Gastric cavernous hemangioma in 48-years male patient: a rare case presenting upper gastrointestinal bleeding manifestations

Abstract

Gastric hemangioma (GH) is a rare benign tumor that may cause to upper gastrointestinal bleeding. Furthermore, this condition could lead life-threatening conditions thus should be recognized sooner to minimize unnecessary invasive surgical intervention, and accident. We reported a 48 years old man which came to emergency room (ER) with the chief complaint of hematemesis and black stool accompanied by abdominal pain, cold sweat, body weakness and enlarger stomach. Physical examination showed slightly icteric eye, and conjunctival pallor. On palpation, the epigastric and right upper quadrant was tender, and occult blood was detected in the excrement. A minor microcytic hypochromic anemia, absolute neutrophilia, hypoalbuminemia, and an increase in urea and creatinine were determined by laboratory tests. Moreover, the esophagogastroduodenoscopy was performed, and showed broad mass with dilated blood vessels. The histopathological examination result showed gastric mass with the histological erythrocyte extravasation. The diagnosis was hematemesis melena owing to cavernous GH with differential diagnosis of hematoma, and other gastric mass, with anemia gravis. For the treatment, patient received fluid resuscitation, omeprazole, tranexamic acid, somatostatin, and antibiotics. He received two kolfs transfusion of packed red cell. Gastric hemangiomas are benign vascular tumors that can lead to severe gastrointestinal bleeding. These benign tumors are lesions that develop as a result of endothelial cell proliferation, and concomitant pericytic hyperplasia, which leads to a collection of dilated vessels. The cavernous subtype of GHs often comprises of bigger blood-filled areas and larger blood vessels. It is more likely for the cavernous GH to rupture, leading to substantial bleeding. Endoscopic assessment is important in the patients with upper GI bleeding, and GH appear as well-circumscribed vascular submucosal mass. Although this disease is benign with a lower recurrence, we suggest for further surgical treatment and the requirement for long-term follow-up to assess the outcome.

Keywords: Endoscopy; Gastric cavernous hemangioma; Histopathology.

Figure 1

Esophagogastroduodenoscopy showed broad mass with dilated blood vessels extended from the gastric fundus via the angulus

Figure 2

Histopathological examination result revealed gastric mass with the histological erythrocyte extravasation that could be found in hemangioma (Hematoxylin-Eosin Staining; Left 40x, Right 100x)