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Reljic M, Rajovic N, Rakocevic J, Tadic B, Markovic K, Ostojic S, Raspopovic M, Toskovic B, Masic JV, Masic S, Milic N, Knezevic D. Recurrence-Free Survival in Composite Hemangioendothelioma: A Case Study and Updated Systematic Review. J Clin Med 2025; 14:2541. [PMID: 40283372 PMCID: PMC12028118 DOI: 10.3390/jcm14082541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2025] [Revised: 03/19/2025] [Accepted: 03/25/2025] [Indexed: 04/29/2025] Open
Abstract
Background/Objectives: Composite hemangioendothelioma (CHE) is a rare vascular endothelial tumor with borderline malignancy. This study presents a case of CHE and an updated systematic review of previously reported cases, providing insights into recurrence patterns and survival outcomes. Methods: A comprehensive electronic search was conducted across PubMed, Scopus, the Cochrane Library, and Web of Science up to 31 December 2024, to identify eligible case reports. Kaplan-Meier curves were used to estimate event-free survival. Results: We report a 61-year-old man with a splenic lesion associated with weight loss and abdominal pain persisting for 1 year. Intraoperative findings revealed an enlarged spleen and multiple hepatic deposits. Splenectomy and liver biopsy revealed a well-demarcated, nodular tumor measuring 160 × 145 × 100 mm, with histological and immunohistochemical findings consistent with CHE, complicated by hepatic metastasis. Of 405 potentially eligible studies, 59 were included in the review, covering cases from 2000 to 2024, with a peak in 2020 and 2023. The median age of patients was 42 years, with the most common tumor sites being the lower extremities (30.48%), followed by the face, head, and neck (20.95%), and upper extremities (18.1%). Surgical intervention was the most common treatment (60.95%). Recurrence-free survival was observed in 42.86% of cases, while 15.24% experienced recurrence with or without metastasis. Two patients (1.90%) died from the disease. The median recurrence-free survival was 48 months (95% CI: 7.3-88.7). Conclusions: CHE exhibits significant morphological variation and can mimic other vascular tumors. Accurate diagnosis is crucial for proper prognosis and avoiding overtreatment due to misdiagnosis as more aggressive neoplasms. Patients with high-risk CHE should undergo closer surveillance to ensure timely detection of progression.
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Affiliation(s)
- Milorad Reljic
- Department for HBP Surgery, Clinic for Digestive Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Nina Rajovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine University of Belgrade, 11000 Belgrade, Serbia
| | - Jelena Rakocevic
- Institute of Histology and Embryology “Aleksandar Đ. Kostić”, Faculty of Medicine University of Belgrade, 11000 Belgrade, Serbia
| | - Boris Tadic
- Department for HBP Surgery, Clinic for Digestive Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Department for Surgery with Anesthesiology, Faculty of Medicine University of Belgrade, 11000 Belgrade, Serbia
| | - Ksenija Markovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine University of Belgrade, 11000 Belgrade, Serbia
| | - Slavenko Ostojic
- Department for HBP Surgery, Clinic for Digestive Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Department for Surgery with Anesthesiology, Faculty of Medicine University of Belgrade, 11000 Belgrade, Serbia
| | - Milos Raspopovic
- Clinic of Emergency Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Borislav Toskovic
- Department for HBP Surgery, Clinic for Digestive Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Department for Surgery with Anesthesiology, Faculty of Medicine University of Belgrade, 11000 Belgrade, Serbia
| | - Jelena Vladicic Masic
- Department of Internal Medicine, Faculty of Medicine Foca University of East Sarajevo, 73300 Foca, Bosnia and Herzegovina
| | - Srdjan Masic
- Department for Primary Health Care and Public Health, Faculty of Medicine Foca University of East Sarajevo, 73300 Foca, Bosnia and Herzegovina
| | - Natasa Milic
- Institute for Medical Statistics and Informatics, Faculty of Medicine University of Belgrade, 11000 Belgrade, Serbia
| | - Djordje Knezevic
- Department for HBP Surgery, Clinic for Digestive Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Department for Surgery with Anesthesiology, Faculty of Medicine University of Belgrade, 11000 Belgrade, Serbia
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Cordier F, Ferdinande L, Loontiens S, Van der Meulen J, Van Dorpe J, Creytens D. A Challenging Case of an Intraosseous Composite Hemangioendothelioma of the Occipital Bone With YAP1::FOXR1 Fusion. Genes Chromosomes Cancer 2024; 63:e70016. [PMID: 39636090 DOI: 10.1002/gcc.70016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2024] [Accepted: 11/21/2024] [Indexed: 12/07/2024] Open
Affiliation(s)
- Fleur Cordier
- Department of Pathology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Liesbeth Ferdinande
- Department of Pathology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Siebe Loontiens
- CRIG, Cancer Research Institute Ghent, Ghent University Hospital, Ghent University, Ghent, Belgium
- Molecular Diagnostics Ghent University Hospital (MDG), Ghent University Hospital, Ghent University, Ghent, Belgium
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Joni Van der Meulen
- CRIG, Cancer Research Institute Ghent, Ghent University Hospital, Ghent University, Ghent, Belgium
- Molecular Diagnostics Ghent University Hospital (MDG), Ghent University Hospital, Ghent University, Ghent, Belgium
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Jo Van Dorpe
- Department of Pathology, Ghent University Hospital, Ghent University, Ghent, Belgium
- CRIG, Cancer Research Institute Ghent, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - David Creytens
- Department of Pathology, Ghent University Hospital, Ghent University, Ghent, Belgium
- CRIG, Cancer Research Institute Ghent, Ghent University Hospital, Ghent University, Ghent, Belgium
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Huang W, Zhou Y, Yang Q, Li L, Kang L. Extraosseous Uptake and Multiple Metastases of Splenic Composite Hemangioendothelioma on 99m Tc-MDP Scintigraphy. Clin Nucl Med 2023; 48:1107-1110. [PMID: 37801594 DOI: 10.1097/rlu.0000000000004875] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
ABSTRACT Composite hemangioendothelioma is a rare disease that exhibits biological potency ranging from benign to low-grade malignancy, and hepatic and bone metastases are even rarer. Here, we present the imaging findings of a 65-year-old man with splenic composite hemangioendothelioma and multiple metastases. A bone scan revealed abnormal uptake of 99m Tc-MDP in multiple bones and spleen, whereas enhanced CT demonstrated splenic lesions with low density and mild enhancement. Based on pathological examination, the patient was diagnosed with splenic composite hemangioendothelioma with bone metastasis.
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Affiliation(s)
- Wenpeng Huang
- From the Department of Nuclear Medicine, Peking University First Hospital, Beijing
| | - Yuhan Zhou
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Qi Yang
- From the Department of Nuclear Medicine, Peking University First Hospital, Beijing
| | - Liming Li
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Lei Kang
- From the Department of Nuclear Medicine, Peking University First Hospital, Beijing
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Deng Y, Li M. Composite hemangioendothelioma- report of two cases located in bone and review of the literature. BMC Musculoskelet Disord 2023; 24:676. [PMID: 37620851 PMCID: PMC10463315 DOI: 10.1186/s12891-023-06745-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/22/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Composite hemangioendothelioma (CHE) is a rare intermediate-grade vascular tumor characterized by a complex histologic component. It occasionally metastasizes, but local recurrence is not uncommon. CHE is mainly located in the extremities' distal dermis and subcutaneous soft tissues. It is rarely located in the bone. We report here two cases originally occurred in bone. CASE PRESENTATION The first case of CHE occurred solely on the left pubis. The second case is a patient post-resection of CHE in the manubrium sterni 10 years ago [1], who presented with multiple lesions in the left ilium and T6, T12 vertebra. All these lesions in the two cases showed osteolytic bone destruction on computed tomography (CT) scans and showed relatively high signal intensity on the fat-suppressed sequences of T2-weighted magnetic resonance (MR) images and isointense signal intensity on T1-weighted MR images. After injection of contrast agent (Gd-DTPA), the lesions showed inhomogeneous enhancement. 2-deoxy-2 [F-18] fluoro-D-glucose positron emission tomography-computed tomography (18FDG PET-CT) showed increased FDG uptake in these osteolytic bone destruction areas with SUVmax around 5.0. Both patients underwent surgery. Lesions in the left pubis and left ilium were confirmed by postoperative pathology while lesions on the vertebrae were only biopsied, not surgically resected. The first patient had no recurrence or metastasis in 5 years after surgery. The second patient had surgery recently and is still being followed up. CONCLUSIONS CHE occurring in bone is rarely reported. Our report provides more detailed information on the diagnosis of CHE. Given that CHE is locally aggressive and occasionally metastatic, PET-CT may be helpful in staging and follow-up.
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Affiliation(s)
- Yunyang Deng
- Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mei Li
- Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Nakamura S, Uehara M, Kobayashi S, Hasegawa H, Tanaka A, Takahashi J. Composite hemangioendothelioma in the cervical spine with kaposiform hemangioendothelioma features in an elderly patient: a case report. BMC Geriatr 2022; 22:952. [PMID: 36494779 PMCID: PMC9733294 DOI: 10.1186/s12877-022-03677-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/03/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Composite hemangioendothelioma (CHE) is an intermediate group of tumors with features between hemangioma and angiosarcoma both histologically and biologically. CHE is predominant in young and middle-aged adults, but very infrequently affects the spine. We describe the case of primary CHE in the cervical spine exhibiting kaposiform hemangioendothelioma (KHE)-like components that was associated with cervical myelopathy with vertebral body destruction in an elderly woman. We retrospectively reviewed the case of a primary cervical spinal tumor, diagnosed as CHE with KHE-like components in pathological findings, associated with cervical myelopathy and cervical vertebral body destruction. CASE PRESENTATION An 80-year-old woman presented with progressive cervical myelopathy caused by a cervical spine tumor. Preoperative cervical MRI revealed a neoplastic lesion invading the cervical spine that strongly compressed the spinal cord, causing right upper-limb paralysis. We performed partial tumor resection along with posterior decompression and fixation. Postoperatively, pathological findings showed that the tumor was CHE with KHE-like features. Following radiotherapy, no recurrences have been observed in 21 months. CONCLUSIONS This is the first report of CHE with features of KHE in the spine of an elderly patient. Posterior decompression and fusion of the cervical spine and subsequent radiotherapy resulted in a good outcome.
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Affiliation(s)
- Shunsuke Nakamura
- grid.263518.b0000 0001 1507 4692Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621 Japan
| | - Masashi Uehara
- grid.263518.b0000 0001 1507 4692Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621 Japan
| | - Shota Kobayashi
- grid.263518.b0000 0001 1507 4692Department of Laboratory Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621 Japan
| | - Hiromasa Hasegawa
- grid.411611.20000 0004 0372 3845Hard Tissue Pathology Unit, Graduate School of Oral Medicine, Matsumoto Dental University, 1780 Gobara, Hirooka, Shiojiri, Nagano, 399-0781 Japan
| | - Atsushi Tanaka
- grid.263518.b0000 0001 1507 4692Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621 Japan
| | - Jun Takahashi
- grid.263518.b0000 0001 1507 4692Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621 Japan
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Miyamoto E, Seki K, Katsuragawa H, Yoshimoto Y, Ohsumi Y, Fukui T, Gotoh M, Nakagawa T. Thoracic composite hemangioendothelioma with neuroendocrine marker expression. Surg Case Rep 2021; 7:249. [PMID: 34837560 PMCID: PMC8627540 DOI: 10.1186/s40792-021-01331-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 11/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Composite hemangioendothelioma is an extraordinarily rare form of vascular neoplasm which develops predominantly in the skins and soft tissues of the adults. Neuroendocrine marker expression in composite hemangioendothelioma is considered as specifically relevant to the more aggressive behavior. CASE PRESENTATION The patient was a 71-year-old man complaining continuous back pain. Computed tomography (CT) showed that 10 cm of contrast-enhanced soft tissue mass was occurring on the right posterior chest wall and developing adjacent to the spinal canal. Via the laminectomy, the tumor end was identified and separated from the dura mater. Then, via the posterolateral thoracotomy, the en bloc resection was achieved by separating the tumor from the diaphragm and vertebras. Histologic examination showed a complex combination of epithelioid and retiform hemangioendothelioma areas which were positive for anti-synaptophysin staining. At 12-month follow-up, there were no signs of tumor recurrence on CT, and the patient had no symptom. CONCLUSIONS We achieved the complete resection of a huge thoracic neuroendocrine composite hemangioendothelioma developing adjacent to the spinal canal. The combination of the posterior lumbar laminectomy and the following posterior thoracotomy is a viable approach to radically resect a thoracic neuroendocrine composite hemangioendothelioma involving chest wall.
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Affiliation(s)
- Ei Miyamoto
- Division of Thoracic Surgery, Department of Surgery, Tenri Hospital, 200 Mishimacho, Tenri, Nara, 6328552, Japan.
| | - Kenji Seki
- Division of Orthopedic Surgery, Department of Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Hiroyuki Katsuragawa
- Department of Diagnostic Pathology, Pathologist, Tenri Hospital, Tenri, Nara, Japan
| | - Yuji Yoshimoto
- Division of Plastic Surgery, Department of Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Yuki Ohsumi
- Division of Thoracic Surgery, Department of Surgery, Tenri Hospital, 200 Mishimacho, Tenri, Nara, 6328552, Japan
| | - Takamasa Fukui
- Division of Thoracic Surgery, Department of Surgery, Tenri Hospital, 200 Mishimacho, Tenri, Nara, 6328552, Japan
| | - Masashi Gotoh
- Division of Thoracic Surgery, Department of Surgery, Tenri Hospital, 200 Mishimacho, Tenri, Nara, 6328552, Japan
| | - Tatsuo Nakagawa
- Division of Thoracic Surgery, Department of Surgery, Tenri Hospital, 200 Mishimacho, Tenri, Nara, 6328552, Japan
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7
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McCollum KJ, Al-Rohil RN. Cutaneous Vascular Neoplasms of Uncertain Biological Behavior. BIOLOGY 2021; 10:biology10111160. [PMID: 34827153 PMCID: PMC8614966 DOI: 10.3390/biology10111160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 10/25/2021] [Accepted: 11/04/2021] [Indexed: 06/13/2023]
Abstract
Neoplasms of uncertain biological behavior present physicians with a genuine conundrum in practice. Cutaneous vascular neoplasms within this category are exceedingly rare, possessing significant gaps and uncertainty in many facets of clinical practice. Firstly, lesions were selected for review based on their categorization as indeterminate behavior, indicating the potential for local recurrence and rarely metastasize. After identification of the target lesions, a comprehensive review of the literature using national databases produced several landmark studies and case series regarding these neoplasms. Limiting the review to only cutaneous limited tumors narrowed the pool of studies; however, quite a large sum of papers remained. Examination of each paper yielded beneficial results on diagnosing, effective treatments, follow-up findings, and prognosis for each indeterminate lesion discussed. Overall, the literature search combined the molecular, histologic, immunohistochemical, surgical strategies to develop an up-to-date and comprehensive framework to guide physicians when encountering such lesions. The tumors reviewed include: kaposiform hemangioendothelioma, endovascular papillary angioendothelioma, pseudomyogenic hemangioendothelioma, retiform hemangioendothelioma, epithelioid hemangioendothelioma, and composite hemangioendothelioma.
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Affiliation(s)
- Kasey J. McCollum
- Department of Pathology, Duke University Medical Center, Durham, NC 27710-0001, USA;
| | - Rami N. Al-Rohil
- Department of Pathology, Duke University Medical Center, Durham, NC 27710-0001, USA;
- Department of Dermatology, Duke University Medical Center, Durham, NC 27710-1000, USA
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8
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Li WW, Liang P, Zhao HP, Zhang YX, Liu YY, Gao JB. Composite hemangioendothelioma of the spleen with multiple metastases: CT findings and review of the literature. Medicine (Baltimore) 2021; 100:e25846. [PMID: 34032697 PMCID: PMC8154451 DOI: 10.1097/md.0000000000025846] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 04/18/2021] [Indexed: 01/04/2023] Open
Abstract
Composite hemangioendothelioma (CHE) is a rare vascular neoplasm of intermediate malignant potential. Only 52 cases have been reported in the English literature, and one case previously reported occurred in the spleen. The purpose of our study was to report a 65-year-old man diagnosed as CHE primary arising from the spleen with multiple metastases.Clinical and imaging features, laboratory tests, and pathological results about CHE were described in detail in this study.The patient presented with multiple lesions in bilateral lungs and spleen that had been incidentally detected by computed tomography (CT). Except for thrombocytopenia, other laboratory tests were not significant. The CT scan of the abdomen revealed multiple round-like and irregularly mixed density masses with unclear borders in enlarged spleen. And contrast enhancement showed mild heterogeneous enhancement. CT scan also showed widespread liver, ribs, lungs, and vertebral bodies metastases. This diagnosis was confirmed by histopathological examination. The patient underwent splenectomy and still survives with tumors after six months followed-up.Due to the lack of specificity of clinical features and laboratory tests, it is necessary to combine imaging features and pathological findings to make a correct diagnosis.
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Affiliation(s)
- Wei wei Li
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou
| | - Pan Liang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou
| | - Hui ping Zhao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou
| | - Yan xing Zhang
- Department of Cardiology, The People's Hospital of HEBI, Hebi, Henan Province, China
| | - Yi yang Liu
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou
| | - Jian bo Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou
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9
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Mani H, Bellizzi A, Miller B, Milhem M, Monga V. A rare case series of composite hemangioendothelioma presenting as bone tumors. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2020. [DOI: 10.1016/j.cpccr.2020.100026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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10
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Wildgruber M, Sadick M, Müller-Wille R, Wohlgemuth WA. Vascular tumors in infants and adolescents. Insights Imaging 2019; 10:30. [PMID: 30868300 PMCID: PMC6419671 DOI: 10.1186/s13244-019-0718-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/12/2019] [Indexed: 12/16/2022] Open
Abstract
Malignant vascular tumors as part of the vascular anomalies spectrum are extremely rare in children and young adults. Instead, benign vascular neoplasias are frequently encountered in the pediatric patient population. While vascular malformations are congenital vascular lesions, originating from a mesenchymal stem cell defect, vascular tumors are neoplastic transformations of endothelial and other vascular cells. The appropriate differential diagnosis and nomenclature according to the classification of the International Society for the Study of Vascular Anomalies (ISSVA) is decisive to initiate correct therapy. While infantile hemangioma can be routinely diagnosed by clinical means and rarely require therapy, more rare vascular tumors are frequently difficult to diagnose, require dedicated cross-sectional imaging, and benefit from an interdisciplinary treatment approach. The focus of this review is to provide an overview over the spectrum of vascular tumors, typical imaging characteristics, and summarize treatment options including interventional radiology approaches.
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Affiliation(s)
- Moritz Wildgruber
- Institut für Klinische Radiologie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, 48149, Münster, Germany.
| | - Maliha Sadick
- Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - René Müller-Wille
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Göttingen, Robert-Koch Strasse 40, 37075, Göttingen, Germany
| | - Walter A Wohlgemuth
- Universitätsklinik und Poliklinik für Radiologie, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany
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11
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Composite hemangioendothelioma with neuroendocrine marker expression: an aggressive variant. Mod Pathol 2017; 30:1589-1602. [PMID: 28731049 DOI: 10.1038/modpathol.2017.83] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/16/2017] [Accepted: 05/20/2017] [Indexed: 11/08/2022]
Abstract
Aberrant expression of neuroendocrine markers is extremely rare in endothelial neoplasms, with only a single report describing three cases. Although originally classified as conventional angiosarcoma, further assessment of these tumors revealed a strikingly composite morphology composed of retiform and epithelioid elements reminiscent of composite hemangioendothelioma, a rare subtype of hemangioendothelioma. To further investigate these findings, available materials from 11 morphologically distinctive endothelial tumors showing neuroendocrine marker expression were retrieved from our archives. Immunohistochemistry for CD31, CD34, FLI-1, synaptophysin, chromogranin, D2-40, ERG, keratin (OSCAR), and CAMTA1 was performed. Total RNA from five cases were extracted and subjected to whole transcriptome sequencing. Clinical follow-up was obtained. These tumors were found to arise in five males and six females in patients from 9 to 55 years in age (median 47 years). They arose both in superficial (wrist, ankle, scalp, hip, and foot) and deep (periaortic tissues, C5 vertebra, pulmonary vein, and liver) locations. All contained elongated, retiform vascular channels lined by hyperchromatic 'hobnail' endothelial cells and a solid growth of uniform epithelioid cells reminiscent of epithelioid hemangioendothelioma. Hemangioma-like foci also lined by hobnail endothelial cells were frequently present. Mitotic activity was typically <1/10 HPF, and necrosis or areas of conventional angiosarcoma was absent. The results of immunohistochemistry were: CD31 (10/10), FLI-1 (10/10), ERG (9/9), CD34 (5/10), D2-40 (7/10), synaptophysin (11/11), chromogranin A (1/11), CD56 (5/11), keratin (0/11), and CAMTA1 (0/6). Sequencing analysis showed one case with PTBP1-MAML2 and one case with EPC1-PHC2 fusion transcripts; fusion transcripts were not identified in the remaining cases. Follow-up (8 cases) revealed local recurrence in one patient and metastatic spread in four individuals (bone, lung, liver, and brain). One person died of disease. Although the morphological features of these tumors are characteristic of composite hemangioendothelioma, this distinctive subset with neuroendocrine differentiation more often involves deep locations and displays more aggressive behavior than typically described in other cases of composite hemangioendothelioma.
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12
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Leen SLS, Clarke PM, Chapman J, Fisher C, Thway K. Composite Hemangioendothelioma of the Submandibular Region. Head Neck Pathol 2015; 9:519-24. [PMID: 25666464 PMCID: PMC4651927 DOI: 10.1007/s12105-015-0612-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 01/29/2015] [Indexed: 11/27/2022]
Abstract
Composite hemangioendothelioma (HE) is a rare vascular neoplasm of intermediate malignant potential that predominantly occurs within the dermis or subcutis of the extremities, and occurs in a wide age range. It is locally aggressive with a high rate of local recurrence, and more rarely regional lymph node or distant metastasis. Histologically, it is composed of a complex admixture of benign, intermediate and malignant vascular components. Although composite HE may contain angiosarcoma-like areas, its prognosis is better than that of pure angiosarcoma. We describe a case of composite HE presenting as a submandibular mass in a 43 year-old male, which included areas of prominent 'high grade' epithelioid angiosarcoma. This adds to the range of anatomic sites of these neoplasms, highlights the importance of recognition of the head and neck as a potential site, and emphasizes the importance of accurate diagnosis for correct management (including of long term follow up) and prognostication.
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Affiliation(s)
- Sarah Lam Shang Leen
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London, SW3 6JJ, UK
| | - Peter M Clarke
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - John Chapman
- Department of Histopathology, Ipswich Hospital, Ipswich, UK
| | - Cyril Fisher
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London, SW3 6JJ, UK
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Khin Thway
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London, SW3 6JJ, UK.
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK.
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