Anastomosing Ovarian Hemangioma: Still A Challenge In Diagnosis – A Review Of The Morphologic And Clinical Characteristics With Differential Diagnosis

Objectives: Anastomosing hemangioma and vascular tumors in general are relatively rare tumors that must be differentiated from their potential mimics in clinical and morphologic examinations. Case report: In this article, we present an incidentally verified ovarian hemangioma in a slightly enlarged ovary with a well-demarcated solid and spongy tan lesion and focal hemorrhagic specks on the cut section. Microscopically, sections showed a pseudo-lobular lesion with solid nests of tightly packed cells, with clear cytoplasm and clusters of hepatoid cells with eosinophilic cytoplasm, Leydig-like cells, and were immunohistochemically positive for inhibin, calretinin, vimentin, and some for SMA. Between these cells, there were multiple, various-sized, anastomosing, thin-walled blood vessels, some filled with red blood cells. In contrast, endothelial cells were prominent, slightly pleomorphic, and positive for CD31 and CD34, confirming the vascular origin. Conclusion: The differential diagnosis includes different benign to frank malignancies, and diagnosis requires careful and thorough study as it determines patient management. An ovarian hemangioma may be associated with stromal luteinization, which has been reported in some cases, although its pathogenesis is not clearly known.