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Zhang L, Li H, Tong H, Cui H, Guo H, Wen S, Song Z, Chen J, Xiang S, Liu Z, Fan B, Wang L. Clinicopathological features and genetic mutation spectrum of primary anastomosing hemangioma arising from the kidney. Front Immunol 2025; 16:1554203. [PMID: 40416971 PMCID: PMC12098607 DOI: 10.3389/fimmu.2025.1554203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2025] [Accepted: 04/14/2025] [Indexed: 05/27/2025] Open
Abstract
Background Renal anastomosing hemangioma (RAH) is a rare benign renal tumor, and its clinicopathologic characteristics and genetic mutation spectrum related to its mechanisms of pathogenesis are unclear. Methods We carried out whole-genome sequencing (WGS) on RAH samples to explore the genetic mutation spectrum and verified the results by Sanger sequencing. Immunohistochemical analysis was also performed to reveal the histopathological characteristics and the tumor microenvironment components. Moreover, a population-based study was conducted after searching the PubMed, EMBASE, and Ovid SP databases to systematically summarize the clinicopathologic features of patients with RAH. Results WGS analysis revealed 10532 somatic single-nucleotide variants (SNVs), 6705 somatic insertions and deletions (INDELs), and mutations in 32 predisposing genes and 10 driver genes, among which the mutations in 8 of the predisposing genes, CNTNAP2, NCOA2, FAT1, MET, TJP2, MAML2, SRGAP3, and CSMD3, and the mutation site in the driver gene HIP1 were confirmed by Sanger sequencing. Moreover, the immunohistochemical profile of the tumor microenvironment revealed that the expression content of tumor-associated macrophages (CD163, CD68) and fibroblasts (SMA) differs between cancerous and precancerous tissues which may regulate the disease development. On the basis of our population-based analysis, we summarized the clinicopathological features of 100 patients with RAH and identified significant differences in age (p=0.001), tumor site (p<0.001), tumor focality (p<0.001), largest tumor diameter (p=0.001) and surgical approach (p=0.010) between patients with RAH with end-stage renal disease (ESRD) and those without ESRD. Conclusions The distinct phenotypes of RAH may be associated with the different genetic mutation spectra identified in our study. The presence or absence of comorbid ESRD varies among patients with RAH. However, additional studies are required to validate our results.
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Affiliation(s)
- Luxin Zhang
- Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Liaoning Provincial Key Laboratory of Urological Digital Precision Diagnosis and Treatment, Dalian, Liaoning, China
- Liaoning Engineering Research Center of Integrated Precision Diagnosis and Treatment Technology for Urological Cancer, Dalian, Liaoning, China
- Dalian Key Laboratory of Prostate Cancer Research, Dalian, Liaoning, China
| | - Haozhen Li
- Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Liaoning Provincial Key Laboratory of Urological Digital Precision Diagnosis and Treatment, Dalian, Liaoning, China
- Liaoning Engineering Research Center of Integrated Precision Diagnosis and Treatment Technology for Urological Cancer, Dalian, Liaoning, China
- Dalian Key Laboratory of Prostate Cancer Research, Dalian, Liaoning, China
| | - Heyao Tong
- Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Liaoning Provincial Key Laboratory of Urological Digital Precision Diagnosis and Treatment, Dalian, Liaoning, China
- Liaoning Engineering Research Center of Integrated Precision Diagnosis and Treatment Technology for Urological Cancer, Dalian, Liaoning, China
- Dalian Key Laboratory of Prostate Cancer Research, Dalian, Liaoning, China
| | - Hepeng Cui
- Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Liaoning Provincial Key Laboratory of Urological Digital Precision Diagnosis and Treatment, Dalian, Liaoning, China
- Liaoning Engineering Research Center of Integrated Precision Diagnosis and Treatment Technology for Urological Cancer, Dalian, Liaoning, China
- Dalian Key Laboratory of Prostate Cancer Research, Dalian, Liaoning, China
| | - Huahang Guo
- Department of Pathology, Dalian Friendship Hospital, Dalian, Liaoning, China
| | - Shuang Wen
- Department of Pathology, Dalian Friendship Hospital, Dalian, Liaoning, China
| | - Zhuwei Song
- Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Liaoning Provincial Key Laboratory of Urological Digital Precision Diagnosis and Treatment, Dalian, Liaoning, China
- Liaoning Engineering Research Center of Integrated Precision Diagnosis and Treatment Technology for Urological Cancer, Dalian, Liaoning, China
- Dalian Key Laboratory of Prostate Cancer Research, Dalian, Liaoning, China
| | - Jiaqiang Chen
- Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Liaoning Provincial Key Laboratory of Urological Digital Precision Diagnosis and Treatment, Dalian, Liaoning, China
- Liaoning Engineering Research Center of Integrated Precision Diagnosis and Treatment Technology for Urological Cancer, Dalian, Liaoning, China
- Dalian Key Laboratory of Prostate Cancer Research, Dalian, Liaoning, China
| | - Shengxiang Xiang
- Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Liaoning Provincial Key Laboratory of Urological Digital Precision Diagnosis and Treatment, Dalian, Liaoning, China
- Liaoning Engineering Research Center of Integrated Precision Diagnosis and Treatment Technology for Urological Cancer, Dalian, Liaoning, China
- Dalian Key Laboratory of Prostate Cancer Research, Dalian, Liaoning, China
| | - Zhiyu Liu
- Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Liaoning Provincial Key Laboratory of Urological Digital Precision Diagnosis and Treatment, Dalian, Liaoning, China
- Liaoning Engineering Research Center of Integrated Precision Diagnosis and Treatment Technology for Urological Cancer, Dalian, Liaoning, China
- Dalian Key Laboratory of Prostate Cancer Research, Dalian, Liaoning, China
| | - Bo Fan
- Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Liaoning Provincial Key Laboratory of Urological Digital Precision Diagnosis and Treatment, Dalian, Liaoning, China
- Liaoning Engineering Research Center of Integrated Precision Diagnosis and Treatment Technology for Urological Cancer, Dalian, Liaoning, China
- Dalian Key Laboratory of Prostate Cancer Research, Dalian, Liaoning, China
| | - Liang Wang
- Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Liaoning Provincial Key Laboratory of Urological Digital Precision Diagnosis and Treatment, Dalian, Liaoning, China
- Liaoning Engineering Research Center of Integrated Precision Diagnosis and Treatment Technology for Urological Cancer, Dalian, Liaoning, China
- Dalian Key Laboratory of Prostate Cancer Research, Dalian, Liaoning, China
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Hoxhaj I, Piccino M, Grossi U, Maffeis V, Beleù A, Baciorri F, Morana G, Zanatta P, Zanus G. Systematic Review and Case Report of a Left Gonadal Vein Anastomosing Hemangioma. J Clin Med 2025; 14:3108. [PMID: 40364141 PMCID: PMC12072553 DOI: 10.3390/jcm14093108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2025] [Revised: 04/22/2025] [Accepted: 04/26/2025] [Indexed: 05/15/2025] Open
Abstract
Background/Objectives: Anastomosing hemangioma (AH) is a rare, benign vascular tumor predominantly found in the genitourinary tract and often associated with impaired renal function. Due to its nonspecific radiological features, AH is frequently misinterpreted as a malignant vascular neoplasm, particularly angiosarcoma (AS), leading to potentially unnecessary surgical interventions. This study presents a systematic review of AH cases and describes a rare instance of retroperitoneal AH arising from the left gonadal vein, which was resected due to diagnostic uncertainty. Methods: A 68-year-old man underwent imaging for benign prostatic hyperplasia, incidentally revealing a 15-mm hypervascular retroperitoneal nodule adjacent to the left psoas muscle. Imaging findings, including moderate metabolic uptake on 18FDG-PET/CT, raised suspicion for AS. Given the diagnostic uncertainty and high-risk location, the multidisciplinary team (MDT) recommended surgical resection. Laparoscopic excision was performed, and histopathological analysis confirmed AH. The patient remained asymptomatic at a 22 month follow-up. In addition, a systematic review of 159 cases from 64 studies (2009-2024) was conducted to analyze radiological features, treatment approaches, and outcomes. Results: Among the reviewed cases, 68% were incidentally diagnosed, with AH occurring predominantly in the genitourinary system (70%), especially in the kidney, adrenal gland, and ovary. Chronic kidney disease (CKD) was present in 23.3% of cases, while 19.5% had a history of malignancy. Imaging was inconclusive in differentiating AH from malignancies: CT (71.9%) and MRI (6.1%) were the most used modalities, but none could reliably exclude AS. Management strategies included upfront surgical resection in 85%, while a growing proportion (9%) of cases underwent biopsy-based observation rather than immediate surgery. No cases were followed with imaging alone. Conclusions: AH remains a diagnostic challenge due to its overlap with malignant vascular tumors. While surgical excision is often performed, our review highlights an increasing trend toward conservative management with biopsy-based diagnosis. Improved awareness and the integration of histopathology, molecular markers, and MDT-based decision-making are crucial to prevent overtreatment in cases of suspected AH.
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Affiliation(s)
- Ilda Hoxhaj
- Surgery Unit 2, Department of Surgery, Regional Hospital Treviso AULSS 2 Marca Trevigiana, 31100 Treviso, Italy; (I.H.); (M.P.); (G.Z.)
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00168 Rome, Italy
| | - Marco Piccino
- Surgery Unit 2, Department of Surgery, Regional Hospital Treviso AULSS 2 Marca Trevigiana, 31100 Treviso, Italy; (I.H.); (M.P.); (G.Z.)
| | - Ugo Grossi
- Surgery Unit 2, Department of Surgery, Regional Hospital Treviso AULSS 2 Marca Trevigiana, 31100 Treviso, Italy; (I.H.); (M.P.); (G.Z.)
| | - Valeria Maffeis
- Department of Pathology, “Ca’ Foncello” Regional Hospital, 31100 Treviso, Italy; (V.M.); (F.B.)
| | - Alessandro Beleù
- Department of Radiology, Regional Hospital Treviso AULSS 2 Marca Trevigiana, 31100 Treviso, Italy; (A.B.); (G.M.)
| | - Francesca Baciorri
- Department of Pathology, “Ca’ Foncello” Regional Hospital, 31100 Treviso, Italy; (V.M.); (F.B.)
| | - Giovanni Morana
- Department of Radiology, Regional Hospital Treviso AULSS 2 Marca Trevigiana, 31100 Treviso, Italy; (A.B.); (G.M.)
| | - Paolo Zanatta
- Department of Anesthesiology and Critical Care, Regional Hospital Treviso AULSS 2 Marca Trevigiana, 31100 Treviso, Italy;
| | - Giacomo Zanus
- Surgery Unit 2, Department of Surgery, Regional Hospital Treviso AULSS 2 Marca Trevigiana, 31100 Treviso, Italy; (I.H.); (M.P.); (G.Z.)
- Department of Surgery, Oncology and Gastroenterology—DiSCOG, University of Padova, 35121 Padua, Italy
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Dashti NK, Swanson AA, Keeney GL, Edgar MA, Gupta S, Schoolmeester JK. Alterations of G-protein Activating Subunit Genes in Ovarian Hemangiomas: A Molecular Study of 6 Cases Including 3 Anastomosing Hemangiomas With a Cavernous Component. Int J Gynecol Pathol 2025:00004347-990000000-00234. [PMID: 40341275 DOI: 10.1097/pgp.0000000000001107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2025]
Affiliation(s)
- Nooshin K Dashti
- Dartmouth-Hitchcock Medical Center and Geisel School of Medicine, Lebanon, New Hampshire
| | - Amy A Swanson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester Minnesota
| | - Gary L Keeney
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester Minnesota
| | - Mark A Edgar
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville Florida
| | - Sounak Gupta
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester Minnesota
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Papke DJ. Mesenchymal Neoplasms of the Kidney and Perinephric Soft Tissue. Surg Pathol Clin 2025; 18:209-227. [PMID: 39890305 DOI: 10.1016/j.path.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2025]
Abstract
Mesenchymal neoplasms of the kidney present challenges because they are uncommon, and because perinephric soft tissue biopsies are sometimes submitted as "kidney" masses, causing diagnostic confusion. Here, the author thoroughly reviews mesenchymal neoplasms of the kidney, including metanephric stromal tumor, classic and cellular congenital mesoblastic nephroma, anaplastic sarcoma and clear cell sarcoma of the kidney, malignant rhabdoid tumor, PEComa/angiomyolipoma, and anastomosing hemangioma. The author also discusses perinephric myxoid pseudotumor of fat, as well as diagnostic pitfalls presented by well-differentiated/dedifferentiated liposarcoma and sarcomatoid carcinoma.
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Affiliation(s)
- David J Papke
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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Yeh YC, Chu PY, Lin CI, Wang SY, Lin SY, Ho HL, Hsieh MS. Frequent PIK3CA and GNAQ mutations in solitary pulmonary capillary haemangioma and pulmonary cavernous haemangioma: genetic link to vascular malformations. Pathology 2025:S0031-3025(25)00086-8. [PMID: 40155264 DOI: 10.1016/j.pathol.2024.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 11/10/2024] [Accepted: 11/26/2024] [Indexed: 04/01/2025]
Abstract
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.
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Affiliation(s)
- Yi-Chen Yeh
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ping-Yuan Chu
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-I Lin
- Department of Pathology, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan
| | - Shu-Ying Wang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shin-Ying Lin
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiang-Ling Ho
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Biotechnology and Laboratory Science in Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Min-Shu Hsieh
- Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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6
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Choi JH, Thung SN. Mesenchymal Tumors of the Liver: An Update Review. Biomedicines 2025; 13:479. [PMID: 40002892 PMCID: PMC11852400 DOI: 10.3390/biomedicines13020479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2025] [Revised: 02/11/2025] [Accepted: 02/13/2025] [Indexed: 02/27/2025] Open
Abstract
Hepatic mesenchymal tumors (HMTs) are non-epithelial benign and malignant tumors with or without specific mesenchymal cell differentiation. They are relatively uncommon. Except for mesenchymal hamartoma, calcified nested stromal-epithelial tumor, and embryonal sarcoma, most mesenchymal lesions are not specific to the liver. Pathologists face challenges in diagnosing HMTs due to their diverse morphologies and phenotypic variations. Accurate diagnosis is critical for directing appropriate patient care and predicting outcomes. This review focuses on mesenchymal tumors with a relative predilection for the liver, including vascular and non-vascular mesenchymal neoplasms. It provides a thorough and up-to-date overview, concentrating on clinical and pathological features, differential diagnosis, and diagnostic approaches.
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Affiliation(s)
- Joon Hyuk Choi
- Department of Pathology, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Namgu, Daegu 42415, Republic of Korea
| | - Swan N. Thung
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY 10029, USA;
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Aravind A, Ahuja S, Malik S, Zaheer S. Anastomosing hemangioma of the kidney: A rare case report. Int J Surg Case Rep 2025; 126:110659. [PMID: 39608330 PMCID: PMC11636329 DOI: 10.1016/j.ijscr.2024.110659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Revised: 11/20/2024] [Accepted: 11/22/2024] [Indexed: 11/30/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Hemangiomas are benign vascular neoplasms primarily affecting the skin and soft tissues but can also occur in visceral organs, with the liver being the most common site. Renal hemangiomas are exceedingly rare, with fewer than 300 cases reported. Various subtypes, including cavernous, capillary, and anastomosing hemangiomas, have been identified. Anastomosing hemangioma (AH), a histological subtype of capillary hemangioma, was first described in 2009. AH has a distinctive histological architecture of anastomosing sinusoidal-like vascular spaces and often mimics angiosarcoma. CASE PRESENTATION A 28-year-old male presented with an incidentally detected left renal mass found during an evaluation for abdominal pain and dyspepsia. The patient was asymptomatic with no history of hematuria or dysuria. Physical examination was unremarkable. Contrast computed tomography revealed a heterogeneously enhancing solid mass in the left kidney, suggesting a neoplastic etiology. Laparoscopic enucleation of the tumor was performed, and histopathological examination revealed a well-circumscribed tumor composed of irregular capillary-sized vascular spaces lined by plump endothelial cells with mild atypia. Immunohistochemical analysis showed positivity for CD34, CD31, and Factor VIII, confirming the diagnosis of anastomosing hemangioma. The patient has been under follow-up with no evidence of recurrence. CLINICAL DISCUSSION Anastomosing hemangioma of the kidney, although rare, is an important benign entity that can mimic malignant vascular tumors like angiosarcoma. Accurate diagnosis relies on histopathological examination and immunohistochemistry. CONCLUSION Despite its benign nature, AH often leads to overtreatment due to its diagnostic challenges. Increased awareness and reporting of AH cases are essential to improve diagnostic accuracy and management strategies.
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Affiliation(s)
- Amrutha Aravind
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sana Ahuja
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Shaivy Malik
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sufian Zaheer
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
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Pilch J, Mizera J, Tota M, Donizy P. GNAQ/GNA11-Related Benign and Malignant Entities-A Common Histoembriologic Origin or a Tissue-Dependent Coincidence. Cancers (Basel) 2024; 16:3672. [PMID: 39518110 PMCID: PMC11544895 DOI: 10.3390/cancers16213672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Revised: 10/24/2024] [Accepted: 10/29/2024] [Indexed: 11/16/2024] Open
Abstract
Uveal melanoma (UM), recognized as the most prevalent primary intraocular malignancy in adults, is primarily driven by mutations in the GNAQ and GNA11 genes. These genetic alterations are also implicated in other conditions, which exhibit distinct morphological characteristics. In this article, we investigate the role of GNAQ and GNA11 mutations across varied disorders (e.g., UM, skin blue nevi, and hemangiomas), emphasizing the shared pathogenic mechanisms that connect them despite their differing clinical manifestations. By investigating the molecular pathways affected by these mutations, we provide insights into the potential for targeted therapies that could address not only UM but also other disorders associated with GNAQ/GNA11 mutations. Moreover, we discuss the role of SOX10-positive perivascular cells that may be implicated in the complex pathophysiology of GNAQ/GNA11-related entities. Understanding the common molecular foundation of these conditions opens new ways for research and treatment opportunities, potentially leading to more effective, personalized therapeutic strategies.
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Affiliation(s)
- Justyna Pilch
- Department of Clinical and Experimental Pathology, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Jakub Mizera
- Department of Clinical and Experimental Pathology, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Maciej Tota
- Department of Clinical and Experimental Pathology, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Piotr Donizy
- Department of Clinical and Experimental Pathology, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Department of Pathology and Clinical Cytology, Jan Mikulicz-Radecki University Hospital, 50-556 Wroclaw, Poland
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Jawalkar S, Jacob KA, Patil VS. Incidental Hemangioma in Tubectomy and Hemorrhoidectomy Specimens: A Report of Two Cases. Cureus 2024; 16:e64390. [PMID: 39130892 PMCID: PMC11317121 DOI: 10.7759/cureus.64390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 07/12/2024] [Indexed: 08/13/2024] Open
Abstract
Benign vascular neoplasms, or hemangiomas, can develop anywhere in the body.As they are usually asymptomatic, they are discovered incidentally while evaluating other coexisting diseases or conditions. We herein report two cases of capillary hemangioma at two extremely rare sites. A woman in her early 30s with a history of nine months of amenorrhea came for safe confinement and underwent an elective lower segment cesarean section (LSCS) with bilateral concurrent tubectomy. Another case involved a man in his 40s who presented with bleeding per rectum for three months. Per rectal examination, two purplish red masses were noted at the 3 and 11 o'clock positions, which were noncompressible and did not bleed on touch. Subsequently, a hemorrhoidectomy was performed. A well-defined vascular lesion in the fallopian tube and hemorrhoidal tissue were seen during the histopathological examination, which was compatible with a capillary hemangioma. The vascular endothelium was emphasized by immunostaining with CD34.Due to the potential for these lesions to manifest as surgical emergencies, it is imperative for surgeons to recognize and appropriately manage such presentations.
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Affiliation(s)
- Sneha Jawalkar
- Pathology and Laboratory Medicine, Shri B M Patil Medical College, Hospital and Research Centre, Bijapur Lingayat District Educational (BLDE) (Deemed to be University), Vijayapura, IND
| | - Kezia A Jacob
- Pathology, Shri B M Patil Medical College, Hospital and Research Centre, Bijapur Lingayat District Educational (BLDE) (Deemed to be University), Vijayapura, IND
| | - Vijayalaxmi S Patil
- Pathology, Shri B M Patil Medical College, Hospital and Research Centre, Bijapur Lingayat District Educational (BLDE) (Deemed to be University), Vijayapura, IND
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10
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Rewari H, Wadhwa P, Talwar H, Taneja D. Anastomosing haemangioma of adrenal gland: an unusual vascular tumour. BMJ Case Rep 2024; 17:e259092. [PMID: 38670570 PMCID: PMC11057196 DOI: 10.1136/bcr-2023-259092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
With only 15 reported cases, anastomosing haemangioma of adrenal is a rare entity and usually presents as adrenal incidentaloma. A hypertensive, diabetic, non-smoker man in his late 60s presented with irritative voiding symptoms. On evaluation, he was found to have a urinary bladder mass and left adrenal incidentaloma measuring 8 cm. Metabolic evaluation confirmed it to be non-functional.The patient underwent transurethral resection of bladder tumour with left laparoscopic adrenalectomy. Intraoperatively, the adrenal tumour was highly vascular with multiple feeder vessels. Grossly it was soft, encapsulated with focal grey-brown areas. Microscopically, most of adrenal gland was replaced by anastomosing proliferating capillary vessels within framework of non-endothelial supporting cells reminiscent of splenic sinusoids. The tumour was positive for CD-31, CD-34, Glut-1 and SMA.Anastomosing haemangioma is a benign entity but it must be differentiated from angiosarcoma. Characteristic imaging features are not yet defined and is, therefore, difficult to diagnose preoperatively.
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Affiliation(s)
- Harshit Rewari
- Kidney and Urology Institute, Medanta - The Medicity, Gurugram, Haryana, India
| | - Pankaj Wadhwa
- Kidney and Urology Institute, Medanta - The Medicity, Gurugram, Haryana, India
| | | | - Divya Taneja
- Department of Histopathology, Medanta - The Medicity, Gurugram, Haryana, India
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11
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Hammill AM, Boscolo E. Capillary malformations. J Clin Invest 2024; 134:e172842. [PMID: 38618955 PMCID: PMC11014659 DOI: 10.1172/jci172842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024] Open
Abstract
Capillary malformation (CM), or port wine birthmark, is a cutaneous congenital vascular anomaly that occurs in 0.1%-2% of newborns. Patients with a CM localized on the forehead have an increased risk of developing a neurocutaneous disorder called encephalotrigeminal angiomatosis or Sturge-Weber syndrome (SWS), with complications including seizure, developmental delay, glaucoma, and vision loss. In 2013, a groundbreaking study revealed causative activating somatic mutations in the gene (GNAQ) encoding guanine nucleotide-binding protein Q subunit α (Gαq) in CM and SWS patient tissues. In this Review, we discuss the disease phenotype, the causative GNAQ mutations, and their cellular origin. We also present the endothelial Gαq-related signaling pathways, the current animal models to study CM and its complications, and future options for therapeutic treatment. Further work remains to fully elucidate the cellular and molecular mechanisms underlying the formation and maintenance of the abnormal vessels.
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Affiliation(s)
- Adrienne M. Hammill
- Division of Hematology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Elisa Boscolo
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
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12
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Caldwell NJ, Ackman JB, Chebib I, Mino-Kenudson M, Nielsen GP, Hung YP. Anastomosing haemangioma of the mediastinum: Clinicopathological series with radiological and genetic characterisation. Histopathology 2024; 84:463-472. [PMID: 37936489 DOI: 10.1111/his.15085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/12/2023] [Accepted: 10/14/2023] [Indexed: 11/09/2023]
Abstract
AIMS Anastomosing haemangiomas are benign tumours with anastomosing vascular channels that may mimic angiosarcoma. While anastomosing haemangiomas have been described in diverse locations, particularly the abdominal/paraspinal region, data on anastomosing haemangiomas in the mediastinum remain limited. We report the clinicopathological, radiological and molecular characteristics of the largest single-institutional series of mediastinal anastomosing haemangiomas. METHODS AND RESULTS In our pathology archives in 2011-23, we reviewed all vascular lesions involving the mediastinum and identified seven anastomosing haemangiomas. Clinical information was abstracted from medical charts; available radiological imaging was reviewed. Targeted DNA-based next-generation sequencing (447 genes, including GNAQ and GNA11) was performed on five cases. The seven patients included five women and two men, with an age range of 55-77 (median = 72) years. Of the six tumours with available radiology, two each were in the prevascular, visceral and paravertebral mediastinum, with lobulated peripheral enhancement in all tumours examined with contrast enhancement. Six patients underwent tumour resection; one patient received proton radiotherapy. Microscopically, each tumour was solitary and characterised by anastomosing capillary-sized vessels lined by hobnail endothelial cells. Fibrin microthrombi, hyaline globules and extramedullary haematopoiesis were common. In the five tumours analysed by next-generation sequencing, GNAQ p.Q209P was identified in one tumour; no additional reportable alterations were identified in the remaining cases. No recurrence was noted in the four patients with available follow-up of 3-58 (median = 9.5) months after resection. CONCLUSION While mediastinal anastomosing haemangiomas can microscopically mimic angiosarcoma, awareness of this entity and radiological correlation may help to circumvent this diagnostic pitfall.
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Affiliation(s)
- Nicholas J Caldwell
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeanne B Ackman
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ivan Chebib
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - G Petur Nielsen
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yin P Hung
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Gestrich CK, Vivero MP, Konczyk DJ, Goss JA, Labow BI, Pearson GD, Cottrell CE, Mathew MT, Prasad V, Kozakewich HP, Fletcher CDM, Greene AK, Al-Ibraheemi A. Papillary Hemangioma Harbors Somatic GNA11 and GNAQ Mutations. Am J Surg Pathol 2024; 48:106-111. [PMID: 37750536 PMCID: PMC10843298 DOI: 10.1097/pas.0000000000002127] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Papillary hemangioma (PH) is a small, primarily dermal lesion occurring predominantly in the head and neck in both children and adults. Its signature characteristics are dilated thin-walled channels containing papillary clusters of mainly capillary-sized vessels and endothelial cytoplasmic eosinophilic inclusions. Given certain histopathologic similarities to congenital hemangioma which harbor mutations in GNAQ and GNA11 , we investigated whether similar mutations are present in PH. Seven PH specimens were studied. All presented in the first 4 years of life, with one being noted at birth. With the exception of one lesion, all were in the head and neck. Lesions were bluish and ranged in size from 0.5 to 2.8 cm. Four samples had GNA11 p.Q209L and 3 had GNAQ p.Q209L missense mutations. Mutations in GNA11 and GNAQ are associated with other types of somatic vascular lesions including capillary malformation, congenital hemangioma, anastomosing hemangioma, thrombotic anastomosing hemangioma, and hepatic small cell neoplasm. Shared mutations in GNA11 and GNAQ may account for some overlapping clinical and pathologic features in these entities, perhaps explicable by the timing of the mutation or influence of the germline phenotype.
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Affiliation(s)
| | - Mathew P. Vivero
- Department of Plastic & Oral Surgery, Boston Children’s Hospital, Boston, MA, USA
| | - Dennis J. Konczyk
- Department of Plastic & Oral Surgery, Boston Children’s Hospital, Boston, MA, USA
| | - Jeremy A. Goss
- Department of Plastic & Oral Surgery, Boston Children’s Hospital, Boston, MA, USA
| | - Brian I Labow
- Department of Plastic & Oral Surgery, Boston Children’s Hospital, Boston, MA, USA
| | - Gregory D. Pearson
- Department of Plastic Surgery, Nationwide Children’s Hospital, Columbus, OH, USA
| | | | - Mariam T. Mathew
- Institute for Genomic Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Vinay Prasad
- Department of Pathology, Nationwide Children’s Hospital, Columbus, OH, USA
| | | | | | - Arin K. Greene
- Department of Plastic & Oral Surgery, Boston Children’s Hospital, Boston, MA, USA
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14
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Ferrell LD, Kakar S, Terracciano LM, Wee A. Tumours and Tumour-Like Lesions. MACSWEEN'S PATHOLOGY OF THE LIVER 2024:842-946. [DOI: 10.1016/b978-0-7020-8228-3.00013-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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15
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Braun A, Solari M, Gattuso P, Agarwal I. Benign Vascular Lesions of the Breast: A Clinical, Radiographic, and Pathologic Review. Int J Surg Pathol 2023; 31:1437-1448. [PMID: 37032453 DOI: 10.1177/10668969231160254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Vascular lesions of the breast are uncommon, however, these are increasingly encountered now due to more frequent use of magnetic resonance imaging. They comprise a spectrum of lesions including benign, atypical, and malignant tumors. The prototype is a hemangioma, which is most often nonpalpable and is detected on routine screening. Different histopathologic subtypes of hemangioma have been described, including perilobular, venous, cavernous, and capillary hemangioma. Other benign vascular lesions include anastomosing hemangioma, a well-circumscribed proliferation of anastomosing blood vessels with lobular or diffuse growth pattern which affects a large segment of the breast, presenting as a painless slow enlarging palpable mass. Recent data suggest that benign vascular lesions diagnosed on core needle biopsy with concordant radiologic and pathologic findings do not require excision and have an excellent prognosis, except angiomatosis, which can be locally aggressive and may recur. The main focus of this study is to present the radiographic, gross, and histopathologic characteristics of benign vascular lesions of the breast and their differential diagnoses.
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Affiliation(s)
- Ankica Braun
- Rush University Medical Center, Department of Pathology, Chicago, IL, USA
| | - Mariana Solari
- Rush University Medical Center, Department of Pathology, Chicago, IL, USA
- Rush University Medical Center, Department of Radiology, Chicago, IL, USA
| | - Paolo Gattuso
- Rush University Medical Center, Department of Pathology, Chicago, IL, USA
| | - Indu Agarwal
- Rush University Medical Center, Department of Radiology, Chicago, IL, USA
- Northwestern University, McGaw Medical Center, Department of Pathology, Chicago, IL, USA
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16
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Alaghehbandan R, Remer EM, Berber E, McKenney JK. Anastomosing haemangioma of the adrenal gland: A clinicopathological series of seven cases. Histopathology 2023; 83:791-797. [PMID: 37553871 DOI: 10.1111/his.15022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023]
Abstract
AIMS Anastomosing haemangioma is a rare benign vascular neoplasm that may histologically mimic angiosarcoma. We report the largest single institution series of anastomosing haemangioma in the adrenal gland with emphasis on clinical and radiological features. METHODS AND RESULTS Our laboratory information system was searched for a 25-year period (1999-2023), yielding seven cases confirmed as anastomosing haemangioma of the adrenal gland after pathological re-review. Clinical, radiological and pathological information was obtained from medical charts and submitting pathologists. Of a total of seven patients, four (57.1%) were men and three women, ranging in age from 37 to 75 years (mean = 61). Six of seven patients underwent adrenalectomies and one had radical nephrectomy. Tumours ranged from 0.7 to 6.4 cm (mean = 2.1 cm) and five of seven (71%) were grossly well-circumscribed. Five of seven lesions were found incidentally at imaging for other indications. All tumours were unifocal except one, which presented with multifocal disease with a concurrent adjacent retroperitoneal anastomosing haemangioma. Three of five tumours imaged with contrast enhancement were almost completely hyperenhancing with a small central non-enhancing portion, features overlapping with pheochromocytoma. One of seven tumours involved the peri-adrenal adipose tissue with a focally infiltrative pattern. There were no recurrences or metastases in six patients with available follow-up data (median = 95 months). CONCLUSIONS Benign anastomosing haemangiomas of the adrenal gland tend to occur in older patients, may mimic pheochromocytoma on imaging and must be distinguished from angiosarcoma pathologically. Better awareness of this entity by pathologists, radiologists and surgeons is crucial to appropriate work-up, diagnosis and management.
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Affiliation(s)
- Reza Alaghehbandan
- Department of Anatomic Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Erick M Remer
- Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eren Berber
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Jesse K McKenney
- Department of Anatomic Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
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17
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Zhang L, Wu J. Multimodal imaging features of retroperitoneal anastomosing hemangioma: a case report and literature review. Front Oncol 2023; 13:1269631. [PMID: 37954079 PMCID: PMC10634416 DOI: 10.3389/fonc.2023.1269631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/02/2023] [Indexed: 11/14/2023] Open
Abstract
Background Anastomotic hemangioma is a rare subtype of capillary hemangioma primarily found in the genitourinary tract. We present a case of a patient with an anastomotic hemangioma located in the retroperitoneal space; then, we explore and summarize the imaging features from previously reported cases for accurate diagnosis. Case presentation A 57-year-old woman complained of left lower back pain. Contrast-enhanced ultrasound revealed a hypoechoic mass with "slow-in and slow-out" enhancement. Abdominal CT scan displayed a well-defined, round soft tissue mass in the right retroperitoneal region with obvious enhancement. MRI indicated low signal on T1-weighted imaging, high signal on T2-weighted imaging and diffusion-weighted imaging, and progressive enhancement after enhancement. Surgical removal of the tumor was performed. Histopathological examination exhibited a distinct tumor border with interconnected blood vessels and a cavity lined by a single layer of cubic endothelial cells. Immunohistochemistry confirmed the presence of CD31[+] and CD34[+]. The final pathological diagnosis was anastomotic hemangioma. No recurrence was observed during a 40-month follow-up. Conclusion Retroperitoneal anastomotic hemangioma is a rare and benign neoplasm that may be misdiagnosed as ectopic pheochromocytoma or angiosarcoma. This case report presents and analyzes the imaging characteristics of a series of retroperitoneal anastomotic hemangiomas, which can be valuable for future diagnoses and help prevent unnecessary surgeries.
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Affiliation(s)
- Liqing Zhang
- Department of Radiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian Wu
- Department of Pathology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
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18
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Paparo AJ, Hillery S, Gan E, Chai S, Khor TS. Anastomosing haemangioma of the colon. Pathology 2023; 55:892-894. [PMID: 37393147 DOI: 10.1016/j.pathol.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/03/2023] [Accepted: 03/19/2023] [Indexed: 07/03/2023]
Affiliation(s)
| | | | - Eng Gan
- GI Clinic, Myaree, WA, Australia; Wexford Gastroenterology, St John of God Murdoch Hospital, Murdoch, WA, Australia
| | - Siaw Chai
- Department of Anatomical Pathology, PathWest Murdoch, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Tze S Khor
- Department of Anatomical Pathology, PathWest QEII Site, Nedlands, WA, Australia
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19
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Capinha MD, Carvalho-Dias E, Cerqueira-Alves M, Mota P. Renal anastomosing haemangioma. BMJ Case Rep 2023; 16:e254131. [PMID: 37723090 PMCID: PMC10510885 DOI: 10.1136/bcr-2022-254131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Anastomosing haemangioma is a rare subtype of haemangioma, a benign vascular tumour. Its rarity stems from its low incidence and difficulty in obtaining an accurate diagnosis. In addition, its histological resemblance to malignant neoplasms may lead to unnecessary overtreatment. Here, we report the case of an asymptomatic male patient with a slight increase in kidney function who underwent an abdominal ultrasound and a CT scan for suspected renal cell carcinoma. Subsequently, the patient underwent laparoscopic left radical nephrectomy. Histological analysis revealed an anastomosing haemangioma. The patient is currently asymptomatic with no relapse or imaging progression. We also present a literature review on anastomosing haemangioma.
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Affiliation(s)
| | | | | | - Paulo Mota
- Urology, Hospital de Braga, Braga, Portugal
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20
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Papke DJ. Mesenchymal Neoplasms of the Liver. Surg Pathol Clin 2023; 16:609-634. [PMID: 37536892 DOI: 10.1016/j.path.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Mesenchymal neoplasms of the liver can be diagnostically challenging, particularly on core needle biopsies. Here, I discuss recent updates in neoplasms that are specific to the liver (mesenchymal hamartoma, undifferentiated embryonal sarcoma, calcifying nested stromal-epithelial tumor), vascular tumors of the liver (anastomosing hemangioma, hepatic small vessel neoplasm, epithelioid hemangioendothelioma, angiosarcoma), and other tumor types that can occur primarily in the liver (PEComa/angiomyolipoma, inflammatory pseudotumor-like follicular dendritic cell sarcoma, EBV-associated smooth muscle tumor, inflammatory myofibroblastic tumor, malignant rhabdoid tumor). Lastly, I discuss metastatic sarcomas to the liver, as well as pitfalls presented by metastatic melanoma and sarcomatoid carcinoma.
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Affiliation(s)
- David J Papke
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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21
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Ye TW, Huang DS. Hepatic anastomosing hemangioma: A case report. Shijie Huaren Xiaohua Zazhi 2023; 31:655-658. [DOI: 10.11569/wcjd.v31.i15.655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/19/2023] [Accepted: 08/04/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Anastomosing hemangioma (AH) is a rare benign vascular tumor, which is often discovered in the genitourinary system and paravertebral region and rarely occurs in the liver. AH lacks specific clinical manifestations and is prone to overtreatment.
CASE SUMMARY A 29-year-old male patient sought medical attention due to the discovery of a liver tumor for 2 years and tumor enlargement for 7 mo. The preoperative diagnosis suggested the possibility of focal nodular hyperplasia. However, due to the rapid increase in the volume of the liver tumor, the possibility of malignancy cannot be ruled out. After surgical treatment, the diagnosis was confirmed as liver AH, and there was no recurrence during long-term follow-up after surgery.
CONCLUSION Hepatic AH, as a benign tumor of blood vessels, lacks specific clinical manifestations. It can manifest as a stable tumor in the liver with a rapid increase in the volume in a short period of time, similar to a malignancy. Therefore, for cases with short-term progressive enlargement of intrahepatic masses, clinicians should broaden the scope of diagnosis and treatment, reduce misdiagnosis rates, and avoid overtreatment.
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Affiliation(s)
- Tai-Wei Ye
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Dong-Sheng Huang
- Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou 310059, Zhejiang Province, China
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22
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Wang Z, Hu J. A case report of anastomosing hemangioma of the ovary. Medicine (Baltimore) 2023; 102:e33801. [PMID: 37171299 PMCID: PMC10174374 DOI: 10.1097/md.0000000000033801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/27/2023] [Indexed: 05/13/2023] Open
Abstract
RATIONALE Anastomosing hemangioma (AH) is a rare benign neoplastic vascular lesion that histologically resembles a well-differentiated angiosarcoma. AH commonly involves the urinary system and testes. However, these tumors can also involve the ovaries in some rare cases. This manuscript presents the case of a 28-year-old Chinese woman diagnosed with ovarian AH. PATIENT CONCERNS The woman was admitted to the hospital with a 4-month history of a right ovarian mass discovered by ultrasound (US) after a spontaneous abortion. The US examination showed a 4 cm × 4 cm irregularly shaped mass with a rich blood supply. DIAGNOSES AH of the right ovar. INTERVENTION The patient underwent laparoscopic surgery to remove the mass. The postoperative pathological examination revealed that the mass contained capillaries arranged in a characteristic anastomotic or confluent pattern commonly seen in AHs. OUTCOMES The mass was successfully removed. The follow-up examination at 7 months post-surgery showed that the patient recovered well, and no recurrence or metastasis was found. LESSONS AH of the ovary is a rare benign vascular tumor. On imaging examinations, AHs appear as mostly well-defined, heterogeneous nodules with peripheral enhancement as other benign nodules. However, a definitive diagnosis can only be achieved through histopathological examination.
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Affiliation(s)
- Zhen Wang
- Hubei University of Medicine, Shiyan, China
- Department of Pathology, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Junbo Hu
- Hubei University of Medicine, Shiyan, China
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23
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Diaz-Perez JA, Kerr DA. Benign and low-grade superficial endothelial cell neoplasms in the molecular era. Semin Diagn Pathol 2023:S0740-2570(23)00041-2. [PMID: 37149395 DOI: 10.1053/j.semdp.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/24/2023] [Indexed: 05/08/2023]
Abstract
Vascular tumors are the most common mesenchymal neoplasms of the skin and subcutis, and they encompass a heterogeneous group with diverse clinical, histological, and molecular features, as well as biological behavior. Over the past two decades, molecular studies have enabled the identification of pathogenic recurrent genetic alterations that can be used as additional data points to support the correct classification of these lesions. The purpose of this review is to summarize the available data related to superficially located benign and low-grade vascular neoplasms and to highlight recent molecular advances with the role of surrogate immunohistochemistry to target pathogenic proteins as diagnostic biomarkers.
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Affiliation(s)
- Julio A Diaz-Perez
- Departments of Dermatology and Pathology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Darcy A Kerr
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
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24
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Anastomosing hemangioma of the liver: An unusual variant in abdominal MRI imaging. Radiol Case Rep 2022; 17:4889-4892. [PMID: 36276658 PMCID: PMC9579299 DOI: 10.1016/j.radcr.2022.09.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 09/14/2022] [Indexed: 11/05/2022] Open
Abstract
The liver is a rare site for anastomosing hemangiomas with only a few cases reported that characterize the lesions on magnetic resonance imaging (MRI). These lesions may be underreported due to overlapping features with classic hemangiomas. Anastomosing hemangiomas have a well-defined histological profile and are often diagnosed by biopsy in the setting of atypical imaging features. We report a case of biopsy-proven hepatic anastomosing hemangioma found on a screening MRI for hepatocellular carcinoma in a 52-year-old female with cirrhosis. This lesion initially demonstrated interval growth but has shown no local recurrence in the 2-year surveillance period following microwave ablation.
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25
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Chen B, Guo R, Erickson LA. Anastomosing Hemangioma. Mayo Clin Proc 2022; 97:1756-1757. [PMID: 36058589 DOI: 10.1016/j.mayocp.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Beiyun Chen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Ruifeng Guo
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Lori A Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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26
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Chang Chien YC, Beke L, Méhes G, Mokánszki A. Anastomosing Haemangioma: Report of Three Cases With Molecular and Immunohistochemical Studies and Comparison With Well-Differentiated Angiosarcoma. Pathol Oncol Res 2022; 28:1610498. [PMID: 35979530 PMCID: PMC9376968 DOI: 10.3389/pore.2022.1610498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/23/2022] [Indexed: 11/26/2022]
Abstract
Anastomosing haemangioma (AH) is a newly described distinct vascular neoplasm that histologically may confuse with well-differentiated angiosarcoma (AS) for those who are unfamiliar with this rare entity. We aimed to identify molecular genetic differences between AHs and ASs by carrying out immunohistochemistry (IHC), fluorescence in situ hybridization (FISH), and next-generation sequencing (NGS). Immunohistochemically, all six cases showed positivity for cyclinD1 and pERK. All cases of AH showed focal weak positive reaction for p53 and MIB-1, and the IHCs for HIF-1α were all negative for all three cases. Those three cases of angiosarcoma revealed strong, diffuse positivity for p53, 50%–70% MIB-1 labelling, and multifocal, moderate to strong HIF-1α expression. To further clarify the difference in p53 expression, we carried out a FISH which revealed 17p polysomy in all three ASs whereas copy number aberration was absent in the AH group. In one AH case, the GNA11 c.627G > T nucleotide variant was detected. Due to the rarity and overlapping morphological features, AH might be difficult to separate from other vascular tumours, in particular from well-differentiated AS also featured by mild hyperchromatic, hobnail-like endothelial cells. The potential molecular differences between these two entities presented here may be used in support of the correct diagnosis.
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27
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Zhang ZY, Hong P, Deng SH, Tang SY, Liu Z, He HY, Ma LL, Zhang SD, Tian XJ. Spermatic cord anastomosing hemangioma mimicking a malignant inguinal tumor: A case report and literature review. Front Surg 2022; 9:930160. [PMID: 35937604 PMCID: PMC9354528 DOI: 10.3389/fsurg.2022.930160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background Anastomosing hemangioma (AH) is a rare vascular tumor and occurs in various organs. It is difficult to distinguish AH from malignant tumors even through multimodal imaging examination. AH located in the inguinal region is even rare. We present the diagnosis and treatment of a patient with spermatic cord AH in detail and conduct a literature review. Case Report An 84-year-old Chinese man had swelling pain in his right scrotum. A hard and fixed mass was palpable in the right inguinal region. Preoperative radiological examination considered it a neurogenic or vascular tumor. Malignant soft tissue sarcoma could not be excluded. He underwent radical inguinal right orchiectomy under intraspinal anesthesia. The diagnosis of spermatic cord AH was confirmed by pathological examination. The patient recovered uneventfully and remained disease-free during an 18-month follow-up. Conclusion Spermatic cord AH is quite rare and could be misdiagnosed as a malignant tumor. Pathological evidence might be necessary. The optimal choice of treatment should be determined through a comprehensive assessment of both tumor and patient factors.
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Affiliation(s)
- Zhan-yi Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Peng Hong
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Shao-hui Deng
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Shi-ying Tang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Zhuo Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Hui-ying He
- Department of Pathology, Peking University Third Hospital, Beijing, China
| | - Lu-lin Ma
- Department of Urology, Peking University Third Hospital, Beijing, China
- Correspondence: Lulin Ma Shudong Zhang Xiaojun Tian
| | - Shu-dong Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China
- Correspondence: Lulin Ma Shudong Zhang Xiaojun Tian
| | - Xiao-jun Tian
- Department of Urology, Peking University Third Hospital, Beijing, China
- Correspondence: Lulin Ma Shudong Zhang Xiaojun Tian
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Abstract
PURPOSE OF REVIEW The advances of molecular techniques have led to the refinement of the classification of mesenchymal tumors, leading to newly introduced entities in the recently published fifth edition of the WHO Classification of Soft Tissue and Bone Tumors, which are discussed in this review. RECENT FINDINGS For the first time, entities are included of which the name refers to the underlying molecular alteration including round cell sarcoma with EWSR1 -non-ETS fusions, CIC -rearranged sarcoma, and sarcoma with BCOR genetic alteration. EWSR1-SMAD3 -positive fibroblastic tumor and NTRK -rearranged spindle cell neoplasm are provisionally included as 'emerging' entities based on the underlying molecular alteration, though the entity still needs to be better defined. Other newly recognized entities are not named after their molecular change, but the molecular alteration helped to delineate them from others: atypical spindle cell/pleomorphic lipomatous tumor, anastomosing hemangioma, angiofibroma of soft tissue, myxoid pleomorphic liposarcoma, and poorly differentiated chordoma. SUMMARY Classification of mesenchymal tumors is increasingly based on the underlying molecular changes, although this cannot be interpreted separately from clinical, morphological, and immunohistochemical characteristics.
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Galeffi F, Snellings DA, Wetzel-Strong SE, Kastelic N, Bullock J, Gallione CJ, North PE, Marchuk DA. A novel somatic mutation in GNAQ in a capillary malformation provides insight into molecular pathogenesis. Angiogenesis 2022; 25:493-502. [PMID: 35635655 DOI: 10.1007/s10456-022-09841-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/09/2022] [Indexed: 01/01/2023]
Abstract
Sturge-Weber syndrome (SWS) is a sporadic, congenital, neuro-cutaneous disorder characterized by a mosaic, capillary malformation. SWS and non-syndromic capillary malformations are both caused by a somatic activating mutation in GNAQ encoding the G protein subunit alpha-q protein. The missense mutation R183Q is the sole GNAQ mutation identified thus far in 90% of SWS-associated or isolated capillary malformations. In this study, we sequenced skin biopsies of capillary malformations from 9 patients. We identified the R183Q mutation in nearly all samples, but one sample exhibited a Q209R mutation. This new mutation occurs at the same residue as the constitutively-activating Q209L mutation, commonly seen in tumors. However, Q209R is a rare variant in this gene. To compare the effect of the Q209R mutation on downstream signaling, we performed reporter assays with a GNAQ-responsive reporter co-transfected with either GNAQ WT, R183Q, Q209L, Q209R, or C9X (representing a null allele). Q209L showed the highest reporter activation, with R183Q and Q209R showing significantly lower activation. To determine whether these mutations had similar or different downstream consequences we performed RNA-seq analysis in microvascular endothelial cells (HMEC-1) electroporated with the same GNAQ variants. The R183 and Q209 missense variants caused extensive dysregulation of a broad range of transcripts compared to the WT or null allele, confirming that these are all activating mutations. However, the missense variants exhibited very few differentially expressed genes (DEGs) when compared to each other. These data suggest that these activating GNAQ mutations differ in magnitude of activation but have similar downstream effects.
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Affiliation(s)
- F Galeffi
- Molecular Genetics & Microbiology, Duke University Medical Center, Durham, NC, USA
| | - D A Snellings
- Molecular Genetics & Microbiology, Duke University Medical Center, Durham, NC, USA
| | - S E Wetzel-Strong
- Molecular Genetics & Microbiology, Duke University Medical Center, Durham, NC, USA
| | - N Kastelic
- Molecular Genetics & Microbiology, Duke University Medical Center, Durham, NC, USA
| | - J Bullock
- Molecular Genetics & Microbiology, Duke University Medical Center, Durham, NC, USA
| | - C J Gallione
- Molecular Genetics & Microbiology, Duke University Medical Center, Durham, NC, USA
| | - P E North
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - D A Marchuk
- Molecular Genetics & Microbiology, Duke University Medical Center, Durham, NC, USA.
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Gunn E, Barnett CC, Duong AT, Beierle EA, Kelly DR, Vaid YN, Keene KS, Soike M, Whelan K. Bloom where you are planted: Hemangioma or malignancy? Pediatr Blood Cancer 2022; 69:e29485. [PMID: 34843167 DOI: 10.1002/pbc.29485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/01/2021] [Accepted: 11/08/2021] [Indexed: 12/30/2022]
Abstract
Vascular anomalies comprise a spectrum of disorders characterized by the abnormal development or growth of blood and lymphatic vessels. These growths have unique features and diverse behaviors, mandating a multidisciplinary approach in their evaluation, diagnosis, and management. Here we describe the case of a male toddler presenting with an abdominal mass, originally treated as a metastatic retroperitoneal tumor, but subsequently felt to represent a vascular anomaly.
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Affiliation(s)
- Elizabeth Gunn
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christopher C Barnett
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Anh Teressa Duong
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elizabeth A Beierle
- Division of Pediatric Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David R Kelly
- Department of Pediatric Pathology and Laboratory Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yoginder N Vaid
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kimberly S Keene
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael Soike
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kimberly Whelan
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Sasaki M, Jung Y, North P, Elsey J, Choate K, Toussaint MA, Huang C, Radi R, Perricone AJ, Corces VG, Arbiser JL. Introduction of Mutant GNAQ into Endothelial Cells Induces a Vascular Malformation Phenotype with Therapeutic Response to Imatinib. Cancers (Basel) 2022; 14:cancers14020413. [PMID: 35053574 PMCID: PMC8773683 DOI: 10.3390/cancers14020413] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Mutations in GNAQ underlie vascular malformations, including Sturge-Weber disease. In order to develop novel therapies for lesions with mutant GNAQ, we introduced mutant GNAQ into MS1 endothelial cells. Mutant GNAQ conferred a novel phenotype of progressive vascular malformations in mice. Chromatin analysis revealed upregulation of C-Kit in the vascular endothelial cells, and we found C-Kit to be highly expressed in Sturge-Weber disease. Given that imatinib is an FDA approved multikinase inhibitor that blocks C-Kit, we evaluated it in our mouse model, and showed that imatinib had activity against these vascular malformations. Repurposing imatinib should be evaluated in clinical trials, including Sturge-Weber disease. Abstract GNAQ is mutated in vascular and melanocytic lesions, including vascular malformations and nevi. No in vivo model of GNAQ activation in endothelial cells has previously been described. We introduce mutant GNAQ into a murine endothelial cell line, MS1. The resultant transduced cells exhibit a novel phenotype in vivo, with extensive vasoformative endothelial cells forming aberrant lumens similar to those seen in vascular malformations. ATAC-seq analysis reveals activation of c-Kit in the novel vascular malformations. We demonstrate that c-Kit is expressed in authentic human Sturge–Weber vascular malformations, indicating a novel druggable target for Sturge–Weber syndrome. Since c-Kit is targeted by the FDA-approved drug imatinib, we tested the ability of imatinib on the phenotype of the vascular malformations in vivo. Imatinib treated vascular malformations are significantly smaller and have decreased supporting stromal cells surrounding the lumen. Imatinib may be useful in the treatment of human vascular malformations that express c-Kit, including Sturge–Weber syndrome.
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Affiliation(s)
- Maiko Sasaki
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA 30322, USA; (M.S.); (J.E.); (C.H.); (R.R.)
- Departments of Dermatology, Veterans Affairs Medical Center, Decatur, GA 30322, USA
| | - Yoonhee Jung
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA 30322, USA; (Y.J.); (V.G.C.)
| | - Paula North
- Department of Pathology, Laboratory Medicine Children’s Hospital of Wisconsin, Milwaukee, WI 53226, USA;
| | - Justin Elsey
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA 30322, USA; (M.S.); (J.E.); (C.H.); (R.R.)
| | - Keith Choate
- Departments of Dermatology, Pathology and Genetics, Yale University School of Medicine, New Haven, CT 06510, USA;
| | - Michael Andrew Toussaint
- Department of Pathology, Emory University School of Medicine, Atlanta, GA 30322, USA; (M.A.T.); (A.J.P.)
| | - Christina Huang
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA 30322, USA; (M.S.); (J.E.); (C.H.); (R.R.)
| | - Rakan Radi
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA 30322, USA; (M.S.); (J.E.); (C.H.); (R.R.)
| | - Adam J. Perricone
- Department of Pathology, Emory University School of Medicine, Atlanta, GA 30322, USA; (M.A.T.); (A.J.P.)
| | - Victor G. Corces
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA 30322, USA; (Y.J.); (V.G.C.)
| | - Jack L. Arbiser
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA 30322, USA; (M.S.); (J.E.); (C.H.); (R.R.)
- Departments of Dermatology, Veterans Affairs Medical Center, Decatur, GA 30322, USA
- Correspondence: ; Tel.: +1-(404)-727-5063; Fax: +1-(404)-727-0923
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Torrence D, Antonescu CR. The genetics of vascular tumours: an update. Histopathology 2022; 80:19-32. [PMID: 34958509 PMCID: PMC8950088 DOI: 10.1111/his.14458] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 01/03/2023]
Abstract
Recent molecular advances have shed significant light on the classification of vascular tumours. Except for haemangiomas, vascular lesions remain difficult to diagnose, owing to their rarity and overlapping clinical, radiographic and histological features across malignancies. In particular, challenges still remain in the differential diagnosis of epithelioid vascular tumours, including epithelioid haemangioma and epithelioid haemangioendothelioma at the benign/low-grade end of the spectrum, and epithelioid angiosarcoma at the high-grade end. Historically, the classification of vascular tumours has been heavily dependent on the clinical setting and histological features, as traditional immunohistochemical markers across the group have often been non-discriminatory. The increased application of next-generation sequencing in clinical practice, in particular targeted RNA sequencing (such as Archer, Illumina), has led to numerous novel discoveries, mainly recurrent gene fusions (e.g. those involving FOS, FOSB, YAP1, and WWTR1), which have resulted in refined tumour classification and improved diagnostic reproducibility for vascular tumours. However, other molecular alterations besides fusions have been discovered in vascular tumours, including somatic mutations (e.g. involving GNA family and IDH genes) in a variety of haemangiomas, as well as copy number alterations in high-grade angiosarcomas (e.g. MYC amplifications). Moreover, the translation of these novel molecular abnormalities into diagnostic ancillary markers, either fluorescence in-situ hybridisation probes or surrogate immunohistochemical markers (FOSB, CAMTA1, YAP1, and MYC), has been remarkable. This review will focus on the latest molecular discoveries covering both benign and malignant vascular tumours, and will provide practical diagnostic algorithms, highlighting frequently encountered pitfalls and challenges in the diagnosis of vascular lesions.
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Affiliation(s)
- Dianne Torrence
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Cristina R Antonescu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY,Corresponding author: Cristina R Antonescu, MD, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065,
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Omiyale AO. Primary vascular tumours of the kidney. World J Clin Oncol 2021; 12:1157-1168. [PMID: 35070735 PMCID: PMC8716994 DOI: 10.5306/wjco.v12.i12.1157] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/01/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
Primary vascular tumours of the kidney are rare and may pose diagnostic difficulties because of their similar clinical, morphological, and immunohistochemical features. This article summarizes the clinical and pathological features of primary renal angiosarcoma and anastomosing haemangioma of the kidney including epidemiology, genetics, and prognosis. Renal anastomosing haemangiomas are benign neoplasms characterized by anastomosing capillary-sized vascular channels. These tumours are rare, with about 75 cases reported in the literature. Most anastomosing haemangiomas are found incidentally on ultrasound, computed tomography, or magnetic resonance imaging. Common symptoms include abdominal pain, haematuria, and abdominal mass. Renal anastomosing haemangiomas are characterized by recurrent mutations in GNAQ and GNA14 genes. The prognosis of anastomosing haemangioma is excellent. Primary renal angiosarcomas are malignant tumours showing endothelial differentiation. To date, 76 cases have been described in the literature. Primary renal angiosarcomas are frequently symptomatic. The clinical features of renal angiosarcomas are similar to those of renal anastomosing haemangiomas, including abdominal pain, haematuria, and abdominal mass. Angiogenesis-related genes and vascular-specific receptor tyrosine kinases such as KDR, TIE1, SNRK, TEK, and FLT1 are upregulated in angiosarcomas. Primary renal angiosarcomas are highly aggressive neoplasms with a poor prognosis despite surgical treatment, chemotherapy, radiotherapy, or targeted therapy.
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Affiliation(s)
- Ayo O Omiyale
- Department of Cellular Pathology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, United Kingdom
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Abstract
In this article, the authors have reviewed all the recent news regarding how the discovery of some novel and recurrent molecular and genetic changes has modified the classification of some entities and have addressed to the description of new variants of vascular tumors. And even more important, the authors also reviewed on how these findings, in addition to gain insight into the tumoral biology, portend significant clinical consequences not only regarding to their diagnosis but also to their management and prognosis because some of these mutations are potential targets for treatment. The authors have also highlighted immunohistochemical markers can help us as a surrogate marker of those molecular alterations.
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36
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Gu W, Talevich E, Hsu E, Qi Z, Urisman A, Federman S, Gopez A, Arevalo S, Gottschall M, Liao L, Tung J, Chen L, Lim H, Ho C, Kasowski M, Oak J, Holmes BJ, Yeh I, Yu J, Wang L, Miller S, DeRisi JL, Prakash S, Simko J, Chiu CY. Detection of cryptogenic malignancies from metagenomic whole genome sequencing of body fluids. Genome Med 2021; 13:98. [PMID: 34074327 PMCID: PMC8167833 DOI: 10.1186/s13073-021-00912-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 05/20/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Metagenomic next-generation sequencing (mNGS) of body fluids is an emerging approach to identify occult pathogens in undiagnosed patients. We hypothesized that metagenomic testing can be simultaneously used to detect malignant neoplasms in addition to infectious pathogens. METHODS From two independent studies (n = 205), we used human data generated from a metagenomic sequencing pipeline to simultaneously screen for malignancies by copy number variation (CNV) detection. In the first case-control study, we analyzed body fluid samples (n = 124) from patients with a clinical diagnosis of either malignancy (positive cases, n = 65) or infection (negative controls, n = 59). In a second verification cohort, we analyzed a series of consecutive cases (n = 81) sent to cytology for malignancy workup that included malignant positives (n = 32), negatives (n = 18), or cases with an unclear gold standard (n = 31). RESULTS The overall CNV test sensitivity across all studies was 87% (55 of 63) in patients with malignancies confirmed by conventional cytology and/or flow cytometry testing and 68% (23 of 34) in patients who were ultimately diagnosed with cancer but negative by conventional testing. Specificity was 100% (95% CI 95-100%) with no false positives detected in 77 negative controls. In one example, a patient hospitalized with an unknown pulmonary illness had non-diagnostic lung biopsies, while CNVs implicating a malignancy were detectable from bronchoalveolar fluid. CONCLUSIONS Metagenomic sequencing of body fluids can be used to identify undetected malignant neoplasms through copy number variation detection. This study illustrates the potential clinical utility of a single metagenomic test to uncover the cause of undiagnosed acute illnesses due to cancer or infection using the same specimen.
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Affiliation(s)
- Wei Gu
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, 94107, USA.
- UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, 91407, USA.
- Department of Pathology, Stanford University, Stanford, CA, 94305, USA.
- Stanford Health Care, Stanford University, Stanford, CA, 94305, USA.
| | | | - Elaine Hsu
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, 94107, USA
| | - Zhongxia Qi
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, 94107, USA
| | - Anatoly Urisman
- Department of Pathology, University of California San Francisco, San Francisco, CA, 94107, USA
| | - Scot Federman
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, 94107, USA
- UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, 91407, USA
| | - Allan Gopez
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, 94107, USA
- UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, 91407, USA
| | - Shaun Arevalo
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, 94107, USA
- UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, 91407, USA
| | - Marc Gottschall
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, 94107, USA
| | - Linda Liao
- Stanford Health Care, Stanford University, Stanford, CA, 94305, USA
| | - Jack Tung
- Department of Pathology, Stanford University, Stanford, CA, 94305, USA
| | - Lei Chen
- Stanford Health Care, Stanford University, Stanford, CA, 94305, USA
| | - Harumi Lim
- Stanford Health Care, Stanford University, Stanford, CA, 94305, USA
| | - Chandler Ho
- Stanford Health Care, Stanford University, Stanford, CA, 94305, USA
| | - Maya Kasowski
- Department of Pathology, Stanford University, Stanford, CA, 94305, USA
| | - Jean Oak
- Department of Pathology, Stanford University, Stanford, CA, 94305, USA
- Stanford Health Care, Stanford University, Stanford, CA, 94305, USA
| | - Brittany J Holmes
- Department of Pathology, Stanford University, Stanford, CA, 94305, USA
- Stanford Health Care, Stanford University, Stanford, CA, 94305, USA
| | - Iwei Yeh
- Department of Pathology, University of California San Francisco, San Francisco, CA, 94107, USA
| | - Jingwei Yu
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, 94107, USA
| | - Linlin Wang
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, 94107, USA
| | - Steve Miller
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, 94107, USA
- UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, 91407, USA
| | - Joseph L DeRisi
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA, 94107, USA
- Chan Zuckerberg Biohub, San Francisco, CA, 94107, USA
| | - Sonam Prakash
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, 94107, USA
| | - Jeff Simko
- Department of Pathology, University of California San Francisco, San Francisco, CA, 94107, USA
| | - Charles Y Chiu
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, 94107, USA.
- UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, 91407, USA.
- Department of Medicine, Division of Infectious Diseases, University of California San Francisco, San Francisco, CA, 94107, USA.
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Jansen P, Müller H, Lodde GC, Zaremba A, Möller I, Sucker A, Paschen A, Esser S, Schaller J, Gunzer M, Standl F, Bauer S, Schadendorf D, Mentzel T, Hadaschik E, Griewank KG. GNA14, GNA11, and GNAQ Mutations Are Frequent in Benign but Not Malignant Cutaneous Vascular Tumors. Front Genet 2021; 12:663272. [PMID: 34040639 PMCID: PMC8141909 DOI: 10.3389/fgene.2021.663272] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/07/2021] [Indexed: 12/14/2022] Open
Abstract
Cutaneous vascular tumors consist of a heterogeneous group of benign proliferations, including a range of hemangiomas and vascular malformations, as well as heterogeneous groups of both borderline and malignant neoplasms such as Kaposi’s sarcoma and angiosarcomas. The genetics of these tumors have been assessed independently in smaller individual cohorts making comparisons difficult. In our study, we analyzed a representative cohort of benign vascular proliferations observed in a clinical routine setting as well as a selection of malignant vascular proliferations. Our cohort of 104 vascular proliferations including hemangiomas, malformations, angiosarcomas and Kaposi’s sarcoma were screened by targeted next-generation sequencing for activating genetic mutations known or assumed to be potentially relevant in vascular proliferations. An association analysis was performed for mutation status and clinico-pathological parameters. Frequent activating hotspot mutations in GNA genes, including GNA14 Q205, GNA11 and GNAQ Q209 were identified in 16 of 64 benign vascular tumors (25%). GNA gene mutations were particularly frequent (52%) in cherry (senile) hemangiomas (13 of 25). In angiosarcomas, activating RAS mutations (HRAS and NRAS) were identified in three samples (16%). No activating GNA or RAS gene mutations were identified in Kaposi’s sarcomas. Our study identifies GNA14 Q205, GNA11 and GNAQ Q209 mutations as being the most common and mutually exclusive mutations in benign hemangiomas. These mutations were not identified in malignant vascular tumors, which could be of potential diagnostic value in distinguishing these entities.
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Affiliation(s)
- Philipp Jansen
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Essen, Germany
| | | | - Georg C Lodde
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Essen, Germany
| | - Anne Zaremba
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Essen, Germany
| | - Inga Möller
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Essen, Germany
| | - Antje Sucker
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Essen, Germany
| | - Annette Paschen
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Essen, Germany
| | - Stefan Esser
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Essen, Germany
| | | | - Matthias Gunzer
- Institute for Experimental Immunology and Imaging, University Duisburg-Essen, Essen, Germany
| | - Fabian Standl
- Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), University of Duisburg-Essen, Essen, Germany
| | - Sebastian Bauer
- Department of Medical Oncology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Essen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Essen, Germany
| | - Thomas Mentzel
- Dermatopathologie Friedrichshafen, Friedrichshafen, Germany
| | - Eva Hadaschik
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Essen, Germany
| | - Klaus G Griewank
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Essen, Germany.,Dermatopathologie bei Mainz, Nieder-Olm, Germany
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Anderson WJ, Doyle LA. Updates from the 2020 World Health Organization Classification of Soft Tissue and Bone Tumours. Histopathology 2021; 78:644-657. [PMID: 33438273 DOI: 10.1111/his.14265] [Citation(s) in RCA: 136] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 12/16/2022]
Abstract
The fifth edition of the World Health Organization (WHO) classification of soft tissue and bone tumours was published in May 2020. This 'Blue Book', which is also available digitally for the first time, incorporates an array of new information on these tumours, amassed in the 7 years since the previous edition. Major advances in molecular characterisation have driven further refinements in classification and the development of ancillary diagnostic tests, and have improved our understanding of disease pathogenesis. Several new entities are also included. This review summarises the main changes introduced in the 2020 WHO classification for each subcategory of soft tissue and bone tumours.
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Affiliation(s)
- William J Anderson
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Leona A Doyle
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Rekhi B. Recent updates in the diagnosis of soft tissue tumors: Newly described tumor entities, newer immunohistochemical and genetic markers, concepts, including "inter-tumor relationships". INDIAN J PATHOL MICR 2021; 64:448-459. [PMID: 34341252 DOI: 10.4103/ijpm.ijpm_1361_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
During the last two decades, there have been significant strides in the diagnosis of soft tissue tumors, including identification of various tumor entities, newer immunohistochemical markers, and an increasing number of molecular signatures, defining certain tumors. Lately, there are certain emerging tumor entities, defined by their molecular features with an impact on treatment. At the same time, there is a certain degree of overlap in the expression of certain immunohistochemical antibody markers, as well as genetic markers, with certain gene rearrangements and chimeric fusions observed among completely different tumors. Moreover, a certain amount of clinicopathological, immunohistochemical, and molecular proximity has been unraveled among certain tumor types. Over the years, the World Health Organization (WHO) fascicles on tumors of soft tissue have succinctly brought out these aspects. The present review describes recent updates in the diagnosis of soft tissue tumors, including certain newly described tumor entities; emphasizing upon newer, specific immunohistochemical and molecular markers, along with concepts, regarding "intertumor relationships".
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Affiliation(s)
- Bharat Rekhi
- Department of Surgical Pathology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
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40
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Choi JH, Ro JY. The 2020 WHO Classification of Tumors of Soft Tissue: Selected Changes and New Entities. Adv Anat Pathol 2021; 28:44-58. [PMID: 32960834 DOI: 10.1097/pap.0000000000000284] [Citation(s) in RCA: 242] [Impact Index Per Article: 60.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Soft tissue tumors are a relatively rare and diagnostically challenging group of neoplasms that can have varying lines of differentiation. Accurate diagnosis is important for appropriate treatment and prognostication. In the 8 years since the publication of the 4th Edition of World Health Organization (WHO) classification of soft tissue tumors, significant advances have been made in our understanding of soft tissue tumor molecular biology and diagnostic criteria. The 5th Edition of the 2020 WHO classification of tumors of soft tissue and bone incorporated these changes. Classification of tumors, in general, but particularly in soft tissue tumors, is increasingly based on the molecular characteristics of tumor types. Understanding tumor molecular genetics improves diagnostic accuracy for tumors that have been difficult to classify on the basis of morphology alone, or that have overlapping morphologic features. In many large hospitals in the United States and Europe, molecular tests on soft tissue tumors are a routine part of diagnosis. Therefore, surgical pathologists should be familiar with newly emerging molecular genetic techniques in clinical settings. In the near future, molecular tests, particularly in soft tissue tumor diagnosis, will become as routine during diagnosis as immunohistochemistry is currently. This new edition provides an updated classification scheme and essential diagnostic criteria for soft tissue tumors. Newly recognized entities and subtypes of existing tumor types, several reclassified tumors, and newly defined molecular and genetic data have been incorporated. Herein, we summarize the updates in the WHO 5th Edition, focusing on major changes in each category of soft tissue tumor, and the newly described tumor entities and subtypes.
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Affiliation(s)
- Joon Hyuk Choi
- Department of Pathology, Yeungnam University College of Medicine, Daegu, South Korea
| | - Jae Y Ro
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX
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Functional characterization of uveal melanoma oncogenes. Oncogene 2020; 40:806-820. [PMID: 33262460 PMCID: PMC7856047 DOI: 10.1038/s41388-020-01569-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/05/2020] [Accepted: 11/11/2020] [Indexed: 02/07/2023]
Abstract
Uveal melanoma (UM) is a currently untreatable form of melanoma with a 50% mortality rate. Characterization of the essential signaling pathways driving this cancer is critical to develop target therapies. Activating mutations in the Gαq signaling pathway at the level of GNAQ, GNA11, or rarely CYSLTR2 or PLCβ4 are considered alterations driving proliferation in UM and several other neoplastic disorders. Here, we systematically examined the oncogenic signaling output of various mutations recurrently identified in human tumors. We demonstrate that CYSLTR2 → GNAQ/11 → PLCβ act in a linear signaling cascade that, via protein kinase C (PKC), activates in parallel the MAP-kinase and FAK/Yes-associated protein pathways. Using genetic ablation and pharmacological inhibition, we show that the PKC/RasGRP3/MAPK signaling branch is the essential component that drives the proliferation of UM. Only inhibition of the MAPK branch but not the FAK branch synergizes with inhibition of the proximal cascade, providing a blueprint for combination therapy. All oncogenic signaling could be extinguished by the novel GNAQ/11 inhibitor YM-254890, in all UM cells with driver mutation in the Gαq subunit or the upstream receptor. Our findings highlight the GNAQ/11 → PLCβ → PKC → MAPK pathway as the central signaling axis to be suppressed pharmacologically to treat for neoplastic disorders with Gαq pathway mutations.
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Zheng LP, Shen WA, Wang CH, Hu CD, Chen XJ, Shen YY, Wang J. Anastomosing hemangioma arising from the left renal vein: A case report. World J Clin Cases 2020; 8:4986-4992. [PMID: 33195671 PMCID: PMC7642539 DOI: 10.12998/wjcc.v8.i20.4986] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/14/2020] [Accepted: 09/09/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Anastomosing hemangioma (AH) is a rare subtype of benign hemangioma that is most commonly found in the genitourinary tract. Due to the lack of specific clinical and radiologic manifestations, it is easily misdiagnosed preoperatively. Here, we report a case of AH arising from the left renal vein that was discovered incidentally and confirmed pathologically, and then describe its imaging characteristics from a radiologic point of view and review its clinicopathologic features and treatment.
CASE SUMMARY A 74-year-old woman was admitted to our department for a left retroperitoneal neoplasm measuring 2.6 cm × 2.0 cm. Her laboratory data showed no significant abnormalities. A non-contrast-enhanced computed tomography (CT) scan showed a heterogeneous density in the neoplasm. Non-contrast-enhanced magnetic resonance imaging (MRI) revealed a heterogeneous hypointensity on T1-weighed images and a heterogeneous hyperintensity on T2-weighed images. On contrast-enhanced CT and MRI scans, the neoplasm presented marked septal enhancement in the arterial phase and persistent enhancement in the portal phase, and its boundary with the left renal vein was ill-defined. Based on these clinical and radiological manifestations, the neoplasm was initially considered to be a neurogenic neoplasm in the left retroperitoneum. Finally, the neoplasm was completely resected and pathologically diagnosed as AH.
CONCLUSION AH is an uncommon benign hemangioma. Preoperative misdiagnoses are common not only because of a lack of specific clinical and radiologic manifestations but also because clinicians lack vigilance and diagnostic experience in identifying AH. AH is not exclusive to the urogenital parenchyma. We report the first case of this neoplasm in the left renal vein. Recognition of this entity in the left renal vein can be helpful in its diagnosis and distinction from other neoplasms.
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Affiliation(s)
- Li-Ping Zheng
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Wei-Ai Shen
- University of Ningbo, Ningbo 315000, Zhejiang Province, China
| | - Chun-Hua Wang
- Department of Pathology, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Chun-Dong Hu
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Xu-Jian Chen
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Yi-Yu Shen
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Jing Wang
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
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Congenital hepatic hemangiomas: Clinical, histologic, and genetic correlation. J Pediatr Surg 2020; 55:2170-2176. [PMID: 32115227 DOI: 10.1016/j.jpedsurg.2020.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/27/2019] [Accepted: 02/07/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The guide for monitoring and treatment of congenital hepatic hemangiomas (CHH) will depend on the subtype and the postnatal clinical behavior. Our aim is to present a series of CHH and characterize its clinical, histologic and genetic correlation, compared to cutaneous congenital hemangiomas (CCH). MATERIAL AND METHODS A retrospective review of CHH patients diagnosed between 1991 and 2018 was performed. Clinical, morphological and histological data were analyzed and deep high-throughput sequencing was performed. MAIN RESULTS Sixteen patients with CHH were included. Five patients were followed up with serial ultrasounds while pharmacological treatment (corticosteroids and propranolol) was decided in five. Surgical resection was performed in five owing to hemorrhage and suspicion of malignancy, and the last patient underwent embolization. Histologic analysis was available in 7 patients and confirmed CHH, showing two different histological patterns that could be associated with the presence of somatic pathogenic variants in GNAQ and/or PIK3CA detected in the genetic testing. Review of 7 samples of CCH revealed some histologic differences compared to CHH. CONCLUSION CHH resemble its cutaneous homonym with similar clinical behavior. Histologic analysis can differentiate two subgroups while genetic testing can confirm mutations in GNAQ and in PIK3CA in a subset of CHH. TYPE OF STUDY Treatment study. LEVEL OF EVIDENCE IV.
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Paral K, Krausz T. Vascular tumors of the mediastinum. MEDIASTINUM (HONG KONG, CHINA) 2020; 4:25. [PMID: 35118293 PMCID: PMC8794384 DOI: 10.21037/med-20-40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 07/16/2020] [Indexed: 01/09/2023]
Abstract
Vascular tumors represent only a sliver of all tumors affecting the mediastinum, but they pose diagnostic challenges due to significant overlap among entities, ever-evolving classification schemes, and the exquisite rarity of some of the entities not only in the mediastinum but in pathology practice as a whole. Most of the vascular tumors are better known to the practice of soft tissue pathology, from which some of the knowledge of clinical behavior can be extrapolated. For example, the stratification of epithelioid hemangioendothelioma (EHE) into two biologically separate categories has effectively translated from the somatic soft tissues to the thorax. For other entities, the effective validation of soft tissue parameters is hindered by the small numbers of reported mediastinal cases. Many of the treatment modalities have also transferred over, with the key differences resting on the difficulty in achieving complete surgical resection for mediastinal tumors as opposed to those in the somatic soft tissues. Accordingly, systemic drug therapies have emerged as attractive options for some of the mediastinal vascular tumors, such as kaposiform hemangioendothelioma (KHE) and Kaposi sarcoma (KS). The categories presented herein mirror the classification scheme set forth by the 5th Edition WHO Classification of Soft Tissue and Bone Tumors. This review focuses on the biologically aggressive vascular neoplasms while limiting discussion of the benign entities to relevant comparisons in the differential diagnoses. While distinguishing among the benign entities has academic importance, in practice, the stakes are far higher for diagnosing the biologically aggressive tumors given their marked heterogeneity in clinical outcomes. Practical advice for problem areas in pathology will be reviewed alongside tumor pathobiology, including the latest in molecular diagnostics.
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Affiliation(s)
- Kristen Paral
- Section of Dermatopathology, Consolidated Pathology Consultants, Libertyville, IL, USA
| | - Thomas Krausz
- Department of Pathology, University of Chicago, Chicago, IL, USA
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Gaeta R, Lessi F, Mazzanti C, Modena M, Garaventa A, Boero S, Michelis MB, Capanna R, Aretini P, Franchi A. Diffuse bone and soft tissue angiomatosis with GNAQ mutation. Pathol Int 2020; 70:452-457. [PMID: 32314513 DOI: 10.1111/pin.12933] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/18/2020] [Accepted: 03/25/2020] [Indexed: 12/15/2022]
Abstract
We describe a unique case of skeletal and extraskeletal angiomatosis complicated by Kasabach-Merritt syndrome. The patient was a 3-year-old boy, who presented with involvement of both femurs and left tibia, as well as with soft tissue lesions of the left thigh. At birth, multiple hemangiomas of the soft tissues of the frontal and parietal scalp had been identified, together with a space-occupying lesion of the lung. Histologically, the skeletal and soft tissue lesions consisted of a proliferation of thin-walled, dilated blood vessels, with an endothelial lining devoid of atypia and exhibiting immunoreactivity for CD31 and CD34, while podoplanin and GLUT1 were negative. Whole exome sequencing performed on samples from the lesion of the femur, the tibia and the skin of the thigh, showed a GNAQ (c.286A>T:p.T96S) variant in all specimens, that was confirmed with digital droplet PCR. This case expands the clinical and pathologic spectrum of vascular proliferations showing similar molecular biology, characterized by GNAQ, GNA11 or GNA14 mutations.
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Affiliation(s)
- Raffaele Gaeta
- Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,Genomic Section, Fondazione Pisana per la Scienza, Pisa, Italy
| | - Francesca Lessi
- Genomic Section, Fondazione Pisana per la Scienza, Pisa, Italy
| | - Chiara Mazzanti
- Genomic Section, Fondazione Pisana per la Scienza, Pisa, Italy
| | - Martina Modena
- Genomic Section, Fondazione Pisana per la Scienza, Pisa, Italy.,Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | - Silvio Boero
- Department of Paediatric Orthopaedics, IRCCS Istituto Giannina Gaslini, ItalyBond-ERN (European Reference Network for Bone and Muscoloskeletal Rare Disease), Genoa, Italy
| | - Maria Beatrice Michelis
- Department of Paediatric Orthopaedics, IRCCS Istituto Giannina Gaslini, ItalyBond-ERN (European Reference Network for Bone and Muscoloskeletal Rare Disease), Genoa, Italy
| | - Rodolfo Capanna
- Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Paolo Aretini
- Genomic Section, Fondazione Pisana per la Scienza, Pisa, Italy
| | - Alessandro Franchi
- Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Johnstone KJ, Strutton GM, Perry-Keene JL, Hazratwala K, Delahunt B. Multifocal anastomosing haemangioma of the kidney with intravascular growth and sinus fat invasion: a rare benign mimic of angiosarcoma. Pathology 2020; 52:394-396. [PMID: 32111399 DOI: 10.1016/j.pathol.2020.01.681] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/22/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Kate J Johnstone
- Pathology Queensland, Princess Alexandra Hospital Laboratory, Woolloongabba, Qld, Australia; School of Medicine, The University of Queensland, Herston, Qld, Australia.
| | - Geoffrey M Strutton
- Pathology Queensland, Princess Alexandra Hospital Laboratory, Woolloongabba, Qld, Australia
| | - Joanna L Perry-Keene
- Aquesta Specialised Uropathology, Toowong, Qld, Australia; Pathology Queensland, Sunshine Coast University Hospital Laboratory, Birtinya, Qld, Australia
| | - Kiran Hazratwala
- Northern Urology Clinic, Mater Medical Centre, Pimlico, Qld, Australia
| | - Brett Delahunt
- Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
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Stewart CJR, Salfinger SG. Anastomosing haemangioma of the ovary with hilus cell hyperplasia. Pathology 2020; 52:392-394. [PMID: 32107081 DOI: 10.1016/j.pathol.2019.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 11/21/2019] [Indexed: 10/24/2022]
Affiliation(s)
- Colin J R Stewart
- Department of Histopathology, King Edward Memorial Hospital, Perth, WA, Australia; School of Women's and Infants' Health, University of Western Australia, WA, Australia.
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Lin MS, Ngo T, Schwartz MR, Mehta RR, Ayala AG, Ro JY. Anastomosing Hemangioma of the Breast: An Unusual Case at an Unusual Site. J Breast Cancer 2020; 23:326-330. [PMID: 32595995 PMCID: PMC7311365 DOI: 10.4048/jbc.2020.23.e15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/05/2020] [Indexed: 11/30/2022] Open
Abstract
Anastomosing hemangioma (AH) is an unusual benign vascular lesion that commonly occurs in the kidney and genitourinary tract. We report a case of AH in a 49-year-old woman presenting as a mass in the breast, a site which, to the best of our knowledge, has not been previously documented in the English literature. Microscopic examination of the mass revealed a well-demarcated proliferation of anastomosing vascular spaces lined by bland endothelial cells, with focal hobnailing and scattered intravascular fibrin thrombi. No mitotic activity was observed and the Ki-67 proliferative index was low. These features were interpreted as AH, a lesion that may be difficult to distinguish from low-grade angiosarcoma or other benign vascular lesions of the breast which may demonstrate anastomosing channels. Due to the presence of atypical histologic features which can raise suspicion for angiosarcoma on biopsy, complete excision of these lesions is recommended for optimal treatment.
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Affiliation(s)
- Michelle S Lin
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, Texas, USA
| | - Thu Ngo
- Department of Pathology, Houston Methodist West Hospital, Houston, Texas, USA
| | - Mary R Schwartz
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, Texas, USA
| | - Rajul R Mehta
- Department of Radiology, Houston Methodist Hospital, Houston, Texas, USA
| | - Alberto G Ayala
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, Texas, USA
| | - Jae Y Ro
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, Texas, USA
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Linos K. Sarcomas. Genomic Med 2020. [DOI: 10.1007/978-3-030-22922-1_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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50
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Liau JY, Tsai JH, Lan J, Chen CC, Wang YH, Lee JC, Huang HY. GNA11 joins GNAQ and GNA14 as a recurrently mutated gene in anastomosing hemangioma. Virchows Arch 2019; 476:475-481. [DOI: 10.1007/s00428-019-02673-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/28/2019] [Accepted: 09/22/2019] [Indexed: 12/13/2022]
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