A case report of a renal anastomosing hemangioma and a literature review: an unusual variant histologically mimicking angiosarcoma.

Li-Li Tao,Yi Dai,Weihua Yin,Joan Chen

doi:10.1186/s13000-014-0159-y

Li-Li Tao, Yi Dai + Show 2 more

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https://doi.org/10.1186/s13000-014-0159-y

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Abstract

Anastomosing hemangioma, a benign vascular neoplasm histologically simulating angiosarcoma, is newly recognized and has been described primarily in the genitourinary tract. Here, we present a case of renal anastomosing hemangioma originating in the left kidney of a 32-year-old Chinese man with detailed computerized tomography (CT) and enhanced CT image information. The patient had no obvious signs and symptoms. The tumor was incidentally found by color Doppler imaging during a routine heath check-up. Subsequently, a detailed CT and an enhanced CT scan were performed. The tumor was well demarcated, and mahogany brown lesions, which measured 2.6 cm in maximum diameter, were observed. Microscopically, the tumor shows a lobular architecture with alternating cellular areas composed of anastomosing sinusoidal capillary-sized vessels lined by hobnail endothelial cells and edematous, hyaline paucicellular areas. Cytologically, the tumor cells were generally bland and exhibited positivity for CD31 and CD34 immunohistochemically. The patient had good status without evidence of tumor recurrence 21 months after the surgery. We suggest that more attention should be focused on this rare renal hemangioma variant and that it should not be over-diagnosed as a malignance, particularly an angiosarcoma.Virtual SlidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/13000_2014_159

Highlights

Primary benign vascular lesions of the kidney are uncommonly encountered in routine surgical pathology practice
Montgomery and Epstein recently described 6 cases of new variants of benign vascular tumors involving the kidneys, perinephric adipose tissue, and testes, which the authors designated as anastomosing hemangiomas [1]
Macroscopic examination demonstrated a round, wellcircumscribed mass composed of firm, fleshy, mahogany brown tissue that measured 2.6 cm in maximum diameter, Figure 1 Unenhanced axial computerized tomography (CT) and contrast-enhanced CT scans. (A) Unenhanced axial CT scan. (B) Arterial phase of contrast-enhanced CT. (C) Venous phase of contrast-enhanced CT. (D) Delayed phase of contrast-enhanced CT

Summary

Introduction

Primary benign vascular lesions of the kidney are uncommonly encountered in routine surgical pathology practice. A concern is that these lesions can mimic malignancy. Anastomosing hemangioma is a newly recognized variant of capillary hemangioma. Montgomery and Epstein recently described 6 cases of new variants of benign vascular tumors involving the kidneys, perinephric adipose tissue, and testes, which the authors designated as anastomosing hemangiomas [1]. More cases of this novel vascular tumor have been reported. This tumor seemed to be unique in the genitourinary system [1,2,3], with a particular proclivity for the kidney. More reports showed that, in addition to the genitourinary system, the

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