D'Annibale Giorgio, Aulicino Matteo, Orsini Cecilia, Abatini Carlo, El Halabieh Miriam Attalla, Gallotta Valerio, Rosati Andrea, Tinelli Giovanni, Santullo Francesco, Pacelli Fabio, Lodoli Claudio
General Surgery Department, Università Cattolica del Sacro Cuore, Rome, Italy.
Surgical Unit of Peritoneum and Retroperitoneum Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Ann Surg Oncol. 2025 Oct;32(10):7829-7831. doi: 10.1245/s10434-025-17892-8. Epub 2025 Jul 28.
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.
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.
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.
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.
吻合性血管瘤（AH）是一种罕见的良性血管肿瘤，在组织学上与血管肉瘤相似，已在包括肾脏、肝脏、肾上腺、膀胱和腹膜后等多个部位被报道。当起源于肾静脉或其与下腔静脉的交界处时，AH极为罕见，仅有少数病例被描述。其高血管特性常导致影像学检查提示恶性肿瘤，使得术前与血管肉瘤的鉴别具有挑战性。手术切除既是诊断方法也是治疗手段，在特定病例和专业中心可行腹腔镜切除术。
我们报告了一例77岁男性病例，其腹膜后肿块偶然被发现，起源于左肾静脉并延伸至下腔静脉。影像学检查显示一个强化良好的高血管病变，提示为恶性肿瘤。经过多学科评估，计划在无肾静脉重建的情况下进行手术切除，这得到了关于无重建肾静脉结扎安全性的文献证据支持。术后72小时的多普勒超声检查证实通过保留的分支血管有足够的静脉引流。6个月的随访，包括肾功能检查和多普勒超声检查，显示没有肾功能障碍或形态学异常。
随附视频展示了病变的逐步腹腔镜解剖和切除过程，突出了关键的解剖标志、血管控制策略以及减少术中出血的技术。组织病理学分析显示由温和的内皮细胞衬里的吻合性毛细血管大小的血管，符合AH，免疫组化CD34、SMA和ERG呈阳性。
在腹膜后血管肿瘤的鉴别诊断中应考虑AH。在涉及主要血管结构的病例中，术前活检通常不可行，手术切除对于明确诊断和治疗是必要的。在高容量中心可以安全地进行腹腔镜切除，提供微创手术的益处以及良好的肿瘤学和功能结果。
