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CORRESPONDENCE
Year : 2016  |  Volume : 12  |  Issue : 4  |  Page : 1323

21 cases reports on haemangioma of spleen


1 Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
2 Biomedical Engineering Center, Beijing University of Technology, Beijing, China

Date of Web Publication7-Feb-2017

Correspondence Address:
Yuan Huang
Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.199575

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 > Abstract 

The growing activity of hemangioma of spleen keeps unknown. To search theoretical basis for whether to take the operation, this study analyzed clinical data of 21 hemangioma patients, and 16 surgical specimens were analyzed immunohistochemistry of Ki-67, Bcl-2 and vascular endothelial growth factor (VEGF). Both 14 cases of cavernous hemangioma were positive for VEGF, and negative in capillary hemangioma, there was statistical significant difference between two types of hemangioma (P < 0.05). The most tumors had a low expression of Ki-67 with a mean ± standard deviation (SD) of 6.62 ± 6.24%, whereas the mean ± SD of Bcl-2 labeling index was 36.06 ± 19.05%. According to the statistical results, the expression of Ki-67 and Bcl-2 did not correlate with age, gender, tumor size, amount of tumor and angiomatous types. Hemangioma of spleen was one benign tumor with a tendency of slow growth. Therefore, operation should be strictly selected, we recommend observation of patients with small, asymptomatic splenic lesions, which meet the radiologic criteria for hemangiomas.

Keywords: Bcl-2, hemangioma of spleen, immunohistochemistry, Ki-67


How to cite this article:
Huang Y, Mu G, Qin X, Lin J, Li S, Zeng Y. 21 cases reports on haemangioma of spleen. J Can Res Ther 2016;12:1323

How to cite this URL:
Huang Y, Mu G, Qin X, Lin J, Li S, Zeng Y. 21 cases reports on haemangioma of spleen. J Can Res Ther [serial online] 2016 [cited 2020 Oct 24];12:1323. Available from: https://www.cancerjournal.net/text.asp?2016/12/4/1323/199575


 > Introduction Top


Hemangioma of spleen is the most common benign tumor of spleen, but it is still quite rare. Limited to number of cases, we still lack in-depth understanding of the pathophysiology and natural history of hemangioma of spleen. Until now, it keeps controversial in whether and when to take surgical treatment for hemangioma of spleen. Husni [1] suggested that splenectomy should be recommended for the cases who presented symptoms or spontaneous rupture. However, most hemangiomas are usually small in size and have no symptoms, and there are few studies discussing which measure should be taken for these patients.[2] This paper summarizes and analyzes clinical data in 21 cases of hemangioma of spleen and analyzes immunohistochemistry of Ki-67, Bcl-2 and vascular endothelial growth factor (VEGF) in 16 cases, in order to realize the growing activity of hemangioma of spleen, and then provide a theoretical basis for whether to take the operation.


 > Case Report Top


A total of 21 patients who were diagnosed hemangioma of spleen from January 2003 to August 2012, were included. Among them, 12 were men, and 9 were women; the ages ranged from 17 to 68 years old with a median age of 38.7-year-old. Sixteen patients had received surgical treatment of splenectomy, and the specimens were examined by hematoxylin and eosin-stained sections and immunohistochemical analysis of Ki-67, Bcl-2 and VEGF. Ten normal spleen samples from the patients who undergone splenectomy because of the third degree of traumatic rupture of spleen were regarded as controlled study. The other five cases had received observed treatment in a long time. All patients have been followed-up for 1-5 years.

Fourteen cases were confirmed to be cavernous hemangioma, and two cases were capillary hemangioma [Figure 1]. The tumor size ranged from 0.9 to 21.0 cm with an average diameter of 4.2 cm. Among them, 13 cases were <4 cm, and 8 cases were equivalent to or larger than 4 cm.
Figure 1: Photograph of the cut surface of capillary hemangioma after splenectomy

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Fourteen cases of cavernous hemangioma were positive for VEGF and two cases of capillary hemangioma were negative for VEGF [Figure 2]. There was statistical significant difference between two types (P < 0.05). Most tumors have a low expression of Ki-67, the mean ± standard deviation (SD) of Ki-67 labeling index (LI) was 6.62 ± 6.24% with a range of 0% to 20%, whereas the mean ± SD of Bcl-2 LI was36.06 ± 19.05% with a range of 5–80%. According to the statistical results, the expression of Ki-67 and Bcl-2 did not correlate with age, gender, tumor size, amount of tumor and angiomatous types [the detailed information could be seen in [Table 1]. And 10 normal spleen samples showed relative expression levels of Ki-67, Bcl-2 and VEGF, there were no significant difference from hemangioma (P > 0.05), the detailed information could be seen in [Table 2] and [Table 3].
Figure 2: Positive for vascular endothelial growth factor in cavernous hemangioma (×400)

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Table 1: The expressions of Ki‑67 and Bcl‑2 in hemangioma of spleen

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Table 2: The expressions of Ki‑67 and Bcl‑2 in hemangioma of spleen and normal spleen samples

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Table 3: The expressions of VEGF in hemangioma of spleen and normal spleen samples

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All surgery patients' clinical history has been uneventful during the follow-up period without relapse, except for one died of gastric cancer. In the observed patients, there were no obvious changes in the tumor in the follow-up period.


 > Discussion Top


Hemangioma of spleen is the most common benign tumor of the spleen, but it still keeps one kind of very rare disease. According to the reports, the incidence of hemangioma of spleen ranges from 0.03% to 14%. And most occurs in women.[3] However in this study, it's more common in male patients than female patients (ratio = 1:0.75). Willcox et al.[3] reported that most tumors (76.2%) were smaller than 4 cm. According to our study, the tumors of ≥4 cm only happened in eight patients (38.1%), but they had a high frequency of symptoms or positive signs.

Ki-67, which was used for assessing prognosis or as an ancillary diagnostic tool has been widely studied in other organ sites.[4] There were some studies about Ki-67 expressed in hemangioma of other organs, but few studies were taken in hemangioma of spleen. This study showed that most tumors revealed a general low expression of Ki-67, which means that it has a tendency of slow growth and fits hemangioma of spleen as one benign tumor. The growth rate of tumors depends not only on the proliferative activity of the tumor cells but also on the rate of cell death. Bcl-2 proteins, a key family of regulators, control the central apoptotic pathway and protect cells from a variety of apoptotic stimuli.[5],[6] Our study showed that hemangioma of spleen mainly revealed a high expression of Bcl-2. It seemed that hemangioma may enlarge fast because of a low rate of cell death. However, it is strange that the normal spleen samples also revealed a high expression with a mean LI of 27.50%. There was no statistical difference between hemangioma of spleen and normal spleen samples. Based on this strange result, we speculate it was depended on the characters of spleen itself. The relationship between Bcl-2 and hemangioma of spleen remains to be further discussed.

Vascular endothelial growth factor is known to play an important role not only in the angiogenesis and prognosis of different human tumors, but also in physiological and nonmalignant pathological conditions.[7] VEGF was expressed in all 14 cavernous hemangioma of spleen and was negative in 2 capillary hemangiomas in our series. Overexpression of VEGF might involve in the genesis and growth of cavernous haemangioma and prompted that cavernous haemangioma might have a higher proliferating potential than capillary hemangioma. Also, the different expressions of VEGF between cavernous hemangioma and capillary hemangioma could explain why the size of cavernous hemangioma was always larger than capillary hemangioma. But limited to the number of cases, we could not draw any definite conclusion. So the expressions of VEGF in hemangioma of spleen, especially in capillary hemangioma need to be further researched.

Early reports suggested that the hemangioma of spleen presented symptoms or spontaneous ruptures, splenectomy was recommended for all cases.[1] In contrast, we observed no patients happened spontaneous rupture, and almost observed patients had no obvious change in the tumor for a long time. And the low expression of Ki-67also reflects a tendency of slow growth and confirms hemangioma of spleen to be a benign tumor.

As a result, according to follow-up of five patients managed with observation and low expression of Ki-67 in 16 surgery patients, we suggest that operation should be strictly chosen, in order to avoid unnecessary splenectomy. And we recommend observation of patients with small, asymptomatic splenic lesions, which meet the radiologic criteria for hemangiomas.

 
 > References Top

1.
Husni EA. The clinical course of splenic hemangioma with emphasis on spontaneous rupture. Arch Surg 1961;83:681-8.  Back to cited text no. 1
    
2.
Ghuliani D, Agarwal S, Thomas S, Pathania OP. Giant cavernous haemangioma of the spleen presenting as massive splenomegaly and treated by partial splenectomy. Singapore Med J 2008;49:e356-8.  Back to cited text no. 2
    
3.
Willcox TM, Speer RW, Schlinkert RT, Sarr MG. Hemangioma of the spleen: Presentation, diagnosis, and management. J Gastrointest Surg 2000;4:611-3.  Back to cited text no. 3
    
4.
Chaloob MK, Ali HH, Qasim BJ, Mohammed AS. Immunohistochemical expression of Ki-67, PCNA and CD34 in astrocytomas: A clinicopathological study. Oman Med J 2012;27:368-74.  Back to cited text no. 4
    
5.
Adams JM, Cory S. Life-or-death decisions by the Bcl-2 protein family. Trends Biochem Sci 2001;26:61-6.  Back to cited text no. 5
    
6.
Murakami M, Sakai H, Kodama A, Mori T, Maruo K, Yanai T, et al. Expression of the anti-apoptotic factors Bcl-2 and survivin in canine vascular tumours. J Comp Pathol 2008;139:1-7.  Back to cited text no. 6
    
7.
El-Assal ON, Yamanoi A, Soda Y, Yamaguchi M, Igarashi M, Yamamoto A, et al. Clinical significance of microvessel density and vascular endothelial growth factor expression in hepatocellular carcinoma and surrounding liver: Possible involvement of vascular endothelial growth factor in the angiogenesis of cirrhotic liver. Hepatology 1998;27:1554-62.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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