1
|
Singh Y, Gupta A, Mridha AR, Rangarajan K. Calvarial Epithelioid Hemangioendothelioma Mimicking Osteosarcoma. Radiol Imaging Cancer 2024; 6:e230198. [PMID: 38456786 PMCID: PMC10988330 DOI: 10.1148/rycan.230198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/24/2024] [Accepted: 02/05/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Yashaswi Singh
- From the Department of Radiodiagnosis and Interventional Radiology,
All India Institute of Medical Sciences, New Delhi, India (Y.S., A.G.);
Department of Pathology, All India Institute of Medical Sciences, New Delhi,
India (A.R.M.); and Department of Radiology, All India Institute of Medical
Sciences, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, Rm No. 160D,
Ansari Nagar, New Delhi 110029, India (K.R.)
| | - Amit Gupta
- From the Department of Radiodiagnosis and Interventional Radiology,
All India Institute of Medical Sciences, New Delhi, India (Y.S., A.G.);
Department of Pathology, All India Institute of Medical Sciences, New Delhi,
India (A.R.M.); and Department of Radiology, All India Institute of Medical
Sciences, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, Rm No. 160D,
Ansari Nagar, New Delhi 110029, India (K.R.)
| | - Asit Ranjan Mridha
- From the Department of Radiodiagnosis and Interventional Radiology,
All India Institute of Medical Sciences, New Delhi, India (Y.S., A.G.);
Department of Pathology, All India Institute of Medical Sciences, New Delhi,
India (A.R.M.); and Department of Radiology, All India Institute of Medical
Sciences, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, Rm No. 160D,
Ansari Nagar, New Delhi 110029, India (K.R.)
| | - Krithika Rangarajan
- From the Department of Radiodiagnosis and Interventional Radiology,
All India Institute of Medical Sciences, New Delhi, India (Y.S., A.G.);
Department of Pathology, All India Institute of Medical Sciences, New Delhi,
India (A.R.M.); and Department of Radiology, All India Institute of Medical
Sciences, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, Rm No. 160D,
Ansari Nagar, New Delhi 110029, India (K.R.)
| |
Collapse
|
2
|
Haughey AM, Moloney BM, O'Brien CM. Epithelioid Haemangioendothelioma; Not simply a hepatic pathology. Clin Imaging 2023; 102:42-52. [PMID: 37541086 DOI: 10.1016/j.clinimag.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/26/2023] [Accepted: 07/16/2023] [Indexed: 08/06/2023]
Affiliation(s)
- Aoife M Haughey
- Department of Medical Imaging, JDMI University Health Network, University of Toronto, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada
| | - Brian M Moloney
- The Christie NHS Foundation Trust, Wilmslow Rd, Manchester M20 4BX, United Kingdom
| | - Ciara M O'Brien
- Department of Medical Imaging, JDMI University Health Network, University of Toronto, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada. ciara.o'
| |
Collapse
|
3
|
Xu W, Cai J, Meng T, Pang Y, Chen H. 68 Ga-FAPI Versus 18 F-FDG PET/CT in the Evaluation of Epithelioid Hemangioendothelioma of Bone. Clin Nucl Med 2023; 48:460-462. [PMID: 36800246 DOI: 10.1097/rlu.0000000000004605] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
ABSTRACT Epithelioid hemangioendothelioma (EHE) is a rare type of vascular tumor that may arise in bone. Here we presented a 62-year-old man with suspected bone metastases who underwent PET/CT to detect the primary tumor. He underwent 18 F-FDG and 68 Ga-FAPI PET/CT under the prospective trial NCT04416165. Radiotracer uptake was much higher with 68 Ga-FAPI PET/CT than with 18 F-FDG PET/CT in most of bone lesions. No intense uptake likely presenting the primary tumor was observed. Subsequent bone biopsy confirmed the diagnosis of EHE of bone. This case suggested that 68 Ga-FAPI PET/CT might be a useful tool for evaluation of EHE.
Collapse
Affiliation(s)
- Weizhi Xu
- From the Department of Nuclear Medicine and Minnan PET Center, Xiamen Cancer Center, The First Affiliated Hospital ofXiamen University, School of Medicine, Xiamen University, Xiamen, China
| | | | | | | | | |
Collapse
|
4
|
Stacchiotti S, Miah AB, Frezza AM, Messiou C, Morosi C, Caraceni A, Antonescu CR, Bajpai J, Baldini E, Bauer S, Biagini R, Bielack S, Blay JY, Bonvalot S, Boukovinas I, Bovee JVMG, Boye K, Brodowicz T, Callegaro D, De Alava E, Deoras-Sutliff M, Dufresne A, Eriksson M, Errani C, Fedenko A, Ferraresi V, Ferrari A, Fletcher CDM, Garcia Del Muro X, Gelderblom H, Gladdy RA, Gouin F, Grignani G, Gutkovich J, Haas R, Hindi N, Hohenberger P, Huang P, Joensuu H, Jones RL, Jungels C, Kasper B, Kawai A, Le Cesne A, Le Grange F, Leithner A, Leonard H, Lopez Pousa A, Martin Broto J, Merimsky O, Merriam P, Miceli R, Mir O, Molinari M, Montemurro M, Oldani G, Palmerini E, Pantaleo MA, Patel S, Piperno-Neumann S, Raut CP, Ravi V, Razak ARA, Reichardt P, Rubin BP, Rutkowski P, Safwat AA, Sangalli C, Sapisochin G, Sbaraglia M, Scheipl S, Schöffski P, Strauss D, Strauss SJ, Sundby Hall K, Tap WD, Trama A, Tweddle A, van der Graaf WTA, Van De Sande MAJ, Van Houdt W, van Oortmerssen G, Wagner AJ, Wartenberg M, Wood J, Zaffaroni N, Zimmermann C, Casali PG, Dei Tos AP, Gronchi A. Epithelioid hemangioendothelioma, an ultra-rare cancer: a consensus paper from the community of experts. ESMO Open 2021; 6:100170. [PMID: 34090171 PMCID: PMC8182432 DOI: 10.1016/j.esmoop.2021.100170] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 12/22/2022] Open
Abstract
Epithelioid hemangioendothelioma (EHE) is an ultra-rare, translocated, vascular sarcoma. EHE clinical behavior is variable, ranging from that of a low-grade malignancy to that of a high-grade sarcoma and it is marked by a high propensity for systemic involvement. No active systemic agents are currently approved specifically for EHE, which is typically refractory to the antitumor drugs used in sarcomas. The degree of uncertainty in selecting the most appropriate therapy for EHE patients and the lack of guidelines on the clinical management of the disease make the adoption of new treatments inconsistent across the world, resulting in suboptimal outcomes for many EHE patients. To address the shortcoming, a global consensus meeting was organized in December 2020 under the umbrella of the European Society for Medical Oncology (ESMO) involving >80 experts from several disciplines from Europe, North America and Asia, together with a patient representative from the EHE Group, a global, disease-specific patient advocacy group, and Sarcoma Patient EuroNet (SPAEN). The meeting was aimed at defining, by consensus, evidence-based best practices for the optimal approach to primary and metastatic EHE. The consensus achieved during that meeting is the subject of the present publication. This consensus paper provides key recommendations on the management of epithelioid hemangioendothelioma (EHE). Recommendations followed a consensus meeting between experts and a representative of the EHE advocacy group and SPAEN. Authorship includes a multidisciplinary group of experts from different institutions from Europe, North America and Asia.
Collapse
Affiliation(s)
- S Stacchiotti
- Adult Mesenchymal Tumor and Rare Cancer Unit, Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
| | - A B Miah
- The Royal Marsden Hospital and The Institute of Cancer Research, London, UK
| | - A M Frezza
- Adult Mesenchymal Tumor and Rare Cancer Unit, Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - C Messiou
- Department of Radiology, The Royal Marsden Hospital and The Institute of Cancer Research, London, UK
| | - C Morosi
- Radiology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - A Caraceni
- Palliative Care Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - C R Antonescu
- Department of Pathology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, USA
| | - J Bajpai
- Medical Oncology Department, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - E Baldini
- Department of Radiation Oncology, Dana-Farber Cancer Center/Brigham and Women's Hospital, Boston, USA
| | - S Bauer
- Department of Medical Oncology, West German Cancer Center, Sarcoma Center, University of Duisburg-Essen, University Hospital, Essen, Germany
| | - R Biagini
- Orthopaedic Department, Regina Elena National Cancer Institute, Rome, Italy
| | - S Bielack
- Klinikum Stuttgart - Olgahospital, Zentrum für Kinder-, Jugend- und Frauenmedizin, Stuttgart Cancer Center, Pädiatrische Onkologie, Hämatologie, Immunologie, Stuttgart, Germany
| | - J Y Blay
- Department of Medical Oncology, Centre Leon Berard, Université Claude Bernard Lyon, Unicancer, Lyon, France
| | - S Bonvalot
- Department of Surgical Oncology, Institut Curie, Université Paris Sciences et Lettres, Paris, France
| | | | - J V M G Bovee
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - K Boye
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - T Brodowicz
- Medical University Vienna & General Hospital Department of Internal Medicine 1/Oncology, Vienna, Austria
| | - D Callegaro
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - E De Alava
- Institute of Biomedicine of Sevilla (IBiS), Virgen del Rocio University Hospital/CSIC/University of Sevilla/CIBERONC, Seville, Spain; Department of Normal and Pathological Cytology and Histology, School of Medicine, University of Seville, Seville, Spain
| | | | - A Dufresne
- Department of Medical Oncology, Centre Leon Berard, Université Claude Bernard Lyon, Unicancer, Lyon, France
| | - M Eriksson
- Department of Oncology, Skane University Hospital and Lund University, Lund, Sweden
| | - C Errani
- Orthopaedic Service, Musculoskeletal Oncology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - A Fedenko
- Medical Oncology Division, P.A. Herzen Cancer Research Institute, Moscow, Russian Federation
| | - V Ferraresi
- Sarcomas and Rare Tumors Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - A Ferrari
- Paediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - C D M Fletcher
- Department of Pathology Brigham & Women's Hospital, Boston, USA
| | - X Garcia Del Muro
- University of Barcelona and Genitourinary Cancer and Sarcoma Unit Institut Català d'Oncologia, Hospitalet, Barcelona, Spain
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - R A Gladdy
- University of Toronto and Lunenfeld-Tanenbaum Research Institute, Toronto, Canada
| | - F Gouin
- Department of Surgery, Centre Leon Berard, Lyon, France
| | - G Grignani
- Division of Medical Oncology, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Italy
| | - J Gutkovich
- The EHE Foundation, Wisconsin, USA; NUY Langone Medical Center, New York, USA
| | - R Haas
- Department of Radiotherapy, the Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Radiotherapy, the Leiden University Medical Center, Leiden, the Netherlands
| | - N Hindi
- Group of Advanced Therapies and Biomarkers in Sarcoma, Institute of Biomedicine of Seville (IBIS, HUVR, CSIC, Universidad de Sevilla), Seville, Spain
| | - P Hohenberger
- Division of Surgical Oncology & Thoracic Surgery, Mannheim University Medical Center, University of Heidelberg, Heidelberg, Germany
| | - P Huang
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - H Joensuu
- Department of Oncology, Helsinki University Hospital & Helsinki University, Helsinki, Finland
| | - R L Jones
- Department of Cancer, The Royal Marsden Hospital and The Institute of Cancer Research, London, UK
| | - C Jungels
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - B Kasper
- University of Heidelberg, Mannheim University Medical Center, Sarcoma Unit, Mannheim, Germany
| | - A Kawai
- Musculoskeletal Oncology and Rehabilitation Medicine, Rare Cancer Center National Cancer Center Hospital, Tokyo, Japan
| | - A Le Cesne
- International Department, Gustave Roussy, Villejuif, France
| | - F Le Grange
- UCLH - University College London Hospitals NHS Foundation Trust, London, UK
| | - A Leithner
- Department of Orthopaedics and Trauma Medical University Graz, Graz, Austria
| | - H Leonard
- Chair of Trustees of the EHE Rare Cancer Charity (UK), Charity number 1162472
| | - A Lopez Pousa
- Medical Oncology Department, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - J Martin Broto
- Hospital Universitario Fundación Jimenez Diaz, Madrid, Spain
| | - O Merimsky
- Unit of Soft Tissue and Bone Oncology, Division of Oncology, Tel-Aviv Medical Center affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - P Merriam
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - R Miceli
- Department of Clinical Epidemiology and Trial Organisation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - O Mir
- Sarcoma Group, Gustave Roussy, Villejuif, France
| | - M Molinari
- University of Pittsburgh Medical Center, Thomas Starzl Transplant Institute, Pittsburgh, USA
| | | | - G Oldani
- Division of Abdominal Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - E Palmerini
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M A Pantaleo
- Division of Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - S Patel
- Sarcoma Center, The University of Texas M.D. Anderson Cancer Center, Houston, USA
| | | | - C P Raut
- Department of Surgery, Brigham and Women's Hospital, Boston, USA; Center for Sarcoma and Bone Oncology, Harvard Medical School, Boston, USA; Dana Farber Cancer Center, Harvard Medical School, Boston, USA
| | - V Ravi
- Sarcoma Center, The University of Texas M.D. Anderson Cancer Center, Houston, USA
| | - A R A Razak
- Princess Margaret Cancer Centre and Sinai Healthcare System & Faculty of Medicine, University of Toronto, Toronto, Canada
| | - P Reichardt
- Helios Klinikum Berlin-Buch, Department of Oncology and Palliative Care, Berlin, Germany
| | - B P Rubin
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, USA
| | - P Rutkowski
- Maria Sklodowska-Curie National Research Institute of Oncology, Department of Soft Tissue/Bone Sarcoma and Melanoma, Warsaw, Poland
| | - A A Safwat
- Aarhus University Hospital, Aarhus, Denmark
| | - C Sangalli
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - G Sapisochin
- Multi-Organ Transplant and HPB Surgical Oncology, Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - M Sbaraglia
- Department of Pathology, Azienda Ospedaliera Università Padova, Padua, Italy
| | - S Scheipl
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | | | - D Strauss
- Department of Surgery, The Royal Marsden Hospital and The Institute of Cancer Research, London, UK
| | - S J Strauss
- University College London Hospital, London, UK
| | - K Sundby Hall
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - W D Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, USA
| | - A Trama
- Department of Research, Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - A Tweddle
- Palliative Care, The Royal Marsden Hospital and The Institute of Cancer Research London
| | - W T A van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M A J Van De Sande
- Department of Orthopedic Surgery Bone and Soft Tissue Tumor Unit, Leiden University Medical Center, Leiden, The Netherlands
| | - W Van Houdt
- Sarcoma and Melanoma Unit, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - G van Oortmerssen
- Co-Chair of Sarcoma Patients EuroNet (SPAEN), Woelfersheim, Germany & Chairman of the Dutch organisation for sarcoma patients (Patiëntenplatform Sarcomen), Guest researcher at Leiden University (Leiden Institute for Advanced Computer Science), Leiden University, Leiden, The Netherlands
| | - A J Wagner
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - M Wartenberg
- Chair of the Board of Directors of Sarcoma Patients EuroNet (SPAEN), Sarcoma Patients EuroNet (SPAEN), Woelfersheim, Germany
| | - J Wood
- The Royal Marsden NHS Foundation Trust, London, UK
| | - N Zaffaroni
- Molecular Pharmacology Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - C Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre and Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - P G Casali
- Adult Mesenchymal Tumor and Rare Cancer Unit, Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - A P Dei Tos
- Department of Pathology, Azienda Ospedaliera Università Padova, Padua, Italy
| | - A Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| |
Collapse
|
5
|
Chen PK, Lin QT, Feng YZ, Weng ZP, Cai XR. Epithelioid hemangioendothelioma of spine: A case report with review of literatures. Radiol Case Rep 2020; 15:2687-2692. [PMID: 33117468 PMCID: PMC7581828 DOI: 10.1016/j.radcr.2020.10.024] [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: 08/18/2020] [Revised: 10/10/2020] [Accepted: 10/10/2020] [Indexed: 01/07/2023] Open
Abstract
Primary epithelioid hemangioendothelioma of the spine is the extremely rare malignant vascular neoplasm with an unpredictable outcome. A case of epithelioid hemangioendothelioma with multiple lytic lesions of thoracolumbar spine and other bones in a 29-year-old male patient is reported. A review of the published data regarding this rare neoplasm is also presented. The features of epithelioid hemangioendothelioma include the occurrence in the young male patient, multiple osteolytic lesions with thin sclerotic rim and hypermetabolic activities. However, its imaging features are not specific. Positron emission tomography/computed tomography is essential for identification of the lesions and subsequent follow-up for treatment.
Collapse
Affiliation(s)
- Ping-Kang Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, No.613 West Huangpu Avenue, Tianhe District, Guangzhou 510630, Guangdong, China
| | - Qi-Ting Lin
- Medical Imaging Center, First Affiliated Hospital of Jinan University, No.613 West Huangpu Avenue, Tianhe District, Guangzhou 510630, Guangdong, China
| | - You-Zhen Feng
- Medical Imaging Center, First Affiliated Hospital of Jinan University, No.613 West Huangpu Avenue, Tianhe District, Guangzhou 510630, Guangdong, China
| | - Ze-Ping Weng
- Department of Pathology, First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China
| | - Xiang-Ran Cai
- Medical Imaging Center, First Affiliated Hospital of Jinan University, No.613 West Huangpu Avenue, Tianhe District, Guangzhou 510630, Guangdong, China
| |
Collapse
|
6
|
Baliga K, G S, Kasturi N. A Rare Case of Hemangioendothelioma of Upper Thigh. Cureus 2020; 12:e10642. [PMID: 33133812 PMCID: PMC7586378 DOI: 10.7759/cureus.10642] [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] [Indexed: 11/26/2022] Open
Abstract
Hemangioendothelioma is a rare tumor arising from the vascular endothelium of soft tissue, skin, bone, and viscera. The disease has an indolent course, with the potential for recurrence, and is often associated with multi-organ involvement. We present a rare case of subcutaneous tumor in the thigh, without systemic involvement in a middle-aged woman. The tumor was completely excised after ligation of the feeding vessels, and the histopathologic diagnosis was consistent with hemangioendothelioma. Regular follow-up is suggested due to the potential for recurrence.
Collapse
Affiliation(s)
- Kapil Baliga
- Surgery, Indira Gandhi Medical College and Research Institute, Puducherry, IND
| | - Sriramulu G
- Surgery, Indira Gandhi Government General Hospital and Research Institute, Puducherry, IND
| | - Nirupama Kasturi
- Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| |
Collapse
|
7
|
A Review of the Spectrum of Imaging Manifestations of Epithelioid Hemangioendothelioma. AJR Am J Roentgenol 2020; 215:1290-1298. [PMID: 32841059 DOI: 10.2214/ajr.20.22876] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE. The purpose of this article is to review the spectrum of imaging manifestations of epithelioid hemangioendothelioma across different organ systems and briefly describe its current treatment strategies. CONCLUSION. Epithelioid hemangioendothelioma is a rare, locally invasive neoplasm with metastatic potential. Although most commonly occurring in liver, lungs, and bones, it can also present at multiple other sites. Because of its nonspecific clinical and imaging manifestations, it is often misdiagnosed. The possibility of epithelioid hemangioendothelioma must be considered in the presence of a slowly growing mass that invades adjacent structures. Imaging can help plan percutaneous biopsy, detect sites of disease, and identify poor prognostic factors.
Collapse
|
8
|
Triplett JD, Khor TS, Kermode AG. Recurrent upper limb neuropathies secondary to an epithelioid haemangioendothelioma - A rare mimic of nerve tumours. J Clin Neurosci 2019; 73:326-328. [PMID: 31708405 DOI: 10.1016/j.jocn.2019.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 04/20/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
Abstract
Epithelioid haemangioendothelioma (EHE) is an uncommon type of vascular tumour with intermediate malignant potential, classified as a sarcoma which occasionally involves neurovascular structures and can mimic nerve sheath tumours. EHE is difficult to distinguish from other nerve sheath tumours based on imaging, including MRI, and biopsy is often required for diagnosis. Diagnosis of EHE from biopsy often requires the use of vascular immunohistochemical stains. We present a case of left upper limb neurovascular bundle EHE presenting with proximal ulnar nerve neuropathy and subsequent median nerve neuropathy and liver, lungs and bone metastases. The tumour had been identified 20 years prior with a similar presentation of upper limb weakness and sensory disturbance, yet following surgical excision it was misdiagnosed as inflammatory fibrous tissue. Treatment with propranolol has resulted in disease stability and surgical debulking resulted in improved upper limb function. The use of beta-adrenergic receptor antagonists in EHE and other sarcomas have been shown to increase T-cell infiltration and decrease immunosuppressive PD-1 expression in neoplastic cells.
Collapse
Affiliation(s)
- James D Triplett
- Department of Neurology, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Tze S Khor
- PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, Australia
| | - Allan G Kermode
- Department of Neurology, Sir Charles Gairdner Hospital, Nedlands, Australia; Faculty of Medicine, University of Western Australia, Perth, Australia; Centre for Neuromuscular and Neurological Disorders, Perron Research Institute, Perth, Australia; Institute of Immunology and Infectious Diseases, Murdoch University, Perth, Australia.
| |
Collapse
|
9
|
Gomez M, Bem S, El-Zammar O, Naous R. Classic Hodgkin lymphoma with initial extranodal osseous presentation: a case report and literature review. AME Case Rep 2019; 3:22. [PMID: 31463427 DOI: 10.21037/acr.2019.07.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/26/2019] [Indexed: 11/06/2022]
Abstract
Initial extranodal osseous presentation of Classic Hodgkin lymphoma (CHL) is extremely rare. The present study describes a case of CHL in an 11-year-old male presenting with lower back and right hip pain. Radiologic imaging showed a solitary lytic lesion involving the L5 vertebrae and sacrum. Pathologic examination led to a diagnosis of extranodal osseous CHL and further workup proved bone marrow and nodal disease. Diagnosis of extranodal osseous CHL is challenging, especially in this age group and location. When confronted with a solitary lytic bone lesion in a young patient, more common benign and neoplastic entities enter the differential diagnosis and include osteomyelitis, Langerhans cell histiocytosis, epithelioid hemangioma of bone, leukemia, and anaplastic large cell lymphoma (ALCL) among others, with extranodal osseous CHL being one of the less common entities in the differential diagnosis. This case report raises the awareness of extranodal osseous CHL as one of the entities to consider when confronted with a solitary lytic bone lesion in a young patient.
Collapse
Affiliation(s)
- Mariangela Gomez
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Sylva Bem
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Ola El-Zammar
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Rana Naous
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA
| |
Collapse
|
10
|
Lytle M, Bali SD, Galili Y, Bednov B, Murillo Alvarez RM, Carlan SJ, Madruga M. Epithelioid Hemangioendothelioma: A Rare Case of an Aggressive Vascular Malignancy. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:864-867. [PMID: 31209195 PMCID: PMC6597141 DOI: 10.12659/ajcr.915874] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patient: Female, 46 Final Diagnosis: Epithelioid hemangioendothelioma Symptoms: Pain Medication: — Clinical Procedure: — Specialty: Oncology
Collapse
Affiliation(s)
- Meghan Lytle
- Department of Internal Medicine, Orlando Regional Healthcare, Orlando, FL, USA
| | - Sunil Daniel Bali
- Division of Pulmonology, Orlando Regional Healthcare, Orlando, FL, USA
| | - Yehuda Galili
- Department of Internal Medicine, Orlando Regional Healthcare, Orlando, FL, USA
| | - Brittany Bednov
- Department of Internal Medicine, Orlando Regional Healthcare, Orlando, FL, USA
| | | | - Stephen J Carlan
- Department of Obstetrics and Gynecology, Division of Academic Affairs and Research, Orlando Regional Healthcare, Orlando, FL, USA
| | - Mario Madruga
- Department of Internal Medicine, Orlando Regional Healthcare, Orlando, FL, USA
| |
Collapse
|
11
|
Epelboym Y, Engelkemier DR, Thomas-Chausse F, Alomari AI, Al-Ibraheemi A, Trenor CC, Adams DM, Chaudry G. Imaging findings in epithelioid hemangioendothelioma. Clin Imaging 2019; 58:59-65. [PMID: 31238187 DOI: 10.1016/j.clinimag.2019.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/28/2019] [Accepted: 06/11/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE-OBJECTIVE Epithelioid hemangioendothelioma (EHE) is a rare vascular malignancy with varying biologic behavior. The purpose of this study was to identify imaging findings most characteristic of EHE. METHODS Retrospective review of clinical and imaging records in patients referred to our Vascular Anomalies Center over a 17 year period with biopsy proven EHE. RESULTS We evaluated 29 patients (17 F) with median age of 16 years (range 2-76 y). The most common presenting symptoms were pain (n = 13) and palpable mass (n = 7). 22 (70%) had multifocal disease. Most common sites of involvement were lung (n = 25), liver (n = 16), bone (n = 12), soft tissue (n = 3) and lymph nodes (n = 1). Of patients with single site disease, 3 had lung, 3 liver, and 1 had bone lesions. In 18/25 with lung disease, there were multiple nodules of varying sizes and characteristics. In 14/16 with hepatic disease there were multiple nodules with predominantly peripheral distribution. Subcapsular retraction was seen in 10/16 and a "lollipop" sign (hepatic or portal vein tapering at the edge of a well-defined hypoenhancing lesion) identified in 5/16. Of 12 osseous lesions, 11 were lytic, 8 involved vertebrae and 9 involved the axial skeleton. CONCLUSION EHE has varied imaging findings. The most common sites are lungs, liver, and bone, with multi-organ involvement seen in most. Lung disease is most commonly characterized by multiple nodules. Hepatic lesions demonstrate the most distinctive findings, with peripheral distribution, lack of early enhancement, subcapsular retraction and "lollipop" sign. Osseous lesions are commonly lytic and more prevalent in the axial skeleton.
Collapse
Affiliation(s)
- Yan Epelboym
- Division of Vascular and Interventional Radiology, Boston Children's Hospital and Harvard Medical School, United States of America
| | - Dawn R Engelkemier
- Division of Vascular and Interventional Radiology, Boston Children's Hospital and Harvard Medical School, United States of America
| | - Frederic Thomas-Chausse
- Division of Vascular and Interventional Radiology, Boston Children's Hospital and Harvard Medical School, United States of America
| | - Ahmad I Alomari
- Division of Vascular and Interventional Radiology, Boston Children's Hospital and Harvard Medical School, United States of America; Vascular Anomalies Center, Boston Children's Hospital and Harvard Medical School, United States of America
| | - Alyaa Al-Ibraheemi
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, United States of America; Vascular Anomalies Center, Boston Children's Hospital and Harvard Medical School, United States of America
| | - Cameron C Trenor
- Division of Hematology/Oncology, Boston Children's Hospital and Harvard Medical School, United States of America; Vascular Anomalies Center, Boston Children's Hospital and Harvard Medical School, United States of America
| | - Denise M Adams
- Division of Hematology/Oncology, Boston Children's Hospital and Harvard Medical School, United States of America; Vascular Anomalies Center, Boston Children's Hospital and Harvard Medical School, United States of America
| | - Gulraiz Chaudry
- Division of Vascular and Interventional Radiology, Boston Children's Hospital and Harvard Medical School, United States of America; Vascular Anomalies Center, Boston Children's Hospital and Harvard Medical School, United States of America.
| |
Collapse
|
12
|
Grondin K, Salomon S, Sevestre H, Goëb V. Hémangioendothéliome épithélioïde osseux. Rev Med Interne 2018; 39:875-878. [DOI: 10.1016/j.revmed.2018.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 06/26/2018] [Accepted: 08/01/2018] [Indexed: 01/01/2023]
|
13
|
Zhang H, Fu Y, Ye Z. Bone multicentric epithelioid hemangioendothelioma of the lower and upper extremities with pulmonary metastases: A case report. Oncol Lett 2015; 9:2177-2180. [PMID: 26137035 DOI: 10.3892/ol.2015.3018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 02/17/2015] [Indexed: 01/07/2023] Open
Abstract
The present study reports a rare case of bone multicentric epithelioid hemangioendothelioma (EH) involving the upper and lower extremities simultaneously, with visceral involvement of the lung. Osteolytic lesions were first identified in the right distal femur and proximal tibia. Slight increased radionuclide uptake was observed in the right shoulder joint on bone scintigraphy, however, this was ignored, as no clinical symptoms were present. The patient was initially misdiagnosed with multifocal chondroblastoma, and an extra-articular curettage of lesions was performed in the proximal tibia and medial femoral condyle, which was filled with bone cement. The histopathological diagnosis was corrected post-operatively following immunohistochemical analysis, which indicated EH, and subsequently, an amputation of the right leg at thigh level was performed. In addition, multiple lytic lesions in the right shoulder joint and pulmonary metastases were identified on whole-body radiological examination. Radiotherapy was administered to the right shoulder joint, however, the patient refused chemotherapy or further surgery. At 15 months after the initial surgery, the patient currently remains alive. This case indicates that an improved understanding with regard to the clinical features of this disease may prevent misdiagnosis and improve EH treatment.
Collapse
Affiliation(s)
- Hua Zhang
- Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China
| | - Yanbiao Fu
- Department of Pathology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China
| | - Zhaoming Ye
- Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China
| |
Collapse
|
14
|
Lee SE, Park HY, Kim S, Bang H, Min JH, Choi YL. Epithelioid hemangioendothelioma with extensive cystic change and CAMTA1 rearrangement. Pathol Int 2013; 63:502-5. [PMID: 24134632 DOI: 10.1111/pin.12097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 08/26/2013] [Indexed: 11/29/2022]
Abstract
Epithelioid hemangioendothelioma (EHE) is a rare vascular neoplasm that has the ability to recur locally and metastasize. Thus, it is important to distinguish this tumor from other epithelioid vascular neoplasms. A 47-year-old man presented to our hospital with a pelvic mass with severe ischialgia and weight loss. Surgical resection was performed, and the mass was found to have dark red multiloculated cysts with hemorrhage and calcification. The histopathologic examination showed a central sclerotic, hypocellular zone and a peripheral cellular zone. Only the peripheral portion of the wall revealed nested tumor cells in light blue myxoid stroma. These tumors are typically composed of short strands or cords of bland epithelioid cells with occasional intracytoplasmic lumens embedded in a myxohyalinized stroma. The tumor cells were positive for CD31 and CD34 and negative for factor VIII-related antigen, CK (AE1/AE3) and S-100. The tumor nuclei showed distinct break-apart signals with individual green and/or red signals, indicating the presence of CAMTA1 rearrangement. In this study, we report a case of EHE that was difficult to diagnose based on histology alone. Therefore, we also performed fluorescence in situ hybridization, and found that the tumor harbored a CAMTA1 gene rearrangement, which confirmed the diagnosis.
Collapse
Affiliation(s)
- Seung Eun Lee
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | | | | | | | | |
Collapse
|
15
|
Gracia IA, Proubasta IR, Peiró AI, Trullols LT, Llauger J, Palmer J, Bagué S. Epithelioid hemangioendothelioma of the pisiform. Hand (N Y) 2012; 7:214-6. [PMID: 23730246 PMCID: PMC3351509 DOI: 10.1007/s11552-012-9409-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Isidre A. Gracia
- Orthopaedic Department, Hospital Sant Pau, Avda. San Antonio Mª Claret, 167, 08025 Barcelona, Spain
| | - Ignacio R. Proubasta
- Orthopaedic Department, Hospital Sant Pau, Avda. San Antonio Mª Claret, 167, 08025 Barcelona, Spain
| | - Ana I. Peiró
- Orthopaedic Department, Hospital Sant Pau, Avda. San Antonio Mª Claret, 167, 08025 Barcelona, Spain
| | - Laura T. Trullols
- Orthopaedic Department, Hospital Sant Pau, Avda. San Antonio Mª Claret, 167, 08025 Barcelona, Spain
| | - Jaume Llauger
- Radiology Department, Hospital Sant Pau, Barcelona, Spain
| | - Jaume Palmer
- Radiology Department, Hospital Sant Pau, Barcelona, Spain
| | - Silvia Bagué
- Pathology Department, Hospital Sant Pau, Barcelona, Spain
| |
Collapse
|
16
|
Gómez-Arellano LI, Ferrari-Carballo T, Domínguez-Malagón HR. Multicentric epithelioid hemangioendothelioma of bone. Report of a case with radiologic-pathologic correlation. Ann Diagn Pathol 2011; 16:43-7. [PMID: 22154336 DOI: 10.1016/j.anndiagpath.2011.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 08/03/2011] [Indexed: 11/26/2022]
Abstract
Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor of uncertain biologic behavior. Most cases come out as a single lesion of the soft tissue but also may appear in the lung, liver, and other locations. Epithelioid hemangioendothelioma of bone is an extremely rare tumor and more prevalent in the second and third decades of life; its behavior is uncertain, it most commonly is unifocal, and it affects preferentially lower extremities. In this work, we present the clinical, radiologic, and pathologic findings of a 19-year-old man with a multicentric EHE of bone that involved 3 vertebrae and developed lung metastasis.
Collapse
|
17
|
Mohankumar R, Varia H, Patnaik L, Susnerwala S. Multi-focal epithelioid haemangioendothelioma of the bone and skin. Skeletal Radiol 2011; 40:955-6. [PMID: 21340449 DOI: 10.1007/s00256-011-1126-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2010] [Revised: 01/31/2011] [Accepted: 02/03/2011] [Indexed: 02/02/2023]
Affiliation(s)
- Rakesh Mohankumar
- Department of Radiology, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, Lancashire, FY3 8NR, UK.
| | | | | | | |
Collapse
|
18
|
Henriquez CR, Cazes A, Fabiani JN, Bruneval P. [Epithelioid hemangioendothelioma of the inferior vena cava]. Ann Pathol 2011; 31:218-21. [PMID: 21737006 DOI: 10.1016/j.annpat.2011.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 02/21/2011] [Indexed: 11/17/2022]
Abstract
Epithelioid hemangioendothelioma is a rare endothelial cell-derived tumor of intermediate grade malignancy. It has an unpredictable outcome, independently of the usual histoprognostic criteria. Thirty-three cases with intravascular localisation are described in the literature. We describe a case occurring in a 31-year-old male, which developed an inferior veina cava tumor, with recurrence after incomplete surgical resection and chemotherapy. He was operated on again under extracorporeal circulation and complete surgical resection was then performed. Histologic examination found an intravascular epithelioid hemangioendothelioma developing in the vascular lumen without vascular wall infiltration. This entity represents a challenge not only for the vascular surgeon, but also for the pathologist given its difficult diagnosis.
Collapse
Affiliation(s)
- Clarissa Rodriguez Henriquez
- Service d'anatomie et cytologie pathologiques, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75908 Paris cedex 15, France
| | | | | | | |
Collapse
|
19
|
Heldenberg E, Rabin I, Cheyn D, Lorber J, Elkabetz E, Sandbank J, Bass A. Epithelioid hemangioendothelioma as a rare cause of blue toe syndrome. J Vasc Surg 2011; 54:854-6. [PMID: 21571496 DOI: 10.1016/j.jvs.2011.02.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 02/15/2011] [Accepted: 02/15/2011] [Indexed: 11/26/2022]
Abstract
Blue toe syndrome (BTS), is a well-known entity of toe gangrene and rest pain secondary to micro emboli lodged within the digital arteries. BTS among young patients should alert physicians to look for causes such as trauma, connective tissue disease, hypercoagulability state, and others. We hereby describe a 32-year-old female with right BTS. A mass obstructing 80% of the right popliteal artery lumen was the source of emboli. The histologic results of the replaced arterial segment revealed a thrombus on top of epithelioid hemangioendothelioma. This is the first description of the association between primary vascular tumor and BTS.
Collapse
Affiliation(s)
- Eitan Heldenberg
- Department of Vascular Surgery, Assaf Harofeh Medical Center, The Sackler School of Medicine, Tel Aviv University, Zerifin, Israel.
| | | | | | | | | | | | | |
Collapse
|
20
|
Liu Q, Miao J, Lian K, Huang L, Ding Z. Multicentric epithelioid hemangioendothelioma involving the same lower extremity: a case report and review of literature. Int J Med Sci 2011; 8:558-63. [PMID: 21960748 PMCID: PMC3180772 DOI: 10.7150/ijms.8.558] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Accepted: 09/12/2011] [Indexed: 11/19/2022] Open
Abstract
Epithelioid hemangioendothelioma (EH) is an uncommon low-grade malignant soft-tissue tumor; no case has been previously reported where multicentric epithelioid hemangioendothelioma occurred in the same lower extremity at different sites. We report a case involving the common peroneal nerve and subsequently the long bone and the short bones of the same lower extremity, and also review the literature. After establishing case of several lesions, we reviewed the histopathology properly and followed up the patient for a long time with serial whole body assessment to pick up any subsequent lesions.
Collapse
Affiliation(s)
- Qingjun Liu
- Department of Orthopaedic Surgery, the Affiliated Southeast Hospital of Xiamen University, Orthopaedic Trauma Center of PLA, Zhangzhou, 363000, PR China
| | | | | | | | | |
Collapse
|
21
|
|
22
|
Wang CG, Jia NY, Yu HY, Liu HM, Wang J. Epithelioid hemangioendothelioma of thoracic vertebra: a case report (2008: 11b). Eur Radiol 2009; 19:517-20. [PMID: 19153746 DOI: 10.1007/s00330-008-1035-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2007] [Revised: 04/02/2008] [Accepted: 04/03/2008] [Indexed: 10/21/2022]
Abstract
Epithelioid hemangioendothelioma is a rare, low-grade malignant hemangioendothelioma first reported in 1982. The disease is more likely to occur between 20 and 30 years with a 2:1 male-to-female ratio. Epithelioid hemangioendothelioma may occur in multiple organs and tissues, but it rarely involves the skeleton. We present a case in a thoracic vertebra.
Collapse
Affiliation(s)
- Chen-guang Wang
- Department of Radiology, ShangHai Changzheng Hospital, Second Military Medical University, Shanghai, China, 200003
| | | | | | | | | |
Collapse
|
23
|
Watanabe S, Yano F, Kita T, Soga S, Shinmoto H, Kosuda S, Ozeki Y, Aida S, Sakata I. 18F-FDG-PET/CT as an indicator for resection of pulmonary epithelioid hemangioendothelioma. Ann Nucl Med 2008; 22:521-4. [PMID: 18670859 DOI: 10.1007/s12149-007-0159-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Accepted: 09/11/2007] [Indexed: 11/25/2022]
Abstract
A 60-year-old man with a 7-year history of multiple pulmonary nodules presented to our hospital because the nodules were seen to have increased in size on review of films on a regular medical checkup 1 week earlier. Computed tomography (CT) revealed multiple pulmonary nodules with calcification in the lungs. The largest nodule measuring 2.5 cm in the maximum dimension was lobulated and ill-defined. The patient underwent 18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG-PET/CT) to evaluate the multiple nodules and to search for a primary lesion. 18F-FDG-PET/CT revealed increased uptake in only two nodules with a standardized uptake value of 4.61 and 2.10, respectively. The two foci with increased 18F-FDG uptake were resected and pathologically proven to be pulmonary epithelioid hemangioendothelioma (PEH). PEH can transform into malignancy with metastasis. An 18F-FDG-PET/CT finding may be an indicator to decide on PEH resection.
Collapse
Affiliation(s)
- Sadahiro Watanabe
- Department of Radiology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Nuthakki S, Fessell D, Lal N, Shirkhoda A, Irwin T, Irwin R. Epithelioid hemangioendothelioma mimicking a nerve sheath tumor clinically and on MR imaging. Skeletal Radiol 2007; 36 Suppl 1:S58-62. [PMID: 17077984 DOI: 10.1007/s00256-006-0197-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2005] [Revised: 06/27/2006] [Accepted: 08/02/2006] [Indexed: 02/02/2023]
Abstract
Epithelioid hemangioendothelioma is a tumor of the soft tissues arising from the vascular endothelium. It is considered an intermediate grade malignancy. A 42-year-old female patient presented with pain and tingling down her right arm and a mass at the right medial upper extremity. MRI revealed an oblong mass along the course of the neurovascular bundle. Given the clinical and MR findings, a nerve sheath tumor was suspected. At surgery, the mass was adherent to both the brachial artery medially and the median nerve posteriorly. Pathology revealed epithelioid hemangioendothelioma. The imaging characteristics of epithelioid hemangioendothelioma on ultrasound, CT, and MRI are reviewed. Epithelioid hemangioendothelioma can mimic a nerve sheath tumor clinically and radiologically and should be considered in the differential diagnosis of tumors involving or adjacent to a neurovascular bundle.
Collapse
Affiliation(s)
- S Nuthakki
- Department of Radiology, William Beaumont Hospital, 3601 W Thirteen Mile Road, Royal Oak, MI 48073-6769, USA
| | | | | | | | | | | |
Collapse
|
25
|
Bruegel M, Waldt S, Weirich G, Woertler K, Rummeny EJ. Multifocal epithelioid hemangioendothelioma of the phalanges of the hand. Skeletal Radiol 2006; 35:787-92. [PMID: 16132980 DOI: 10.1007/s00256-005-0943-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2005] [Revised: 04/15/2005] [Accepted: 04/15/2005] [Indexed: 02/02/2023]
Abstract
Epithelioid hemangioendothelioma (EH) of bone is a rare vascular neoplasm characterized by epithelioid endothelial cells and a variable biologic behaviour. The principal sites of occurrence of this osteolytic tumor are the lower extremity and the axial skeleton. Approximately half of the cases present with multifocal disease. The latter feature can be helpful in suggesting the diagnosis of a vascular tumor; on the other hand, it strengthens the need for a skeletal survey or whole-body MRI/CT. We report on the clinical, histologic and radiologic features-including CT and MRI findings-of EH in a case of multifocal disease of the phalanges of the hand, a very uncommon anatomic site of affliction.
Collapse
Affiliation(s)
- Melanie Bruegel
- Department of Radiology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Strasse 22, 81675, Munich, Germany.
| | | | | | | | | |
Collapse
|
26
|
Charfi L, Mrad K, Karray S, Sassi S, Driss M, Abbes I, Ben Romdhane K. [Epithelioid hemangioendothelioma of bone complicated by femoral fracture]. ACTA ACUST UNITED AC 2006; 91:788-91. [PMID: 16553002 DOI: 10.1016/s0035-1040(05)84491-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 54-year-old man was seen with a fracture of the left femur. Plain radiographs revealed a 40-mm lytic centromedullary lesion. Magnetic resonance T1- and T2-weighted sequences showed high and low signals. After stabilization of the fracture, the tumor was removed followed by reconstruction with a vascularized fibula. The pathological examination demonstrated proliferation of non atypical CD34 and CD31 positive epithelioid cells with few lumens, accompanied by abundant fibrous stroma, sometimes masking tumor cells. Satisfactory motion was achieved with no recurrence at 20 months follow-up. Bone hemangioendothelioma can simulate metastasis and must be distinguished by immunohistochemistry. Prognosis is a subject of debate as the tumor is considered to exhibit intermediate malignancy by some authors while other consider it to be a malignant tumor.
Collapse
Affiliation(s)
- L Charfi
- Service d'Anatomie et Cytologie Pathologique, Institut Salah-Azaiez, Tunis, Tunisie
| | | | | | | | | | | | | |
Collapse
|
27
|
Larochelle O, Périgny M, Lagacé R, Dion N, Giguère C. Best cases from the AFIP: epithelioid hemangioendothelioma of bone. Radiographics 2006; 26:265-70. [PMID: 16418256 DOI: 10.1148/rg.261055017] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Olivier Larochelle
- Department of Radiology, Centre Hospitalier Universitaire de Québec, LHôtel-Dieu de Québec, Laval University, 11 côte du Palais, Québec City, Québec, Canada G1R 2J6.
| | | | | | | | | |
Collapse
|
28
|
Shah ZK, Peh WCG, Shek TWH, Wong JWK, Chien EP. Hemangioendothelioma with an epithelioid phenotype arising in hemangioma of the fibula. Skeletal Radiol 2005; 34:750-4. [PMID: 15834563 DOI: 10.1007/s00256-005-0912-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2004] [Revised: 02/11/2005] [Accepted: 02/14/2005] [Indexed: 02/02/2023]
Abstract
The classification of certain vascular bone tumors that show an epithelioid cytologic appearance remains confusing, with overlap in features of epithelioid hemangioma, hemangioendothelioma and epithelioid hemangioendothelioma. Radiographs of a 27-year-old woman who presented with ankle pain showed an expanded lytic-sclerotic lesion in the distal left fibula. Magnetic resonance imaging showed an intramedullary lesion with a small lateral intracortical component. The lesion was hypo- to isointense to muscle on T1-weighted images and heterogeneously hyperintense on T2-weighted images. Initial incisional biopsy was inconclusive. Open biopsy showed hemangioendothelioma with epithelioid morphology, and the lesion was completely resected with reconstruction using a peroneal fibular rotation graft. Examination of the resected specimen showed focal hemangioendothelioma with an epithelioid phenotype arising in a hemangioma. This case illustrates the difficulty and pitfalls of making the correct diagnosis on the basis of a small biopsy specimen.
Collapse
Affiliation(s)
- Zarine K Shah
- Department of Diagnostic Radiology, Changi General Hospital, Singapore
| | | | | | | | | |
Collapse
|
29
|
Castelli P, Caronno R, Piffaretti G, Tozzi M. Epithelioid hemangioendothelioma of the radial artery. J Vasc Surg 2005; 41:151-4. [PMID: 15696060 DOI: 10.1016/j.jvs.2004.10.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Epithelioid hemangioendothelioma (EHE) is an extremely rare vascular tumor of intermediate malignancy. Generally it develops from the peripheral veins (usually the femoral vein). We report on a case of EHE of the radial artery, developed in a 26-year-old male patient, which presented as a solitary painless mass. He had a complete resection of the tumor and of the segment of radial artery involved. The histologic examination revealed an intravascular EHE, with low mitotic index and with insufficient histologic anormalities.
Collapse
Affiliation(s)
- Patrizio Castelli
- Postgraduate School in Vascular Surgery, Department of Surgery, University of Insubria, 21100, Varese, Italy
| | | | | | | |
Collapse
|
30
|
Charette S, Nehler MR, Whitehill TA, Gibbs P, Foulk D, Krupski WC. Epithelioid hemangioendothelioma of the common femoral vein: Case report and review of the literature. J Vasc Surg 2001; 33:1100-3. [PMID: 11331856 DOI: 10.1067/mva.2001.111993] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A young competitive skier had venous claudication. A stenosis of the left common femoral vein was revealed by means of an examination. Exploration and vein patch angioplasty were performed, and because of both the unusual appearance (focal thickening of vein wall) and the unclear etiology of the lesion, frozen and permanent sections of the wall were obtained. Epithelioid hemangioendothelioma, a rare intravascular sarcoma, was revealed by means of an examination of the permanent sections. Two additional procedures were required to completely excise the epithelioid hemangioendothelioma. We discuss these rare vascular malignancies and include a review of the available literature. Also, oncologic principles important in both the diagnosis and therapy of intravascular sarcomas are discussed.
Collapse
Affiliation(s)
- S Charette
- Department of Surgery, University of North Dakota Health Sciences Center, Grand Forks, USA
| | | | | | | | | | | |
Collapse
|
31
|
Arbelaez A, Castillo M, Williams L, Armao DM. Vertebral hemangioendothelial sarcoma: MR findings. J Comput Assist Tomogr 1999; 23:981-3. [PMID: 10589582 DOI: 10.1097/00004728-199911000-00031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- A Arbelaez
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill 27599-7510, USA
| | | | | | | |
Collapse
|