title: A case of diffuse cavernous hemangioma of the appendix: laparoscopic surgery can facilitate diagnosis and treatment.
abstract: BACKGROUND
  A cavenous hemangioma of the appendix (CHA) is rare. The clinical pathophysiology and adequate management of a CHA have not been sufficiently explained since reports on CHA are scarce.
  
  
  METHODS
  A 56-year-old woman presented with chronic right lower quadrant pain. Abdominal contrast-enhanced computed tomography revealed a thickened appendix (1.5 cm in diameter) and some focal calcifications in the appendiceal wall. No acute inflammatory signs were visible around the appendix. For diagnosis and treatment, we performed a laparoscopic surgery. Intraoperative findings included purple granular lesions that were spread diffusely along the surface of the appendix. Since these lesions were spread to the terminal ileum, laparoscopic ileocecal resection was performed. Upon macroscopic inspection, purple-colored, raspberry-like lesions were found diffusely on the serosal surface of the appendix. No lesions were found on the mucosal surface. Hematoxylin and eosin staining indicated the presence of blood-filled sinus-like spaces largely in the subserosal layer. Immunohistochemistry analysis indicated that CD34-positive cells lined these spaces. Given these findings, we diagnosed the patient with a diffuse cavernous vascular malformation of the appendix.
  
  
  CONCLUSIONS
  CHA is difficult to diagnose. A laparoscopic approach may be useful for both the diagnosis and treatment of the disease.
authors.affiliation: Department of Surgery, Saitama City Hospital, 2460 Mimuro, Midori-ku, Saitama City, Saitama, 336-8522, Japan. ctakagi@a7.keio.jp.
authors.forename: Chisato
authors.initials: C
authors.lastname: Takagi
authors.affiliation: Department of Surgery, Saitama City Hospital, 2460 Mimuro, Midori-ku, Saitama City, Saitama, 336-8522, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yamafuji
authors.affiliation: Department of Surgery, Saitama City Hospital, 2460 Mimuro, Midori-ku, Saitama City, Saitama, 336-8522, Japan.
authors.forename: Hidena
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Department of Surgery, Saitama City Hospital, 2460 Mimuro, Midori-ku, Saitama City, Saitama, 336-8522, Japan.
authors.forename: Atsunori
authors.initials: A
authors.lastname: Asami
authors.affiliation: Department of Surgery, Saitama City Hospital, 2460 Mimuro, Midori-ku, Saitama City, Saitama, 336-8522, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Takeshima
authors.affiliation: Department of Surgery, Saitama City Hospital, 2460 Mimuro, Midori-ku, Saitama City, Saitama, 336-8522, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
authors.affiliation: Department of Surgery, Saitama City Hospital, 2460 Mimuro, Midori-ku, Saitama City, Saitama, 336-8522, Japan.
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Okamoto
authors.affiliation: Department of Surgery, Saitama City Hospital, 2460 Mimuro, Midori-ku, Saitama City, Saitama, 336-8522, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Kubochi
keywords: Appendicitis; Cavernous hemangioma; Chronic abdominal pain; Laparoscopic surgery; Vascular malformation