- Email: [email protected]
Hemangioma of the stomach
HEMANGIOMA
OF THE STOMACH
JAMES ROBERT GLADDEN, M.D. Assistant Resident in Surgery, Provident Hospital BALTIMORE,
MARYLAND
T
about z cm. to left of midline midway between xiphoid process and umbiIicus. The Laceration of skin was about one inch in Iength and horizontal in direction. Palpation about the wound showed some tenderness in both lumbar regions. No physica sign of fluid in his abdomen was noted. His skin was dark brown, smooth, moist, and showed a number of healed scars over the extremities. No nevi or otherwise unusua1 Iesions were noted. BIood count showed 4,200,000 red ceIIs and 11,850 white ceIIs per cmm. with 88 per cent CASE REPORT hemogIobin. The Wassermann reaction of the C. C., aged forty, a common laborer, was blood was positive. Except for traces of aIbumin admitted to the surgical service of Provident and sugar urinaIysis was essentially negative. HospitaI on ApriI 22, 1941, with a history of a (Test made after infusion of glucose and normal stab wound of his abdomen. The injury was saIine.) acquired folIowing an aItercation about ten At operation a lengthy midline incision blocks from the hospital. was made for expIoration of abdominal conImmediateIy after examination in the accitents. A laceration of the omentum near the greater curvature of stomach close to pyIorus, dent room, the patient was pIaced in bed in and two smaI1 Iacerations of jejunum were antishock position and given treatment for A protruding, paIpabIe, prominent shock. In less than an hour he was operated repaired. bluish-red mass about the size of a small upon. marbIe, and covered by an apparently norma The history of patient prior to this accident was not remarkabIe. Not infrequently, he had serosa, was noted on anterior surface of the stomach. This mass was near the greater suffered from pains in the epigastric area and headaches foIlowing overinduIgence in aIcohoIic curvature in the pyloric portion of the stomach. The tumor mass was excised and the operative beverages. These attacks usuaIIy cIeared up wounds were cIosed in the accepted manner. within twenty-four hours. There was no history No diagnosis of the type of tumor was atof constipation, black stools or even a IittIe tempted prior to time the specimen reached the blood in his stoo1 and no history of weight Ioss pathological Iaboratory. Lvmph gIands were at any time. His eyes were good, hearing was norma and no pathoIogrca1 changes were normal, appetite was good and his nose, throat, noted in any of the abdominai viscera examined and chest except for infrequent attacks of during the operation. The patient had an coryza in the faI1 and winter seasons had uneventfu1 convalescence and Ieft the hospital caused no serious trouble. He gave a history on MaJ- 1st. He was Iast seen twenty-five days oi’ a gonococca1 infection at age of seventeen after the operation, at which time he was in the ,vears and again at the age of thirty-four years. best of heaIth and offered no complaints. In both instances, symptoms were eliminated Pathological Report. The specimen confollowing medica treatment. Physical examination reveaIed a fairIy we11 sisted of a smaI1 mass removed in an eIIiptica1 manner, about the size of a smaI1 marbIe and developed and we11 nourished aduIt negro covered by two we11 defined Iayers of tissue. patient. Head, neck and chest were essentiaIIy A Iight bluish-red coIor was noted over both negative. The abdomen was normaI in size surfaces about the firm, spherical and someand shape. A penetrating stab wound, with what movable inner mass. Section revealed omentum protruding from same, was noted
HIS report includes the record of one case of hemangioma of the stomach and a review of the Iiterature concerning this condition. This case is of interest because there were no symptoms, and the tumor was accidentaIly found during an exploratory operation for a stab wound of the abdomen. The mass was excised and sent to the pathoIogy Iaboratory for diagnosis.
494
496
American Journal of Surgery
GIadden-Hemangioma
definite outer Iayers surrounding a circumscribed bIuish-red, geIatinous-like rounded mass of tissue with a diameter of I cm. A
of Stomach capiIIary type with varying transition between the two. In reviewing the Iiterature,
MAY, 1~2
changes
in
it is obvious
2. Photomicrograph of the hemangioma showing more in detai1 the cavernous spaces. x 100.
FIG.
FIG. I. Photomicrograph showing section of the hemangioma in the muscular waII of the stomach. The mucosa of the stomach is at the top and is distinct. The cavernous spaces in the tumor mass are outstanding and the tumor can be seen to invade the subserosa beIow. X 8.
sanguineous fluid exuded from the cut surface. Microscopic Examination. The mucous membrane of the stomach was normaI throughout. The growth was in the muscular wall and extended through to the submucosa. It was characterized by capiIIary waIIs Iined by endothebum. The area was supported by proIiferating endotheIium in which there were many Iymphocytes and large monocytes most of which contained bIood pigment. There were a few poIymorphonucIears and proIiferating JibrobIasts present. Diagnosis: Cavernous hemangioma in the muscular layers of the stomach wal1. COMMENT
A hemangioma is a tumor produced by a new formation of bJood vesseIs. It is quite common in some Iocations and is usuaIIy caIIed an angioma. Two types are usuaIJy seen: the capiJIary and the cavernous. Cavernous hemangiomas are less common, having the same structure as erectiIe tissue, and are composed of Iarge bIood spaces or sinusoids Iined by endotheIium. It is extremeIy rare to find a tumor showing a compIete cavernous change. In aImost aJI reported cases if the cavernous hemangioma is present, it is associated with the
that benign tumors of the stomach are infrequent, and that vascuIar tumors are especiaIIy rare in this group. Lemon, in 1920, reported one case of angioma of the stomach to add to the five of which he had knowIedge, nameIy, the cases reported by Guisez, Stockis, Burty, Lammers, and one by SherriI and Graves. Kornmann, in 1913, stated that hemangioma constituted onJy 7 per cent of a11 benign tumors of the entire gastrointestina1 tract. BaIfour and Henderson, in 1927, pubJished a report on a study of Jifty-eight cases of benign tumors of the stomach that had come up for operation at the Mayo CJinic up to the time the articJe was written. In this series there were onIy four cases of hemangioma of the stomach. Three of the four patients with hemangioma had suffered from sIight dyspepsia and a fourth from recurring attacks of diarrhea. The outstanding features of this group, however, were the previous occurrence of meIena in three cases and of severe hematemesis in one. In 0nIy one case was gastric acidity abnorma1; there was no free hydrochIoric acid. The hemogJobin in two of the cases was 44 and 47 per cent, respectively. The tumors varied from 2.5 to 6 cm. in diameter, and the Iargest weighted 108 Gm. They were a11 singIe and peduncuIated. Two were ulcerated and none had undergone mabgnant degeneration.
NEW SERIES VOL. LVI.
No.
z
GIadden-Hemangioma
McCIure and Ellis, in 1930, published the records of twenty-five patients who had been found to have hemangioma of the gastrointestinal tract. Of these, fourteen were single and eleven multipIe. There were no cases of hemangioma of the stomach in this group. The records of two additiona patients and a complete review of the literature were published by Kaijser in 1936. He classified seventy-four verified
BY
KAIJSER
OF
VERIFIED
Grwp.
................ Sex...... ............
Age variation. I .ocation Esophagus. Stomach ._,.... ,“:. Duodenum. Jejunum IIeum. Meckel’s diverticulum Small intestine. Cecum. Sigmold fIexure. Rectum.. L.arge intestine......................! GastrointestinaI tract. Total cases..
INSTANCES
I OF
HEMANGIO’4A
Diffuse Infiltrating Cavernous Hemangioma
Pinpoint Multiple Varicosities
Classitication (Kaijseri
OF
GASTROINTESTINAL
Circumscribed Cavernous Polypoid Hemangioma
I
II
IV
14M
5M
8F 3 mo.-48
7
3 9
12
j
yr.
I
I I
2F 3 mo.-64
/
2
’
:
I-
L instances of hemangioma of the gastrointestinal tract into five groups, which may be summarized as in the accompanying TabIe I. (From Pierose’s report of hemangioma of the gastrointestina1 tract.) Ewing refers to Kaijser’s “ hemangioma simplex” group as being synonymous with “ teIangiectasis.” Kaijser also inchrded a fifth group in his cIassification, “ hemangiomatosis.” Cases under this classification presented hemangiomas in other organs in addition to those found in the gastrointestinal tract. Minnes and Geschickter, in 1936, published an articIe reviewing the Iiterature
\
2M
SF; I? yr. 12 mo.-61 yr.
2 :
I
4
3
I
I
3 I I
___-
27
22
TRACT
Hemangioma jll emangioSimplex (TeIangiI matosis ectasis) i
2q.M 3F 2c79
7
I
497
of benign tumors of the stomach and presented the cIinica1 and pathological features of fifty benign tumors of the stomach recorded in the Johns Hopkins Hospital from I 889 to September 1936. According to the tissue of origin they divided the tumors into two groups: epithelial and mesenchymal. Among the epitheIia1 tumors were adenomas, adenopapiIIomas, adenomyomas and fibroade-
TABLE CLASSIFICATION
American~~~~~~~of surgery
of Stomach
I I
7
: 8
I
noma. Chief among the mesenchyma1 tumors were the Ieiomyomas, fibromas, Iipomas, neurofibromas and the rare angiomas and osteomas. According to their report hemangiomas are rare. Ten had been collected by EIiason and Wright, to which five more recent cases were added. In the series of fifty cases reported by Minnes and Geschickter, there was only one case of hemangioma. In regard to the mesenchymal tumors, the latter authors state that they may be sessile or pedunculated. They Iie within the waI1 of the stomach, project into its Iumen or remain subserous and project into the peritonea1 cavity. They are usuaIIy
498
GIadden-Hemangioma
American Journal of Surgery
smaII but sometimes grow to tremendous size. OccasionaIIy, by virtue of their size and position, they cause embarrassment of the circuIation to the supra-adjacent mucosa, resuking in necrosis and ukeration. RareIy do they undergo hyaIine, cystic or mahgnant change. TABLE II INCIDENCEOF BENIGN TUMORS OF THE STOMACH GATHERED FROM THE LITERATURE BY MINNES AND GESCHICKTER Per No. Cent EpitheliaI PoIyps .._. _. 182 19.5 PapilIomas. 89 9.5 Adenomas.. 42 4.5 Polyposis. , 16 I .7 MesenchymaI Leiomyomas, 341 36.6 Neurofibromas., . 102 10.9 Fibromas.................. 42 4.5 Lipomas.. 32 3.4
I 0.1 I 0.1
Osteomas Osteochondromas. Myomas. . . Endothelial Hemangiomas Lymphadenomas.. EndotheIiomas. cysts Simple.. Dermoid. . Echinococcic. Total. SUMMARY
3
.
15 14 12
I 6 1.5 I.2
29
3.2
5 0.3 4
... AND
A patient came hospita1 with the
0.3
.
0.4
. . 931
CONCLUSION
to accident room of compIaint of a stab
of Stomach
Mau. ,942
wound of the abdomen. During the operation a smaI1 bIuish area projecting from the serosa1 surface of the stomach was excised. A pathologica diagnosis of cavernous hemangioma of stomach was made. There was no history of any symptoms in reIation to the tumor. REFERENCES BALFOUR, D. C. and HENDERSON, E. F. Benign tumors of the stomach. Ann. Surg., 85: 354-359, 1927. 2. BURTY. Un cas de volumineux, angiosarcome sousmuqueux, pCdicuIii de Ia grande courbure de I’Cstomac. Paris cbir., 6: 731-735, 1914. 3. ELIASON, E. L. and WRIGHT, V. W. Benign tumors of the stomach. Surg., Gynec. TVObst., 41: 461-472, I.
1925. 4. EWING, JAMES. Neoplastic Diseases. 3rd ed. PhiIadeIphia, 1934. W. B. Saunders Company. oeso5. GUISEZ. Angiome du cardia, diagnostique phagoscopique. Larynx,. 6: 201-203, 1913. 6. KAIJSER, R. Arch. j. k&n. Cbir., 187: 351 and 661, 1936. 7. KORNMANN. Zentralbl. f. Cbir., p. 1427, 1913. 8. LAMMERS, R. Angioma ventriculi simpIex. Inaug. Diss., GreifswaId, Abel, 1893. 9. LEMON, W. S. Angioma of stomach. Med. Rec., 97: 220, 1920. IO. MCCLURE, R. D. and ELLIS, S. W. Am. J. Surg., 10: 241, 1930. II. MINNES, J. F. and GESCHICKTER, C. F. Benign tumors of the stomach. Am. J. Cancer, 28: 136149, 1936. 12. PIEROSE, P. N. Hemangioma of the gastrointestina tract. J. A. M. A., I 15: zog, 1940. ‘3. SHERRIL, T. G. and GRAVES, F. S. Hemangioendothelio-blastoma of the stomach. Surg., Gynec. & Obst., 20: 443-446, 1915.
OF THE STOMACH
JAMES ROBERT GLADDEN, M.D. Assistant Resident in Surgery, Provident Hospital BALTIMORE,
MARYLAND
T
about z cm. to left of midline midway between xiphoid process and umbiIicus. The Laceration of skin was about one inch in Iength and horizontal in direction. Palpation about the wound showed some tenderness in both lumbar regions. No physica sign of fluid in his abdomen was noted. His skin was dark brown, smooth, moist, and showed a number of healed scars over the extremities. No nevi or otherwise unusua1 Iesions were noted. BIood count showed 4,200,000 red ceIIs and 11,850 white ceIIs per cmm. with 88 per cent CASE REPORT hemogIobin. The Wassermann reaction of the C. C., aged forty, a common laborer, was blood was positive. Except for traces of aIbumin admitted to the surgical service of Provident and sugar urinaIysis was essentially negative. HospitaI on ApriI 22, 1941, with a history of a (Test made after infusion of glucose and normal stab wound of his abdomen. The injury was saIine.) acquired folIowing an aItercation about ten At operation a lengthy midline incision blocks from the hospital. was made for expIoration of abdominal conImmediateIy after examination in the accitents. A laceration of the omentum near the greater curvature of stomach close to pyIorus, dent room, the patient was pIaced in bed in and two smaI1 Iacerations of jejunum were antishock position and given treatment for A protruding, paIpabIe, prominent shock. In less than an hour he was operated repaired. bluish-red mass about the size of a small upon. marbIe, and covered by an apparently norma The history of patient prior to this accident was not remarkabIe. Not infrequently, he had serosa, was noted on anterior surface of the stomach. This mass was near the greater suffered from pains in the epigastric area and headaches foIlowing overinduIgence in aIcohoIic curvature in the pyloric portion of the stomach. The tumor mass was excised and the operative beverages. These attacks usuaIIy cIeared up wounds were cIosed in the accepted manner. within twenty-four hours. There was no history No diagnosis of the type of tumor was atof constipation, black stools or even a IittIe tempted prior to time the specimen reached the blood in his stoo1 and no history of weight Ioss pathological Iaboratory. Lvmph gIands were at any time. His eyes were good, hearing was norma and no pathoIogrca1 changes were normal, appetite was good and his nose, throat, noted in any of the abdominai viscera examined and chest except for infrequent attacks of during the operation. The patient had an coryza in the faI1 and winter seasons had uneventfu1 convalescence and Ieft the hospital caused no serious trouble. He gave a history on MaJ- 1st. He was Iast seen twenty-five days oi’ a gonococca1 infection at age of seventeen after the operation, at which time he was in the ,vears and again at the age of thirty-four years. best of heaIth and offered no complaints. In both instances, symptoms were eliminated Pathological Report. The specimen confollowing medica treatment. Physical examination reveaIed a fairIy we11 sisted of a smaI1 mass removed in an eIIiptica1 manner, about the size of a smaI1 marbIe and developed and we11 nourished aduIt negro covered by two we11 defined Iayers of tissue. patient. Head, neck and chest were essentiaIIy A Iight bluish-red coIor was noted over both negative. The abdomen was normaI in size surfaces about the firm, spherical and someand shape. A penetrating stab wound, with what movable inner mass. Section revealed omentum protruding from same, was noted
HIS report includes the record of one case of hemangioma of the stomach and a review of the Iiterature concerning this condition. This case is of interest because there were no symptoms, and the tumor was accidentaIly found during an exploratory operation for a stab wound of the abdomen. The mass was excised and sent to the pathoIogy Iaboratory for diagnosis.
494
496
American Journal of Surgery
GIadden-Hemangioma
definite outer Iayers surrounding a circumscribed bIuish-red, geIatinous-like rounded mass of tissue with a diameter of I cm. A
of Stomach capiIIary type with varying transition between the two. In reviewing the Iiterature,
MAY, 1~2
changes
in
it is obvious
2. Photomicrograph of the hemangioma showing more in detai1 the cavernous spaces. x 100.
FIG.
FIG. I. Photomicrograph showing section of the hemangioma in the muscular waII of the stomach. The mucosa of the stomach is at the top and is distinct. The cavernous spaces in the tumor mass are outstanding and the tumor can be seen to invade the subserosa beIow. X 8.
sanguineous fluid exuded from the cut surface. Microscopic Examination. The mucous membrane of the stomach was normaI throughout. The growth was in the muscular wall and extended through to the submucosa. It was characterized by capiIIary waIIs Iined by endothebum. The area was supported by proIiferating endotheIium in which there were many Iymphocytes and large monocytes most of which contained bIood pigment. There were a few poIymorphonucIears and proIiferating JibrobIasts present. Diagnosis: Cavernous hemangioma in the muscular layers of the stomach wal1. COMMENT
A hemangioma is a tumor produced by a new formation of bJood vesseIs. It is quite common in some Iocations and is usuaIIy caIIed an angioma. Two types are usuaIJy seen: the capiJIary and the cavernous. Cavernous hemangiomas are less common, having the same structure as erectiIe tissue, and are composed of Iarge bIood spaces or sinusoids Iined by endotheIium. It is extremeIy rare to find a tumor showing a compIete cavernous change. In aImost aJI reported cases if the cavernous hemangioma is present, it is associated with the
that benign tumors of the stomach are infrequent, and that vascuIar tumors are especiaIIy rare in this group. Lemon, in 1920, reported one case of angioma of the stomach to add to the five of which he had knowIedge, nameIy, the cases reported by Guisez, Stockis, Burty, Lammers, and one by SherriI and Graves. Kornmann, in 1913, stated that hemangioma constituted onJy 7 per cent of a11 benign tumors of the entire gastrointestina1 tract. BaIfour and Henderson, in 1927, pubJished a report on a study of Jifty-eight cases of benign tumors of the stomach that had come up for operation at the Mayo CJinic up to the time the articJe was written. In this series there were onIy four cases of hemangioma of the stomach. Three of the four patients with hemangioma had suffered from sIight dyspepsia and a fourth from recurring attacks of diarrhea. The outstanding features of this group, however, were the previous occurrence of meIena in three cases and of severe hematemesis in one. In 0nIy one case was gastric acidity abnorma1; there was no free hydrochIoric acid. The hemogJobin in two of the cases was 44 and 47 per cent, respectively. The tumors varied from 2.5 to 6 cm. in diameter, and the Iargest weighted 108 Gm. They were a11 singIe and peduncuIated. Two were ulcerated and none had undergone mabgnant degeneration.
NEW SERIES VOL. LVI.
No.
z
GIadden-Hemangioma
McCIure and Ellis, in 1930, published the records of twenty-five patients who had been found to have hemangioma of the gastrointestinal tract. Of these, fourteen were single and eleven multipIe. There were no cases of hemangioma of the stomach in this group. The records of two additiona patients and a complete review of the literature were published by Kaijser in 1936. He classified seventy-four verified
BY
KAIJSER
OF
VERIFIED
Grwp.
................ Sex...... ............
Age variation. I .ocation Esophagus. Stomach ._,.... ,“:. Duodenum. Jejunum IIeum. Meckel’s diverticulum Small intestine. Cecum. Sigmold fIexure. Rectum.. L.arge intestine......................! GastrointestinaI tract. Total cases..
INSTANCES
I OF
HEMANGIO’4A
Diffuse Infiltrating Cavernous Hemangioma
Pinpoint Multiple Varicosities
Classitication (Kaijseri
OF
GASTROINTESTINAL
Circumscribed Cavernous Polypoid Hemangioma
I
II
IV
14M
5M
8F 3 mo.-48
7
3 9
12
j
yr.
I
I I
2F 3 mo.-64
/
2
’
:
I-
L instances of hemangioma of the gastrointestinal tract into five groups, which may be summarized as in the accompanying TabIe I. (From Pierose’s report of hemangioma of the gastrointestina1 tract.) Ewing refers to Kaijser’s “ hemangioma simplex” group as being synonymous with “ teIangiectasis.” Kaijser also inchrded a fifth group in his cIassification, “ hemangiomatosis.” Cases under this classification presented hemangiomas in other organs in addition to those found in the gastrointestinal tract. Minnes and Geschickter, in 1936, published an articIe reviewing the Iiterature
\
2M
SF; I? yr. 12 mo.-61 yr.
2 :
I
4
3
I
I
3 I I
___-
27
22
TRACT
Hemangioma jll emangioSimplex (TeIangiI matosis ectasis) i
2q.M 3F 2c79
7
I
497
of benign tumors of the stomach and presented the cIinica1 and pathological features of fifty benign tumors of the stomach recorded in the Johns Hopkins Hospital from I 889 to September 1936. According to the tissue of origin they divided the tumors into two groups: epithelial and mesenchymal. Among the epitheIia1 tumors were adenomas, adenopapiIIomas, adenomyomas and fibroade-
TABLE CLASSIFICATION
American~~~~~~~of surgery
of Stomach
I I
7
: 8
I
noma. Chief among the mesenchyma1 tumors were the Ieiomyomas, fibromas, Iipomas, neurofibromas and the rare angiomas and osteomas. According to their report hemangiomas are rare. Ten had been collected by EIiason and Wright, to which five more recent cases were added. In the series of fifty cases reported by Minnes and Geschickter, there was only one case of hemangioma. In regard to the mesenchymal tumors, the latter authors state that they may be sessile or pedunculated. They Iie within the waI1 of the stomach, project into its Iumen or remain subserous and project into the peritonea1 cavity. They are usuaIIy
498
GIadden-Hemangioma
American Journal of Surgery
smaII but sometimes grow to tremendous size. OccasionaIIy, by virtue of their size and position, they cause embarrassment of the circuIation to the supra-adjacent mucosa, resuking in necrosis and ukeration. RareIy do they undergo hyaIine, cystic or mahgnant change. TABLE II INCIDENCEOF BENIGN TUMORS OF THE STOMACH GATHERED FROM THE LITERATURE BY MINNES AND GESCHICKTER Per No. Cent EpitheliaI PoIyps .._. _. 182 19.5 PapilIomas. 89 9.5 Adenomas.. 42 4.5 Polyposis. , 16 I .7 MesenchymaI Leiomyomas, 341 36.6 Neurofibromas., . 102 10.9 Fibromas.................. 42 4.5 Lipomas.. 32 3.4
I 0.1 I 0.1
Osteomas Osteochondromas. Myomas. . . Endothelial Hemangiomas Lymphadenomas.. EndotheIiomas. cysts Simple.. Dermoid. . Echinococcic. Total. SUMMARY
3
.
15 14 12
I 6 1.5 I.2
29
3.2
5 0.3 4
... AND
A patient came hospita1 with the
0.3
.
0.4
. . 931
CONCLUSION
to accident room of compIaint of a stab
of Stomach
Mau. ,942
wound of the abdomen. During the operation a smaI1 bIuish area projecting from the serosa1 surface of the stomach was excised. A pathologica diagnosis of cavernous hemangioma of stomach was made. There was no history of any symptoms in reIation to the tumor. REFERENCES BALFOUR, D. C. and HENDERSON, E. F. Benign tumors of the stomach. Ann. Surg., 85: 354-359, 1927. 2. BURTY. Un cas de volumineux, angiosarcome sousmuqueux, pCdicuIii de Ia grande courbure de I’Cstomac. Paris cbir., 6: 731-735, 1914. 3. ELIASON, E. L. and WRIGHT, V. W. Benign tumors of the stomach. Surg., Gynec. TVObst., 41: 461-472, I.
1925. 4. EWING, JAMES. Neoplastic Diseases. 3rd ed. PhiIadeIphia, 1934. W. B. Saunders Company. oeso5. GUISEZ. Angiome du cardia, diagnostique phagoscopique. Larynx,. 6: 201-203, 1913. 6. KAIJSER, R. Arch. j. k&n. Cbir., 187: 351 and 661, 1936. 7. KORNMANN. Zentralbl. f. Cbir., p. 1427, 1913. 8. LAMMERS, R. Angioma ventriculi simpIex. Inaug. Diss., GreifswaId, Abel, 1893. 9. LEMON, W. S. Angioma of stomach. Med. Rec., 97: 220, 1920. IO. MCCLURE, R. D. and ELLIS, S. W. Am. J. Surg., 10: 241, 1930. II. MINNES, J. F. and GESCHICKTER, C. F. Benign tumors of the stomach. Am. J. Cancer, 28: 136149, 1936. 12. PIEROSE, P. N. Hemangioma of the gastrointestina tract. J. A. M. A., I 15: zog, 1940. ‘3. SHERRIL, T. G. and GRAVES, F. S. Hemangioendothelio-blastoma of the stomach. Surg., Gynec. & Obst., 20: 443-446, 1915.