E1685. Multi-Modality Imaging of Anastomosing Hemangioma at Common and Uncommon Locations of the Body
  1. Min Kong; Mayo Clinic
  2. Kenneth Huynh; University of California Irvine Medical Center
  3. Amanda Nguyen; Mayo Clinic
  4. Felipe Martinez; Mayo Clinic
  5. Ba Nguyen; Mayo Clinic
Anastomosing hemangioma is a rare benign vascular tumor composed of packed capillary channels characterized by anastomosing sinusoidal patterns, nonlobular growth, mild endothelial atypia with hobnail endothelial cell, rare or absent mitotic activity and associated mature fat and extramedullary hematopoiesis. Frequent GNAQ, GNA11, and GNA14 gene mutations are involved. Initially reported in the kidney, adrenal gland, liver and retroperitoneum, it could be ubiquitous in the body. Anastomosing hemangioma differs from other types of hemangiomas by its occurrence mostly at deep or visceral sites of the body in the adult patient population. Usually asymptomatic, anastomosing hemangioma is depicted incidentally during the cross-sectional imaging evaluation of other pathologies mimicking primary or secondary malignancies. The authors present the multimodality imaging of this benign vascular neoplasm with US, CT, MR and PET/CT at common and uncommon sites of the body

Educational Goals / Teaching Points
To present the ultrasound, CT, MRI and PET/CT features of anastomosing hemangioma and to discuss the differential diagnosis of these imaging features mimicking angiosarcoma and other malignant hypervascular lesions. To present the common and unusual sites of anastomosing hemangioma.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The characteristic imaging features with CT and MR showing well-circumscribed lesions with peripheral, discontinuous, nodular enhancement or homogeneous diffuse internal enhancement with coexisting non-enhancing components from hyaline degeneration, vascular thrombi and occasional fat component. Ultrasound showing well-circumscribed lesions with mixed echogenicity, variable vascularity and potential intense internal vascularity on Doppler evaluation. PET/CT showing low tracer avidity ranging from mediastinal blood pool uptake level to hepatic parenchymal uptake intensity. The sites (kidney, adrenal gland, liver, retroperitoneum, mediastinum, pleura, spleen, spinal canal, neural foramen and musculoskeletal system).

Learners will be familiar with the imaging features of benign anastomosing hemangioma at different locations of the body especially kidney, retroperitoneum and liver.