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Malignant hemangioendothelioma presenting as omental masses in a child
M a l i g n a n t H e m a n g i o e n d o t h e l i o m a Presenting as Omental M a s s e s in a Child By Shin-Lin Shih, Jin-Cherng Sheu, Be-Fong Chen, and Yei-Chang Ma Taipei, Taiwan, Repubfic of China • Malignant hemangioendothelioma is an uncommon lesion of the omentum in children. Multiple foci of malignant hemangioendothelioma is evenmore rare in the omentum. In the present case, a computed tomography scan of the abdomen showed multiple enhanced nodular lesions. To our knowledge, this is the first report of this tumor occurring in a child.
Copyright © 1995by W.B. Saunders Company INDEX WORDS: Malignant hernangioendothelioma, omenturn.
hemangioendothelioma can be found in any organ, especially the skin, soft M ALIGNANT tissues, bone, and liver. 1 The 0mental lesions commonly seen in children are enteric duplication cysts, cystic lymphangioma, nonpancreatic pseudocysts, and mesothelial cysts. 2Malignant omental hemangioendothelioma is rare. We report this case to add this tumor to the differential list Of abdominal masses occurring in children. Awareness of the radiological features is helpful in predicting the operative findings. CASE REPORT A 13-year-old girl presented with a 10-day history of abdominal pain. A 6- x 6-cm mass was palpable in the right lower abdomen. Sonography showed the mass to be of mixed echogenicity. A computed tomography (CT) scan (Fig 1) showed two ill-defined enhanced nodular lesions in the right lower abdomen. During surgery, multiple yarions-sized nodular lesions were found in the omentum, which were smooth and glistening; some were yellowish. Bloody ascites, tumor implants on the peritoneal surface, and Douglas pouch were seen. Omentectomy was performed. The postoperative course was smooth. Pathological examination showed the tumors to. be malignant hemangioendotheliomas Of the omentum.
the second most common abdominal tumor. 3Abdominal tumors in patients aged 12 to 21 years usually are lymphomas, hepatocellular carcinomas, and rhabdomyosarcomas.4 The common omental lesions in children are enteric duplication cysts, cystic lymphangiomas, nonpancreatic pseudocysts, and mesothelial cysts.2 There also have been sporadic cases of leiomyoma,5 American Burkitt lymphoma,6 and lipoma. 7 Malignant hemangioendothelioma had not been reported previously. Malignant hemangioendothelioma is a malignant tumor of vascular endothelial cells. It is common in the skin, and occurs in the area of the scalp in approximately one third of the patients. Approximately one fourth of the cases occur in soft tissues. Another fourth occur in sites such as the breast, liver, and bones. 1 Abdominal computed tomography is helpful in evaluating the extent of the disease and in determining the character of the mass. The omental lesions in cases of benign inflammatory disease were indistinguishable from those of malignant cases. However, the smudged pattern with omental inv01vement, as in the present case, is most common with malignant disease, s The nearly homogenous enhancement in the lesions of the omentum in the present case is highly suggestive of a vascuIar lesion.
DISCUSSION
Abdominal masses in children are always a diagnostic challenge. Organomegaly secondary to leukemia or lymphoma is the most common. Neuroblastoma is From the Departments of Radiology, Surgery, and Pathology, Mackay Memorial Hospital, Taipei, Taiwan, 10449, Republic of China. Address reprint requests to Shin-Lin Shih, MD, Department of Radiology, Mackay Memorial Hospital, 92, Section 2, Chung San North Rd, Taipei, Taiwan, Republic of China. Copyright © 1995 by W.B. Saunders Company 0022-3468/95/3001-0031503.00/0
118
Fig 1. CT scan of the lower abdomen shows tWO ill-defined enhancednodular lesions (arrowheads) in the right lower abdomenl
JournalofPediatric'Surgery, Vo130,'No 1 (January),'1995: pp 1'18-119
MALIGNANT HEMANGIOENDOTHELIOMA IN THE OMENTUM
119 REFERENCES
1. Enzinger FM, Weiss SW: Soft Tissue Tumors (ed 2). St Louis, MO, Mosby, 1988, pp 545-546 2. Stringer DA: Pediatric Gastrointestinal Imaging (ed 1). Toronto, Ontario, Decker, 1989, pp 262-268 3. Oski FA, DeAngelis CD, Feigin RD, et al: Principles and Practice of Pediatrics. Philadelphia, PA, Lippincott, 1990, pp 1564-1567, 1589-1590 4. DeVita VT Jr, Hellman S, Rosenberg SA: Cancer: Principles and Practice of Oncology (ed 3). Philadelphia, PA, Lippincott, 1989, pp 1612-1614
5. O'Brien JG, Allen JE, Queen TA: Leiomyoma of the omenturn in a child. J Pediatr Surg 21:981-982, 1986 6. Goodman P, Raval B: Omental cakes in American Burkitt lymphoma--Computed tomography demonstration. Clin Imaging 13:117-118, 1989 7. Haller JO, Schneider M, Kassher EG, et al: Sonographic evaluation of mesenteric and omental masses in children. AIR 130:269-274, 1978 8. Cooper C, Jeffrey RB, Silverman PM, et al: Computed tomography of omental pathology. J Comput Assist Tomogr 10:62-66, 1986
Copyright © 1995by W.B. Saunders Company INDEX WORDS: Malignant hernangioendothelioma, omenturn.
hemangioendothelioma can be found in any organ, especially the skin, soft M ALIGNANT tissues, bone, and liver. 1 The 0mental lesions commonly seen in children are enteric duplication cysts, cystic lymphangioma, nonpancreatic pseudocysts, and mesothelial cysts. 2Malignant omental hemangioendothelioma is rare. We report this case to add this tumor to the differential list Of abdominal masses occurring in children. Awareness of the radiological features is helpful in predicting the operative findings. CASE REPORT A 13-year-old girl presented with a 10-day history of abdominal pain. A 6- x 6-cm mass was palpable in the right lower abdomen. Sonography showed the mass to be of mixed echogenicity. A computed tomography (CT) scan (Fig 1) showed two ill-defined enhanced nodular lesions in the right lower abdomen. During surgery, multiple yarions-sized nodular lesions were found in the omentum, which were smooth and glistening; some were yellowish. Bloody ascites, tumor implants on the peritoneal surface, and Douglas pouch were seen. Omentectomy was performed. The postoperative course was smooth. Pathological examination showed the tumors to. be malignant hemangioendotheliomas Of the omentum.
the second most common abdominal tumor. 3Abdominal tumors in patients aged 12 to 21 years usually are lymphomas, hepatocellular carcinomas, and rhabdomyosarcomas.4 The common omental lesions in children are enteric duplication cysts, cystic lymphangiomas, nonpancreatic pseudocysts, and mesothelial cysts.2 There also have been sporadic cases of leiomyoma,5 American Burkitt lymphoma,6 and lipoma. 7 Malignant hemangioendothelioma had not been reported previously. Malignant hemangioendothelioma is a malignant tumor of vascular endothelial cells. It is common in the skin, and occurs in the area of the scalp in approximately one third of the patients. Approximately one fourth of the cases occur in soft tissues. Another fourth occur in sites such as the breast, liver, and bones. 1 Abdominal computed tomography is helpful in evaluating the extent of the disease and in determining the character of the mass. The omental lesions in cases of benign inflammatory disease were indistinguishable from those of malignant cases. However, the smudged pattern with omental inv01vement, as in the present case, is most common with malignant disease, s The nearly homogenous enhancement in the lesions of the omentum in the present case is highly suggestive of a vascuIar lesion.
DISCUSSION
Abdominal masses in children are always a diagnostic challenge. Organomegaly secondary to leukemia or lymphoma is the most common. Neuroblastoma is From the Departments of Radiology, Surgery, and Pathology, Mackay Memorial Hospital, Taipei, Taiwan, 10449, Republic of China. Address reprint requests to Shin-Lin Shih, MD, Department of Radiology, Mackay Memorial Hospital, 92, Section 2, Chung San North Rd, Taipei, Taiwan, Republic of China. Copyright © 1995 by W.B. Saunders Company 0022-3468/95/3001-0031503.00/0
118
Fig 1. CT scan of the lower abdomen shows tWO ill-defined enhancednodular lesions (arrowheads) in the right lower abdomenl
JournalofPediatric'Surgery, Vo130,'No 1 (January),'1995: pp 1'18-119
MALIGNANT HEMANGIOENDOTHELIOMA IN THE OMENTUM
119 REFERENCES
1. Enzinger FM, Weiss SW: Soft Tissue Tumors (ed 2). St Louis, MO, Mosby, 1988, pp 545-546 2. Stringer DA: Pediatric Gastrointestinal Imaging (ed 1). Toronto, Ontario, Decker, 1989, pp 262-268 3. Oski FA, DeAngelis CD, Feigin RD, et al: Principles and Practice of Pediatrics. Philadelphia, PA, Lippincott, 1990, pp 1564-1567, 1589-1590 4. DeVita VT Jr, Hellman S, Rosenberg SA: Cancer: Principles and Practice of Oncology (ed 3). Philadelphia, PA, Lippincott, 1989, pp 1612-1614
5. O'Brien JG, Allen JE, Queen TA: Leiomyoma of the omenturn in a child. J Pediatr Surg 21:981-982, 1986 6. Goodman P, Raval B: Omental cakes in American Burkitt lymphoma--Computed tomography demonstration. Clin Imaging 13:117-118, 1989 7. Haller JO, Schneider M, Kassher EG, et al: Sonographic evaluation of mesenteric and omental masses in children. AIR 130:269-274, 1978 8. Cooper C, Jeffrey RB, Silverman PM, et al: Computed tomography of omental pathology. J Comput Assist Tomogr 10:62-66, 1986