Cavernous hemangioma of the rectum and appendix: report of a case

A case of diffuse cavernous hemangioma of the appendix: laparoscopic surgery can facilitate diagnosis and treatment

Background

A cavenous hemangioma of the appendix (CHA) is rare. The clinical pathophysiology and adequate management of a CHA have not been sufficiently explained since reports on CHA are scarce.

Case presentation

A 56-year-old woman presented with chronic right lower quadrant pain. Abdominal contrast-enhanced computed tomography revealed a thickened appendix (1.5 cm in diameter) and some focal calcifications in the appendiceal wall. No acute inflammatory signs were visible around the appendix. For diagnosis and treatment, we performed a laparoscopic surgery. Intraoperative findings included purple granular lesions that were spread diffusely along the surface of the appendix. Since these lesions were spread to the terminal ileum, laparoscopic ileocecal resection was performed. Upon macroscopic inspection, purple-colored, raspberry-like lesions were found diffusely on the serosal surface of the appendix. No lesions were found on the mucosal surface. Hematoxylin and eosin staining indicated the presence of blood-filled sinus-like spaces largely in the subserosal layer. Immunohistochemistry analysis indicated that CD34-positive cells lined these spaces. Given these findings, we diagnosed the patient with a diffuse cavernous vascular malformation of the appendix.

Conclusions

CHA is difficult to diagnose. A laparoscopic approach may be useful for both the diagnosis and treatment of the disease.

Appendiceal Hemangioma, Mimicking Acute Appendicitis in a 17-Year-Old Girl

Epithelial tumors of appendix are not so common, and mesenchymal tumors of the appendix are even less common. Capillary hemangioma of the appendix is an extremely rare event and to the best of our knowledge only 4 cases have been reported in the English literature so far. In this case report we want to explain our experience with an extremely rare occurrence of capillary hemangioma of appendix in a 17-year-old girl presented with right lower quadrant pain that was operated with the clinical impression of acute appendicitis. The patient has been operated as a routine appendectomy with a completely uneventful postoperative period.

Atypical florid vascular proliferation in appendix: a diagnostic dilemma

Vascular abnormality of the intestine is rare, except angiodysplasia. We report on an unusual case of atypical florid vascular proliferations of the appendix. A 41-year old male presented with melena. Adhesioned blood clots in the appendiceal orifice were observed by colonoscopy. He underwent laparoscopic appendectomy. Microscopically, a tiny exophytic polypoid mass was observed. The mass showed pyogenic granuloma-like features in the superficial portion and infiltrative florid vascular proliferations in the deeper portion. Endothelial cells showed minimal nuclear atypia, and mitotic figures were observed infrequently and showed positivity for CD31 and CD34 and negativity for HHV-8. Differential diagnoses include from benign vascular tumor to angiosarcoma or Kaposi's sarcoma, but this lesion does not fit the description of any defined vascular entity. We diagnosed atypical florid vascular proliferations and the patient has been well during the five-month postoperative follow-up.

VIRTUAL SLIDE

The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1386921325843104.

Cavernous hemangiomas of the rectum: report of three cases

Cavernous hemangioma of the rectum are uncommon benign vascular lesions. Misdiagnosis often occurs because of lack of awareness of classic clinical features. Endoscopy, plain x-ray abdomen, barium enema, and selective angiography are useful means of investigation for accurate diagnosis. Three cases of rectal haemangioma are presented that were earlier misdiagnosed as ulcerative colitis.

Coloanal sleeve anastomosis in the treatment of diffuse cavernous haemangioma of the rectum: long-term results

Diffuse cavernous haemangioma of the rectum is an unusual lesion. In 1971 Parks and co-workers described resection and coloanal sleeve anastomosis as an alternative operation in the treatment of this rare malformation. The clinical presentation, diagnosis and long-term results of patients with this condition managed by such a surgical technique are described. Resection and coloanal sleeve anastomosis offers major advantages such as a lower risk of intraoperative bleeding, no risk of damaging the pelvic nerves, sparing of continence and avoidance of a permanent colostomy. It should therefore be considered the treatment of choice for this uncommon condition.

Large-bowel hemangiomas

A case of large-bowel hemangioma is presented, and radiologic and histologic abnormalities are illustrated. Ultrasonographic features, not previously described, are reported. The literature is reviewed and the frequency of misdiagnosis is emphasized. Pathologic classification, epidemiologic factors, and etiology are considered. Clinical manifestations and current approaches to recognition and management are summarized. Vascular tumors are serious, albeit uncommon, intestinal lesions. Greater awareness of the condition and earlier consideration of the diagnosis are prerequisites to lessened morbidity and improved survival.