Mesenteric Cavernous Hemangioma Involving Small Bowel and Appendix: A Rare Presentation of a Vascular Tumor

Abstract

We report on a case of cavernous hemangioma of the small bowel mesentery. Fewer than five cases of large mesenteric cavernous hemangioma have been reported in the English literature. Cavernous hemangioma of the small bowel mesentery is extremely rare. A 32-year-old black male presented with 1 week of abdominal pain, nausea, vomiting, and anorexia. He had recently undergone computed tomographic guided biopsy of a pelvic mass at another facility. Repeat CT guided biopsy was nondiagnostic, mesenteric angiography was inconclusive, and magnetic resonance imaging was performed as well. Complete workup was performed to localize primary source of abdominal mass and eventual open biopsy was planned resulting in en bloc resection of the mass, which had invaded the terminal ileum and appendix. Final pathologic diagnosis was cavernous mesenteric hemangioma. The patient experienced a prolonged postoperative ileus and was eventually discharged in stable condition, tolerating a regular diet with adequate bowel and urinary function. Diagnosis of cavernous mesenteric hemangioma is difficult and multiple imaging modalities can prove inconclusive. Adequate biopsy can be difficult to obtain even in patients with small body habitus. Standard of care is resection of entire mass en bloc.

Cavernous hemangioma of the mesorectum involving the rectum: A rare case report

“…Other studies have shown that calci cations may ultimately form phleboliths, which represent an important diagnostic feature, seen in 26 to 50% of affected adult patients (4). Phleboliths are usually signal voided on both Tl and T2 weighted images, and thrombosed vessels show serpiginous structures with high signal intensity on MRI (11). An important imaging nding in our case suggested that a mesenteric hemangioma originated from the mesentery rather than the bowel wall, which is different from some reported cases.…”

“…Calci cations were seen scattered throughout the lesion on CT. Some studies suggested that this was due to degenerative changes as a consequence of the thrombosis within the sinuses, caused by perivascular in ammation and stasis of blood ow (4,11). Other studies have shown that calci cations may ultimately form phleboliths, which represent an important diagnostic feature, seen in 26 to 50% of affected adult patients (4).…”

“…It is not clear whether mesenteric hemangiomas originate in the bowel wall or in the mesentery. Some reported cases have been thought to originate in the bowel wall and extend into the mesentery (5)(6)(7)(8)(9)(10)(11)(12). In previous reports, hemangiomas have been mostly located in the small intestine mesentery (5,6,(8)(9)(10)(11)(12).…”

The “Endothelialized Muscularis Mucosae”: A Case Report Describing a Large Cavernous Hemangioma at the Terminal Ileum and a New Histologic Clue for Preoperative Diagnosis from Endoscopic Biopsy

“…Little has been written in the literature on the histologic findings in biopsies of cavernous hemangiomas of the gastrointestinal tract. Accordingly, even lesions accessible for biopsy have evaded diagnosis due to inconclusive findings [ 2 ], and cavernous hemangiomas have almost exclusively required surgical resection for a definitive diagnosis [ 1 , 12 ]. However, upon review of the original endoscopic biopsy in this case, we observed a second layer of fibromuscular tissue which was tightly apposed to the muscularis mucosae of the small bowel mucosa, with a layer of flat endothelial cells lining the antiluminal side of the second fibromuscular layer.…”

“…Cavernous hemangiomas of the gastrointestinal tract are quite rare and, until now, difficult to diagnose preoperatively [ 1 ] due to a dearth of specific histologic description pertaining to small superficial biopsies such as those obtained endoscopically [ 2 , 3 ]. We report a unique case of a 4 cm transmural cavernous hemangioma in the terminal ileum with literature review and describe a new histologic finding—the “endothelialized muscularis mucosae,” which was discovered upon review of the endoscopic biopsy and could potentially facilitate preoperative diagnosis of these lesions from endoscopic biopsies in the future.…”