Infiltrating rectal cavernous hemangioma mimicking rectal tumor.

Tumors of the rectum can be primary or metasta-tic, as observed with the other organs. Primary cancer of the rectum is not rare and accounts for one-third of all cases of colorectal cancer. Invasion of a cancer originating from other pelvic organs might also be seen. Beyond malignant diseases, rectal polyps are reported with a prevalence of 7-50% in the general population, especially in older patients (1). Congenital and developmental cysts, diffuse cavernous hemangioma, infiltrating forms of endometriosis, and lesions secondary to inflam-matory processes may be found in the rectum as well. Diffuse cavernous hemangioma is a rare, benign vascular malformation. It consists of a network of vascular structures located in the intestinal wall, but it can also infiltrate the surrounding connective tissues. Diagnosis of rectal hemangio-ma is very important because of its tendency to cause massive rectal bleeding that may be life-threatening (2). We describe a patient with infiltrating cavernous hemangioma of the rectum, which mimicked a malignant process. A 50-year-old male patient presented with abdominal disten-tion and lack of appetite; no history of rectal bleeding was defined. Physical examination was normal except for a nodular lesion in the anterior wall of the rectum. Thereafter, an abdominal computed tomography (CT) was performed, which demonstrated a mass causing asymmetric wall thickening in a 5 cm-long segment and invading the connective tissue in the mesorectal and ischiorectal fossa (Figure 1). Additional findings in the abdominal CT were deep inguinal enlarged lymph nodes on the left side, but no sign of vessel thrombosis or pelvic phleboliths. The presence of phleboliths is common in colorectal hemangiomas and is a useful sign in patients, but was absent in our case. According to these findings, pelvic magnetic resonance imaging (MRI) and endoscopic examination were recommended. Endoscopy of the rectum showed no sign of a mu-cosal lesion, but revealed a nodular mass thought to be localized in the submucosa in a 6-7 cm segment of the rectal wall. The pelvic MRI of the patient revealed that the mass was tubular with low vascularity. The mass infiltrated the pelvis deeply, causing partial invasion of the left rectal wall and extending to the left gluteal muscular structures (Figure 2). The differential diagnosis of the mass included plexiform neurofibroma, angiofibroma and caver-nous hemangioma, and biopsy for histopathologic examination was suggested. Hence, a fine needle aspiration biopsy was performed, and the patholo-gic examination revealed fibroadipose tissue, which was insufficient for …