Anastomosing Hemangioma of the Kidney: Radiologic and Pathologic Distinctions of a Kidney Cancer Mimic

Abstract

Anastomosing hemangioma (ah) is a rare subtype of primary vascular tumour that can, clinically and radiologically, present similarly to malignant renal tumours such as renal cell carcinoma (rcc) and angiosarcoma. Rarely seen in the genitourinary system, the ah we report here occurred in a 40-year-old male patient diagnosed initially with rcc based on imaging and successfully treated by laparoscopic left radical nephrectomy, with adrenal sparing and perihilar lymph node dissection. The pathologic diagnosis of ah can be challenging on small biopsy specimens; we therefore opine that it is appropriate to excise these lesions to facilitate diagnosis and definitively exclude common renal cancers. However, in this review, we describe some radiologic and pathologic distinctions between ah and malignant tumours.

Incidental finding of bilateral renal and adrenal anastomosing hemangiomas: A rare case report

“…These hemangiomas were initially documented by Montgomery and Epstein who described six cases of anastomosing hemangiomas of the kidneys, perinephric adipose tissue, and testicles 2 . Consequently, more cases of this vascular tumor have been reported in literature involving tissues from the genitourinary system, adrenal glands, liver, and gastrointestinal tract 3 . Approximately 60% of anastomosing hemangiomas are asymptomatic.…”

“…Anastomosing hemangiomas are a variant of vascular tumors with complex pathologic architecture characterized by anastomosing vessels, rare hobnailing, and benign features 2 . Although anastomosing hemangioma is predominately observed in the genitourinary system, it has been reported in the adrenal glands, liver and gastrointestinal tract 3 . In this case report, we present a patient with incidental findings of renal and adrenal anastomosing hemangiomas during workup for glomerulonephritis.…”

Intracranial thrombosed anastomosing hemangioma: Case report

“…6 Given its imaging appearance on extracranial lesions often suggests a malignant entity, there is a tendency for more aggressive treatment than likely necessary. 6,8 As this diagnosis has not been reported intracranially previously, the patient's long-term risk for a third recurrence is uncertain. Based on the literature reviewed, complete surgical resection of other types of intracranial hemangiomas as well as extracranial locations of anastomosing hemangiomas have resulted in promising longterm control.…”

“…On MRI, these lesions look like solid masses similar to sarcomas and diagnosis on imaging alone is difficult . The differential diagnosis of anastomosing hemangioma based on its imaging findings extra‐cranially includes well‐differentiated angiosarcoma, intravascular papillary endothelial hyperplasia, angiomyolipoma, renal cell carcinoma, Kaposi sarcoma, and papillary intralymphatic angioendothelioma . A tissue specimen is usually required to confirm the diagnosis of this benign lesion as it can mimic more malignant entities …”

“…This disease has not been known to metastasize and has a low recurrence rate after complete excision . Given its imaging appearance on extracranial lesions often suggests a malignant entity, there is a tendency for more aggressive treatment than likely necessary …”