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Background <p>Anastomosing hemangioma (AH) is a rare benign vascular neoplasm that histologically mimics angiosarcoma and has been reported in various sites, including the kidney, liver, adrenal gland, bladder, and retroperitoneum. When arising from the renal vein or its junction with the inferior vena cava, AH is exceptionally uncommon, with only a few cases described. Its hypervascular nature often leads imaging to suggest malignancy, making preoperative differentiation from angiosarcoma challenging. Surgical excision remains both diagnostic and curative, with laparoscopic resection feasible in selected cases and specialized centers.</p> Methods <p>We report the case of a 77-year-old man with an incidentally discovered retroperitoneal mass arising from the left renal vein and extending toward the inferior vena cava. Imaging revealed a well-enhancing hypervascular lesion suggestive of malignancy. After multidisciplinary evaluation, surgical excision without renal vein reconstruction was planned, supported by literature evidence on the safety of renal vein ligation without reconstruction. Postoperative Doppler ultrasound at 72 h confirmed adequate venous drainage via preserved tributary vessels. Follow-up at 6 months, including renal function tests and Doppler ultrasound, showed no renal dysfunction or morphologic abnormalities.</p> Results <p>The accompanying video demonstrates step-by-step laparoscopic dissection and resection of the lesion, highlighting key anatomic landmarks, vascular control strategies, and techniques to minimize intraoperative bleeding. Histopathologic analysis revealed anastomosing capillary-sized vessels lined by bland endothelial cells, consistent with AH, with immunohistochemistry positive for CD34, SMA, and ERG.</p> Conclusions <p>AH should be considered in the differential diagnosis of retroperitoneal vascular tumors. In cases involving major vascular structures, preoperative biopsy is often unfeasible, and surgical excision becomes necessary for definitive diagnosis and treatment. Laparoscopic resection can be performed safely in high-volume centers, offering the benefits of minimally invasive surgery along with excellent oncologic and functional outcomes.</p>

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Laparoscopic Approach to a Rare Hypervascular Renal Vein Tumor: A Case of Anastomosing Hemangioma

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月28日

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  • Giorgio D’Annibale,
  • Matteo Aulicino,
  • Cecilia Orsini,
  • Carlo Abatini,
  • Miriam Attalla El Halabieh,
  • Valerio Gallotta,
  • Andrea Rosati,
  • Giovanni Tinelli,
  • Francesco Santullo,
  • Fabio Pacelli,
  • Claudio Lodoli

摘要

Background

Anastomosing hemangioma (AH) is a rare benign vascular neoplasm that histologically mimics angiosarcoma and has been reported in various sites, including the kidney, liver, adrenal gland, bladder, and retroperitoneum. When arising from the renal vein or its junction with the inferior vena cava, AH is exceptionally uncommon, with only a few cases described. Its hypervascular nature often leads imaging to suggest malignancy, making preoperative differentiation from angiosarcoma challenging. Surgical excision remains both diagnostic and curative, with laparoscopic resection feasible in selected cases and specialized centers.

Methods

We report the case of a 77-year-old man with an incidentally discovered retroperitoneal mass arising from the left renal vein and extending toward the inferior vena cava. Imaging revealed a well-enhancing hypervascular lesion suggestive of malignancy. After multidisciplinary evaluation, surgical excision without renal vein reconstruction was planned, supported by literature evidence on the safety of renal vein ligation without reconstruction. Postoperative Doppler ultrasound at 72 h confirmed adequate venous drainage via preserved tributary vessels. Follow-up at 6 months, including renal function tests and Doppler ultrasound, showed no renal dysfunction or morphologic abnormalities.

Results

The accompanying video demonstrates step-by-step laparoscopic dissection and resection of the lesion, highlighting key anatomic landmarks, vascular control strategies, and techniques to minimize intraoperative bleeding. Histopathologic analysis revealed anastomosing capillary-sized vessels lined by bland endothelial cells, consistent with AH, with immunohistochemistry positive for CD34, SMA, and ERG.

Conclusions

AH should be considered in the differential diagnosis of retroperitoneal vascular tumors. In cases involving major vascular structures, preoperative biopsy is often unfeasible, and surgical excision becomes necessary for definitive diagnosis and treatment. Laparoscopic resection can be performed safely in high-volume centers, offering the benefits of minimally invasive surgery along with excellent oncologic and functional outcomes.