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Li T. Pancreatic cavernous hemangioma complicated with chronic intracapsular spontaneous hemorrhage: A case report and review of literature. World J Clin Cases 2023; 11:5615-5621. [PMID: 37637682 PMCID: PMC10450382 DOI: 10.12998/wjcc.v11.i23.5615] [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: 06/08/2023] [Revised: 07/11/2023] [Accepted: 07/25/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Pancreatic cavernous hemangioma (pCH) is a rare type of benign vascular tumor. Making the right diagnosis is challenging due to low clinical suspicion and the lack of existing cross-sectional imaging tools to distinguish it from other pancreatic lesions. CASE SUMMARY We describe a male patient, age 18, who presented with a pCH. Computed tomography, magnetic resonance imaging, and ultrasound showed cystic space in the tail of the pancreas. A dark spot sign on the T2 weighted image sequence was observed. Clinically, a mucinous cystic neoplasm with hemorrhage was suspected preoperatively by combining imaging, and the operative indication was clear. The patient underwent a distal pancreatic tumor resection under laparoscopic control. Immunohistochemical staining for CD31 and CD34 was positive; D2-40 was positive in interstitial lymphatic vessels and negative in vascular epithelial cells; and calcium-binding protein was negative. The results support the diagnosis of pCH combined with chronic intracapsular spontaneous hemorrhage. No complications or recurrences were observed during the follow-up period. CONCLUSION Chronic spontaneous hemorrhage may occur in pCH, which may greatly influence the accuracy of diagnosis using imaging modalities. Surgical resection for uncertain pCH seems reasonable with a good outcome.
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Affiliation(s)
- Ting Li
- Department of Radiology, Yongkang First People’s Hospital, Yongkang 321300, Zhejiang Province, China
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2
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Langmaid T, Ellis S, Fisher L, Pilgrim C. Conservative management of adult pancreatic haemangioma: case study and literature review. BMJ Case Rep 2021; 14:14/1/e239147. [PMID: 33500307 PMCID: PMC7839894 DOI: 10.1136/bcr-2020-239147] [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: 01/28/2023] Open
Abstract
Pancreatic haemangiomas are a rare cause of pancreatic lesions in adults. Diagnosis is challenging as they are seldom suspected and difficult to differentiate on imaging. Historically, pancreatic haemangiomas have been managed surgically despite their benign nature, largely due to diagnostic uncertainty. We present the case of a 69-year-old woman who, through combination of radiological, biochemical and endoscopic investigations, was diagnosed with pancreatic haemangioma and managed conservatively, avoiding the morbidity and mortality associated with surgical resection of a benign lesion.
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Affiliation(s)
- Tess Langmaid
- Department of General Surgery, Hepato Pancreato Billiary Unit, Alfred Health, Melbourne, Victoria, Australia
| | - Samantha Ellis
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Leon Fisher
- Department of Gastroenterology, Cabrini Health, Malvern, Victoria, Australia
| | - Charles Pilgrim
- Department of General Surgery, Hepato Pancreato Billiary Unit, Alfred Health, Melbourne, Victoria, Australia
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Zhou J, Chen Z. Rare adult pancreatic hemangioma: review of the literature with a case report. Gland Surg 2020; 9:1596-1604. [PMID: 33224837 DOI: 10.21037/gs-20-281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Adult pancreatic hemangioma is an especially rare benign tumor that is hard to diagnose through imaging examinations, meanwhile its histopathological and immunohistochemical studies have rarely been reported. At this time, only 29 cases in 27 publications have been reported. We report a new case as well as review these literatures. A 71-year-old woman came to our hospital with slight pain on left upper abdomen for three days. But the results obtained from the physical or laboratory examination were all negative so that her symptoms could not be explained clearly. The imaging examinations including ultrasonography and computed tomography both showed a mixed mass in the neck of the pancreas. The preoperative diagnosis of cystadenoma or adenocarcinoma was made, with high suspicious of malignancy. The patient underwent a central pancreatectomy with pancreatojejunostomy, but the pathologic diagnosis was pancreatic hemangioma. The immunohistochemical examination found the positive benign vascular markers (CD31, CD34) and negative lymphocyte markers (D2-40). Moreover, Ki-67 negativity also revealed its benign nature. After 36 months of follow-up, the patient has no complaints for abdominal pain. In conclusion, adult pancreatic hemangioma is extremely rare without any specific clinical manifestations. It is usually diagnosed postoperatively by histological examination and immunohistochemical studies. Imaging examinations, including computed tomography and magnetic resonance imaging, can't give definite conclusion. Endoscopic-ultrasound guided fine needle aspiration is conditionally worth doing, which can give some hints and exclude the malignancy of the lesion. If malignancy can be safely ruled out, the surgical decision must be made according to risk-benefit analysist. Maybe close observation and regular follow-up are more beneficial options.
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Affiliation(s)
- Junfeng Zhou
- Department of Hepatobiliary Surgery, The 960th Hospital of PLA, Jinan, China
| | - Zhong Chen
- Department of Hepatobiliary Surgery, The 960th Hospital of PLA, Jinan, China
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Jin C, Mo JG, Jiang H, Wang LZ, Zou H, Wang KP. Adult pancreatic hemangioma: a rare case report and literature review. BMC Surg 2020; 20:118. [PMID: 32493358 PMCID: PMC7268514 DOI: 10.1186/s12893-020-00779-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 05/20/2020] [Indexed: 12/16/2022] Open
Abstract
Background Adult pancreatic hemangioma is an extremely rare type of benign vascular tumor. To date, about 20 cases have been reported in the English literature. Adult patients with pancreatic hemangiomas usually have no specific symptoms, particularly in early stages. Therefore, it is difficult to detect and diagnose these lesions, which usually are identified during cross sectional imaging for an apparently unrelated causes or when biliary obstruction occurs because of compression by a tumor. Case presentation This study presents the case of a 52-year-old female with a chief complaint of epigastric pain. Contrast-enhanced computed tomography revealed a well-defined mass with mildly inhomogeneous enhancement in the body of the pancreas. Endoscopic ultrasonography showed calcifications in the lesion, and a few small vessels were detected by Doppler imaging. The patient received a central pancreatectomy, and pathological examination confirmed the diagnosis of pancreatic hemangioma. Conclusion In this report, we reviewed the clinical manifestations, radiologic features, preoperative diagnosis, pathologic characteristics, and surgical treatment of adult pancreatic hemangioma.
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Affiliation(s)
- Chong Jin
- Department of General Surgery, Taizhou Central Hospital, Taizhou University Hospital, Taizhou, Zhejiang, 318000, China
| | - Jing-Gang Mo
- Department of General Surgery, Taizhou Central Hospital, Taizhou University Hospital, Taizhou, Zhejiang, 318000, China
| | - Hao Jiang
- Department of General Surgery, Taizhou Central Hospital, Taizhou University Hospital, Taizhou, Zhejiang, 318000, China
| | - Lie-Zhi Wang
- Department of General Surgery, Taizhou Central Hospital, Taizhou University Hospital, Taizhou, Zhejiang, 318000, China
| | - Heng Zou
- Department of General Surgery, Second Xiangya Hospital, Central South University, Changsha, 410000, Hunan, China
| | - Kun-Peng Wang
- Department of General Surgery, Taizhou Central Hospital, Taizhou University Hospital, Taizhou, Zhejiang, 318000, China.
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Lianyuan T, Yafeng W, Haibo Y, Yadong D, Jiahao M, Yuanxiang L, Deyu L. Adult pancreatic cavernous hemangioma: case presentation of a benign tumor with a complex composition. BMC Gastroenterol 2019; 19:197. [PMID: 31771513 PMCID: PMC6880481 DOI: 10.1186/s12876-019-1119-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 11/15/2019] [Indexed: 12/31/2022] Open
Abstract
Background Pancreatic cavernous hemangioma is an extremely rare benign tumor that is difficult to diagnose on an imaging examination, and its histopathological examination has rarely been reported. Case presentation Herein, we present the case of a 63-year-old man who was admitted to the hospital due to left upper abdominal pain and defecation unformed for more than 2 years. None of the positive results obtained from the physical examination could explain his symptoms. The imaging examination indicated a multilocular cyst with septa in the head of the pancreas. The patient underwent a pancreaticoduodenectomy, and the pathologic diagnosis was pancreatic cavernous hemangioma. The histopathological examination showed that the lesion was positive for benign vascular markers, such as CD31, CD34 and F8, and negative for lymphocyte markers, such as D2–40. Moreover, it was also positive for ERG and cytokeratin markers, CAM5.2 and AE1/AE3, indicating the complexity of its components, and Ki-67 negativity revealed its benign nature. Conclusions Pancreatic cavernous hemangioma has a complex composition that may be reflected not only in the imaging examination but also in the immunohistochemical detection, and it may achieve a good outcome by surgical excision.
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Affiliation(s)
- Tao Lianyuan
- Department of Hepatobiliary Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, No. 7 Weiwu Road, Zhengzhou, 450003, China
| | - Wang Yafeng
- Department of Hepatobiliary Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, No. 7 Weiwu Road, Zhengzhou, 450003, China
| | - Yu Haibo
- Department of Hepatobiliary Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, No. 7 Weiwu Road, Zhengzhou, 450003, China
| | - Dong Yadong
- Department of Hepatobiliary Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, No. 7 Weiwu Road, Zhengzhou, 450003, China
| | - Ma Jiahao
- Department of Hepatobiliary Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, No. 7 Weiwu Road, Zhengzhou, 450003, China
| | - Lu Yuanxiang
- Department of Hepatobiliary Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, No. 7 Weiwu Road, Zhengzhou, 450003, China
| | - Li Deyu
- Department of Hepatobiliary Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, No. 7 Weiwu Road, Zhengzhou, 450003, China.
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Raymundo SRDO, Hussain KMK, Hussein KG, Kuga ML. Rare case of adult pancreatic haemangioma and literature review. BMJ Case Rep 2018; 2018:bcr-2018-226456. [PMID: 30297496 DOI: 10.1136/bcr-2018-226456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Pancreatic haemangiomas are benign vascular tumours very rare in adults. Twenty-two cases are described in the literature. The symptoms are non-specific, and therefore rarely clinically suspected, and the vast majority are incidental findings in imaging tests such as ultrasound, CT, angiography or MRI. They appear on CT as a cystic lesion with contrast enhancement in the arterial phase. We present the case of a 36-year-old male patient with no history of disease, referred with lumbar pain and suspected renal calculus after tomography showing hypervascular enhancement in the pancreatic body and infiltrative lesion (possible neuroendocrine neoplasia) on MRI and biliopancreatic echoendoscopy. He was submitted to laparotomy with subtotal pancreatectomy and splenectomy and satisfactory evolution.
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Affiliation(s)
- Selma Regina de Oliveira Raymundo
- Cardiologia e Cirugia Vascular, Faculdade de Medicina de Sao Jose do Rio Preto, São José do Rio Preto, Brazil.,Cirurgia Geral, Hospital Austa, Sao Jose Rio Preto, Brazil
| | - Kassim Mohamede Kassim Hussain
- Cirurgia Geral, Hospital Austa, Sao Jose Rio Preto, Brazil.,Cirurgia Geral, Faculdade de Medicina de Sao Jose do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | | | - Magali Lúcia Kuga
- Cirurgia Geral, Hospital Austa, Sao Jose Rio Preto, Brazil.,Cirurgia Geral, Faculdade de Medicina de Sao Jose do Rio Preto, São José do Rio Preto, São Paulo, Brazil
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Søreide JA, Greve OJ, Gudlaugsson E. Adult pancreatic hemangioma in pregnancy--concerns and considerations of a rare case. BMC Surg 2015; 15:119. [PMID: 26518354 PMCID: PMC4628376 DOI: 10.1186/s12893-015-0106-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 10/19/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Pancreatic tumors in pregnancy are rare but clinically challenging. Careful diagnostic workup, including appropriate imaging examinations, should be performed to evaluate surgery indications and timing . In the present case a diagnosis of an adult pancreatic hemangioma was made. We were not able to identify a similar case in the very sparse literature on this rare disease. CASE PRESENTATION A 30-year-old woman at 12 weeks of gestation was diagnosed with a large pancreatic tumor having a cystic pattern based on imaging. Although the preoperative diagnosis was uncertain, patient preference and clinical symptoms and signs suggested surgery. Open distal pancreatic resection including splenectomy was performed, and complete resection of the large cystic tumor was successfully achieved, with no postoperative complications. Although a solid pseudopapillary epithelial neoplasm (SPEN) was suspected, specimen morphology, including immunohistochemistry, supported the diagnosis of an adult benign pancreatic hemangioma. CONCLUSION Although mucinous cystic neoplasm (MCN) and adenocarcinoma are the most common pancreatic tumors during pregnancy, various other malignant and benign lesions can be encountered. This report adds to the very small number of pancreatic hemangiomas reported in the literature and involves the first patient diagnosed with this rare condition during pregnancy. Careful clinical considerations regarding diagnostic workup and treatments are required to ensure that mother and child receive the best possible care.
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Affiliation(s)
- Jon Arne Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, N-4068, Stavanger, Norway. .,Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Ole Jakob Greve
- Department of Radiology, Stavanger University Hospital, Stavanger, Norway.
| | - Einar Gudlaugsson
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway.
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