Unenbat Gurbadam, MD. National Cancer Center of Mongolia.
Introduction: Pancreatic hemangioma is very rare and hardly suspected clinically due to their nonspecific symptoms and diagnostic characteristics. We report an adult pancreatic hemangioma diagnosed on pathological specimen review following laparoscopic distal pancreatectomy with splenectomy for a two cystic mass in the body of the pancreas.
Case report: A 49-years-old woman was admitted to our institution because of bowel distention, constipation, and fatigue. Pancreatic cystic lesions were incidentally found on ultrasound when she visited a gynecologist for evaluation of suspected uterus myoma. A computed tomography (CT) scan demonstrated two lesions, first lesion was 2.7×2.3cm sized unilocular cystic tumor and second lesion was 2.4×2.3cm sized multilocular cystic tumor with septation and intramural nodules in the pancreatic body. The suspicious intramural nodule and wall enhancement could not exclude a malignancy, and then we decided a surgical removal. She underwent in laparoscopic distal pancreatosplenectomy. Her perioperative course was uneventful. The histological result is pancreatic cavernous hemangioma.
Method: We used three trocars of 5mm and two trocars of 12mm. After the insertion of trocars, the entire gastro colic ligament from distal antrum up to the fundus of stomach, including the short gastric vessels, are divided by Ligasure. The splenic artery is identified at the upper border of the body of pancreas, double clipped and divided. The splenorenal, splenophrenic ligaments, superior pole of the spleen and retrogastric vessels are divided. The splenic vein and the body of pancreas are divided by Endo-GIA stapler. The resected specimen of pancreas and spleen is placed into a bag then retrieved by pfannenstiel incision. The surgery was successfully finished by laparoscopy without a perioperative complication.
Result: Gross examination of the tumor revealed a two mass; first lesion composed of well-defined wall, containing a dark green fluid, and second lesion is composed of cystic spaces containing gelatinous material and hemorrages. The tumor did not involve the surgical margin. On microscopic examination shows pancreatic acinar tissue consisted of blood vessel with dilated cystic lumen filled with red blood cell (Figures 4). Immunohistochemistry (IHC) examination revealed that this lining was positive for CD34 (Figures 5). And CD68 stain shows macrophage cells in cystic lumen filled with red blood cell. The histological results demonstrate that tumor was pancreatic cavernous hemangioma.
Conclusion: This case of an adult pancreatic hemangioma is the sixteenth reported in literature since 1939. The histological examinations are very important role for pancreatic hemangioma diagnosis. In pediatric cases, they often regress, no surgical removal is advocated other than follow-up. But in adult cases, the risk of sudden hemorrhage, abdominal pain, and possible differential diagnosis with malignant tumors, surgical resection is recommended.