Masson's tumor of the kidney: a new renal lesion

Intravascular papillary endothelial hyperplasia in the cecum: a case report

Background

 Intravascular papillary endothelial hyperplasia (IPEH), also known as Masson's tumor, is a benign, non-neoplastic vascular lesion that is characterized by reactive proliferation of papillary endothelial cells associated with a thrombus. These lesions typically develop in the vascular regions of the head and neck, oral cavity, or extremities; however, other organ systems have been affected. IPEH in the gastrointestinal tract is rare, with only a few cases reported to date. Thus, the pathogenesis and clinical features of IPEH in the gastrointestinal tract are not entirely understood. Moreover, the local excision of certain subtypes of IPEH can be curative; this makes timely diagnosis essential. We present the case of a patient with IPEH in the cecum that was discovered while investigating the cause of severe anemia.

Case presentation

A 29-year-old woman visited a general practitioner (GP) with the complaint of abdominal pain. She was diagnosed with acute appendicitis and was prescribed antibiotics. After treatment, her abdominal pain disappeared. However, she was found to be severely anemic (hemoglobin level, 6.5 g/dl). To determine the cause of her anemia, the GP referred her to our hospital for further examination and treatment. Computed tomography scan revealed cecal wall thickening. Further, a lower gastrointestinal endoscopy revealed a 2-cm raised mass-like lesion in the cecum. This lesion was pathologically identified as an inflammatory granuloma. The cause of her anemia was determined to be bleeding from the lesion in the cecum. She underwent laparoscopic ileocecal resection.

Histopathological examination of the surgical specimen revealed a spongy structure comprising many small papillary fibrous tissues lined by a typical monolayer endothelium. Further, immunohistochemical analysis showed that the cells of the endothelium monolayer expressed CD31, CD34. The Ki-67 labeling index was < 1%. Based on these findings, the lesion was identified as an IPEH in the cecum. The patient’s postoperative course was uneventful, and there was no evidence of recurrence during the 1.3 years of follow-up.

Conclusions

 IPEH rarely arises within the abdominal cavity. Surgery remains the only treatment for IPEH and is associated with an excellent prognosis and a low recurrence rate. More aggressive lesions such as angiosarcoma should be excluded when considering the histologic diagnoses of IPEH, and expert pathologic review is vital. This is the first report of IPEH occurring in the cecum and represents a novel cause of gastrointestinal bleeding which the clinician should consider when evaluating a patient with atypical or difficult gastrointestinal bleeding sources.

Scrotal Masson's tumour masquerading as dysplastic polyorchidism - a case report

This case describes a rare genitourinary presentation of a Masson's tumour, preoperatively assumed to be a dysplastic third testis.

Masson's tumor of the kidney: a case report

BACKGROUND

Intravascular papillary endothelial hyperplasia (known also as Masson's tumor) is a benign vascular lesion that commonly occurs in the skin and is rarely found in solid organs, especially in the kidney. In what follows, we will look into the first case of an unexpectedly diagnosed Masson's tumor of the kidney presenting as a suspicious renal cyst.

CASE PRESENTATION

A 61-year-old Arab man presented with a left renal cyst, incidentally revealed by ultrasonography. The laboratory values were unremarkable. Computed tomography and magnetic resonance imaging demonstrated a 38 mm left renal midportion Bosniak IV cyst. Our patient underwent a radical nephrectomy. Histopathology revealed the diagnosis of intravascular papillary endothelial hyperplasia. There was no recurrence detected after 9 years of follow-up.

CONCLUSIONS

Renal intravascular papillary endothelial hyperplasia is a rare benign tumor which can mimic a suspicious renal mass on radiological findings. Thus, this entity should be considered more often in the thick of the diagnostic possibilities in order to avoid unnecessary nephrectomies.

Intravascular Papillary Endothelial Hyperplasia of the Jejunum as a Cause of Obscure-Overt Gastrointestinal Bleeding

Intravascular papillary endothelial hyperplasia (IPEH), or Masson’s tumor, is a rare, benign vascular lesion characterized by reactive endothelial proliferation with venous stasis and thrombus. Lesions typically arise in vascular regions of the head and neck or extremities, but involvement of other organ systems has been reported. Clinically, IPEH mimics other benign lesions (hemangiomas) and malignant neoplasms (angiosarcoma) depending on the affected site. Diagnosis is essential because local excision of certain IPEH subtypes is curative. IPEH in the gastrointestinal tract is rare with few reported cases. We present a case of obscure-overt gastrointestinal bleeding from IPEH of the jejunum.

The first recurrent intravascular papillary endothelial hyperplasia (Masson's tumor) of the kidney

Intravascular papillary endothelial hyperplasia (IPEH, Masson's Tumor) of the kidney is an unusual, benign vascular lesion. A rare case of recurrent IPEH in the kidney was presented in this article. A 50-year-old male with a diagnosis of a suspicious mass in the left kidney was referred to our center for robotic partial nephrectomy. Robotic zero ischemia partial nephrectomy was performed due to the suspicion of a renal malignancy. On the basis of the histopathological results, the patient was diagnosed as IPEH. A urinary ultrasound was performed on the 3(rd) postoperative month and a hyper echoic solid lesion, which was in the same localization, was detected. Due to the previous atypical pathological result, computed tomography (CT) guided fine-needle aspiration biopsy from the left renal mass was performed but malignant cytology was not confirmed with this biopsy. On follow-up CT done 6 months later, a persistent suspicious left renal mass, measuring 40 × 30 cm in size was detected with no change in its dimensions and appearance. Additionally, magnetic resonance imaging (MRI) scan revealed a bone lesion of 15 × 10 mm in the left hip, which was not present on previous MRI/CT scans. In view of the solid masses in the left kidney, and left hip on CT and MRI scan suspicious for a probably metastatic renal neoplasm, left radical nephrectomy via a left subcostal transperitoneal incision was performed. The ultimate pathological report of the patient was also supported the diagnosis of Masson's tumor and any renal malignancy was not encountered The patient was discharged on the 4(th) postoperative day and has been followed up for 4 months without any problems. In this case, we discuss the clinical features, histopathological characteristics, and the management of Masson's tumor of the kidney in the light of the current literature.

Intravascular Papillary Endothelial Hyperplasia of the Jejunum

Intravascular papillary endothelial hyperplasia is considered to be an unusual form of thrombus organization that is marked by an excessive papillary endothelial proliferation. This lesion has the propensity to occur in the skin and the subcutis. Occurrence in the gastrointestinal tract is very rare. The authors report an exceptional case of a 20-year-old young woman with intravascular papillary endothelial hyperplasia in the jejunum. The patient was referred to the hospital with a 1-week history of melena. The lesion did not recur after surgery. Histopathological examination revealed a papillary endothelial hyperplasia with an underlying arteriovenous malformation.

Primary benign vascular tumors and tumorlike lesions of the kidney: a clinicopathologic analysis of 15 cases

Primary benign vascular lesions of the kidney are uncommonly encountered in routine surgical pathology practice. They can, however, mimic malignancy or be an incidental finding adjacent to a malignancy. Fifteen specimens harboring 16 primary benign renal lymphatic/vascular lesions were identified from our files from 1999 to 2011 and subjected to a detailed pathologic evaluation and clinicopathologic correlation. Clinical and demographic data were available for all the 15 cases. There were ten males and five female patients with age range of 33-74 years (mean 54 years). Lesions ranged from 0.5 cm to 40 cm (average, 6.6 cm). There were six arteriovenous malformations (AVMs), four hemangiomas, three anastomosing hemangiomas, two lymphangiomas, and one solid intravascular papillary endothelial hyperplasia (IPEH). Five AVMs were located in the kidney parenchyma and one in the pelviureteric system. Additional associated lesions ranged from renal stones to renal cell carcinoma in two cases (one lymphangioma and one AVM). One AVM was associated with a capillary hemangioma in the vicinity, and another with a history of renal cell carcinoma in the contralateral kidney. Capillary hemangiomas and lymphangiomas were noninfiltrative and lacked cytological atypia and mitotic activity. Except for a renal pelvic AVM, all other renal AVMs radiologically mimicked malignancy. The patients had undergone partial or radical nephrectomies except for the renal pelvic AVM which was laparoscopically excised. To the best of our knowledge, none of the cases had any syndromic/systemic associations. Benign vascular lesions of the kidney are rarely seen in routine surgical pathology practice, partly because a vast majority of them are medically treated by embolization. However, lesions mimicking renal malignancy are subjected to surgery. They may exist as isolated lesions or coexist with malignant lesions either in the ipsilateral or the contralateral kidney.

Sonographic features of intravascular papillary endothelial hyperplasia (Masson's tumor) in the forearm

Intravascular papillary endothelial hyperplasia, also known as Masson's tumor, is a benign, vascular lesion in which there is papillary proliferation of endothelial cells. The lesion presents as a palpable soft-tissue mass, often located within normal or dilated vascular spaces, and may be mistaken for a sarcomatous tumor on imaging. We present the case of an intravascular papillary endothelial hyperplasia in the forearm, with a remarkable appearance on color Doppler sonography, and suggest that this entity will be encountered more frequently by sonologists in the future.

Intravascular Papillary Endothelial Hyperplasia of the Renal Vein

Intravascular papillary endothelial hyperplasia (IPEH) is a benign, florid proliferation of endothelial cells forming hyaline papillae covered by monolayered cells, which has rarely been described in the renal vein, most often being equated to tumors because of the difficulties in correctly interpreting imaging findings and accordingly treated by nephrectomy. If the kidney is end-staged for preexisting medical diseases, the risk of overtreatment is obviously negligible, but overdiagnosing IPEH as an intravascular tumor, either benign or malignant, may be perilous for the patient because of the possible consequences on the clinical management.

Intravascular papillary endothelial hyperplasia of renal vein: report of 2 cases

Intravascular papillary endothelial hyperplasia is a benign intravascular process thought to arise from an organizing thrombus. The lesion may present clinically as an abnormal mass and, depending on the location, may be confused with benign or malignant neoplasms. It has been described in a variety of locations. Involvement of the renal vein by papillary endothelial hyperplasia is extremely rare, with only 4 cases reported in the literature. We describe 2 additional cases. In both cases, the radiologic examination revealed a well-circumscribed mass in the hilar region of the kidney, which was considered to be a renal neoplasm. Nephrectomy specimen in each case revealed characteristic features of intravascular papillary endothelial hyperplasia. It is suggested that intravascular papillary endothelial hyperplasia should be included in the differential diagnosis of a hilar renal mass.

Extravascular papillary endothelial hyperplasia arising from parapharyngeal space

A 66-year-old man visited our clinic suffering from swelling of right pharyngeal space. He was not aware of other symptoms. The contrast CT showed patchy enhancement with calcification. The enhanced MRI revealed a non-homogeneous signal pattern and patchy central enhancement. During surgery, egg-shaped hard elastic tumor was observed in parapharyngeal space without any sign indicating an invasion into surrounding nerves or feeding vessels. Then the tumor was removed without significant hemorrhage or damage to the cranial nerve. Histological examination of the tumor revealed a nodular lesion with blood clot and hematoma encapsulated with fibrous tissue having vascular spaces of irregular shape and size. From those findings, the tumor was diagnosed as papillary endothelial hyperplasia (PEH). However, since the location of the tumor differed from that of PEH commonly observed in the intravascular space, the tumor was classified as extravascular PEH.

A case of intravascular papillary endothelial hyperplasia (Masson's tumor) arising from renal sinus

A 55-year-old woman had a right renal tumor incidentally diagnosed by ultrasonography. CT revealed a perirenal low density mass 3 cm in diameter. Dynamic CT showed peripheral enhancement of the tumor in early phase and internal homogeneous enhancement in delayed phase. Since hemangioma was considered most likely, we performed tumor resection and spared the right kidney. The tumor was supplied by the superior ureteral artery from the right main renal artery which was considered to be derived from the renal sinus. The tumor was diagnosed as intravascular papillary endothelial hyperplasia (Masson's tumor). This is the first report of intravascular papillary endothelial hyperplasia existing in the perirenal space. Although preoperative diagnosis of intravascular papillary endothelial hyperplasia is difficult, intra-operative pathology and kidney-sparing treatment should be considered in such a case.

Intravascular papillary endothelial hyperplasia in a thrombosed renal allograft vein

Intravascular papillary endothelial hyperplasia (IPEH) is a benign endothelial proliferation of unclear pathogenesis, usually associated with thrombus as an unusual mode of organization and occasionally coexisting with vascular neoplasms. A 65-year-old white woman with chronic renal disease caused by focal segmental glomerulosclerosis experienced the failure of a cadaveric renal allograft 10 days after implantation. Pathological manifestations in the resected graft included total infarction and thrombi in both the renal artery and vein, the latter of which showed typical histopathologic features of IPEH. Papillary formations with fibrinous cores lined by bland endothelial cells surrounded fresh and organizing thrombus, and the proliferation had a highly cellular peripheral zone not readily recognizable as vascular. Immunohistochemical stains for factor VIII, CD34, and in particular CD31, however, confirmed the nature of both the papillary and solid areas of the proliferation as vascular endothelium. We present the first report of this lesion in an allograft vessel, and we find its rapid development, in association with a thrombus of clinically discernable age, to be strong evidence supporting the hypothesis that IPEH represents an uncommon morphology of organizing thrombus.