Saudi Journal of Kidney Diseases and Transplantation

LETTER TO THE EDITOR
Year
: 2011  |  Volume : 22  |  Issue : 4  |  Page : 812--814

Mesenteric cavernous hemangioma in a cryptorchid man


Hassan Ahmadnia1, Alireza Khooei2, Ehsan Mansourian1,  
1 Department of Urology, Ghaem Medical Center, Mashhad University of Medical Sciences, Mashhad, Iran
2 Department of Pathology, Ghaem Medical Center, Mashhad University of Medical Sciences, Mashhad, Iran

Correspondence Address:
Ehsan Mansourian
Department of Urology, Ghaem Medical Center, Mashhad University of Medical Sciences, Mashhad
Iran




How to cite this article:
Ahmadnia H, Khooei A, Mansourian E. Mesenteric cavernous hemangioma in a cryptorchid man.Saudi J Kidney Dis Transpl 2011;22:812-814


How to cite this URL:
Ahmadnia H, Khooei A, Mansourian E. Mesenteric cavernous hemangioma in a cryptorchid man. Saudi J Kidney Dis Transpl [serial online] 2011 [cited 2020 Aug 7 ];22:812-814
Available from: http://www.sjkdt.org/text.asp?2011/22/4/812/82725


Full Text

To the Editor,

Cavernous hemangiomas are hamartomatous neoplastic lesions with mesodermal origin and composed of large dilated vessels. [1],[2] They are most common during childhood and are usually located in the upper portion of the body but have also been reported from other organs such as gastrointestinal tract (colon, rectum), liver, spleen, retroperitoneum, central nervous system, soft tissue, etc. [1],[2] Cavernous hemangiomas of the mesentery are extremely rare. [2]

A 38 year-old cryptorchid man presented with a history of abdominal mass for about 60 days, anorexia and nausea without any other significant constitutional or urological symptoms. The patient had a history of left cryptorchidism operated eight years ago but no testis was found in inguinal canal. As per the history obtained, abdominal exploration was not done at the time of that operation, although he gave a history of appendectomy. Physical examination showed a fixed, non-tender, non-pulsatile mass in the left side of abdomen with regular borders. No signs of infection were found. Genital examination showed empty left hemiscrotum and digital examination of rectum was normal.

The routine laboratory tests were all normal including platelet count. Tumor markers showed normal levels of alfa fetoprotein (4 ng/mL), beta human chorionic gonadotrophin (0.1 mIU/L) and lactate dehydrogenase (279 IU/L). Ultrasonography of the abdomen showed a solid mass measuring about 12 × 15 cm. Abdominal CT-scan with oral and IV contrasts showed a solid heterogeneous intra-peritoneal mass with regular border [Figure 1]. With the history of cryptorchidism in this patient, a diagnosis of a germ cell tumor arising from the undescended testis was considered the most likely diagnoses.{Figure 1}

Surgical removal of the mass was considered and laparotomy revealed a large, purple, well demarcated mass attached to intestine and mesentery. This was removed with no significant bleeding. Gross pathologic examination of the tumor showed an encapsulated mass with almost regular surface weighing 625 grams and measuring 16 × 12 × 9 cm with blood filled, rather spongy cut surface. Microscopic examination revealed an encapsulated mass composed of large dilated blood-filled vessels lined by simple flattened endothelium. Some fresh thrombi with focal tissue necrosis were also noted. The lesion was diagnosed as cavernous hemangioma of the mesentery [Figure 2] and [Figure 3].{Figure 2}{Figure 3}

Hemangioma is a congenital hamartomatous lesion that originates from embryonic sequestrations of mesodermal tissue and can be seen in any organ. [1],[2] Depending of the tumor location, various manifestations related to that organ have been reported. Cavernous hemangioma of the omentum and mesentery is an extremely rare tumor. [2],[3],[4] Mesenteric cavernous hemangioma can present with abdominal mass and pain, gastrointestinal symptoms like GI bleeding and constitutional symptoms, [2],[3] although, asymptomatic cases also have been reported. Reports show that, usually there are no other associated abnormalities with cavernous hemangioma of mesentery. However, a rare case of cavernous hemangioma of the intestine and mesentery associated with Kasabach-Merritt syndrome (also known as Hemangioma Thrombocytopenia Syndrome) has been reported. [5]

The imaging findings of hemangiomas on plain radiograph and barium studies include phleboliths or mass effect. However, absence of these findings certainly does not exclude the diagnosis. [2] Despite advanced imaging modalities such as ultrasonography and CT-scan, it is still difficult to diagnose these tumors radiologically. Ultrasonography usually shows a solid mass with a heterogeneous multinodular appearance, whereas CT-SCAN may show a homogenous or a heterogeneous mass. [4] Magnetic resonance imaging(MRI) of cavernous hemangioma typically shows a uniform high signal intensity on T2-weighted images, [2] but occasionally shows heterogeneous signal intensity on T2-weighted images, as a result of fibrosis, hemorrhage or calcification, or may show low signal intensity in T2-weighted images when the tumor is mainly occupied with old blood. [2] In addition, on MRI images, one cannot usually differentiate mesenteric hemangioma from fibroma, thecoma, and sub-serosal leiomyoma because of intratumoral hemorrhage. Therefore, cavernous hemangioma of the omentum or mesentery is difficult to diagnose preoperatively, despite advanced imaging techniques.

The treatment of cavernous hemangioma of mesentery is by either open or laparoscopic surgical excision. Recurrence after complete resection has not been reported. [3],[4] Confirmation of this tumor can only be made by histological examination. Histologically, cavernous malformations consist of irregular, sinusoidal, vascular spaces well demarcated from surrounding normal tissue. These lesions may vary in size. [3]

It is worthwhile remembering that although cryptorchid patients are more prone for a germ cell tumor, they can have other benign and malignant neoplasms that may be confused with a germ cell neoplasia clinically. Tumors like cavernous hemangioma as well as any other such tumors should be considered in the differential diagnosis of abdominal mass in these patients.

References

1Kinoshita T, Naganuma H, Yajima Y. Venous hemangioma of the mesocolon. AJR Am J Roentgenol 1997;169:600-601.
2Takamura M, Murakami T, Kurachi H, Kim T, EnomotoT, Narumi Y, Nakamura H. MR imaging of mesenteric hemangioma: a case report. Radiation Med 2000; 18: 67-69.
3Chung J, Kim M, Lee JT, Yoo HS. Cavernous hemangioma arising from the lesser omentum: MR findings. Abdom Imaging 2000;25:542-544.
4Hanatate F, Mizuno Y, Murakami T. Venous hemangioma of the mesoappendix: report of a case and a brief review of the Japanese literature. Surg Today 1995;25:962-964.
5Jun S, Tokihiro Y, AkihiroT. A case of giant diffuse cavernous hemangioma of the intestine and mesenterium associated with repeated kasabachmerritt syndrome.Journal of Japan Surg Assoc.2002 63;3;723-72.