Anastomosing haemangioma of the adrenal gland: A clinicopathological series of seven cases

Abstract

AimsAnastomosing haemangioma is a rare benign vascular neoplasm that may histologically mimic angiosarcoma. We report the largest single institution series of anastomosing haemangioma in the adrenal gland with emphasis on clinical and radiological features.Methods and resultsOur laboratory information system was searched for a 25‐year period (1999–2023), yielding seven cases confirmed as anastomosing haemangioma of the adrenal gland after pathological re‐review. Clinical, radiological and pathological information was obtained from medical charts and submitting pathologists. Of a total of seven patients, four (57.1%) were men and three women, ranging in age from 37 to 75 years (mean = 61). Six of seven patients underwent adrenalectomies and one had radical nephrectomy. Tumours ranged from 0.7 to 6.4 cm (mean = 2.1 cm) and five of seven (71%) were grossly well‐circumscribed. Five of seven lesions were found incidentally at imaging for other indications. All tumours were unifocal except one, which presented with multifocal disease with a concurrent adjacent retroperitoneal anastomosing haemangioma. Three of five tumours imaged with contrast enhancement were almost completely hyperenhancing with a small central non‐enhancing portion, features overlapping with pheochromocytoma. One of seven tumours involved the peri‐adrenal adipose tissue with a focally infiltrative pattern. There were no recurrences or metastases in six patients with available follow‐up data (median = 95 months).ConclusionsBenign anastomosing haemangiomas of the adrenal gland tend to occur in older patients, may mimic pheochromocytoma on imaging and must be distinguished from angiosarcoma pathologically. Better awareness of this entity by pathologists, radiologists and surgeons is crucial to appropriate work‐up, diagnosis and management.

Anastomosing haemangioma of the mediastinum: Clinicopathological series with radiological and genetic characterisation

“…Histologically, each of the seven mediastinal anastomosing haemangiomas was characterised by anastomosing thin-walled capillary-sized vessels lined by a monolayer of hobnail endothelial cells (Figures 2 and 3), with a microscopic appearance identical to those described elsewhere. [2][3][4][5][6][7] In each case, there was a vaguely microcystic architecture with sinusoid-like spaces and delicate collagenous stroma (Figure 2B,C). The endothelial cells were arranged strictly in a monolayer; multilayering was absent (Figure 2D,E).…”

“…1 First described in the kidney and the male genital tract, anastomosing haemangiomas have since been noted in the female genital tract, gastrointestinal tract, liver, adrenal glands and soft tissues. [2][3][4][5][6][7] As anastomosing haemangiomas may infiltrate into adjacent tissues, lack lobulation microscopically and display cytological atypia, they can be mistaken for well-differentiated angiosarcomaa diagnostic pitfall. Recurrent mutations involving GNAQ, GNA14 or GNA11 have been identified in anastomosing haemangiomas.…”