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Review
. 2013;6(4):757-65.
Epub 2013 Mar 15.

Anastomosing hemangioma of the kidney: a case report of a rare subtype of hemangioma mimicking angiosarcoma and review of the literature

Ming Zhao  1 , Changshui Li, Jiangjiang Zheng, Ke Sun
Affiliations
Review

Anastomosing hemangioma of the kidney: a case report of a rare subtype of hemangioma mimicking angiosarcoma and review of the literature

Ming Zhao et al. Int J Clin Exp Pathol. 2013.

Abstract

Anastomosing hemangioma is a recently described, unusual variant of capillary hemangioma which seems to be unique for the genitourinary system, with a particular proclivity for the kidney. Histologically, it is characterized by a unique sinusoidal architecture reminiscent of splenic parenchyma that can lead to concern for angiosarcoma. We herein report a further case of anastomosing hemangioma originating in the right kidney of a 48-year-old Chinese man. The patient had a past medical history significant for hepatocellular carcinoma; this tumor was incidentally identified as an asymptomatic right renal mass during the periodical surveillance of the hepatic cancer. The resected tumor measured 2.5 cm in maximum diameter and microscopically demonstrated an overall lobulated growth pattern with alternating cellular areas composed of anastomosing sinusoidal capillary-sized vessels lined by hobnail endothelial cells, and edematous, hyaline paucicellular areas. Cytologically the tumor cells were generally bland and exhibited positivity for CD31, CD34 immunohistochemically. The patient had been in a good status without evidence of tumor recurrence 12 months after the surgery. This rare variant renal hemangioma is in need of more recognition and should not be over-diagnosed as a malignance, particularly angiosarcoma.

Keywords: Anastomosing hemangioma; kidney; vascular lesions.

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Figures

Figure 1
Figure 1
Contrast-enhanced MRI scan showed a round, well-defined mass lesion in the upper pole of right kidney with homogeneously hyper-intense effect, measuring 2.3x2.1cm.
Figure 2
Figure 2
A. Histological evaluation showed a well-demarcated but un-encapsulated mass with B. small renal tubules entrapped at the periphery of the lesion. C. At low power, the lesion had an overall lobulated architecture with alternating cellular and hypocellular areas. D. At higher magnification, the cellular zones were composed of anastomosing sinusoidal-like irregular vessels lined by hobnail endothelium, seated in a framework of fibrous supporting stromal tissue.
Figure 3
Figure 3
A. Focally, the tumor demonstrated an intravascular growth pattern. B. There existed zones of sclerosis and deposition of collagen between the sinusoidal vascular channels. C. Cytologically, the tumor cells were overall bland with only a slight degree nuclear enlargement but lacking both marked nuclear atypia and any mitotic figures. D. Vascular thrombi were occasionally observed.
Figure 4
Figure 4
Immunohistochemical analysis revealed that (A) the tumor cells were diffusely positive for CD34 and (B) the myoid supporting stromal cells were positive for SMA but (C) negative for desmin, and (D) cytokeratinAE1/AE3 highlighted the entrapped normal renal tubules.
See this image and copyright information in PMC

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