1
|
Endo T, Katsuno H, Kikuchi K, Ochi T, Matsuo K, Suzuki K, Yasuoka H, Nakano Y, Nakagawa M, Kuroda M, Morise Z. Intravascular papillary endothelial hyperplasia in the cecum: a case report. Surg Case Rep 2022; 8:179. [PMID: 36155876 PMCID: PMC9510079 DOI: 10.1186/s40792-022-01512-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background Intravascular papillary endothelial hyperplasia (IPEH), also known as Masson's tumor, is a benign, non-neoplastic vascular lesion that is characterized by reactive proliferation of papillary endothelial cells associated with a thrombus. These lesions typically develop in the vascular regions of the head and neck, oral cavity, or extremities; however, other organ systems have been affected. IPEH in the gastrointestinal tract is rare, with only a few cases reported to date. Thus, the pathogenesis and clinical features of IPEH in the gastrointestinal tract are not entirely understood. Moreover, the local excision of certain subtypes of IPEH can be curative; this makes timely diagnosis essential. We present the case of a patient with IPEH in the cecum that was discovered while investigating the cause of severe anemia. Case presentation A 29-year-old woman visited a general practitioner (GP) with the complaint of abdominal pain. She was diagnosed with acute appendicitis and was prescribed antibiotics. After treatment, her abdominal pain disappeared. However, she was found to be severely anemic (hemoglobin level, 6.5 g/dl). To determine the cause of her anemia, the GP referred her to our hospital for further examination and treatment. Computed tomography scan revealed cecal wall thickening. Further, a lower gastrointestinal endoscopy revealed a 2-cm raised mass-like lesion in the cecum. This lesion was pathologically identified as an inflammatory granuloma. The cause of her anemia was determined to be bleeding from the lesion in the cecum. She underwent laparoscopic ileocecal resection. Histopathological examination of the surgical specimen revealed a spongy structure comprising many small papillary fibrous tissues lined by a typical monolayer endothelium. Further, immunohistochemical analysis showed that the cells of the endothelium monolayer expressed CD31, CD34. The Ki-67 labeling index was < 1%. Based on these findings, the lesion was identified as an IPEH in the cecum. The patient’s postoperative course was uneventful, and there was no evidence of recurrence during the 1.3 years of follow-up. Conclusions IPEH rarely arises within the abdominal cavity. Surgery remains the only treatment for IPEH and is associated with an excellent prognosis and a low recurrence rate. More aggressive lesions such as angiosarcoma should be excluded when considering the histologic diagnoses of IPEH, and expert pathologic review is vital. This is the first report of IPEH occurring in the cecum and represents a novel cause of gastrointestinal bleeding which the clinician should consider when evaluating a patient with atypical or difficult gastrointestinal bleeding sources.
Collapse
|
2
|
Gu HL, Zheng XQ, Zhan SQ, Chang YB. Intravascular papillary endothelial hyperplasia as a rare cause of cervicothoracic spinal cord compression: A case report. World J Clin Cases 2021; 9:10681-10688. [PMID: 35005001 PMCID: PMC8686137 DOI: 10.12998/wjcc.v9.i34.10681] [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: 04/20/2021] [Revised: 06/28/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intravascular papillary endothelial hyperplasia (IPEH) is a rare benign reactive vascular lesion that grows into an expansile compressing mass. It most commonly involves the skin and subcutaneous tissue. Spinal involvement is rare, with only 11 reported cases in the literature. We report, to our knowledge, the first case of IPEH in the cervicothoracic spinal canal and present a literature review.
CASE SUMMARY A 27-year-old man presented with acute-onset neck pain, numbness, and weakness in his extremities. Magnetic resonance imaging showed an epidural mass in the cervicothoracic (C6-T1) spinal canal and vertebral hemangioma (VH) involving the C7 vertebral body. C6-T1 Laminectomy and radical excision of the mass were performed. Histopathological examinations revealed papillary proliferation of vascular endothelial cells with thrombus formation, and an IPEH diagnosis was made. By his 6-mo follow-up appointment, his symptoms were relieved without recurrence. The possible pathogenesis, clinical and imaging features, differential diagnosis, and management of IPEH were reviewed.
CONCLUSION We report, to our knowledge, the first case of IPEH in the cervicothoracic spinal canal, treated via complete resection, and showing a favorable outcome. We found a causal relationship between spinal IPEH and VH; this partly explains the mechanism of IPEH.
Collapse
Affiliation(s)
- Hong-Lin Gu
- Department of Spine Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Xiao-Qing Zheng
- Department of Spine Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Shi-Qiang Zhan
- Department of Spine Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Yun-Bing Chang
- Department of Spine Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| |
Collapse
|
3
|
Safa R, Garcia R, Delius R, Kaur G, Youssef L, Poulik J, Shehata BM. Intravascular Papillary Endothelial Hyperplasia in the Coronary Artery: An Unusual Cause of Massive Myocardial Infarction in Hypoplastic Left Heart Syndrome. Fetal Pediatr Pathol 2019; 38:511-517. [PMID: 31084387 DOI: 10.1080/15513815.2019.1613704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Intravascular papillary endothelial hyperplasia (IPEH) is a benign vascular lesion that usually involves the head and neck or extremities. Involvement of the coronary arterial system is unreported. Case: A 1-month-old patient born with hypoplastic left heart syndrome died from a massive myocardial infarction shortly after first stage palliation with Norwood/Sano. Autopsy demonstrated a massive univentricular hemorrhagic infarction with complete occlusion of the left main coronary artery and its intramural branches by intraluminal papillary endothelial hyperplasia (IPEH). Immunostaining with CD34 and CD31 confirmed the diagnosis. The inferior and superior mesenteric artery branches also had IPEH. Conclusion: IPEH can involve the coronary vasculature, can be multifocal and can occur in the newborn.
Collapse
Affiliation(s)
- Raya Safa
- Children's Hospital of Michigan, Pediatric Cardiology and Critical Care, Detroit, United States
| | - Richard Garcia
- Children's Hospital of Michigan, Pediatric Cardiology and Critical Care, Detroit, United States
| | - Ralph Delius
- Children's Hospital of Michigan, Pediatric Pathology, Detroit, United States
| | - Gunjanpreet Kaur
- Children's Hospital of Michigan, Pediatric Pathology, Detroit, United States
| | | | - Janet Poulik
- Children's Hospital of Michigan, Pediatric Pathology, Detroit, United States
| | - Bahig M Shehata
- Children's Hospital of Michigan, Pediatric Pathology, Detroit, United States
| |
Collapse
|
4
|
Mirmohammadsadeghi H, Mashhadiabbas F, Latifi F. Huge central intravascular papillary endothelial hyperplasia of the mandible: a case report and review of the literature. J Korean Assoc Oral Maxillofac Surg 2019; 45:180-185. [PMID: 31508349 PMCID: PMC6728626 DOI: 10.5125/jkaoms.2019.45.4.180] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/27/2018] [Accepted: 12/20/2018] [Indexed: 01/23/2023] Open
Abstract
Masson's tumor or intravascular papillary endothelial hyperplasia is an inflammatory soft tissue lesion that rarely occurs in the maxillofacial region and skeletal system. Precise clinical and para-clinical investigation is necessary for the accurate diagnosis and correct treatment of this lesion. This paper presents a massive intravascular papillary endothelial hyperplasia lesion in the bony tissue of the mandible. Histopathology features, clinical appearance, and suitable management are discussed, with a complete review of the literature. The patient underwent composite resection of the lesion as well as reconstruction. No recurrence was observed during 6 years of follow-up. To the best of our knowledge, this is the fourth case of Masson's tumor in mandibular skeletal tissue, which has unique and distinctive features due to its size and location. A rare occurrence in skeletal tissue, complex clinical presentations, and complicated histopathologic findings present diagnostic challenges for treatment of this lesion.
Collapse
Affiliation(s)
- Hassan Mirmohammadsadeghi
- Department of Oral and Maxillofacial Surgery, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Mashhadiabbas
- Department of Oral and Maxillofacial Pathology, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Latifi
- Department of Oral and Maxillofacial Surgery, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
5
|
Han Y, Yun S, Choi IH. Intravascular papillary endothelial hyperplasia occurring in the foot: A case report and review of literature. Medicine (Baltimore) 2019; 98:e16391. [PMID: 31305445 PMCID: PMC6641681 DOI: 10.1097/md.0000000000016391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Intravascular papillary endothelial hyperplasia (IPEH; Masson tumor) is a type of vascular lesions composed of reactive proliferation of endothelial cells that occur in organizing thrombus. It commonly occurs on the head, neck, trunk, and upper extremities, but rarely in the foot. PATIENT CONCERNS A 38-year-old woman visited the hospital with a mass on the dorsum of right foot, which gradually increased in size 3 months ago. DIAGNOSES Ultrasonographic examination suggested angiomyolipoma or hemangioma. INTERVENTIONS The patient underwent excision under local anesthesia. OUTCOMES The lesion was confirmed to be IPEH by histological examination. There were no complications or recurrences after successful surgical excision. LESSONS IPEH presenting on the dorsum of the foot is vary uncommon. Radiologic diagnosis may be limited for diagnosis, and histologic confirmation should be made after surgical excision. There are some reports suggesting an association between trauma and IPEH occurrence, but this is not yet conclusive.
Collapse
Affiliation(s)
| | - Sangchul Yun
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | | |
Collapse
|
6
|
Intravascular Papillary Endothelial Hyperplasia (Masson's Tumor) Within Cauda Equina. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2019; 2:e087. [PMID: 30656267 PMCID: PMC6324899 DOI: 10.5435/jaaosglobal-d-17-00087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective: To describe a rare case of intravascular papillary endothelial hyperplasia (IPEH), also called as Masson's tumor, in a patient with the cauda equina syndrome presenting with low back pain and leg pain. Summary of Background Data: There are no studies that have reported a case of IPEH within the cauda equina. Methods: A 40-year-old man with no prior medical history presented with low back pain and leg pain beginning approximately 5 years ago and a month ago, respectively. MRI revealed a mass at the L2-L3 level that was isointense on T1-weighted images and hypointense with partial areas of high signal intensity on T2-weighted images. A myelogram demonstrated an intradural lesion without any respiratory fluctuation of tumor position, thereby suggesting a metastatic lesion; however, no abnormalities were found on a full-body CT scan or serum investigations for tumor markers. Therefore, surgery was performed on the lesion, within the cauda equina, for diagnosis as well as treatment. Results: Histopathological examination of the excised tumor indicated IPEH. The symptoms and quality of life improved postoperatively; there was no recurrence of the lesion. Conclusion: This is the first report of an IPEH intradural lesion within the cauda equina. Study Design: Case report
Collapse
|
7
|
Multiple Intravascular Papillary Endothelial Hyperplasia of Bone Mimicking Malignancy on 99mTc-MDP Bone Scan and 18F-FDG PET/CT. Clin Nucl Med 2018; 44:e151-e153. [PMID: 30371572 DOI: 10.1097/rlu.0000000000002364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Multiple intravascular papillary endothelial hyperplasia involved with bone is rare. In this study, we present the case of a 53-year-old woman having occasional chest pains located in the middle of the sternum and the left chest wall. Multiple intravascular papillary endothelial hyperplasia lesions with high metabolism distributed in the sternum, left ribs, 12th thoracic vertebra, and left ilium on bone scintigraphy as well as PET/CT, which were easily misdiagnosed as bone malignant tumors. Increased awareness of this benign lesion and its high metabolic findings will improve preoperative diagnosis and avoid misinterpretation that may lead to an unnecessary invasive treatment.
Collapse
|
8
|
Intravascular Papillary Endothelial Hyperplasia of the Jejunum as a Cause of Obscure-Overt Gastrointestinal Bleeding. ACG Case Rep J 2017; 4:e80. [PMID: 28670594 PMCID: PMC5482909 DOI: 10.14309/crj.2017.80] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 04/04/2017] [Indexed: 12/20/2022] Open
Abstract
Intravascular papillary endothelial hyperplasia (IPEH), or Masson’s tumor, is a rare, benign vascular lesion characterized by reactive endothelial proliferation with venous stasis and thrombus. Lesions typically arise in vascular regions of the head and neck or extremities, but involvement of other organ systems has been reported. Clinically, IPEH mimics other benign lesions (hemangiomas) and malignant neoplasms (angiosarcoma) depending on the affected site. Diagnosis is essential because local excision of certain IPEH subtypes is curative. IPEH in the gastrointestinal tract is rare with few reported cases. We present a case of obscure-overt gastrointestinal bleeding from IPEH of the jejunum.
Collapse
|
9
|
Sung J, Kim JY, Yoo C. Intravascular papillary endothelial hyperplasia: magnetic resonance imaging of finger lesions. Skeletal Radiol 2016; 45:235-42. [PMID: 26603891 DOI: 10.1007/s00256-015-2296-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 11/08/2015] [Accepted: 11/15/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe magnetic resonance imaging (MRI) features of intravascular papillary endothelial hyperplasia (IPEH), to identify findings differentiating IPEH of the finger from that of other locations, and to correlate these with pathology. MATERIALS AND METHODS Nineteen patients with 20 I.E. masses of the finger (n = 13) and other locations (n = 7) were evaluated. All patients underwent MRI, and the results were correlated with pathology. RESULTS Seventeen IPEHs, including all IPEHs of the finger, were located in the subcutis, the three other lesions in the muscle layer. On T1WI, all masses were isointense or slightly hyperintense. IPEHs of the finger (n = 13) revealed focal hyperintense nodules (n = 2) or central hypointensity (n = 2) on T1WI, hypointensity with a hyperintense rim (n = 7), hyperintensity with hypointense nodules (n = 5), or isointensity with a hypointense rim (n = 1) on T2WI, and rim enhancement (n = 5), heterogeneous enhancement with nodular nonenhanced areas (n = 6), peripheral nodular enhancement (n = 1), or no enhancement (n = 1) on gadolinium-enhanced T1WI. IPEHs of other locations (n = 7) demonstrated focal hyperintense nodules (n = 5) on T1WI, hyperintensity with hypointense nodules (n = 5) or heterogeneous signal intensity (n = 2) on T2WI, and rim or rim and septal enhancement (n = 6) or peripheral nodular enhancement (n = 1). Microscopically, IPEHs were composed of thrombi that were hypointense on T2WI and papillary endothelial proliferations that showed T2 hyperintensity and enhancement. CONCLUSION MRI of finger IPEH reveals well-demarcated subcutaneous masses with hypointensity or hypointense nodules with peripheral hyperintensity on T2WI, as well as peripheral enhancement. T1 hyperintense nodules, internal heterogeneity on T2WI, and septal enhancement are more common in IPEH of other locations.
Collapse
Affiliation(s)
- Jinkyeong Sung
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93, Jungbu-daero, Paldal-gu, Suwon, Gyeonggi-do, 442-723, South Korea
| | - Jee-Young Kim
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93, Jungbu-daero, Paldal-gu, Suwon, Gyeonggi-do, 442-723, South Korea.
| | - Changyoung Yoo
- Department of Hospital Pathology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93, Jungbu-daero, Paldal-gu, Suwon, Gyeonggi-do, 442-723, South Korea
| |
Collapse
|
10
|
Xu SS, Li D. Radiological imaging of florid intravascular papillary endothelial hyperplasia in the mandibule: case report and literature review. Clin Imaging 2013; 38:364-6. [PMID: 24461559 DOI: 10.1016/j.clinimag.2013.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 12/08/2013] [Accepted: 12/13/2013] [Indexed: 12/27/2022]
Abstract
Intravascular papillary endothelial hyperplasia was a rare benign vascular proliferative process as a result of papillary proliferation of the endothelial cells within the vessels. To our knowledge, we reported the second case occurring in the madibule, and the first reported in 1984 in the literature. We discussed manifestations of multislice computed tomography and panoramic radiography about the lesion and relevant literature was reviewed.
Collapse
Affiliation(s)
- Sheng-Sheng Xu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
| | - Dan Li
- Department of Pathology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| |
Collapse
|
11
|
Jazaerly T, Jaratli H, Sakr W, Almardini N, Urabi M, Dhar N, Giorgadze T. Intravascular papillary endothelial hyperplasia of the bladder: Case report and review of the literature. Avicenna J Med 2012; 1:55-7. [PMID: 23210010 PMCID: PMC3507062 DOI: 10.4103/2231-0770.90917] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Intravascular papillary endothelial hyperplasia (IPEH), also known as Masson's tumor, is a benign unusual vascular lesion thought to arise from an organizing thrombus. Histologically, IPEH is characterized by papillary fronds lined by proliferating endothelium that may mimic angiosarcoma, and therefore the correct diagnosis may prevent unnecessary radical procedures. Involvement of the bladder is extremely rare, with only three cases reported in the literature. We report a case of IPEH arising in the bladder of a patient with history of prostate cancer treated with radiotherapy.
Collapse
Affiliation(s)
- Tarek Jazaerly
- Department of Pathology, Wayne State University, Detroit Medical Center, MI, USA
| | | | | | | | | | | | | |
Collapse
|
12
|
Fontes A, Campos MS, de Sousa SCOM, Martins MT, Nunes FD. Diagnostic implications of oral intravascular papillary endothelial hyperplasia. Odontology 2011; 99:92-97. [DOI: 10.1007/s10266-010-0150-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Accepted: 07/04/2010] [Indexed: 12/21/2022]
|
13
|
Differentiation of vascular tumors from vascular malformations by expression of Wilms tumor 1 gene: evaluation of 126 cases. J Am Acad Dermatol 2010; 63:1052-7. [PMID: 21093662 DOI: 10.1016/j.jaad.2009.12.017] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Revised: 11/26/2009] [Accepted: 12/01/2009] [Indexed: 11/23/2022]
Abstract
BACKGROUND Vascular tumors and malformations can be challenging to diagnose. Although they may initially appear very similar, they have distinct clinical courses and management. Wilms tumor 1 (WT1) gene expression has been reported in many different tumors including hematologic malignancies and some solid tumors. OBJECTIVE We sought to evaluate the expression of WT1 in 126 vascular lesions (64 vascular tumors, one Masson tumor, and 61 vascular malformations). METHODS Based on the International Society for the Study of Vascular Anomalies classification of vascular anomalies, we studied the expression of WT1 in vascular tumors composed of infantile hemangioma, congenital hemangiomas (non-involuting, rapidly involuting, and not otherwise specified), pyogenic granuloma, tufted angioma, cherry angioma, Kaposi sarcoma, and angiosarcoma. We also studied WT1 expression in vascular malformations composed of angiokeratoma/verrucous hemangioma, combined vascular malformations, venous malformations, glomuvenous malformations, lymphatic malformations/lymphangioma, telangiectasia, and targetoid hemosiderotic hemangioma. RESULTS All vascular tumors and proliferations had positive WT1 cytoplasmic endothelial immunostaining whereas only 3 vascular malformations were WT1 positive. Moreover the positivity of WT1 in these vascular malformations was focal and involved only re-endothelialized neovessels within thrombi. LIMITATIONS The low number of malignant vascular tumors is a limitation. CONCLUSIONS Immunohistochemical detection of WT1 could be a useful tool to routine evaluation of vascular anomalies allowing the distinction of vascular tumors and proliferations from vascular malformations. Staining for WT1 may guide the clinician in difficult cases, as positive results would suggest a proliferative vascular lesion whereas negative results might point to a vascular malformation.
Collapse
|