Extradural lumbar nerve root cavernous hemangioma: case report and successful surgical resection / Hemangioma cavernoso extradural de raiz nervosa lombar: relato de caso e ressecção cirúrgica bem-sucedida

Extradural lumbar spinal canal cavernous hemangiomas (or cavernomas) are rare lesions that can induce intense back pain and neurological deficit. We present a case report of a patient with a pure radicular lombar extradural cavernoma resembling a benign neurological tumor in imaging exams and a successful surgical resection.

Os hemangiomas cavernosos do canal vertebral lombar extradural (ou cavernomas) são lesões raras que podem induzir dor intensa no dorso e déficit neurológico. Apresentamos um relato de caso de um paciente com um cavernoma extradural lombar radicular puro assemelhando-se a um tumor neurológico benigno em exames de imagem e uma ressecção cirúrgica bem-sucedida.

Cavernoma portal complicada con biliopatía secundario a enfermedad de Gaucher tipo 1: reporte de un caso peruano / Cavernoma complicated with biliopatia secondary to type 1 Gaucher disease: report of a Peruvian case

La enfermedad de Gaucher, es un trastorno autosómico recesivo de depósito lisosomal que se caracteriza por deficiencia de la beta-glucocerebrosidasa que lleva a la acumulación de glucosilceramida principalmente en células del sistema fagocítico mononuclear causando afectaciones sistémicas. Se presenta paciente varón de 20 años que cursa con dolor crónico en hipocondrio izquierdo con episodios de sangrados desde hace 3 años y sensación de alza térmica, al examen físico se identificó ictericia y esplenomegalia masiva, sin afectación neurológica. Como apoyo al diagnóstico se mostró osteoporosis severa, pancitopenia y como hallazgo inesperado la presencia de trombosis de vena porta con transformación cavernomatosa complicada con biliopatía portal simulando un tumor de klatskin, los estudios de médula y enzimáticos eran compatibles con enfermedad de Gaucher, por lo cual recibió tratamiento con imiglucerasa realizando seguimiento. Es un caso poco frecuente, de gran interés, heterogeneidad en sus manifestaciones clínicas e inéditas por su complicación, constituyendo un desafío llegar a su diagnóstico de esta enfermedad huérfana.

Gaucher disease is an autosomal recessive lysosomal storage disorder characterized by deficiency of beta-glucosidase that would lead to the accumulation of glucosylceramide mainly in cells of the mononuclear phagocytic system causing systemic effectations. We present a patient of twenty years who is suffering from chronic pain in the left hypochondrium with episodes of bleeding for 3 years and sensation of thermal rise, physical examination revealed jaundice and massive splenomegaly, without neurological involvement. Severe osteoporosis, pancytopenia, and the presence of portal vein thrombosis with cavernomatous transformation complicated by portal biliopathy simulating a klatskin tumor, marrow and enzymatic studies were compatible with Gaucher disease, were shown as unexpected findings. he received treatment with imiglucerase, following up. It is a rare case, of great interest, heterogeneity in its clinical manifestations and unpublished by its complication, constituting a challenge to reach its diagnosis of this orphan disease.

Hemangioma gástrico como causa de hemorragia digestiva alta / Gastric hemangioma as a cause of upper gastrointestinal bleeding

El hemangioma gástrico como causa de hemorragia digestiva alta (HDA) es un evento clínico raro. Presentamos el caso de un varón de 83 años con historia de dolor abdominal, intolerancia oral y melena con pérdida de peso de 8 Kg. En la endoscopía digestiva alta muestra una lesión elevada en antro gástrico con úlcera y vaso visible en su parte superior el cual recibe terapia endoscópica, en la tomografía abdominal se observa una tumoración dependiente de pared gástrica de contornos definidos captadora de contraste. Por persistencia HDA con descompensación hemodinámica ingresa a laparotomía exploratoria encontrándose una tumoración vascularizada que en el estudio histopatológico se concluye como hemangioma cavernoso gástrico.

Gastric hemangioma as a cause of upper gastrointestinal bleeding (UGIB) is a rare event. We present the case of an 83 years old male with a history of abdominal pain, vomiting and melena, along with an 8 Kg weight loss. The upper gastrointestinal endoscopy showed an elevated, ulcerated lesion in the gastric antrum with a visible vessel, for which he receives endoscopic therapy. In the abdominal computed tomography, a contrast enhancing, well-circumscribed mass attached to the gastric wall is observed. Due to the persistence of the UGIB, the patient suffers hemodynamic decompensation and undergoes exploratory laparotomy, where a vascularized mass is found. The pathology report informs a gastric cavernous hemangioma

Pathological Evaluation of Radiation-Induced Vascular Lesions of the Brain: Distinct from De Novo Cavernous Hemangioma

PURPOSE: We aimed to evaluate the histologic and radiologic findings of vascular lesions after stereotactic radiosurgery (SRS) categorized as radiation-induced cavernous hemangioma (RICH). MATERIALS AND METHODS: Among 89 patients who underwent neurosurgery for cavernous hemangioma, eight RICHs from 7 patients and 10 de novo CHs from 10 patients were selected for histopathological and radiological comparison. RESULTS: Histologically, RICHs showed hematoma-like gross appearance. Microscopically, RICH exhibited a hematoma-like area accompanied by proliferation of thin-walled vasculature with fibrin deposits and infiltrating foamy macrophages. In contrast, CHs demonstrated localized malformed vasculature containing fresh and old clotted blood on gross examination. Typically, CHs consisted of thick, ectatic hyalinized vessels lined by endothelium under a light microscope. Magnetic resonance imaging of RICHs revealed some overlapping but distinct features with CHs, including enhancing cystic and solid components with absence or incomplete popcorn-like appearance and partial hemosiderin rims. CONCLUSION: Together with histologic and radiologic findings, RICH may result from blood-filled space after tissue destruction by SRS, accompanied with radiation-induced reactive changes rather than vascular malformation. Thus, the term "RICH" would be inappropriate, because it is more likely to be an inactive organizing hematoma rather than proliferation of malformed vasculature.

Cavernoma of the lateral ventricule presenting as speech arrests / Cavernoma do ventrículo lateral se apresentando como bloqueios da fala

Cavernous malformations (CM) are formed by dilated thin-walled vascular channels without intervening parenchyma and intraventricular lesions are rare. We report a case of an intraventricular cavernoma in a 54-year old female patient. She presented with speech arrests daily for 10 months. Neurological examination revealed no deficits. The brain MRI study revealed an intraventricular lesion at the level of the left atrium, heterogeneously hyperintense on both T1 and T2-weighted images. It was performed an interhemispheric transcallosal approach with gross-total resection of the lesion. The histological examination was compatible with the diagnosis of cavernous haemangioma. In the postoperative period the patient presented with transient right hemiparesis with recovery in two weeks. We briefly review the literature concerning intraventricular cavernomas...

Malformações cavenosas são formadas por canais vasculares dilatados e de paredes finas sem parênquima cerebral no interior. Lesões dessa natureza são raras nos ventrículos. Neste trabalho descrevemos um caso de cavernoma intraventricular em uma paciente feminina de 54 anos. Ela se apresentou clinicamente com bloqueios de fala diários nos últimos 10 meses. Nenhum déficit neurológico foi observado no exame. A ressonância magnética de encéfalo demonstrou lesão heterogênea na topografia do átrio ventricular esquerdo, hiperintensa em T1 e T2. Foi realizada abordagem interemisférica transcalosa com ressecção total da lesão. A análise histopatológica foi compatível com hemangioma cavernoso. No período pós-operatório a paciente apresentou hemiparesia direita, que melhorou em duas semanas. Revisa-se brevemente a literatura em relação a cavernomas intraventriculares...

Cavernoma de la vena porta. Descripción de casos clínicos pediátricos / Portal vein cavernoma, a description of pediatric clinical cases

La cavernomatosis portal es una patología poco frecuente causada por la trombosis de la vena porta. Es la principal causa de hipertensión portal en niños. La causa muchas veces no se identifica, pudiendo reconocerse factores predisponentes, entre los cuales los más frecuentes son el cateterismo de la vena umbilical y la onfalitis. Se manifiesta a través de sus complicaciones: hemorragia digestiva alta por várices esofágicas y esplenomegalia. El diagnóstico se confirma con ecografía abdominalcon Doppler. La terapéutica incluye el tratamiento médico-endoscópico de las várices esofágicas. La derivación quirúrgica porto-sistémica resuelve la obstrucción portal. Se realizó un estudio retrospectivo con el objetivo de describir las características clínicas de pacientes con cavernomatosis portal en el período enero de 1999 a abril de 2009 en el Hospital Pediátrico del Centro Hospitalario Pereira Rossell (HP-CHPR). Se identificaron ocho pacientes, con una media de edad al momento del diagnóstico de 2 años y 2 meses. La forma de presentación más frecuente fue la hematemesis. En la mayoría se constató esplenomegalia. En tres se identificaron factores predisponentes: cateterismo umbilical, cirugía abdominal. Todos tenían várices esofágicas al diagnóstico. Tres pacientes reiteraron hemorragia digestiva alta, uno en tres y otro en cuatro oportunidades. Cuatro pacientes requirieron escleroterapia o banding por sus várices esofágicas. Un paciente recibió cirugía derivativa. Esta patología no tuvo, en este período de tiempo, una alta prevalencia, pero alta morbilidad. Todos eran pequeños, la mayoría sin factores de riesgo y se presentaron a través de complicaciones de la enfermedad. La mayoría reiteró complicaciones en la evolución.

Hemangioma cavernoso orbitario: presentación de un caso clínico y revisión del tema / Orbital cavernous hemangioma: report of a case and review of the topic

El hemangioma cavernoso orbitario (HCO) constituye una tumoración vascular benigna no infiltrante, que crece lentamente y en función de la clínica, se decidirá la actitud terapéutica más conveniente, la observación o la extirpación quirúrgica. El diagnóstico definitivo se establece tras la extirpación del tumor y posterior estudio histopatológico del mismo. Presentamos el caso de una niña de 6 años de edad, con proptosis ocular derecha progresiva, con diagnóstico imagenológico sugestivo de lesión vascular, el cual fue confirmado en el estudio anatomo-patológico tras la intervención quirúrgica y la paciente evolucionó satisfactoriamente.

Hemangioma cavernoso rectal: caso clínico / Cavernous hemangioma of the rectum: report of one case

We report a 41 years old male with a history of hematochezia since childhood. A colonoscopy showed a highly vascularized submucosal lesion extending from the pectinate line to the distal sigmoid colon. Magnetic resonance showed a thickening of rectal wall with multiple vascular structures and phleboliths. The lesion was excised surgically. The postoperative period was uneventful. The pathological report disclosed a large rectal hemangioma.

El hemangioma rectal es una entidad infrecuente, con menos de 200 casos publicados en la literatura mundial. Se presenta un caso clínico, que debuta con rectorragia y es documentado con estudios endoscópicos e imagenológicos, siendo resuelto quirúrgicamente.

Giant cavernous hemangioma of the cavernous sinus: case report and review of literature

The incidence of cavernous sinuses cavernous hemangiomas is 2 percent of all cavernous malformations. These lesions are well circumscribed benign neoplasm, that are confined to the dural layer of the venous sinus. These lesions are difficult to accurately diagnose them presurgically and the surgical treatment is also difficult. Nevertheless with the new imagining diagnosis technologies and with advancement in microneurosurgical techniques, neurosurgeons can treat these lesions with more confidence. In this article we want to report a case of a 24 year woman who presented to our institution with galactorrea as the only clinical presentation. This patient was investigated and was found to have a giant lesion in the right middle fossa. She was taken to surgery with the suspicion of a giant meningioma but this surgery was aborted when we found that the lesion did not correspond to a meningioma. The patient was followed for 4 years and the galactorrea was treated and she was stable, but then she presented with severe headache and deterioration in her consciousness. She was treated in another institution where she was taken to surgery and a partial resection was performed, the surgery was aborted because the patient presented massive bleeding. we want to present this case that is dealing with an infrequent lesion of a very delicate localization of the skull base. We also want to emphasize in having this differential diagnosis when dealing with lesions in this area. We also want to warn and recommend that if a neurosurgeon stumble into one of these lesions in surgery we recommend to back off and plan better the surgical management. Planning adequately the surgical procedure improve the prognosis in these patients We will present this case and review the literature concerning these rare lesions.

La incidencia de los hemangiomas cavernosos del seno cavernoso es del 2 por ciento de todas las malformaciones cavernosas. Estas lesiones son neoplasias benignas bien diferenciadas, que se encuentran confinadas en la capa dural de los senos venosos. Estas lesiones son difíciles de diagnosticar de manera segura en las etapas prequirugicas y su tratamiento es difícil. Sin embargo con las nuevas tecnologías de imágenes diagnosticas y los avances en la microneurocirugía, los neurocirujanos podemos tratar estas malformaciones de manera más segura. En este artículo queremos reportar un caso de una mujer de 24 años quien consulto a nuestra institución por galactorrea. Esta paciente fue investigada y se le diagnostico una lesión gigante de la fosa media derecha. Se llevo a cirugía bajo la sospecha que presentaba un meningioma gigante pero esta cirugía se aborto cuando se encontró que la lesión se trataba de una patología distinta. La paciente siguió en controles por 4 años donde se mantuvo estable con mejoría de la galactorrea con manejo medico, pero luego comenzó a presentar cefalea severa asociada a deterioro de la conciencia. La paciente fue tratada en otra institución donde fue llevada a cirugía en la cual una resección parcial se le realiza a la paciente. Esta cirugía se aborto por un sangrado excesivo. Queremos presentar este caso que trata de una lesión infrecuente en un sitio de alto riesgo quirúrgico de la base del cráneo. Enfatizamos en tener esta patología entre lo diagnósticos diferenciales de las lesiones de esta localización. Además, recomendar que en caso que uno se encuentre con una de estas lesiones en cirugía, recomendamos que finalice la cirugía en ese momento y que planee un manejo quirúrgico enfocado para esta patología en un nuevo tiempo quirúrgico. Un adecuado planeamiento del procedimiento quirúrgico mejora el pronóstico en estos enfermos. En este artículo queremos reportar un caso y revisar la literatura que concierne estas lesiones raras...

Hemangioma cavernoso: una causa de hemorragia digestiva de origen oscuro / Cavernous hemangioma: a source of bleeding of obscure origin

Comunicamos el caso de un paciente de 32 años, sexo masculino, que consultó por melena intermitente y síndrome anémico de dos años de evolución, sin otros antecedentes patológicos de importancia. El laboratorio reveló anemia hipocroma, sin trastornos de la coagulación. Los exámenes endoscópicos altos y bajos del tubo digestivo no demostraron lesiones sangrantes y la cintigrafía evidenció un sangrado a nivel de intestino delgado. La arteriografía mesentérica selectiva demostró un hemangioma en porción terminal del íleon. Se realizóresección del segmento intestinal comprometido, evolucionando favorablemente, sin reincidencia de sangrado hasta la fecha. Efectuamos una revisión de la literatura principalmente dedicada a la incidencia de esta patología y al enfoque de pacientes que se presentan con un sangrado digestivo de origen oscuro.

A 32 years old man presenting with two years of intermittent episodes of melena and anemia, without other pathological conditions. The laboratory results showed an hypochronic anemia. Coagulation studies were normal. No bleeding lesions were observed at upper and lower endoscopy. A scintigraphic study showed evidences of bleeding at the small bowel. Mesenteric angiography reported an ileal hemangioma. A resection of the lesion was performed without further bleeding until now. A review of the subject was done, looking for the incidence and behavior, in relation of the case, and patients with intestinal bleeding of obscure origin.

Pontine cavernous hemangioma presenting with horizontal gaze palsy.

Pontine cavernous hemangioma presenting as horizontal gaze palsy is extremely rare. A 32-years-old patient presented with left horizontal gaze palsy with left esotropia. A large pontine mass was present which was removed in-toto using a sub-occipital craniotomy. Post- operatively, the gaze palsy showed recovery and the diplopia decreased. Follow-up MRI showed no residual mass.

[Cavernous hemangioma of liver presenting with high fever and severe abdominal pain; a case report]

Intra-tumoral bleeding, rupture and thrombosis are common complications of hemangioma but spontaneous and self limited rupture and fever is a very rare presentation of hemangioma. This report is about a 38-year-old woman with sever abdominal pain and high fever came for evaluation. In US she had a liver mass of about 15 cm in left lobe with possibility of being hemangioma and, CT scan and MRI confirmed diagnosis of hemangioma. She had persistently abdominal discomfort and fullness in upper abdomen and referred for surgery. Left lobectomy and resection of hemangioma was done successfully

The Cavernous Hemangioma of the Colon Inducing Massive Hematochezia and Treated by Endoscopic Polypectomy / 대한소화기학회지

No abstract available

Cavernous hemangioma presenting as a right adnexal mass in a child

This is the case of an 11-year-old girl who presented with a right adnexal mass and vague abdominal symptoms since seven months prior to her hospital admission for surgery. CT-scan and sonographic images were those of a benign lesion, probably ovarian torsion or infarction. Serum tumoral markers were normal. A right salpingo-oophorectomy and appendectomy were performed. Pathology examination revealed a cavernous hemangioma of the ovary. The clinicopathologic presentation of this unusual benign ovarian tumor is discussed.

Transformación cavernomatosa de la vena porta / Cavernous transformation of the portal vein

Se presenta un caso clínico de transformación cavernomatosa de la vena porta, en una paciente de 37 años que debuta con una hemorragia digestiva alta de muy difícil manejo. Se efectúa el diagnóstico mediante una arteriografía selectiva por sustracción digital. Se interviene quirúrgicamente en reiteradas ocasiones realizándose finalmente una derivación mesocava con prótesis de PTFE. Evoluciona con múltiples complicaciones médicas y quirúrgicas, que finalmente la llevan a la falla multisistémica y posterior fallecimiento. En la autopsia se confirma el diagnóstico de cavernomatosis portal.

Cavernous haemangioma of the rectum: an uncommon cause of rectal bleeding.

Cavernous haemangioma of the rectum is an uncommon cause of rectal bleeding. Initial diagnosis is often elusive because of lack of awareness. For accurate diagnosis, investigations such as endoscopy, plain X-ray of the abdomen, barium enema and selective angiography of the inferior mesenteric artery are required. Complete surgical excision of the haemangioma and colo-anal sleeve anastomosis is the most favoured operative procedure to eradicate the disease. We report a case of cavernous haemangioma of the rectum and discuss its salient clinical features, investigations and management.

Distonia segmentar como manifestaçäo de angioma cavernoso: relato de caso / Segmental dystonia as manifestation of cavernous angioma: case report

A distonia é uma síndrome neurológica cuja etiologia costuma não ser bem definida. Relatamos caso de uma paciente que apresentou aos 16 anos de idade dificuldade para tocar piano, havendo um comprometimento progressivo da mão, antebraço e braço esquerdo que posteriormente evoluiu com crises de "ausência" e cefaléia. Realizou exames de imagem que evidenciaram angioma cavernoso na região temporal profunda direita (ínsula). É rara a associação entre essas duas enfermidades, não havendo na literatura relato de distonia segmentar associada a crises de pseudoausência e cefaléia com características migranosas secundária ao angioma cavernoso. Vinte e cinco por cento das distonias são secundárias, o que nos faz sugerir uma investigação mínima em neuroimagem.

Co-existing spinal cord and brain cavernous angiomas.

Cavernous angioma of spinal cord is an extremely rare vascular malformation. The association with brain cavernous angioma is even uncommon. There should be a high index of suspicion for a spinal cord lesion whenever a brain cavernous angioma is diagnosed, in cases with appropriate suggestive spinal symptoms. We present a case of cavernous angioma of the brain involving the genu of the corpus callosum, co-existing with spinal cord hemangioma. Involvement of the corpus callosum by a cavernous angioma is also uncommon. Intraventricular extension of this lesion was also detected.

Laparoscopic cholecystectomy in patient with portal cavernoma and portal hypertension.

Successful laparoscopic cholecystectomy has been reported in patients with cirrhosis of liver with portal hypertension; the procedure has, however, not been reported in patients with portal vein thrombosis, portal cavernoma and portal hypertension. We report an 18-year-old man with portal hypertension due to portal vein thrombosis and portal cavernoma who had symptomatic gallstone disease and was successfully treated with laparoscopic cholecystectomy.