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Liu A, Bauer JS, Lin CC, Appelboom G, Zanazzi G. Dural composite hemangioendothelioma: The first intracranial case. Surg Neurol Int 2024; 15:55. [PMID: 38468685 PMCID: PMC10927221 DOI: 10.25259/sni_3_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 01/18/2024] [Indexed: 03/13/2024] Open
Abstract
Background Composite hemangioendothelioma (CHE) is a rare, locally aggressive neoplasm of intermediate malignant potential. It is composed of a mixture of vascular tumors with a predilection for the dermis and subcutis of the extremities. Case Description In this report, we describe a 41-year-old man who presented with a 2-month history of headache, dizziness, and intermittent seizures. Magnetic resonance imaging showed a hemorrhagic, multilobulated, and dural-based mass with extension into the calvarium. The mass measured 10.3 × 4.8 × 4 cm along the interhemispheric fissure and encased the superior sagittal sinus. Excision was performed, and histopathologic examination revealed a heterogeneous mixture of vascular components consisting of epithelioid hemangioendothelioma, retiform hemangioendothelioma, and hemangioma. This is the first report of a primary intracranial CHE. Conclusion The spectrum of mesenchymal neoplasms within the cranium expands to encompass CHE.
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Affiliation(s)
- Alice Liu
- Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, USA
| | - Joshua S. Bauer
- Department of Emergency Medicine, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Chun-Chieh Lin
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, USA
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, USA
| | - Geoff Appelboom
- Department of Neurosurgery, New York University Langone Health, New York, USA
| | - George Zanazzi
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, USA
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, USA
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Barger J, Tanweer O, Liechty B, Snuderl M, Jafar JJ. Suprasellar epithelioid hemangioendothelioma: Case report and review of the literature. Surg Neurol Int 2016; 7:S596-602. [PMID: 27656318 PMCID: PMC5025957 DOI: 10.4103/2152-7806.189729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 05/24/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Epithelioid hemangioendothelioma (EHE) is a rare sarcoma of vascular origin, which is clinically and histologically intermediate between benign hemangioma and angiosarcoma. It is most commonly found in the liver, lung, and bone, however, 46 intracranial cases have been reported in the literature, of which this is the fifth reported suprasellar tumor. CASE DESCRIPTION A 45-year-old woman developed progressive lethargy, somnolence, and memory decline over the course of 6 months. On computed tomography (CT), she was found to have a large hypothalamic mass and underwent subtotal resection via a bifrontal craniotomy. CONCLUSIONS While primary intracranial EHE is an uncommon presentation of a rare tumor, the suprasellar region does not seem to be an unusual location when it does occur. Prognosis is generally good, and may be better for primary intracranial disease than that for EHE originating elsewhere. Surgery is the first line of therapy, with variable benefit from adjuvant chemotherapy or radiation when total resection is not possible. Chemotherapeutic approaches in current use are directed at preventing endothelial proliferation.
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Affiliation(s)
- James Barger
- Department of Neurosurgery, New York University School of Medicine, New York, USA
| | - Omar Tanweer
- Department of Neurosurgery, New York University School of Medicine, New York, USA
| | - Benjamin Liechty
- Department of Pathology, New York University School of Medicine, New York, USA
| | - Matija Snuderl
- Department of Pathology, New York University School of Medicine, New York, USA
| | - Jafar J Jafar
- Department of Neurosurgery, New York University School of Medicine, New York, USA
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3
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Tsuchiya T, Oya S, Mori H, Matsui T. Multiple hemorrhagic intraparenchymal tumors presenting with fatal intracranial hypertension: A rare manifestation of systemic epithelioid hemangioendothelioma. Surg Neurol Int 2015; 6:156. [PMID: 26539307 PMCID: PMC4604639 DOI: 10.4103/2152-7806.166799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 07/30/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Epithelioid hemangioendotheliomas (EHE) is an extremely rare tumor that can arise not only intracranially but also systemically. Its radiological characteristics and the mechanism underlying the multiple organ involvement in EHE are poorly understood. CASE DESCRIPTION A 24-year-old woman with a 7-month history of coughing and blood-stained sputum complained of visual disturbance in the right eye that had persisted for 1-month. Magnetic resonance (MR) imaging revealed multiple intraparenchymal masses with low-intensity on MR susceptibility-weighted images with minimal enhancement with gadolinium. Systemic computed tomography revealed multiple nodules in both lungs and the liver. Because her neurological status rapidly deteriorated, brain biopsy of the right frontal mass was performed. The pathological diagnosis was EHE. Over the following 3 months, the patient gradually developed disturbance of consciousness. She died at 4 months after admission because of significant intracranial hypertension. CONCLUSION Although intracranial EHEs are extremely rare, they should be included in the differential diagnoses of multiple small-sized masses with low-intensity on MR susceptibility-weighted images. We also emphasize that the systemic involvement of this tumor was more compatible with multicentric development than metastasis.
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Affiliation(s)
- Tsukasa Tsuchiya
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Soichi Oya
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Harushi Mori
- Department of Radiology, Graduate School of Medicine and Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Toru Matsui
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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Epithelioid hemangioendothelioma of the mastoid: resection for recurrence and adjuvant radiation with 8-year followup. Case Rep Surg 2013; 2013:469201. [PMID: 23424708 PMCID: PMC3568894 DOI: 10.1155/2013/469201] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 12/05/2012] [Indexed: 12/11/2022] Open
Abstract
Epithelioid hemangioendothelioma (EH) is a rare, vascular neoplasm that can affect any age group and has been reported previously in sites including bone, liver, lung, breast, and brain. We describe a case of EH located in the mastoid, which appears to be the first report of EH in this site. The patient was 62 years old when they presented with dizziness and nausea. A suboccipital surgical approach was utilized to resect the tumor. After 18-month followup, the patient was symptom-free; however, imaging demonstrated a recurrence and the patient was taken back to the operating room for a resection. There is no evidence of recurrence after 8 years of followup. This paper aims to reinforce the need for a timely radical excision and aggressive clinical followup as the best hope for cure. Here, we describe an illustrative case and review the pertinent literature.
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Zheng J, Liu L, Wang J, Wang S, Cao Y, Zhao J. Primary intracranial epithelioid hemangioendothelioma: a low-proliferation tumor exhibiting clinically malignant behavior. J Neurooncol 2012; 110:119-27. [PMID: 22886511 DOI: 10.1007/s11060-012-0945-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Accepted: 07/16/2012] [Indexed: 12/21/2022]
Abstract
Epithelioid hemangioendothelioma is an extremely rare intracranial tumor and is regarded as a low-proliferation tumor. We present two cases of primary intracranial epithelioid hemangioendothelioma and give an overview of the English literature pertaining to this disease. We described two new cases of primary intracranial epithelioid hemangioendothelioma and performed a search of MEDLINE (PubMed) using the words "epithelioid hemangioendothelioma". Only cases in the English language that were intracranially located and contained clinical information pertinent to the analysis were included. The tumor in case 1 originated from the right temporal bone and invaded the surrounding cranium, dura and temple muscles. The tumor in case 2 was located in the petroclival bone and had also invaded the surrounding cranium. Both tumors were well vascularized. The tumors were totally (case 1) or subtotally (case 2) removed with moderate blood loss. A total of 36 cases of intracranial epithelioid hemangioendothelioma were found in the literature. The tumor was typically diagnosed in young adults and infants. There was no sex predominance in adult patients, while in children, males were more frequently affected (M/F ratio, 3.5:1). Surgical removal was the main therapeutic protocol, and adjuvant therapy included radiotherapy or chemotherapy. Including the 2 patients presented here, a total of 38 patients were analyzed: 32 % showed local invasion, 24 % suffered a recurrence, 15 % had metastases, and the mortality rate was 15 %. Intracranial epithelioid hemangioendothelioma is a rare, low-proliferation tumor, but it exhibits some clinically malignant behaviors, such as local invasion, recurrence and metastasis. Total resection is mandatory where possible, and radiotherapy and/or chemotherapy are otherwise required. Preoperative feeding-artery embolization is recommended.
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Affiliation(s)
- Jian Zheng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 6 Tiantan Xili, Chongwen District, Beijing, 100050, China.
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6
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Raghunathan A, Takei H, Powell SZ. Rare Tumors of the Sellar Region. Acad Forensic Pathol 2012. [DOI: 10.23907/2012.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Context The sellar/ parasellar region is the location for a vast array of neoplastic and nonneoplastic intracranial space-occupying lesions. While several common lesions arising in this location have been well-described in the literature, there are rare and challenging tumors that may also arise in this region. Objective We focus this review on five rare tumors reported to arise in the sellar region, including spindle cell oncocytoma of the adenohypophysis, pituicytoma, intravascular papillary endothelial hyperplasia, epithelioid hemangioendothelioma and xanthogranuloma. We review their clinical presentation, histologic features, differential diagnosis and outcomes for these tumors. Data sources All medical literature pertaining to these entities that was searchable on PubMed was comprehensively reviewed. Conclusions Spindle cell oncocytoma and pituicytoma have recently been included in the 2007 edition of the World Health Organization classification of tumours of the CNS, while intravascular papillary endothelial hyperplasia, epithelioid hemangioendothelioma and xanthogranuloma have only rarely been described in this region. Knowledge of these may help prevent possible diagnostic pitfalls during postmortem evaluation.
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Affiliation(s)
- Aditya Raghunathan
- The Methodist Hospital & University of Texas M.D. Anderson Cancer Center program in Houston, TX
- The Methodist Hospital in Houston, TX, and Weill Cornell Medical College of Cornell University (HT, SZP)
| | - Hidehiro Takei
- The Methodist Hospital in Houston, TX, and Weill Cornell Medical College of Cornell University (HT, SZP)
| | - Suzanne Z. Powell
- The Methodist Hospital in Houston, TX, and Weill Cornell Medical College of Cornell University (HT, SZP)
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7
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El Demellawy D, Nasr A, Alowami S. Epithelioid hemangioendothelioma of the temporal artery presenting as temporal arteritis: case report and literature review. Rare Tumors 2009; 1:e20. [PMID: 21139892 PMCID: PMC2994445 DOI: 10.4081/rt.2009.e20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 07/14/2009] [Indexed: 11/22/2022] Open
Affiliation(s)
- Dina El Demellawy
- University of Northern Ontario School of Medicine, Thunder Bay, William Osler Health Care-Brampton Civic Hospital, Department of Pathology and Laboratory Medicine, Brampton, Ontario, Canada
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8
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Parajón A, Vaquero J. Meningel intracranial epithelioid hemangioendothelioma: case report and literature review. J Neurooncol 2008; 88:169-73. [PMID: 18278439 DOI: 10.1007/s11060-008-9543-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Accepted: 02/04/2008] [Indexed: 11/30/2022]
Abstract
Intracranial epithelioid hemangioendothelioma (EH) is a very rare vascular neoplasm. We describe a case of meningeal intracranial tumor in a 58 year old man, located in the greater wing of the sphenoid bone. The tumor was completely excised via pterional approach and the pahological analysis showed a hemorrhagic lesion with capillary-sized vessels lined by atypical-appearing endothelial cells that expressed CD31, CD34 and Factor VIII antigens. A diagnosis of EH was established, and one year after surgery the patient is symptom-free, without tumor recurrence or residual tumor. A review of the literature disclosed other 34 cases of intracranial EH. In these tumors, total resection is mandatory if possible, otherwise radiotherapy is recommended. Outcome is favorable in the majority of cases.
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Affiliation(s)
- Avelino Parajón
- Department of Neurosurgery, Puerta de Hierro Hospital, Autonomous University, San Martín de Porres, Madrid, Spain
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9
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Mohan S M, Symss NP, Pande A, Chakravarthy VM, Ramamurthi R. Intracranial epithelioid hemangioendothelioma. Childs Nerv Syst 2008; 24:863-8. [PMID: 18478237 DOI: 10.1007/s00381-008-0634-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2007] [Revised: 02/22/2008] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Epithelioid hemangioendothelioma (EHE) is an uncommon soft-tissue vascular neoplasm. Although a well-defined entity outside the neuraxis, its intracranial occurrence is rare. Literature review revealed 35 reported cases till date. CASE REPORT The authors report a case of intracranial EHE in a 15-year-old girl, who presented with a short history and unusual radiology. Following radical removal, the lesion recurred within 1 month and progressed to terminal stages. This tumor is thought to have an indolent intermediate malignancy potential and such rapid progression has not been reported so far.
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Affiliation(s)
- Murali Mohan S
- Post Graduate Institute of Neurological Surgery, ALNC, VHS Hospital, Taramani, Chennai, 600 113, India.
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10
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Baehring JM, Dickey PS, Bannykh SI. Epithelioid hemangioendothelioma of the suprasellar area: a case report and review of the literature. Arch Pathol Lab Med 2005; 128:1289-93. [PMID: 15504067 DOI: 10.5858/2004-128-1289-ehotsa] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intra-axial involvement of the brain by an epithelioid hemangioendothelioma is rare, and biological properties of the tumor are uncertain. Most of the primary brain manifestations are confined to the cerebral hemispheres. We report magnetic resonance imaging and microscopic findings of a case of suprasellar involvement by an epithelioid hemangioendothelioma. The tumor was treated with a subtotal resection only, and no progression of the disease was noted during a 6-month follow-up. Review of the literature suggested that most epithelioid hemangioendotheliomas in the brain are unifocal tumors with a rather favorable clinical outcome.
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Affiliation(s)
- Joachim M Baehring
- Department of Neurology, Yale University School of Medicine, New Haven, Conn 06510, USA
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11
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Abe M, Tabuchi K, Tanaka S, Hodozuka A, Kunishio K, Kubo N, Nishimura Y. Capillary hemangioma of the central nervous system. J Neurosurg 2004; 101:73-81. [PMID: 15255254 DOI: 10.3171/jns.2004.101.1.0073] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object. Capillary hemangiomas are benign tumors or tumorlike lesions that originate from blood vessels and have rarely been reported to develop in the brain or spinal cord. The authors summarize the clinical and histological features of capillary hemangiomas of the central nervous system (CNS).
Methods. The clinical features, imaging characteristics, and outcomes in 10 patients with CNS capillary hemangiomas were reviewed. Histological studies included immunostaining with CD31, α-smooth muscle actin, vascular endothelial growth factor, and Ki-67 antigen. Three patients with lesions in the brain presented with symptoms of increased intracranial pressure or seizures. Seven patients with lesions in the spinal cord presented with progressive sensorimotor disturbances of the lower limbs. Computerized tomography and magnetic resonance imaging demonstrated well-defined, enhancing lesions associated with marked perifocal edema. Angiography demonstrated hypervascular lesions, which have not recurred after resection. In two cases, multiple satellite lesions resolved after the systemic administration of steroid drugs or interferon-α. Histologically, all lesions were consistent with findings of capillary hemangioma of the skin or soft tissues. The CNS lesions differed significantly from other vascular neoplasms, such as hemangioendotheliomas, hemangiopericytomas, and hemangioblastomas.
Conclusions. Capillary hemangiomas of the CNS are benign lesions that can be surgically removed and cured without adjuvant therapy.
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Affiliation(s)
- Masamitsu Abe
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan.
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12
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Endo T, Su CC, Numagami Y, Shirane R. Malignant intracranial epithelioid hemangioendothelioma presumably originating from the lung: case report. J Neurooncol 2004; 67:337-43. [PMID: 15164990 DOI: 10.1023/b:neon.0000024215.79178.27] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE AND IMPORTANCE Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor that presents histological features and biological behavior of low-grade malignancy. The authors report a case of malignant intracranial EHE, in which surgical excisions and additional immuno-chemotherapy were ineffective. Emphasis is placed on the histological features of this rare tumor and its potential for malignancy. CLINICAL PRESENTATION A 69-year old male presented with paresis of the right arm. Magnetic resonance imaging revealed intracranial multiple lesions in the right temporal and parietal and left frontal lobes. Chest radiography revealed a mass lesion occupying the lower lobe of the left lung that had been followed as old tuberculosis since it had not changed in size for as long as 5 years. INTERVENTION We performed craniotomy and excised tumors. Histological examination demonstrated that the excised tumors had the features of EHE. Further intracranial recurrence after the excision of the tumors necessitated adjuvant treatment with interferon alpha-2b. However, the patient continued to deteriorate and died 3 months later. Postmortem study disclosed the tumor cells existing in the left lung, pleura, ribs, intercostal tissues and diaphragm. Other organs including liver, bone, and skin were free from tumor invasion, which indicated that the malignant EHE originated from the left lung and metastasized to the brain. CONCLUSION To the authors knowledge, no case of malignant EHE that simultaneously involves the central nervous system and the lung has been previously reported. An extensive inspection for involvement of other organs is recommended after recognizing an intracranial EHE.
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Affiliation(s)
- Toshiki Endo
- Department of Neurosurgery, Yamagata Prefectural Shinjo Hospital, Shinjo, Japan.
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13
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Brennan JW, Midha R, Ang LC, Perez-Ordonez B. Epithelioid Hemangioendothelioma of the Spine Presenting as Cervical Myelopathy: Case Report. Neurosurgery 2001. [DOI: 10.1227/00006123-200105000-00045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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14
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Brennan JW, Midha R, Ang LC, Perez-Ordonez B. Epithelioid hemangioendothelioma of the spine presenting as cervical myelopathy: case report. Neurosurgery 2001; 48:1166-9. [PMID: 11334287 DOI: 10.1097/00006123-200105000-00045] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE AND IMPORTANCE We report the first case in the literature of cervical myelopathy caused by progressive cord compression as a result of epithelioid hemangioendothelioma of the cervical vertebra. CLINICAL PRESENTATION A 58-year-old man presented with progressive cervical myelopathy. Imaging revealed a vascular, expansile lesion of contiguous cervical vertebrae causing cord compression. The surgical pathology revealed epithelioid hemangioendothelioma, a rare tumor not previously reported to present in such a fashion. INTERVENTION Preoperative embolization and a two-stage anterior and posterior surgical decompression and fusion procedure were performed. The high vascularity of this lesion makes surgery a formidable surgical challenge. Adjuvant radiotherapy was administered to the residual tumor because of its potential for low-grade malignancy. CONCLUSION The diagnosis relied on accurate histopathological assessment. The general principles of achieving cord decompression and tumor control are important. The literature on epithelioid hemangioendothelioma involving the spine is reviewed, and the tumor biology and the role of adjuvant therapy are discussed.
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Affiliation(s)
- J W Brennan
- Department of Surgery, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Ontario, Canada
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15
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Carlotti CG, Jay V, Rutka JT. Infantile hemangioendothelioma of the pericranium presenting as an occipital mass lesion. Case report. J Neurosurg 2000; 92:156-60. [PMID: 10616095 DOI: 10.3171/jns.2000.92.1.0156] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The case of a newborn infant with a large midline mass in the occipital region is presented. Skull x-ray films demonstrated multiple radiolucent defects in the occipital bone. A computerized tomography scan revealed an extracranial mass lesion with marked contrast enhancement. A magnetic resonance image demonstrated that the venous drainage of the lesion passed through the occipital bone into the dural venous sinuses. The anatomy of the hindbrain was normal. The neonate was treated by complete surgical removal of the mass. The histopathological diagnosis was infantile hemangioendothelioma, a tumor commonly found in the liver but rarely in this location. The classification, histopathological characteristics, imaging studies, and treatment of this tumor are discussed.
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Affiliation(s)
- C G Carlotti
- Divisions of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada
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16
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Bakotic BW, Robinson M, Williams M, Van Woy T, Nutter J, Borkowski P. Aggressive epithelioid hemangioendothelioma of the lower extremity: a case report and review of the literature. J Foot Ankle Surg 1999; 38:352-8. [PMID: 10553549 DOI: 10.1016/s1067-2516(99)80007-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A case of epithelioid hemangioendothelioma (EHE) of the left lower extremity in a 50-year-old male is discussed. The neoplasm presented as a tan-purple, painful mass involving the fourth digit of the left foot. Following an excisional biopsy and partial amputation of the fourth digit, the lesion recurred with a multifocal distribution. A physical exam following the recurrence demonstrated multiple palpable lymph nodes in the left inguinal region. A complete amputation of the fourth digit was performed in conjunction with local excisions of the remaining lesions. Additionally, an inguinal lymphadenectomy was performed for staging purposes. Histologically, the tumor was predominantly composed of epithelioid endothelial cells forming nests, cords, and sheets and occasionally forming irregular, primitive vascular structures. Less commonly, nests of tumor cells assumed a spindled morphology. Patches of necrosis and hemorrhage were apparent throughout the neoplasm. There was minimal atypia and mitoses were not identified. Immunohistochemical stains for CD34, CD31, and Ulex europaeus antigens were positive in tumor cells. This case illustrates the potential aggressive behavior of this rare neoplasm and argues against the designation "tumor of low-grade malignancy" with which it is commonly attributed.
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Affiliation(s)
- B W Bakotic
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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