ABSTRACT

The anastomosing hemangioma is a recent described rare variant, which histologically simulates an angiosarcoma and occurs primarily in the genitourinary tract. We present a case of renal anastomosing hemangioma from a radiologic perspective, describing its imaging features and reviewing its presentation and management.

Keywords:
Radiology; Kidney; Magnetic Resonance Imaging

CASE PRESENTATION

A 53-year-old man underwent computed tomography (CT) for renal stone evaluation. His physical examination was otherwise unremarkable. His creatinine level was 1.0mg/dL and his fasting glucose was 91mg/dL. An incidental left renal mass was identified (Figure-1), that was further evaluated with magnetic resonance imaging (MRI).

MRI showed a renal mass with thick septa and progressive enhancement after gadolinium injection. The lesion was interpreted as a complex renal cystic lesion, classified as Bosniak IV (Figures 2–5).

After MRI results, patient underwent video-laparoscopic resection of the lesion, later confirmed to be a renal anastomosing hemangioma by histopathological analysis (Figure-6).

DISCUSSION

Renal vascular tumors are extremely rare, with hemangiomas being the most frequent lesion in this subgroup (¹1. Katabathina VS, Vikram R, Nagar AM, Tamboli P, Menias CO, Prasad SR. Mesenchymal neoplasms of the kidney in adults: imaging spectrum with radiologic-pathologic correlation. Radiographics. 2010;30:1525-40.).

The vast majority of renal hemangiomas are smaller than 2cm, asymptomatic and incidentally found on imaging exams. Symptomatic patients may have recurrent episodes of hematuria and abdominal pain (¹1. Katabathina VS, Vikram R, Nagar AM, Tamboli P, Menias CO, Prasad SR. Mesenchymal neoplasms of the kidney in adults: imaging spectrum with radiologic-pathologic correlation. Radiographics. 2010;30:1525-40., ²2. Prasad SR, Surabhi VR, Menias CO, Raut AA, Chintapalli KN. Benign renal neoplasms in adults: cross-sectional imaging findings. AJR Am J Roentgenol. 2008;190:158-64.).

The anastomosing hemangioma is a rare variant, which histologically simulates an angiosarcoma (³3. Omiyale AO. Anastomosing hemangioma of the kidney: a literature review of a rare morphological variant of hemangioma. Ann Transl Med. 2015;3:151.). This histological subtype has been recently described as morphological variant of hemangioma that occurs primarily in the genitourinary tract. On non-enhanced CT, they are lobulated lesions, with soft-tissue attenuation. After contrast administration, they appear as solid heterogeneous lesions, with intense and progressive enhancement (³3. Omiyale AO. Anastomosing hemangioma of the kidney: a literature review of a rare morphological variant of hemangioma. Ann Transl Med. 2015;3:151.).

On MRI, hemangiomas show hyperintensity on T2 and variable degrees of enhancement after contrast administration. Presentations may resemble cystic lesions with solid component, mimicking cystic renal cell carcinoma as the present case (¹1. Katabathina VS, Vikram R, Nagar AM, Tamboli P, Menias CO, Prasad SR. Mesenchymal neoplasms of the kidney in adults: imaging spectrum with radiologic-pathologic correlation. Radiographics. 2010;30:1525-40., ²2. Prasad SR, Surabhi VR, Menias CO, Raut AA, Chintapalli KN. Benign renal neoplasms in adults: cross-sectional imaging findings. AJR Am J Roentgenol. 2008;190:158-64., ⁴4. Tao LL, Dai Y, Yin W, Chen J. A case report of a renal anastomosing hemangioma and a literature review: an unusual variant histologically mimicking angiosarcoma. Diagn Pathol. 2014;9:159.). When large, these lesions are indistinguishable from malignant lesions such as angiosarcomas and renal cell carcinomas with central necrosis.

Treatment is controversial since preoperative diagnosis is not possible based on imaging exams. When biopsy results are available, it may vary from expectation to partial nephrectomy, embolization and radical nephrectomy, depending on the lesion size, location and presence of symptoms.

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