Anastomosing hemangioma of the liver and gastrointestinal tract: An unusual variant histologically mimicking angiosarcoma

Jingmei Lin, Jeremy Bigge, Thomas Ulbright, Elizabeth Montgomery

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Anastomosing hemangioma, a benign vascular neoplasm histologically simulating angiosarcoma, is newly recognized and has been described primarily in the genitourinary tract. We have encountered this lesion in the liver and gastrointestinal tract, where it can be diagnostically challenging, especially in core biopsy. Herein, we described 6 cases of anastomosing hemangioma of the liver and gastrointestinal tract. They occurred in 4 women and 2 men, ranging in age from 48 to 71 years. The tumors ranged from 0.2 to 6 cm (median, 3.1 cm) and were grossly well demarcated with a gray-brown spongy appearance. Microscopically, they had a loosely lobulated architecture. At higher magnification, lesions consisted of anastomosing sinusoidal capillary-sized vessels with scattered hobnail endothelial cells. Mild cytologic atypia occurred in all cases. Mitoses were absent. Vascular thrombi were seen in 4 cases (66.7%) without necrosis. One tumor (16.7%) featured prominent extramedullary hematopoiesis and 1 (16.7%) hyaline globules. Immunohistochemistry results were available for 3 cases, and the lesions stained with CD34 and/or CD31. Five cases had clinical follow-up information; there were no recurrences or metastases (range, 8 to 96 mo; mean, 41 mo), and 1 patient received no follow-up after a benign diagnosis on her colon polyp. In summary, anastomosing hemangioma of the liver and gastrointestinal tract is a rare distinctive vascular neoplasm displaying overlapping features with well-differentiated angiosarcoma. Despite small numbers and limited follow-up information in our series, evidence to date supports that the lesion is benign. Awareness of this entity is essential to avoid overdiagnosis and unnecessary aggressive treatment.

Original languageEnglish
Pages (from-to)1761-1765
Number of pages5
JournalAmerican Journal of Surgical Pathology
Volume37
Issue number11
DOIs
StatePublished - Nov 2013

Fingerprint

Hemangiosarcoma
Hemangioma
Vascular Neoplasms
Gastrointestinal Tract
Liver
Extramedullary Hematopoiesis
Neoplasms
Hyalin
Polyps
Mitosis
Blood Vessels
Colon
Thrombosis
Necrosis
Endothelial Cells
Immunohistochemistry
Neoplasm Metastasis
Biopsy
Recurrence
Therapeutics

Keywords

  • anastomosing hemangioma
  • angiosarcoma
  • gastrointestinal tract
  • hemangioma
  • liver

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine
  • Surgery

Cite this

Anastomosing hemangioma of the liver and gastrointestinal tract : An unusual variant histologically mimicking angiosarcoma. / Lin, Jingmei; Bigge, Jeremy; Ulbright, Thomas; Montgomery, Elizabeth.

In: American Journal of Surgical Pathology, Vol. 37, No. 11, 11.2013, p. 1761-1765.

Research output: Contribution to journalArticle

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abstract = "Anastomosing hemangioma, a benign vascular neoplasm histologically simulating angiosarcoma, is newly recognized and has been described primarily in the genitourinary tract. We have encountered this lesion in the liver and gastrointestinal tract, where it can be diagnostically challenging, especially in core biopsy. Herein, we described 6 cases of anastomosing hemangioma of the liver and gastrointestinal tract. They occurred in 4 women and 2 men, ranging in age from 48 to 71 years. The tumors ranged from 0.2 to 6 cm (median, 3.1 cm) and were grossly well demarcated with a gray-brown spongy appearance. Microscopically, they had a loosely lobulated architecture. At higher magnification, lesions consisted of anastomosing sinusoidal capillary-sized vessels with scattered hobnail endothelial cells. Mild cytologic atypia occurred in all cases. Mitoses were absent. Vascular thrombi were seen in 4 cases (66.7{\%}) without necrosis. One tumor (16.7{\%}) featured prominent extramedullary hematopoiesis and 1 (16.7{\%}) hyaline globules. Immunohistochemistry results were available for 3 cases, and the lesions stained with CD34 and/or CD31. Five cases had clinical follow-up information; there were no recurrences or metastases (range, 8 to 96 mo; mean, 41 mo), and 1 patient received no follow-up after a benign diagnosis on her colon polyp. In summary, anastomosing hemangioma of the liver and gastrointestinal tract is a rare distinctive vascular neoplasm displaying overlapping features with well-differentiated angiosarcoma. Despite small numbers and limited follow-up information in our series, evidence to date supports that the lesion is benign. Awareness of this entity is essential to avoid overdiagnosis and unnecessary aggressive treatment.",
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