Venous hemangioma of the mesocolon

A cavernous hemangioma of infundibulopelvic vessels presenting as an adnexal tumor: A rare case report and literature review

RATIONALE

Female reproductive organ angiomas are rarely reported and are accidentally found during surgery. Angiomas arising from infundibulopelvic vessels presenting as adnexal masses are even rarer, and a few doctors have experience in their management.

PATIENTS MAIN CONCERNS AND IMPORTANT CLINICAL FINDINGS

Herein, we report the case of a 40-year-old woman who was admitted after a physical examination revealed an ovarian mass. The physical examination revealed a palpable adnexal mass in the right pelvic cavity. Ultrasound showed a 4.5 × 4.0 × 5.0 cm space-occupying lesion close to the right ovary, which had many echogenic lines and calcifications in its cystic cavity.

PRIMARY DIAGNOSIS

Right adnexal mass.

INTERVENTIONS

Laparoscopic surgery was performed in all the patients. During the surgery, the mass was found to be a retroperitoneal hemangioma with distorted and dilated vessels. We separated the right infundibulopelvic vessels and performed tumor resection with minimal blood loss.

OUTCOMES

The patient recovered well, and no abnormalities were observed during the following 2 years. Pathological results showed that this adnexal mass was a type of cavernous hemangioma arising from the infundibulopelvic vessels.

LESSONS

Surgical removal of the affected tissues is an aggressive treatment of choice for cavernous hemangiomas. Laparoscopic resection of infundibulopelvic hemangioma is feasible, and gynecologists are qualified for this operation, as long as damage to the iliac vessels is avoided.

Endoscopic Ultrasound-Guided Ethanol Injection Associated with Trans-arterial Embolization of a Giant Intra-abdominal Cavernous Hemangioma: Case Report and New Therapeutic Option

BACKGROUND

Cavernous hemangiomas are congenital hamartomatous lesions that originate from mesodermal tissue composed of dilated blood vessels. Abdominal pain and palpable mass are the most common presenting symptoms. The different types of treatment for symptomatic patients remain controversial. However, surgical resection is always the most preferred method when possible. To date, there are no reports of endoscopic ultrasound-guided (EUS-guided) absolute ethanol injection as a treatment for such disease when surgery is not an option.

CASE PRESENTATION

A 19-year-old girl with giant cavernous intra-abdominal hemangioma extending to the hepatic hilum, also affecting the gastric wall and occupying the entire supra-mesocolic cavity, initially presents with upper gastrointestinal bleeding and loss of 20 kg in 1 year (BMI = 18 kg/m²). Percutaneous angiography identified a mass with arterial blood supply by the left gastric artery that was embolized. After re-bleeding, an alternative treatment with EUS-guided injection of alcohol was proposed once resection was not feasible without major risks to a young patient. This procedure was repeated 15 and 45 days after the initial treatment, with the ethanol injection of 25 cc and 15 cc, respectively. On the second and third procedure dates, there was evident regression of the hemangioma. On the third procedure, it was possible to identify all anatomic structures that were not clear on the first EUS. After 45 days of last injection, abdominal CT and EUS showed notorious regression of the lesion. Eight months later, abdominal CT showed only a remnant lesion in the hepatogastric ligament with 129 cm³ on volumetry (87% lower in comparison to the initial image), and the patient remains asymptomatic with BMI of 26. In the most recent follow-up CT, 4 years and 2 months after first treatment, the patient presents with a slight increase in the hemangioma-now with 183 cm³ on volumetry.

CONCLUSION

Transgastric EUS-guided ethanol injection in the treatment of giant intra-abdominal cavernous hemangioma can provide good outcomes without major complications and can be repeated if necessary.

Role of Endoscopic Ultrasound for the Diagnosis of Isolated Gastric Cavernous Haemangioma

Isolated gastric cavernous haemangioma is extremely rare in the stomach. Historically, endoscopy, computed tomography and MRI had been used to diagnose gastric cavernous haemangioma. Biopsy, is not an option due to its vascular nature and submucosal location. We report an isolated gastric cavernous haemangioma that was diagnosed by end-oscopic ultrasound in a 25-year-old male and treated by laparotomy. The final diagnosis of cavernous haemagioma was confirmed by post-operative pathology. There was no recurrence during 3-month follow-up period.

Neonatal Hemoperitoneum Secondary to Hemorrhage from Omental Venous Malformation

Hemoperitoneum in the neonate is uncommon. We report our experience with a neonate who suddenly developed hemoperitoneum in late gestation. Ascites with right pleural effusion initially suggested fetal hydrops. However, a decrease in hemoglobin with bloody ascites from the paracentesis gave the impression of hemoperitoneum. Ultrasonography and computed tomography showed no abnormality in the solid organs. Using 3-mm laparoscopic exploration, we found the omental mass and excised it. It was histologically confirmed as a venous malformation. Venous malformation of the omentum with significant bleeding requiring exploration is a very rare condition in the neonate, but it should be considered as a cause of neonatal hemoperitoneum.

A hemangioma of the sigmoid colon mesentery presenting as a retroperitonealtumor: a case report and review

Hemangiomas of the gastrointestinal tract and mesentery are uncommon benign vascular lesions. While spontaneous bleeding is the hallmark of the gastrointestinal tumor variant, clinical signs of mesenteric hemangiomas are mostly unspecific. Despite the increasing imaging quality of computerized tomography (CT), in most cases the final diagnosis is established through surgery and histopathologic analysis of a macrobiopsy.

We present a case report of a 20-year-old female patient who was admitted with progressive abdominal distension and suffered from persistent abdominal pain for 3 months. A large retroperitoneal tumor mass was detected on the CT scan. Due to radiographic signs of an intraabdominal liposarcoma, an explorative laparotomy was performed revealing a large hemangioma originating from the mesosigmoid.

Although rare, gastrointestinal hemangiomas should be kept in mind by oncological visceral surgeons as one differential diagnosis of large intraabdominal tumorous masses, especially in young adults.

Isolated cavernous haemangioma of the stomach in a 3-year-old child: an unusual cause of upper GI bleeding

We present a rare case of a 3-year-old child with a history of recurrent attacks of haematemesis, melena and severe anaemia. Upper gastrointestinal endoscopy revealed a vascular mass at the fundus and greater curvature of the stomach, CT revealed an ill-circumscribed mass of mixed attenuation in the left upper abdomen, which was related to the fundus and greater curvature of the stomach, extending to the spleen, greater omentum and transverse colon with a homogeneous enhancement following contrast injection suggesting the diagnosis of haemangioma. Explorative laparotomy was done and partial gastrectomy together with splenectomy and omentectomy was performed. Histological examination confirmed the diagnosis of cavernous haemangioma.

Gastric cavernous hemangioma: A rare case with upper gastrointestinal bleeding

Upper gastrointestinal bleeding caused by a gastric hemangioma is a relatively rare occurrence. We report the case of a 65-year-old woman who suffered a sudden onset of hematemesis. Endoscopy revealed a 4×3 cm mass located in the gastric fundus. Abdominal contrast-enhanced CT revealed the shadow of enhancing linear blood vessels located in the gastric fundus. Based on her clinical appearance and the laboratory results, the patient was diagnosed with gastric hemangioma. In the laparotomy, a proximal gastrectomy was performed. The final diagnosis of cavernous hemangioma arising from the gastric fundus was confirmed by postoperative pathological examination.

Cavernous hemangioma arising from the gastro-splenic ligament: A case report

We present a rare case of a 45-year-old woman who presented with epigastric pain associated with early satiety and weight loss. Imaging revealed a large intra-abdominal mass in the epigastrium. Despite intensive investigations, including ultrasound scanning, computed tomography, upper gastrointestinal endoscopy, and percutaneous biopsy, a diagnosis could not be obtained. A histological diagnosis of cavernous hemangioma arising from the gastro-splenic ligament was confirmed after laparoscopic excision and histological examination of the intra-abdominal epigastric mass.