Differential Diagnosis Of Hemangioma Research Articles

Hemangiosarcoma in a Cat’s Tongue

Background: Hemangiosarcoma is a primary malignant neoplasm of vascular endothelial cells, common in dogs and uncommon in cats. It is characterized by being aggressive and presenting high metastatic behavior. It corresponds to 0.5% to 2% of all feline neoplasms, with more reports in shorthaired cats aged between 8 and 12.2 years old, with no predisposition for sex or breed. Among the diagnostic methods, histopathological and immunohistochemical exams stand out because they are more accurate, since the result of fine-needle aspiration biopsy is usually hidden by blood contamination. This report aims to describe a case of a hemangiosarcoma in a cat's tongue.Case: A 9-year-old, female, shorthair cat with a history of weight loss, lethargy, chewing difficulty with the evolution of three months and two-day oral bleeding was attended. Physical examination revealed blood in the oral cavity, enlargement, and darkening of the tongue surface, normalized oral and ocular mucous membranes, estimated dehydration of 7%, a rectal temperature of 38,8°C, and pulmonary and cardiac auscultation without changes. The cat was hospitalized, and euthanasia was elected. Cytological and histopathological exams of the tongue were requested, which revealed a neoplastic proliferation of endothelial cells expanding and replacing the muscular layer of the tongue, forming primitive vascular structures filled with a large number of red blood cells and supported by a delicate fibrovascular stroma. There were moderate anisocytosis and anisocariosis and rare figures of mitosis. Immunohistochemical examination showed the expression of von Willebrand factor, smooth muscle vimentin, and actin in the cytoplasm of neoplastic cells, and negative staining for pancitokeratin.Discussion: According to the results of cytological, histopathological and immunohistochemical examinations, the cat was diagnosed with tongue hemangiosarcoma. The involvement of the tongue in cases of feline hemangiosarcoma is not commonly reported, as the oral cavity is an uncommon site of neoplasm in cats and hemangiossarcoma neoplasm is considered rare in this species. The cytological examination of the patient's tongue was useful to suggest the diagnosis of sarcoma due to a large number of neoplastic cells present in the sample, and later, because it is more specific, the histopathological examination was performed to find out the origin of the tissue. The definitive diagnosis of hemangiosarcoma could be confirmed by the alterations found in the histopathological and immunohistochemical exams. The appearance of erythrocytes within tumor vascular channels, the rapid mass development, moderate anisocytosis, anisocariosis, and irregularity of vascular channels, along with the expression of smooth muscle action, excluded the differential diagnosis of hemangioma and lymphangiosarcoma. Due to the ability of the hemangiosarcoma to be a primary or metastatic tumor and the performance of the necropsy examination was not authorized, we could not determinate the primary origin of the tumor. However, we suggest in the present study that the neoplasm is primary of the tongue because there are no skin lesions or alterations in other organs, besides the tongue is not a common site of metastasis. In conclusion, hemangiosarcoma should be included as a differential diagnosis in cases of tongue neoplasia, although uncommon in felines, and that histopathological and immunohistochemical examinations are indispensable to define an accurate diagnosis.

Evaluation of Respiratory Triggered Diffusion-Weighted MRI with Three b-Values Compared to ADC Map and Fast Spin Echo Heavily T2W in Differential Diagnosis of Hemangioma from Malignant Liver Lesions

PurposeThe goal of this study was to evaluate the ability of diffusion-weighted imaging (DWI) with three different b-values compared to apparent diffusion coefficient (ADC) map and fast spin echo heavily T2 weighted (FSE-HT2W) in differential diagnosis of hemangioma from malignant liver lesions. MethodsFifty-four liver lesions in 20 patients (12 females and eight males: mean age of 52 ± 12.3 years) were examined in this study. FSE-HT2W with breath-hold technique and DWI using respiratory triggered with three different b-values (50,400 and 800 s/mm2) were performed on all patients. Mean ADC values were calculated from each lesion. Agreement levels of each sequence with standard of reference were compared by constructing the receiver operating characteristics (ROC) curve and calculation of the area under the ROC curve. ResultsADC maps had the largest area under the ROC curve and also the most agreement with the standard of reference. DWI obtained with high b-value (b-800 s/mm2) and FSE-HT2W technique were ranked next, respectively. Hemangiomas had significantly higher ADC values than malignant liver lesions (P = .001). No significant differences were seen in gender, age, and lesion size between two lesion groups. ConclusionsADC maps and DWI in high b-values are more successful than FSE-HT2W technique in differential diagnosis of hemangioma from malignant liver lesions.

Differential diagnosis of hemangiomas from spinal osteolytic metastases using 3.0 T MRI: comparison of T1-weighted imaging, chemical-shift imaging, diffusion-weighted and contrast-enhanced imaging.

The retrospective study investigated accuracy of quantitative evaluation of T1-weighted imaging (T1WI) with and without fat suppression (FS), chemical-shift, diffusion-weighted imaging (DWI) and enhanced imaging at 3.0 T MRI for distinguishing spinal hemangiomas from metastases. 27 patients with 33 spinal hemangiomas (15 atypical hemangiomas) and 26 patients with 71 metastases were recruited. T1WI, FS T1WI, in- and out-phase, DWI and enhanced T1WI were acquired. Signal intensities (SIs) of lesions were obtained. Signal intensity ratios (SIRs) and enhancement ratios of lesions in enhanced imaging were assessed. Ratio of SI loss of hemangiomas or atypical hemangiomas between T1WI and FS T1WI was higher than those of metastases (p < 0.001). The accuracies of ratio of SI loss between T1WI and FS T1WI for differentiating hemangiomas and atypical hemangiomas from metastases were 96.15% and 91.86%. Ratio of SI loss between in- and out- phase could differentiate hemangiomas and atypical hemangiomas from metastases with accuracies of 74.04% and 84.88%. Cutoff values for hemangiomas in SIRs of ≤ 1.52 (early phase) and ≤ 1.38 (middle phase) yielded accuracies of 92.31% and 82.69%. Enhancement ratios of atypical hemangiomas in middle and delayed phases were higher than that of metastases. Accuracies of apparent diffusion coefficient for differentiating hemangiomas and atypical hemangiomas from metastases were 70.19% and 89.53%. T1WI with and without fat suppression could distinguish spinal hemangiomas from metastases. Quantitative assessment of chemical-shift, DWI and enhanced imaging were helpful to identification of spinal hemangiomas and metastases.

Contrast-Enhanced Magnetic Resonance Imaging with Magnetic Transfer Effect in Differential Diagnosis of Hemangiomas and Metastases of Liver

Objective: to investigate the operating characteristics of contrast MRI of the liver using magnetization transfer effect in the differential diagnosis of hemangiomas and metastatic lesions in comparison with dynamic contrast.Material and methods. The material of the study were dynamic contrast MRI images of 25 patients with diagnosis of direction of focal liver lesion. Inclusion criteria were detection of typical MR-semiotic for hemangioma (n = 10 to 40% of cases) or multiple liver metastases (n = 15 to 60% of cases).In the group with metastases exclusion criteria was the primary detection of obscure single focal lesions, as well as the diagnosis of other primary tumors, in particular cholangiocellular cancer (n = 1). All MRI studies were performed using MRI Toshiba Titan Octave with of 1.5 Tesla magnetic field. T1-weighted static contrast MRI investigation of liver performed after 3–5 minutes after a series of dynamic contrast MRI with modes: T1-FE-FSat and T1-TSEMTS (Δf = -210 Hz, FA = 600°). The magnevist at a dose of 0.1 mmol/kg was used as a contrast agent. Each focal liver lesion differentiated between hemangiomaand metastasis with the calculation of contrast ratio (CR) for each lesion. Statistical analysis of CR was performed using T-test and T-test Welch. The sensitivity and specificity parameters were compared during the ROC-analysis.Results. In our statistical analysis groups formed not from patients, because we were compared results about focal lesions of a liver referred to metastasis or hemangiomas. All the patients included in a research had focal lesions mostly multiple and in the comparative analysis of contrast ratio in the T1-FE-FSat and T1-TSE-MTC was carried out on 21 (20%) hemangiomas and 84 (80%) metastasises. The significant (p &lt; 10–4) contrast enhancement using T1-TSE-MTS, as in the case of hemangiomas and in metastatic lesions relative to T1-FE-FSat revealed by comparing the CRs. No significant differences were found in the differentiation of hemangiomas and liver metastases in modes T1-FE-FSat and T1-TSE-MTS when paired comparison of ROC-curves (p &gt; 0.18). No significant differences were found when paired comparison of CRs between hemangiomas in T1-FE-FSat mode and metastases in T1-TSEMTSimages (p &gt; 0.8). An additive effect (sensitivity and specificity – 98.8% and 85.7%) occurs when we used to CRcomm=35.7% in T1-FE-FSat modes and T1-TSE-MTS.Conclusions. 1. Contrast MRI using magnetization transfer effect allows significantly increase the contrast of focal liver formations on the type of hemangiomas and metastases. 2. The achieved contrast level in 2D TSE images with magnetization transfer effect of liver metastatic foci corresponds to that of hemangiomas in 2D FE mode. 3. Maximum parameters of sensitivity and specificity in the differential diagnosis of hemangiomas and liver metastases obtained by using 2D-FE-FSat and 2D-TSE-MTC in post contrast phase.

Differential diagnosis of hemangiomas and other orbital masses

Aim. To determine the differential diagnostic scintigraphic signs of hemangiomas and malignant tumors of the orbit.Methods. Comprehensive survey of 35 patients with orbital masses included a standard eye examination, ultrasound Doppler sonography, computed tomography or magnetic resonance imaging, scintigraphy using in vivo labeled 99mTs erythrocytes, and morphological study.Results. Scintigraphic studies using in vivo labeled 99mTs erythrocytes in 18 patients with hemangioma of the orbit, no accumulation of radiotracer in the dynamic phase of the study was observed. On the subsequent delayed planar scintigraphy and single-photon emission computerized tomography, intense delayed hyperfixation of in vivo labeled 99mTs erythrocytes in the lesion was revealed. In 8 patients with malignant orbital tumors (adenocarcinoma of the lacrimal gland - 4, osteogenic sarcoma - 1, olfactory neuroblastoma - 1, metastasis of renal cancer in orbit - 1) there was an intense accumulation of labeled erythrocytes in the projection of the affected area in all phases of the nuclear study. In patients with adenoma of the lacrimal gland, cranioorbital meningioma, orbital pseudo tumor, as well as in 1 patient with lacrimal gland adenocarcinoma, no pathological accumulation of in vivo labeled 99mTs erythrocytes in the lesion was observed at any stage of the study.Conclusion. According to the results of scintigraphic studies: (1) patients with orbital hemangioma had no accumulation of in vivo 99mTs labeled red blood cells in the vascular (dynamic) phase of the study and had hyperfixation of radiotracer in delayed planar scintigraphy and single-photon emission computerized tomography; (2) intensive accumulation of labeled 99mTs erythrocytes in tumor vascular (dynamic) phase of the study as well as in delayed planar scintigraphy and single-photon emission computerized tomography was characteristic of malignant neoplasms with hypervascularization.

English

Angioleiomyomas are relatively common neoplasms in skin and superficial planes of extremities (89%), head (48%) and trunk (14%). These tumours are extremely rare in uterus with very few cases described in the literature. These cases have been described with varied names like angiomyoma, angioleiomyoma, or vascular leiomyoma. There is no description of angioleiomyoma as an entity or as a variant of leiomyoma in the latest WHO classification of uterine tumours. There is a mention of vascular leiomyoma as a differential diagnosis of hemangioma under rare mesenchymal tumors but no description provided. A proposal has been made by Glenn Mc Cluggage et.al that angioleiomyoma should be included among the benign leiomyoma variants in the next WHO classification.

Sacrococcygeal Teratoma Masquerading as Congenital Hemangioma

Sacrococcygeal teratoma (SCT) is a rare tumor, present in approximately one in 40,000 live births. A small proportion of SCT have malignant potential, so prompt recognition and surgical resection are necessary. We report two cases of SCT initially misdiagnosed as hemangiomas because of their cutaneous appearance and in particular vascular stains overlying soft tissue mass. These two cases emphasize that SCT should be considered in the differential diagnosis of hemangiomas and in particular of congenital hemangiomas.

Is hepatotropic contrast enhanced MR a more effective method in differential diagnosis of hemangioma than multi-phase CT and unenhanced MR?

BackgroundCavernous hemangiomas are the most frequent neoplasms of the liver and in routine clinical practice they often need to be differentiated from malignant tumors and other benign focal lesions. The purpose of this study is to evaluate whether diagnostic accuracy of magnetic resonance imaging (MRI) of hepatic hemangiomas, showing atypical pattern on US, improves with the use of Gd-BOPTA in comparison with contrast-enhanced multi-phase computed tomography (CT).Methods178 consecutive patients with ambiguous hepatic masses showing atypical hyperechoic pattern on grey-scale US, underwent unenhanced and contrast-enhanced multi-phase multi-detector CT and MR (1.5T) with the use of liver-specific contrast medium gadobenate dimeglumine (Gd-BOPTA). After intravenous contrast administration arterial (HAP), venous-portal (PVP), equilibrium phases (EP) both in CT and MR and additionally hepatobiliary phase (HBP) in MR were obtained. 398 lesions have been detected including 99 hemangiomas and 299 other lesions.ResultsIn non-enhanced MDCT examination detection of hemangiomas was characterized by sensitivity of 76%, specificity of 90%, PPV of 71%, NPV of 92% and accuracy of 86%.Non-enhanced MR examination showed sensitivity of 98%, specificity of 99%, PPV of 99%, NPV of 99% and accuracy of 99%.After intravenous administration of contrast medium in MR the mentioned above parameters did not increase significantly.ConclusionGd-BOPTA-enhanced MR in comparison with unenhanced MRI does not improve diagnostic accuracy in discriminating hemangiomas that show non-specific appearance in ultrasound examination. Unenhanced MR as a method of choice should directly follow US in course of diagnostic algorithm in differentiation of hemangiomas from other liver tumors.

Hemangioma of the Thyroid

Introduction Thyroid hemangioma is very rare, and only a few cases have previously been reported. We encountered a patient with thyroid hemangioma diagnosed after surgery. Case Report A 71-year-old woman visited our hospital with a mass in the left thyroid region. A 5-cm, elastic mass of the thyroid was palpable in the left anterior neck. On cytology by fine-needle aspiration (FNA), the specimen mainly contained blood components without apparent atypical cells. A tumor with abundant blood flow was suspected based on Doppler ultrasonography. Adenomatous goiter was suspected, and subtotal thyroidectomy was performed. A blood clot was present in the tumor, and hemangioma was diagnosed on postoperative histopathological examination. Discussion Preoperative diagnosis of thyroid hemangioma is difficult. However, Doppler ultrasonography and FNA are useful for diagnosis. A differential diagnosis of hemangioma should be considered when blood flow is abundant and only blood components are collected.

The Value of Three-Dimensional Computed Tomographic Angiography in the Diagnosis and Treatment of Vascular Lesions

The accurate classification of vascular lesions is important because treatment and prognosis vary from type to type. Diagnoses are based on a combination of clinical symptoms using many imaging techniques, including ultrasound, magnetic resonance imaging, and three-dimensional computed tomographic angiography, which is a relatively new technique. Until now, however, few studies on the clinical use of three-dimensional computed tomographic angiography reformations in vascular lesions have been published. The authors' study was designed to evaluate the value of three-dimensional computed tomographic angiography in the diagnosis and treatment of vascular lesions. Therapeutic plans of 16 patients with vascular lesions were made based on their three-dimensional computed tomographic angiography images. Pathologic examinations were also performed to verify the authors' diagnoses after surgery. Three-dimensional computed tomographic angiography accurate distinguished hemangiomas and vascular malformations, which was proven pathologically. The information aided much in therapeutic planning. All patients underwent complete treatment without complications. The authors' study suggests that three-dimensional computed tomographic angiography is helpful in differential diagnosis of hemangiomas and vascular malformations and provides a global overview of the lesions. Three-dimensional computed tomographic angiography aids significantly in therapeutic planning.

Giant cavernous hemangiolymphangioma of the bladder without cutaneous hemangiomatosis causing massive hematuria in a child

We report the first case of cavernous hemangiolymphangioma of the urinary bladder without cutaneous hemangiomatosis. A 5-year-old boy was admitted for investigation of a 2-month episode of gross hematuria accompanied by lower abdominal pain. Radiological investigations revealed a solid enhancing mass at the dome of the bladder with associated low-flow lesion in the posterolateral wall of the bladder. Physical examination did not show any cutaneous vascular malformations. A differential diagnosis of hemangioma or rhabdomyosarcoma bladder was made, but fine-needle aspiration cytology did not reveal any malignant cells. At surgery, a red, wide-based, nodular tumor was found on the dome of the bladder and extending to the base and lateral walls. Partial cystectomy and excision of the cystic lymphangioma was performed. Histological examination of the resected specimen showed it to be a cavernous hemangiolymphangioma. The postoperative course was uneventful and no recurrence was seen after 8 months.

Wertigkeit und Stellenwert der Blutpool-Szintigraphie bei Leberhämangiomen

In a prospective study the importance and reliability of blood-pool scanning were checked. 40 patients were investigated. In 36 patients sonographical evidence of one or more hemangiomas was shown. 4 patients with 11 primary or secondary tumors in the liver were taken as control group. All tumors could be verified by histology or CT. Differentiation between hemangiomas and other space-occupying lesions (benign and malignant tumors) was possible with high accuracy. We found a sensitivity of 100% in hemangiomas larger than 4 cm, a sensitivity of 78% in hemangiomas larger than 3 cm and a sensitivity of 69% in hemangiomas larger than 2 cm. Falsely positive results were not observed. In conclusion, blood-pool scanning of the liver is a reliable method in the differential diagnosis of hemangiomas.