Rare case of adult pancreatic haemangioma and literature review

Pancreatic cavernous hemangioma complicated with chronic intracapsular spontaneous hemorrhage: A case report and review of literature

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.

Pancreatic Hemangioma Suspected of Neuroendocrine Tumor

Adult pancreatic hemangioma is an extremely rare disease, with only 22 cases reported since 1939. Pancreatic hemangioma has no specific symptoms, diagnostic imaging, or laboratory findings, making it difficult to be clinically suspected and diagnosed. The majority are confirmed after surgery. In this report, a 61-year-old woman presented with melena and showed multiple small hyper-vascular lesions in the pancreas. A pancreatic neuroendocrine tumor was suspected, and the patient underwent a distal pancreatectomy. The pathology examination and immunohistochemical study revealed a pancreatic hemangioma.

Rare adult pancreatic hemangioma: review of the literature with a case report

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.