S3173 Gastric Masson’s Hemangioma: A Rare Cause of Hematemesis

Abstract

Introduction: Intravascular papillary endothelial hyperplasia (IPEH) or Masson’s Hemangioma (MH) is a rare, benign vascular tumor. It is most commonly reported to occur in the head, neck and hands. MH in the gastrointestinal (GI) tract is exceedingly uncommon, with no reported cases of gastric MH till date. We report a unique patient with gastric MH who presented with massive hematemesis. Case Description/Methods: A 41-year-old male presented to the hospital with several episodes of hematemesis with clots. His medical history was significant for pulmonary embolism status post IVC filter and hepatic arteriovenous malformation status post coil embolization. He denied alcohol abuse, retching or prior episodes of hematemesis. Patient was on aspirin 81 mg/day, but was not taking non steroidal anti inflammatory drugs or anti-coagulants. Vital signs were normal and physical assessment was unremarkable except for melena on the rectal exam. Subsequent esophagogastroduodenoscopy showed a 4x4 cm protuberant, ulcerated gastric submucosal mass on lesser curvature of distal body with overlying clot but no active bleeding (Fig. 1a). A follow up CT scan of the abdomen and pelvis showed a 4.0 x 3.3 x 3.6 cm mass in the lesser curvature of the gastric body which extended into the gastro-hepatic space (Fig. 1b). Patient developed recurrent hematemesis and was immediately taken for surgical resection. Exploratory laparotomy and wedge resection of actively bleeding 5 cm ulcerated gastric mass was performed (Fig. 1c). Histologically, the lesion showed a central area consisting of thrombotic material surrounded by a proliferation of papillary structures and hyperplastic endothelial cells. CD34 and Factor VIII stains were positive for endothelial cells and Elastic Van Gieson stain confirmed the lesion was within a large vessel. These findings were consistent with a diagnosis of Masson’s Hemangioma (Fig. 1d). Patient had an uneventful post-surgical course and was discharged with follow up in the surgery clinic. Discussion: Masson’s Hemangioma in the GI tract is an extremely rare entity which may lead to life threatening GI bleed. Lesions are reactive endothelial hyperplasia around a pre-existing thrombus, mostly associated with underlying prothrombotic states. It is important to rule out aggressive vascular lesions such as angiosarcoma, when considering the histologic diagnoses of MH. Surgical resection represents a definitive cure and is associated with an excellent prognosis.Figure 1.: A: Axial contrast-enhanced CT: Enlarged, heterogeneously-enhancing bilateral ovaries (arrows), representing infiltrating Krukenberg tumors. U, Uterus. A, Ascites. B: Axial contrast-enhanced CT: Enlarged periaortic and pericaval lymph nodes (arrows), suspicious for metastatic disease. A, Ascites. C:Sagittal contrast-enhanced CT: Irregular thickening with nodular enhancement of the gastric body (white arrows), as is seen with infiltrating malignancy. Reticulation and soft-tissue density of the omental fat (red arrows), representing omental caking.