Cardiac Cavernous Hemangioma and Multiple Pulmonary Cavernous Hemangiomas

Frequent PIK3CA and GNAQ mutations in solitary pulmonary capillary haemangioma and pulmonary cavernous haemangioma: genetic link to vascular malformations

Pulmonary haemangiomas are rare diseases with unclear pathogenesis. The molecular alterations underlying these conditions have not yet been identified. In this study, we sought to investigate the genetic alterations in the two most common types of pulmonary haemangiomas: solitary pulmonary capillary haemangiomas (SPCH) and pulmonary cavernous haemangiomas. This study included six patients with SPCH and four patients with pulmonary cavernous haemangioma. Utilising a customised next-generation sequencing panel, we identified a high frequency of PIK3CA hotspot mutations-five of six SPCH cases and three of four pulmonary cavernous haemangiomas, totalling 80%. Additionally, GNAQ mutations were detected in one SPCH and one pulmonary cavernous haemangioma. Overall, nine of 10 (90%) of the pulmonary haemangiomas in our study harboured mutations in either the PIK3CA or GNAQ genes. The variant allele frequencies of these mutations were relatively low, ranging from 4.2% to 15.5%, which complicates detection using Sanger sequencing due to its lower sensitivity. Our study identified a high frequency of PIK3CA mutations and occasional GNAQ mutations in SPCH and pulmonary cavernous haemangioma. The high prevalence of PIK3CA mutations in pulmonary haemangiomas suggests a potential link to the vascular malformation category in the International Society for the Study of Vascular Anomalies (ISSVA) classification where PIK3CA mutations are recognised as significant causative genetic events. The findings from this research represent the first documented evidence of the molecular alterations underlying these pulmonary haemangiomas.

Pulmonary cavernous hemangioma: a case report

BACKGROUND

Cavernous hemangiomas can occur in various internal organs like the liver, kidney, bladder, and skin, or even in subcutaneous tissues. However, they rarely occur in the lungs, making pulmonary cavernous hemangiomas (PCH) an uncommon finding. Herein, we report a rare case of pulmonary cavernous hemangioma that was surgically resected.

CASE PRESENTATION

A 16-year-old adolescent patient was diagnosed with a pulmonary cavernous hemangioma during a physical examination. During the entry physical examination, a chest X-ray showed shadows in the upper lobe of the right lung. The patient was admitted to the Thoracic Surgery Department for further assessment. The patient had a one-year history of smoking; however, he did not experience any clinical symptoms related to respiratory diseases. Among tumor markers assessed, only the cytokeratin-19 fragment (CYFRA21-1) was elevated. Chest computed tomography (CT) showed irregular soft tissue lesions in the upper lobe of the right lung. The lesion presented as a shallow lobe with clear boundaries, accompanied by the presence of spicules around it. The lesion showed mild to moderate uniform enhancement in the arterial phase and slightly reduced in the venous phase on imaging. The lesion was anatomically close to adjacent bronchus and blood vessels. In addition, the patient had multiple enlarged lymph nodes in the mediastinum. In summary, the thoracic surgeon could not rule out the possibility of lung malignant tumors and chose to proceed with surgical excision to secure a conclusive diagnosis. Post-operative histological examination showed that the lesion consisted of dilated nodular hyperplasia rich in red blood cells, leading to a diagnosis of PCH. No recurrence has been observed since postoperative follow-up.

CASE PRESENTATION

We reported a rare PCH case, reviewed the clinical features, imaging findings, histopathological features, and treatment options of PCH based on relevant literature, and gained a further understanding of PCH.

Multiple pulmonary cavernous haemangiomas with concurrent primary pulmonary adenocarcinoma: a case report and literature review

Background

Cavernous haemangiomas (CHs) commonly occurred in the skin, subcutaneous tissue, muscles, and liver. Pulmonary cavernous haemangiomas (PCHs) are quite rare and usually present with nonspecific clinical symptoms. When lung cancer patients are complicated with pulmonary cavernous haemangiomas, radiologically, these haemangioma lesions can be easily misinterpreted as intrapulmonary metastases, potentially resulting in misdiagnosis, or missed diagnosis.

Case presentation

The present study reported the case of a 53-year-old female patient with pulmonary adenocarcinoma coexisting with multiple PCHs. 18F-FDG-Positron emission tomography-computed tomography (PET-CT) showed an elevated glucose metabolism in the apicoposterior segment of the left upper lobe; however, the other nodules were not hypermetabolic. Percutaneous lung biopsy was performed on the nodule in the apicoposterior segment of the left upper lobe, which were diagnosed as primary adenocarcinoma. Some nodules in the upper left lobe underwent wedge resection by video-assisted thoracic surgery (VATS) and intraoperative frozen section identified as PCHs. Finally, the patient underwent lobectomy of the left upper lobe via VATS, cancerous nodule in the apicoposterior segment of the left upper lobe underwent genetic molecular testing of PCR-Sanger sequencing, suggested EGFR mutation, and patient received treatment with Osimertinib. During the 4-months follow-up, contrast-enhanced CT showed no recurrence of either disease. PCHs are rare benign tumours of the lung, which can lead to misdiagnosis due to their non-specific clinical symptoms and radiological features, especially when they coexist with lung cancer. PCHs is easily misunderstood as metastatic lung cancer, in this case, PET-CT can assist in differentiating benign from malignant. For the cases of early lung cancer complicated with PCHs, lung cancer can be surgically resected, and whether PCHs should be removed or not should be determined according to the size and distribution of the lesions.

Pulmonary cavernous hemangioma combined with smooth muscle hyperplasia: a case report and review of the literature

BACKGROUND

Cavernous hemangiomas are usually located in the liver, skin, and subcutaneous tissues. Although they can arise from any organ, cavernous hemangiomas rarely occur as a pulmonary tumor. We herein report a rare case of a pulmonary cavernous hemangioma that was surgically resected.

CASE PRESENTATION

A woman in her 40s was found to have 2 well-defined nodules in the lower lobe of the left lung by computed tomography during following up of bladder cancer. She had a history of surgery for tetralogy of Fallot at 6 years old and pulmonary valve replacement for pulmonary valve insufficiency in her late 30s. She had also undergone surgery for bladder cancer. Although there was no accumulation of 18F-fluorodeoxyglucose on positron emission tomography (PET), the tumor slowly grows. Surgical resection was therefore performed to obtain a definitive diagnosis. The postoperative histological examination revealed an encapsulated nodule comprising large, dilated vessels lined with vascular endothelium and filled with blood, which led to the diagnosis of a pulmonary cavernous hemangioma.

CONCLUSION

We experienced a rare case of pulmonary cavernous hemangioma and reviewed the previous reports.

Enlarging left atrial haemangioma in a patient with Cowden syndrome

A 53-year-old female patient known to have Cowden disease (PTEN mutation positive) was found to have a mass at the left atrium on a CT coronary angiography performed as part of a preoperative workup for an unrelated surgery. Further radiological characterisation of the lesion was achieved using MRI and positron emission tomography. Interval growth prompted surgical excision; however, surgery was expedited after the patient presented with haemopericardium and cardiac tamponade. The patient was discharged home 8 days postoperatively, and no intraoperative or postoperative complications were encountered. A diagnosis of cavernous haemangioma was made on histology.

Atrial Hemangioma: A Case Report and Review of the Literature

A primary cardiac tumor is a rare clinical entity which was reported an incidence of 0.03% in previous autopsy series. 75% cardiac tumors are cardiac myxoma and cardiac hemangiomas constitute only 1–2% of primary cardiac tumors. With the development of modern medical imaging technology and the enhancement of people’s health awareness, more and more asymptomatic cardiac hemangiomas were found and confirmed eventually. Here, we described a case of a 71-year-old man, who was hospitalized with intermittent palpitation for 1 year and a large mass of the heart was removed successfully via sternotomy which was confirmed as atrial hemangioma by postoperative histopathology. Furthermore, a comprehensive review of atrial hemangioma was conducted to date and a few recommendations for the diagnosis and treatment of this uncommon disorder were provided for clinicians.

Multiple cavernous hemangiomas of the lung and liver mimicking metastasis: A case report and literature review

RATIONALE

Cavernous hemangiomas are benign vascular malformations that usually involve the skin, subcutaneous tissue, and liver. Described herein was multiple masses in the lung and liver mimicking metastasis, which was proved to be cavernous hemangiomas histologically.

PATIENT CONCERNS

A 78-year-old man with complaint of dizziness for 3 days was referred to the local hospital for medical attention.

DIAGNOSES

Multiple masses in the lung and liver was diagnosed pathologically as cavernous hemangioma.

INTERVENTIONS

Because of the benign pathological characteristic and multiple distribution, no treatment except some symptomatic treatment for dizziness was administered.

OUTCOME

After more than 2 years of follow-up visits, the patient had no apparent symptoms and was healthy.

LESSONS

Proper diagnosis of multiple cavernous hemangiomas is essential. The final diagnosis depends on the pathology results. The most appropriate management is follow-up. Surgical treatment is suitable for large or symptomatic lesions which can result in satisfactory prognoses.

Cardiac Cavernous Hemangioma Coexisting With Pulmonary Cavernous Hemangiomas and Giant Hepatic Hemangioma

We describe a case of cardiac cavernous hemangioma with coexisting pulmonary cavernous hemangiomas and hepatic hemangioma. A 35-year-old woman who had previously received a living donor liver transplant to cure giant hepatic hemangioma was seen because of chest pain. A cardiac neoplasm and multiple pulmonary nodules were detected. The tumor was surgically removed, and biopsy specimens were taken from the lung nodules. Histopathologic examination confirmed that both lesions were cavernous hemangiomas. The patient was discharged without adverse events postoperatively. Cardiac hemangioma is an extremely rare entity; the present case is unique for its multiorgan involvement. Suspicion of this entity should be aroused if the imaging manifestation suggests a vascular nature.

Giant Cardiac Cavernous Hemangioma

We report the case of an asymptomatic giant cardiac cavernous hemangioma in a 71-year-old man. The intracardiac mass was discovered incidentally during surveillance for his prostate cancer; however, the patient initially declined intervention. On presentation to our institution 7 years later, the lesion had enlarged significantly, and the patient consented to excision. At surgery, an 8 × 6.5 × 4.8 cm intracardiac mass located on the inferior heart border was excised with an intact capsule through a median sternotomy approach. The patient had an uneventful postoperative course. We discuss the diagnostic workup, treatment, and characteristics of this rare cardiac tumor.