Endoscopic ultrasound-guided lauromacrogol injection for treatment of colorectal cavernous hemangioma:Two case reports

BACKGROUND Colorectal cavernous hemangioma is a rare vascular malformation resulting in recurrent lower gastrointestinal hemorrhage,and can be misinterpreted as colitis.Surgical resection is currently the mainstay of treatment,with an emphasis on sphincter preservation.CASE SUMMARY We present details of two young patients with a history of persistent hematochezia diagnosed with colorectal cavernous hemangioma by endoscopic ultrasound(EUS).Cavernous hemangioma was relieved by several EUS-guided lauromacrogol injections and the patients achieved favorable clinical prognosis.CONCLUSION Multiple sequential EUS-guided injections of lauromacrogol is a safe,effective,cost-efficient,and minimally invasive alternative for colorectal cavernous hemangioma.

Retroperitoneal cavernous hemangioma misdiagnosed as lymphatic cyst:A case report and review of the literature

BACKGROUND Primary abdominal and retroperitoneal cavernous hemangioma is a vascular tumor and rarely seen in the clinic.Due to the lack of specific imaging features,retroperitoneal cavernous hemangioma cannot be diagnosed accurately.Some symptoms may develop with the enlargement of lesion volume or the occurrence of complications such as rupture or oppression.We report here a special case who was admitted with chronic abdominal pain.Admission examination suggested a retroperitoneal lymphatic duct cyst.Laparoscopic resection of the retroperitoneal mass was performed,and histological examination confirmed retroperitoneal cavernous hemangioma.CASE SUMMARY The patient was a 43-year-old Tibetan woman with intermittent left lower abdominal pain and discomfort 3 years ago.Ultrasonography revealed a cystic mass in the retroperitoneum with clear boundaries,internal septa,and no blood flow signal.Computed tomography(CT)and magnetic resonance imaging(MRI)showed an irregular space-occupying mass in the retroperitoneum,and retroperitoneal lymphatic cyst was considered.Plain CT scanning showed multiple cystlike hypo-intense shadows in the retroperitoneum,partially fused into a mass,and no obvious enhancement was found on enhanced scanning.MRI showed multiple irregular clump-like long T1 and long T2 signal shadows above the pancreas,within which linear short T2 signal shadows were seen.Diffusionweighted imaging sequence showed hypo-signal shadows,without obvious enhancement on enhanced scanning.Ultrasound,CT,and MRI all suggested the possibility of retroperitoneal lymphatic cyst.However,the patient was finally diagnosed with retroperitoneal cavernous hemangioma by pathological examination.CONCLUSION Retroperitoneal cavernous hemangioma is a benign lesion,and it is difficult to make a diagnosis preoperatively.Surgical resection may be the only treatment,which not only allows histopathological confirmation as a diagnostic purpose and excludes any risk of malignancy,but also avoids invasion of adjacent tissues,oppression,and other complications as a therapeutic goal.

Pancreatic cavernous hemangioma complicated with chronic intracapsular spontaneous hemorrhage:A case report and review of literature

BACKGROUND Pancreatic cavernous hemangioma(pCH)is a rare type of benign vascular tumor.Making the right diagnosis is challenging due to low clinical suspicion and the lack of existing cross-sectional imaging tools to distinguish it from other pancreatic lesions.CASE SUMMARY We describe a male patient,age 18,who presented with a pCH.Computed tomography,magnetic resonance imaging,and ultrasound showed cystic space in the tail of the pancreas.A dark spot sign on the T2 weighted image sequence was observed.Clinically,a mucinous cystic neoplasm with hemorrhage was suspected preoperatively by combining imaging,and the operative indication was clear.The patient underwent a distal pancreatic tumor resection under laparoscopic control.Immunohistochemical staining for CD31 and CD34 was positive;D2-40 was positive in interstitial lymphatic vessels and negative in vascular epithelial cells;and calcium-binding protein was negative.The results support the diagnosis of pCH combined with chronic intracapsular spontaneous hemorrhage.No complications or recurrences were observed during the follow-up period.CONCLUSION Chronic spontaneous hemorrhage may occur in pCH,which may greatly influence the accuracy of diagnosis using imaging modalities.Surgical resection for uncertain pCH seems reasonable with a good outcome.

Autologous transfusion with modified total hepatic vascular exclusion for extracapsular resection of giant hepatic cavernous hemangioma

BACKGROUND: This paper was to review the effects of intraoperative autologous transfusion during modified, normal-temperature, total hepatic vascular exclusion (THVE) for extracapsular resection of giant hepatic cavernous hemangioma. METHODS: The clinical data from 28 patients, who underwent hepatic resection requiring intraoperative autologous transfusion with the cell-saver apparatus, were analyzed retrospectively. The tumors in the 28 patients involved the proximal hepatic veins and inferior vena cava. The diameters of these hemangiomas ranged from 12x15 cm to 18-40 cm. All patients had varying degrees of THVE. ' RESULTS: The 28 patients with hemangioma received integrated resection and recovered. One patient had rupture of tumors resulting in massive hemorrhage of 6000 ml during liver resection; 4 patients had blood transfusions of 400-800 ml; the other 23 patients had no blood transfusion. Only 6 patients underwent the Pringle maneuver with resection. The other 22 patients underwent THVE during the liver resection. The interval of THVE was 5-30 minutes (mean 16 minutes). CONCLUSIONS: Intraoperative autologous transfusion during modified, normal-temperature THVE for extracapsular resection of huge hepatic cavernous hemangioma is feasible.

The origin of blood supply for cavernous hemangioma of the liver

OBJECTIVE: To investigate the origin of blood supply to cavernous hemangioma of the liver (CHL). METHODS: To observe the relation of cavernous hemangioma of the liver to the hepatic artery and portal vein, we performed serial selective hepatic arteriography in 22 patients. Five patients after ligation of the right hepatic arteries underwent portography and liver staining by in jection of methylene blue into the portal veins and 2 patients had hepatic specimens resected, which were made into a model cast by filling the hepatic veins (yellow) and portal venous branches (blue) with methyl methacrylate after vascular lavage. RESULTS: Serial selective hepatic arteriography showed that hepatic arteries and hemangioma were displayed simultaneously, and that hemangioma was supplied by one to numerous arterial branches. In the portal phase of portography, contrast medium failed to enter the tumor and the intrahepatic branches of the portal vein were pushed aside by the tumor; in the liver parenchymal phase, however, the tumor appeared to be a low-density area. Hepatic arteriography and portography revealed that the fistula between the artery and portal vein may not be existed. The liver stained with methylene blue showed that the normal hepatic parenchyma could be stained with deep blue; in contrast, the tumor was not stained at all. The casting specimens showed that the eroded tumor left a round vacant area because of its total shedding, and no blue stained branches of the portal vein extended into the tumor. CONCLUSION: Blood supply of CHL may originate from the hepatic artery.

Blunt abdominal injury with rupture of giant hepatic cavernous hemangioma and laceration of the spleen

A 41-year-old woman with blunt abdominal trauma due to a motor vehicle accident presented to our emergency department. The patient had a history of a giant hepatic cavernous hemangioma. Emergency exploratory laparotomy was performed for suspected intra-abdominal bleeding with abdominal compartment syndrome, and more than 4 liters of blood and blood clots were removed. An active bleeding laceration （5 cm） of a hepatic cavernous hemangioma was detected in segment III of the liver. The bleeding was controlled by sutures, Teflon patches and tamponade. The abdomen was closed temporarily using the vacuum-assisted method. Because of the presence of persistent fresh blood through abdominal drainage at a rate of 〉1 L/h, splenectomy was performed to control the bleeding again by sutures and Teflon patches. Finally, the abdomen was closed using a biologic mesh. The patient was discharged home 30 days after trauma. Bleeding of trauma-caused hepatic hemangioma is rare, but splenic injury due to blunt abdominal trauma is common. An in-depth investigation is necessary to avoid second intervention.

Adhesion of cavernous hemangioma in the orbit revealed by CT and MRI:analysis of 97 cases

AIM: To assess features of cavernous hemangioma (CH) in the orbit revealed by CT and MRI and summarize prediction of preoperative CT and MRI for the adhesion degree of CH in the orbit. METHODS: A total of 97 patients with pathologically confirmed CH in the orbit were examined with axial and coronal CT scan, and axial, coronal, sagittal, and enhanced fat suppression MRI scan. CT and MRI findings and intraoperative adhesion degrees were retrospectively analyzed. RESULTS: There were 47 patients with slight adhesion, for whom CT and MRI showed round masses with well defined margins in the extraocular muscles; 14 patients with mild adhesion, for whom CT and MRI revealed irregular masses with unclear boundary between CH and the optic nerve in coronal images, and emissary veins in the posterior region of masses in contrast-enhanced images; 36 patients with severe adhesion, for whom CT and MRI exhibited an irregular or ovoid mass filling the orbital apex, or showed distorted and even spiky margins in the posterior region of masses in contrast enhanced images at the presence of a transparent triangle between the mass and the orbital apex. CONCLUSION: Preoperative CT and MRI aid in accurate diagnosis, selection of the surgical approach, and assessment of the adhesion degree and surgical risks for CH.

Visual function alterations in cavernous hemangioma of the orbital apex after surgery

Dear Editor,I am Dr.Kang Xue,from the Department of Ophthalmology at the Eye,Ear,Nose and Throat Hospital of Fudan University in Shanghai,China.I am writing to present three case reports of the removal of visual function alterations in cavernous hemangioma of the orbital apex after surgery.Cavernous hemangioma is a relatively common primary benign orbital tumor in adults.

Optical coherence tomography angiography in retinal cavernous hemangioma

Citation： Cennamo G, Amoroso F, Solari D, Alfieri MC, de Crecchio G. Optical coherence tomography angiography in retinal cavernous hernangioma, lnt J Ophthalmol 2017; 10（12）： 1945-1946

Cavernous hemangioma of the ileum in a young man:A case report and review of literature

BACKGROUND Small intestinal cavernous hemangioma is a rare disease,especially in the ileum.It is difficult to accurately diagnose due to its hidden location and nonspecific clinical symptoms.Here,we reported a case of ileal cavernous hemangioma with chronic hemorrhage in a 20-year-old man and review the literature to gain a better understanding of this disease.CASE SUMMARY The patient complained of intermittent melena and hematochezia for > 3 mo.The lowest hemoglobin level revealed by laboratory testing was 3.4 g/d L(normal range:12-16 g/dL).However,the gastroscopy,colonoscopy and peroral doubleballoon enteroscopy(DBE) showed no signs of bleeding.The transanal DBE detected a lesion at about 340 cm proximal to the ileocecal valve.Thus,we performed an exploratory laparoscopy and the lesion was resected.After the operation,the patient had no melena.Finally,the pathological examination identified the neoplasm as an ileal cavernous hemangioma,thereby resulting in gastrointestinal hemorrhage.CONCLUSION This report might improve the diagnosis and treatment of ileal cavernous hemangioma.

Concurrent optic disc pit and retinal cavernous hemangioma

We present, to the authors＇ knowledge, the first reported case of an optic disc pit （ODP） and retinal cavernous hemangioma （RCH） in the same eye in addition to a review of both clinical entities. An ODP is a rare congenital or acquired cavitary defect in the optic nerve head.

Transnasal endoscopic approach for orbital apical cavernous hemangiomas:a case report

Cavernous hemangioma is the most primary benign orbital tumor in adults,and majority of cases could be easily settled by surgical treatment.However,cavernous hemangioma lodged deep in the orbital apex remained a challenge because the surgery may pose a high risk of injury to the optic nerve and significant visual loss.This presentation would report a case of cavernous hemangioma located in orbital apex who presented superonasal and inferotemporal peripheral vision defect.The patient received fully transnasal endoscopic surgery,and a 2 cm×1.5 cm tumor was successfully removed from the left orbital apex.The treatment results were satisfactory,with no after-effects and adverse reactions during follow-up.This case highlighted that transnasal endoscopic surgery is a promising technique for cavernous hemangiomas that are located deep in orbital apex.This approach provides direct pathway to tumor with limiting morbidity,maximal surgical field and ample illumination.The procedure represents a safe and less invasive management.

The Magnetic Resonance Image and Pathology of Spinal Cord Cavernous Hemangioma

Objective To investigate the characteristics of magnetic resonance image (MRI) of spinal cord cavernous hemangioma. Methods Six cases of spinal cord cavernous heman-gioma diagnosed by MRI and confirmed by pathology were reviewed. The characteristics of MRI were analyzed and correlated with pathological characteristics of spinal cord cavernous hemangioma. Results In 4 cases, the tumors were located in thoracic segment of the spinal cord and 2 in cervical cord. All lesions were solitary and the spinal cords were normal or a little thicker. The MRI showed that the images of focus were ball-like popcorn or mulberry with mixed signal,with short T2 signal around the focus. Under microscope, the hemangioma was composed of highly expanded blood sinusoids and its wall was thin and consisted of flat epithelial cells. There were some red blood cells in the cavity of the sinusoid and a little fibrous tissue in the diazoma between blood sinusoids. And also some fresh and old hemorrhages could be seen in the specimen. Conclusion MRI has high sensitivity and specificity in the diagnosis of spinal cavernous hemangioma.

Orbital cavernous hemangioma

A case of orbital cavernous hemangioma(OCH)in the Third Affiliated Hospital of Inner Mongolia Medical University was collected and analyzed on the basis of diagnosis,physical examination and treatment.Misdiagnosis of OCH is very common since it is a rare disease.So this paper aims to enhance the doctors’awareness of OCH during clinical practice.

Characteristic MR imaging findings and surgical treatment of cavernous hemangiomas in cavernous sinus

Objective To analyze the imaging character and surgical therapy of cavernous hemangiomas in cavernous sinus(CSHs).Methods From 2001 to 2008,13 patients with CSHs were surgically treated in our department. The diameters of CSHs varied from 3. 5 cm to 6. 0 cm. Results All the patients were operated on with no mortality.

Resection of Intracranial Giant Cavernous Malformation: Case Report and Literature Review

Cerebral cavernous malformations are a rare and congenital vascular malformation that can present as a challenge in neurosurgical management. The term “giant cerebral cavernous malformations” still does not have a clear definition in the literature, with a wide variety of results. It is known, however, that there is an association between the size of the cavernoma and postoperative sequelae, especially in those with a size greater than 3 cm in its largest diameter. We present a case report of resection of a giant brain cavernoma measuring approximately 8 cm in its largest diameter, emphasizing on clinical presentation, diagnoses and postoperative evolution. Additionally, we performed a comprehensive review of the existing literature on the subject, addressing the epidemiology, pathophysiology, diagnostic methods, treatment options, and prognosis associated with this condition.

Giant cavernous liver hemangiomas： is it the time to change the size categories？

BACKGROUND： Four different sizes （4, 5, 8 and 10 cm in diameter） can be found in the literature to categorize a liver hemangioma as giant. The present review aims to clarify the appropriateness of the size category ＂giant＂ for liver heman- gioma. DATA SOURCES： We reviewed the reports on the categoriza- tion of hemangioma published between 1970 and 2014. The number of hemangiomas, size criteria, mean and range of hemangioma sizes, and number of asymptomatic and symp- tomatic patients were investigated in patients aged over 18 years. Liver hemangiomas were divided into four groups： 〈5.0 cm, 5.0-9.9 cm, 10.0-14.9 cm and 〉15.0 cm in diameter. Inclu- sion criteria were noted in 34 articles involving 1972 （43.0%） hemangiomas （〉4.0 cm）. RESULTS： The patients were divided into the following groups： 154 patients （30.0%） with hemangiomas less than 5.0 cm in diameter （small）, 182 （35.5%） between 5.0 cm and 9.9 cm （large）, 75 （14.6%） between 10.0 and 14.9 cm （giant）, and 102 （19.9%） more than 15.0 cm （enormous）. There were 786 （39.9%） asymptomatic patients and 791 （40.1%） symptomatic patients. Indications for surgery related to symptoms were reported in only 75 （3.8%） patients. Operations including 137 non-anatomical resection （12.9%） and 469 enudeation （44.1%） were undearly related to size and symptoms.CONCLUSIONS： The term ＂giant＂ seems to be justified for liver hemangiomas with a diameter of 10 cm. Hemangiomas categorized as ＂giant＂ are not indicated for surgery. Surgery should be performed only when other symptoms are apparent.

Small bowel autotransplantation combined with pancreato-duodenectomy for enormous cavernous hemangioma of the small intestine mesentery

Recent advances in transplantation techniques have allowed pancreatoduodenectomy, distal gastrectomy,hemicolectomy and small bowel autotransplantation to be the therapy of choice for enormous cavernous hemangioma of the small intestine mesentery. There have been a few case reports about small bowel autotransplantation combined with pancreatoduodenectomy for enormous mesenteric cavernous hemangioma of small intestine. The present surgical methods for enormous cavernous bemangioma of the small intestine mesentery mainly included tumor excision and/or small bowel resection. However, these therapies are not effective for those patients in whom the angiocavemoma has infiltrated the mesenteric artery or pancreas, and these patients often give up therapy. It is recognized that enormous cavernous hemangioma of the small intestine mesentery is a benign lesion, and patients may have an excellent prognosis after complete resection of the lesion.

Treatment of severe diffuse cavernous hemangioma of the lower limb by combination of superficial femoral artery ligation and supergenual thigh amputation

Severe diffuse cavernous hemangioma of the lower limb is rarely seen among young people and sometimes can be a fatal challenge for operation.We reported a case of diffuse cavernous hemangioma invol-ving both skin and muscles of the left lower limb and perineal region in an adolescent patient.The patient who had previously undergone a local hemangioma resection of the foot ultimately ended in superficial femoral artery ligation and supergenual thigh amputation of the left upper leg because of uncontrollable massive bleeding of anastomotic stoma.

An extremely rare case report of vaginal bleeding caused by endometrial cavernous hemangiomatous polyp:Mimicking a cervical polyp

Dear editor:Cavernous hemangioma is an extremely rare disease in female genital tract,most of which diffusely involves the myometrium.Localized cavernous hemangioma of the uterus is even more uncommon.We hereby report a new bona file case of endometrial cavernous hemangiomatous polyp in a 34-yr-old woman.The diagnosis of this patient was confirmed by histopathologic examination.This case is of interest because it indicates that this condition could be found in the vagina,mimicking cervical polyp.Based on previous research articles,1,2 this is the third report of endometrial cavernous hemangiomatous polyp,and it is also the first reported one that presenting as a cervical polyp.Clinicians should keep in mind that a cervical lesion may not only originate from the cervix,rather,the differential diagnosis should be broadened to include cavernous hemangioma,especially when bleeding occurs.