Hemangioma is one of the most common benign tumours widely found in many organs, with a high occurrence during infancy and childhood. About 250 cases have been reported in the gastrointestinal system in the English papers since 1839. Hemangioma involving mesentery is extremely rare, and only twenty cases have been reported, among which four cases were in large size. The four cases were all adults, and no such patients of children or adolescents have been reported to our knowledge. Herein we reported a case aged 5 years in which the tumour was limited to the mesentery of the small bowel.
In histopathology, hemangioma may be classified into several categories according to vessel size and wall thickness [1]. Actually, not all types have been reported to occur in the gastrointestinal system. The classification of the intestinal hemangioma adopted by Abrahamson and Shandling was also supposed to be applied in mesenteric hemangioma [7]. The three types were capillary type, cavernous type, capillary and cavernous mixed type respectively, among which the most common one was cavernous type characteristic of diluted vessel with thin wall. In our case, the tumour was combined with two types. The majority was cavernous hemangioma, with minor part being venous hemangioma characteristic of diluted vessels with thick wall composed of less organized smooth muscles, which was also confirmed by immunohistochemistry. So it was of cavernous and venous mixed type in histology. To our knowledge, such hemangioma has been seldom reported previously except in the case of Ruiz and Ginsberg, in which some vessels had venous-like bundles of mural smooth muscle [3]. It is inferred that the type was not included in Abrahamson and Shandling’s classification due to its rarity.
Hemangiomas of mixed cavernous and venous type are supposed to be one variation of venous type by some pathologists because venous hemangiomas may also have area indistinguishable from cavernous hemangiomas [1]. However, in our case, cavernous hemangioma made up the most of the tumour, whereas the venous hemangioma only took up the minor part. So, the case was better designated of hemangioma of cavernous and venous mixed type. We observed that existence of veins in the tumour was also supposed to be one kind of vascular malformations.
The origin of mesenteric hemangioma is still uncertain. Most reported cases involved both bowel wall and mesentery. Given hemangiomas of mesentery are far rarer than those of bowel, they are always proposed to be originated from the bowel, especially submucosa [3]. But in some cases, including ours, the tumours were limited in the mesentery rather than the bowel wall, and it seemed that the hemangioma was originated from the mesentery.
The symptoms of intestinal and mesenteric hemangiomas were often bleeding or obstruction depending on its location [8–10]. In our case, the tumour was located in mesentery and the bowel wall structure is reserved, so no bleeding was observed. It mainly displayed mass effect thus resulted to ileus.
The preoperative diagnosis of mesenteric hemangioma was difficult, sometimes even nearly impossible. The imaging methods including B-mode ultrasonography, CT, and magnetic resonance (MR) and so on, although provide some useful information, only can demonstrate an abdominal mass rather than diagnose accurately [11–14]. The final diagnosis has to be made by resection and histopathological investigation.
The optimal treatment of intestinal or mesenteric hemangiomas is surgical resection. In our case, operation was adopted successfully. Radiation, cryotherapy and other therapies have been used for some non-resectable cases and more wildly cases named of hemangiomatosis, but the prospect was limited [3, 15].
