{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T19:54:42Z","timestamp":1776196482156,"version":"3.50.1"},"reference-count":73,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T00:00:00Z","timestamp":1745971200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Anastomosing hemangioma (AH) is a rare, benign vascular tumor predominantly found in the genitourinary tract and often associated with impaired renal function. Due to its nonspecific radiological features, AH is frequently misinterpreted as a malignant vascular neoplasm, particularly angiosarcoma (AS), leading to potentially unnecessary surgical interventions. This study presents a systematic review of AH cases and describes a rare instance of retroperitoneal AH arising from the left gonadal vein, which was resected due to diagnostic uncertainty. Methods: A 68-year-old man underwent imaging for benign prostatic hyperplasia, incidentally revealing a 15-mm hypervascular retroperitoneal nodule adjacent to the left psoas muscle. Imaging findings, including moderate metabolic uptake on 18FDG-PET\/CT, raised suspicion for AS. Given the diagnostic uncertainty and high-risk location, the multidisciplinary team (MDT) recommended surgical resection. Laparoscopic excision was performed, and histopathological analysis confirmed AH. The patient remained asymptomatic at a 22 month follow-up. In addition, a systematic review of 159 cases from 64 studies (2009\u20132024) was conducted to analyze radiological features, treatment approaches, and outcomes. Results: Among the reviewed cases, 68% were incidentally diagnosed, with AH occurring predominantly in the genitourinary system (70%), especially in the kidney, adrenal gland, and ovary. Chronic kidney disease (CKD) was present in 23.3% of cases, while 19.5% had a history of malignancy. Imaging was inconclusive in differentiating AH from malignancies: CT (71.9%) and MRI (6.1%) were the most used modalities, but none could reliably exclude AS. Management strategies included upfront surgical resection in 85%, while a growing proportion (9%) of cases underwent biopsy-based observation rather than immediate surgery. No cases were followed with imaging alone. Conclusions: AH remains a diagnostic challenge due to its overlap with malignant vascular tumors. While surgical excision is often performed, our review highlights an increasing trend toward conservative management with biopsy-based diagnosis. Improved awareness and the integration of histopathology, molecular markers, and MDT-based decision-making are crucial to prevent overtreatment in cases of suspected AH.<\/jats:p>","DOI":"10.3390\/jcm14093108","type":"journal-article","created":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T09:16:12Z","timestamp":1746090972000},"page":"3108","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Systematic Review and Case Report of a Left Gonadal Vein Anastomosing Hemangioma"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7086-2456","authenticated-orcid":false,"given":"Ilda","family":"Hoxhaj","sequence":"first","affiliation":[{"name":"Surgery Unit 2, Department of Surgery, Regional Hospital Treviso AULSS 2 Marca Trevigiana, 31100 Treviso, Italy"},{"name":"Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Piccino","sequence":"additional","affiliation":[{"name":"Surgery Unit 2, Department of Surgery, Regional Hospital Treviso AULSS 2 Marca Trevigiana, 31100 Treviso, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5372-2873","authenticated-orcid":false,"given":"Ugo","family":"Grossi","sequence":"additional","affiliation":[{"name":"Surgery Unit 2, Department of Surgery, Regional Hospital Treviso AULSS 2 Marca Trevigiana, 31100 Treviso, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valeria","family":"Maffeis","sequence":"additional","affiliation":[{"name":"Department of Pathology, \u201cCa\u2019 Foncello\u201d Regional Hospital, 31100 Treviso, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Bele\u00f9","sequence":"additional","affiliation":[{"name":"Department of Radiology, Regional Hospital Treviso AULSS 2 Marca Trevigiana, 31100 Treviso, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Baciorri","sequence":"additional","affiliation":[{"name":"Department of Pathology, \u201cCa\u2019 Foncello\u201d Regional Hospital, 31100 Treviso, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Morana","sequence":"additional","affiliation":[{"name":"Department of Radiology, Regional Hospital Treviso AULSS 2 Marca Trevigiana, 31100 Treviso, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Zanatta","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care, Regional Hospital Treviso AULSS 2 Marca Trevigiana, 31100 Treviso, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5489-3009","authenticated-orcid":false,"given":"Giacomo","family":"Zanus","sequence":"additional","affiliation":[{"name":"Surgery Unit 2, Department of Surgery, Regional Hospital Treviso AULSS 2 Marca Trevigiana, 31100 Treviso, Italy"},{"name":"Department of Surgery, Oncology and Gastroenterology\u2014DiSCOG, University of Padova, 35121 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1364","DOI":"10.1097\/PAS.0b013e3181ad30a7","article-title":"Anastomosing Hemangioma of the Genitourinary Tract A Lesion Mimicking Angiosarcoma","volume":"33","author":"Montgomery","year":"2009","journal-title":"Am. 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