterior wall of the right ventricle. Cardiovascular magnetic resonance demonstrated isointense and hyperintense signals on T1- and T2-weighted images, respectively. These imaging studies suggested a pericardial cyst. Perioperative findings indicated a globular, exophytic mass, vascular in nature, arising from the right ventricle. The lesion was resected directly, and the space left by defect in the right ventricular wall was covered with a bovine pericardial patch. Cardiac hemangiomas are generally endoluminal tumors, but we must keep in mind that the differential diagnoses include various pericardial lesions by medical images.     

肝海绵状血管瘤临床特点及病理分析

目的 探讨肝海绵状血管瘤的临床病理特征。方法 收集2014年1月~2017年4月我院存档的25例肝海绵状血管瘤石蜡标本,行HE染色后观察其病理形态,并结合患者病史和影像学资料总结肝海绵状血管瘤的临床病理特征。结果 共25例肝海绵状血管瘤标本,其中女性18例,男性7例;病灶位于左肝叶10例,右肝叶12例,左、右肝叶均有者3例,分布无明显规律;血管瘤单发20例,多发5例;病灶最大径4~10 cm。CT平扫表现为肝实质内圆形、类圆形或不规则形低密度影,边缘尚清楚;动脉期呈结节状强化;门静脉期强化向心性强化;平衡期和延迟期肿瘤持续向心性强化,且强化程度减低。MRI表现为T1WI呈均匀低信号,T2WI呈均匀高信号,病灶边缘清晰。肝海绵状血管瘤表现为质地柔软的肿物,切面无包膜,呈腔隙状;病变与周围肝组织分界清楚,由大量不规则形扩张的血管组成,管腔大小、形状不一。结论 肝海绵状血管瘤临床表现不明显,以女性多见,单发为主;病变主要由大小不等的异常血管腔组成,管腔内衬单层扁平内皮细胞,周围环绕纤维组织。     

Giant gravidarum granuloma of the scalp

Lobular capillary hemangioma (pyogenic granuloma) has been reported more frequently in the skin (88%) than in the mucous membranes (12%). Granuloma gravidarum is a pyogenic granuloma that develops during pregnancy, often in the oral mucosa. Estrogens apparently increase the inflammatory response of mucous membranes. In this article, we describe the first case of a granuloma gravidarum of the scalp.     

Sialadenoma papilliferum of the bronchus: Rare tracheobronchial tumor of salivary gland type

Presented herein is the second case of sialadenoma papilliferum of the bronchus in a 75-year-old man. The bronchial tumor had an exophytic papillary lesion protruding into the lumen of the ostial region of the right superior lobe bronchus on chest CT and bronchoscopy. Grossly, the resected tumor was pedunculated, 5 × 3 × 3 mm in size and consisted of both an exophytic papillary lesion protruding into the bronchial lumen and a glandular component in the bronchial submucosa. Histologically, the papillary structures were lined by ciliated or non-ciliated columnar epithelium and metaplastic non-keratinizing stratified squamous epithelium. The submucosal glandular components were well circumscribed beneath and in continuity with the papillary lesion. The glandular components of cysts and duct-like structures were lined by a double-layer epithelium composed of luminal cells and basal cells. Sialadenoma papilliferum is a rarely recognized salivary gland tumor, mostly occurring at intraoral mucosal sites including the hard and soft palate and buccal mucosa. There have been sporadic cases of sialadenoma papilliferum of the esophagus, nasopharynx and nasal cavity. To the authors' knowledge only one case of sialadenoma papilliferum of the bronchus has been reported previously.     

Pure epidural cavernous hemangioma of the cervical spine that presented with an acute sensory deficit caused by hemorrhage

Pure epidural cavernous hemangioma of the spine without vertebral involvement is rare. Due to the slow growth of this lesion, the most common symptoms are chronic pain, myelopathy, and radiculopathy. In our case, the patient complained of an acute onset sensory deficit of the C4 dermatome. An MRI revealed an epidural mass with an acute hematoma. Here, we report a case of a pure epidural cavernous hemangioma that presented with acute neurologic symptoms caused by intralesional hemorrhage and an acute epidural hematoma, which were demonstrated on the patient's MRI.     

Juvenile hemangioma (infantile hemangioendothelioma) of the parotid gland associated with cytomegalovirus infection

A case of parotid juvenile hemangioma associated with cytomegalovirus infection is reported. A growing lobulated mass, measuring 30 x 20 mm, was extirpated from the left parotid gland in a 4-month-old male. Histologically, the tumor consisted of cellular plump endothelial cells, stromal cells and residual ductal and acinar elements of the parotid gland. Numerous intranuclear and cytoplasmic inclusions were observed in the ductal cells of the whole parenchymal part of the parotid gland and the residual part of the tumor. Immunohistochemically, some nuclei of the ductal cells possessing these inclusions were positive for the anti-cytomegalovirus antibody but there were no positive findings in the endothelial or stromal cells. Although the present lesion may suggest that the human cytomegalovirus plays some role in the etiology of juvenile hemangioma, it is unknown whether or not this association is incidental.