Isolated cavernous hemangioma: a rare benign lesion of the stomach

Gastric cavernous hemangioma in 48-years male patient: a rare case presenting upper gastrointestinal bleeding manifestations

Gastric hemangioma (GH) is a rare benign tumor that may cause to upper gastrointestinal bleeding. Furthermore, this condition could lead life-threatening conditions thus should be recognized sooner to minimize unnecessary invasive surgical intervention, and accident. We reported a 48 years old man which came to emergency room (ER) with the chief complaint of hematemesis and black stool accompanied by abdominal pain, cold sweat, body weakness and enlarger stomach. Physical examination showed slightly icteric eye, and conjunctival pallor. On palpation, the epigastric and right upper quadrant was tender, and occult blood was detected in the excrement. A minor microcytic hypochromic anemia, absolute neutrophilia, hypoalbuminemia, and an increase in urea and creatinine were determined by laboratory tests. Moreover, the esophagogastroduodenoscopy was performed, and showed broad mass with dilated blood vessels. The histopathological examination result showed gastric mass with the histological erythrocyte extravasation. The diagnosis was hematemesis melena owing to cavernous GH with differential diagnosis of hematoma, and other gastric mass, with anemia gravis. For the treatment, patient received fluid resuscitation, omeprazole, tranexamic acid, somatostatin, and antibiotics. He received two kolfs transfusion of packed red cell. Gastric hemangiomas are benign vascular tumors that can lead to severe gastrointestinal bleeding. These benign tumors are lesions that develop as a result of endothelial cell proliferation, and concomitant pericytic hyperplasia, which leads to a collection of dilated vessels. The cavernous subtype of GHs often comprises of bigger blood-filled areas and larger blood vessels. It is more likely for the cavernous GH to rupture, leading to substantial bleeding. Endoscopic assessment is important in the patients with upper GI bleeding, and GH appear as well-circumscribed vascular submucosal mass. Although this disease is benign with a lower recurrence, we suggest for further surgical treatment and the requirement for long-term follow-up to assess the outcome.

Mesenchymal tumors of the stomach: radiologic and pathologic correlation

Mesenchymal tumors of the stomach are uncommon, with gastrointestinal stromal tumor (GIST) being the most common among them. Majority of the tumors may arise from cells of Cajal, smooth muscle cells, neural cells, totipotent stem cells, adipocytes or fibroblasts. Imaging plays an important role not only in staging but also in characterizing these tumors. Many of these tumors have characteristic imaging features. GISTs usually present as large cavitating and necrotic tumors with exophytic component. Presence of fat tissue within the tumor suggests a lipoma or a teratoma, early phase hyperenhancement indicates glomus tumor and hemangioma, and delayed contrast enhancement is seen in schwannoma. Their differentiation from epithelial tumors like carcinoma and neuroendocrine tumors is often possible based on the location (mesenchymal tumors are intramural), spread, morphological appearance and enhancement patterns. However, overlapping features exist between these tumors with imaging often being only suggestive. A biopsy is necessary for a definitive diagnosis in many cases.

Mechanical intestinal obstruction due to isolated diffuse venous malformations in the gastrointestinal tract: A case report and review of literature

BACKGROUND

Isolated gastrointestinal venous malformations (GIVMs) are extremely rare congenital developmental abnormalities of the venous vasculature. Because of their asymptomatic nature, the diagnosis is often quite challenging. However, as symptomatic GIVMs have nonspecific clinical manifestations, misdiagnosis is very common. Here, we report a case of isolated diffuse GIVMs inducing mechanical intestinal obstruction. A literature review was also conducted to summarize clinical features, diagnostic points, treatment selections and differential diagnosis in order that doctors may have a comprehensive understanding of this disease.

CASE SUMMARY

A 50-year-old man presented with recurrent painless gastrointestinal bleeding for two months and failure to pass flatus and defecate with nausea and vomiting for ten days. Digital rectal examination found bright red blood and soft nodular masses 3 cm above the anal verge. Computed tomography showed that part of the descending colon and rectosigmoid colon was thickened with phleboliths in the intestinal wall. Colonoscopy exhibited bluish and reddish multinodular submucosal masses and flat submucosal serpentine vessels. Endoscopic ultrasonography showed anechoic cystic spaces within intestinal wall. The lesions were initially thought to be isolated VMs involving part of the descending colon and rectosigmoid colon. Laparoscopic subtotal proctocolectomy, pull-through transection and coloanal anastomosis and ileostomy were performed. Histopathology revealed intact mucosa and dilated, thin-walled blood vessels in the submucosa, muscularis, and serosa involving the entire colorectum. The patient recovered with complete symptomatic relief during the 52-mo follow-up period.

CONCLUSION

The diagnosis of isolated GIVMs is challenging. The information presented here is significant for the diagnosis and management of symptoms.