1
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Chou C, Hu H, Chen TW, Lin S. A case of primary pleural epithelioid hemangioendothelioma achieving stable disease with paclitaxel treatment: A case report and literature review. Respirol Case Rep 2024; 12:e01341. [PMID: 38559902 PMCID: PMC10978069 DOI: 10.1002/rcr2.1341] [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: 01/22/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
Epithelioid hemangioendothelioma (EHE) is a rare vascular neoplasm with a clinical behaviour that falls between a benign hemangioma and a high-grade angiosarcoma. Pleural EHE is exceptionally rare, and its prognosis is grim, with most patients experiencing survival of less than 1 year. Here, we present a case of pleural EHE in a 45-year-old woman with a month-long history of right-sided pleuritic chest pain. Chest computed tomography revealed consolidation, atelectasis of the right lung, right pleural thickening, and pleural effusion. She underwent video-assisted thoracoscopic surgery for decortication and was diagnosed with conclusively pleural EHE, showing a CAMTA1 rearrangement. Paclitaxel treatment, administered once weekly on days 1, 8 and 15 of a 28-day cycle, resulted in a stable disease after 12 cycles. Managing patients with pleural EHE is challenging because there are still no established standard treatments. Our case achieved 11-month progression-free survival following paclitaxel treatment.
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Affiliation(s)
- Chun‐Ying Chou
- Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Hsiang‐Wei Hu
- Department of PathologyNational Taiwan University HospitalTaipeiTaiwan
| | - Tom Wei‐Wu Chen
- Department of OncologyNational Taiwan University HospitalTaipeiTaiwan
| | - Shu‐Yung Lin
- Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
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2
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Mardani P, Shahriarirad R, Nekooeian M, Anbardar MH, Ziaian B, Kamran H, Ayare N, Vafabin M, Fouladi D. Pleural epithelioid hemangioendothelioma in a 39-Year-old female: a case report. J Cardiothorac Surg 2024; 19:118. [PMID: 38475834 DOI: 10.1186/s13019-024-02602-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 03/05/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Epithelioid hemangioendothelioma (EHE) is a rare malignancy of vascular origin which can be primarily be seen in various tissues. EHE originating from the pleura is an even more uncommon subtype which may mimic mesothelioma and pleural carcinomatosis. The prognosis of pleural EHE is poor and there is no consensus on the optimal therapeutic approach. CASE PRESENTATION A 39-year-old middle-eastern female presented with progressive dyspnea and left shoulder discomfort. Chest computed tomography scan revealed a left side pleural effusion and pleural thickening. Pleuroscopy was done and biopsies were taken which were positive for CD31, CD34, CK, factor 8-R-antigen, and vimentin. Patient was diagnosed with pleural epithelioid hemangioendothelioma (PEHE) and chemotherapy was started and underwent extrapleural pneumonectomy 7 months later. Unfortunately, the patient passed away 10 months after diagnosis due to disease complications. CONCLUSIONS Once PEHE is suspected in histology it can be confirmed with immunohistochemistry. Chemotherapy, surgery or a combination of both is currently used as the treatment but the standard treatment remains a question.
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Affiliation(s)
- Parviz Mardani
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Nekooeian
- Health and System Research center, Shiraz University of Medical Sciences, Shiraz, Iran
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Anbardar
- Department of Pathology, Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bizhan Ziaian
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hooman Kamran
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Students Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nazanin Ayare
- Students Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoud Vafabin
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Damoun Fouladi
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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3
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Rerkpichaisuth V, Hung YP. Mesenchymal tumours of the pleura: review and update. Histopathology 2024; 84:163-182. [PMID: 37691389 DOI: 10.1111/his.15035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 09/12/2023]
Abstract
Primary mesenchymal tumours of the pleura are uncommon and can be diagnostically challenging due to their overlapping histopathologic and immunophenotypic features. Herein we discuss selected mesenchymal tumours of the pleura, including solitary fibrous tumour, calcifying fibrous tumour, desmoid fibromatosis, synovial sarcoma, schwannoma, malignant peripheral nerve sheath tumour, inflammatory myofibroblastic tumour, follicular dendritic cell sarcoma, epithelioid hemangioendothelioma, and desmoplastic small round cell tumour. We review their clinicopathologic characteristics, along with an update on the relevant immunohistochemical and molecular features.
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Affiliation(s)
- Vilasinee Rerkpichaisuth
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yin P Hung
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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4
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Ota Y, Lee E, Sella E, Agarwal P. Vascular Malformations and Tumors: A Review of Classification and Imaging Features for Cardiothoracic Radiologists. Radiol Cardiothorac Imaging 2023; 5:e220328. [PMID: 37693195 PMCID: PMC10483253 DOI: 10.1148/ryct.220328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 05/02/2023] [Accepted: 05/17/2023] [Indexed: 09/12/2023]
Abstract
The International Society for the Study of Vascular Anomalies (ISSVA) classification is a comprehensive histology-based scheme that was updated in 2018. It is important for cardiothoracic imagers to understand this classification to ensure that accurate terminology is used and that archaic terms are avoided when vascular lesions are described. Knowledge of the various malformations (including common conditions, such as venous malformation, arteriovenous fistula, and arteriovenous malformation) and vascular tumors allows for timely diagnosis and appropriate management. This review describes various vascular anomalies, in accordance with ISSVA classification and terminology; highlights key imaging features associated with each; and discusses the role of different imaging modalities. Keywords: Pulmonary, Soft Tissues/Skin, Vascular, Arteriovenous Malformation © RSNA, 2023.
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Affiliation(s)
- Yoshiaki Ota
- From the Division of Cardiothoracic Radiology, Department of
Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI
48109
| | - Elizabeth Lee
- From the Division of Cardiothoracic Radiology, Department of
Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI
48109
| | - Edith Sella
- From the Division of Cardiothoracic Radiology, Department of
Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI
48109
| | - Prachi Agarwal
- From the Division of Cardiothoracic Radiology, Department of
Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI
48109
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5
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Weissferdt A, Moran CA. Primary epithelioid hemangioendotheliomas and angiosarcomas of the pleura: a clinicopathological and immunohistochemical analysis of 13 cases. Hum Pathol 2023; 138:68-75. [PMID: 37364825 DOI: 10.1016/j.humpath.2023.06.010] [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: 05/24/2023] [Revised: 06/13/2023] [Accepted: 06/21/2023] [Indexed: 06/28/2023]
Abstract
Thirteen cases of primary epithelioid hemangioendotheliomas (EHE) and epithelioid angiosarcomas (EA) of the pleura are presented. The patients were 7 men and 6 women between the ages of 34 and 65 years (mean: 47 years). The patients presented with non-specific symptoms of cough, dyspnea, and chest pain. Diagnostic imaging revealed the presence of either diffuse pleural thickening or pleural nodules involving the serosal surfaces. Open surgical biopsies were obtained in all cases. Histologically, eight tumors were characterized by the presence of a cellular proliferation composed of medium-sized epithelioid cells embedded in a myxohyaline stroma and a variable spindle cell component. Cellular atypia was mild to moderate and mitotic activity ranged from 1 to 2 per 2 mm2. Immunohistochemical stains for vascular markers, including CAMTA1 were positive, confirming a diagnosis of EHE. Five cases of epithelioid angiosarcomas were characterized by a neoplastic cellular proliferation admixed with areas of necrosis and hemorrhage and characterized by medium-sized epithelioid to spindle-shaped cells with eosinophilic cytoplasm, round to oval nuclei and prominent nucleoli. In addition, marked cytologic atypia and a mitotic activity ranging from 3 to 5 per 2 mm2 were identified. Immunohistochemical studies demonstrated positive staining for vascular markers; however, CAMTA1 was negative. Clinical follow-up obtained in eleven cases showed that all patients had died within 30 months post diagnosis. The current study highlights that even though it may be important to histologically separate EHE from EA for academic purposes, primary pleural origin of these tumors appears to portent an aggressive clinical behavior.
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Affiliation(s)
- Annikka Weissferdt
- Department of Pathology, University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Cesar A Moran
- Department of Pathology, University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA
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6
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Pathak V, Walker C. Pleural Epithelioid Hemangioendothelioma (EHE): A Case Report. Cureus 2023; 15:e41308. [PMID: 37539424 PMCID: PMC10395256 DOI: 10.7759/cureus.41308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 08/05/2023] Open
Abstract
Pleural epithelioid hemangioendothelioma (EHE) is a rare malignancy of vascular origin. It can affect various organs; pleural involvement is rare and lack of suspicion leads to delay in diagnosis. We present a case of pleural EHE with metastasis to lung parenchyma that presents with chest pain and dyspnea. Chest imaging showed loculated pleural effusion, pleural thickening, mediastinal lymphadenopathy, and pulmonary nodules.
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Affiliation(s)
- Vikas Pathak
- Pulmonary and Critical Care, Virginia Institute of Lung Diseases, Yorktown, USA
| | - Christopher Walker
- Internal Medicine, George Washington University School of Medicine and Health Sciences, Washington DC, USA
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7
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Szczyrek M, Bitkowska P, Jutrzenka M, Szudy-Szczyrek A, Drelich-Zbroja A, Milanowski J. Pleural Neoplasms-What Could MRI Change? Cancers (Basel) 2023; 15:3261. [PMID: 37370871 DOI: 10.3390/cancers15123261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/16/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
The primary pleural neoplasms constitute around 10% of the pleural tumors. The currently recommended method for their imaging is CT which has been shown to have certain limitations. Strong development of the MRI within the last two decades has provided us with a number of sequences that could potentially be superior to CT when it comes to the pleural malignancies' detection and characterization. This literature review discusses the possible applications of the MRI as a diagnostic tool in patients with pleural neoplasms. Although selected MRI techniques have been shown to have a number of advantages over CT, further research is required in order to confirm the obtained results, broaden our knowledge on the topic, and pinpoint the sequences most optimal for pleural imaging, as well as the best methods for reading and analysis of the obtained data.
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Affiliation(s)
- Michał Szczyrek
- Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Paulina Bitkowska
- Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Marta Jutrzenka
- Collegium Medicum, University of Warmia and Mazury in Olsztyn, Aleja Warszawska 30, 11-041 Olsztyn, Poland
| | - Aneta Szudy-Szczyrek
- Department of Haematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-090 Lublin, Poland
| | - Anna Drelich-Zbroja
- Department of Radiology and Neuroradiology, Medical University of Lublin, 20-954 Lublin, Poland
| | - Janusz Milanowski
- Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 20-090 Lublin, Poland
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8
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Rezvani A, Shahriarirad R, Erfani A, Ranjbar K. Primary malignant epithelioid hemangioendothelioma of the pleura: A review and report of a novel case. Clin Case Rep 2022; 10:e6211. [PMID: 35979384 PMCID: PMC9366930 DOI: 10.1002/ccr3.6211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/27/2022] [Accepted: 07/23/2022] [Indexed: 11/06/2022] Open
Abstract
Epithelioid hemangioendothelioma is considered an uncommon tumor originating from vascular tissues. Although this disease is an extremely rare malignant cancer, its pleural subtype is even less common. We discuss a 68‐year‐old man with isolated pleural epithelioid hemangioendothelioma, along with a literature review of all similar cases.
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Affiliation(s)
- Alireza Rezvani
- Bone Marrow Transplantation Center, Nemazi Hospital Shiraz University of Medical Sciences Shiraz Iran
- Thoracic and Vascular Surgery Research Center Shiraz University of Medical Science Shiraz Iran
| | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research Center Shiraz University of Medical Science Shiraz Iran
- Student Research Committee Shiraz University of Medical Sciences Shiraz Iran
| | - Amirhossein Erfani
- Thoracic and Vascular Surgery Research Center Shiraz University of Medical Science Shiraz Iran
- Student Research Committee Shiraz University of Medical Sciences Shiraz Iran
| | - Keivan Ranjbar
- Thoracic and Vascular Surgery Research Center Shiraz University of Medical Science Shiraz Iran
- Student Research Committee Shiraz University of Medical Sciences Shiraz Iran
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9
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Tossan P, Pichon E, Arbion F, Sizaret D, Simionca G, Marchand-Adam S. Hémangioendothéliome épithélioïde pleural, une tumeur rare de diagnostic difficile : à propos d’un cas et revue de la littérature. Rev Mal Respir 2022; 39:398-406. [DOI: 10.1016/j.rmr.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 02/24/2022] [Indexed: 11/26/2022]
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10
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Al-Mahrouqi T, Al-Baali D, Al-Sawafi Y. Pleural epithelioid hemangioendothelioma: Clinical course and response to treatment. SAUDI JOURNAL OF MEDICINE AND MEDICAL SCIENCES 2022; 10:175-176. [PMID: 35602398 PMCID: PMC9121698 DOI: 10.4103/sjmms.sjmms_500_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/07/2022] [Indexed: 11/27/2022] Open
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11
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Lavacchi D, Voltolini L, Comin CE, Mazzoni F, Baldi GG, Briganti V, Luvarà S, Bongiolatti S, Antonuzzo L. Primary pleural epithelioid hemangioendothelioma: case report and review of the literature. Anticancer Drugs 2021; 32:1131-1137. [PMID: 34232937 PMCID: PMC9665943 DOI: 10.1097/cad.0000000000001122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/31/2021] [Indexed: 11/26/2022]
Abstract
Epithelioid hemangioendothelioma (EHE) is an extremely rare vascular sarcoma with an unpredictable clinical behavior. Pleural EHEs have been associated with poor response to treatment and reduced survival. To date, no standard treatment for EHE is available. Here we report the case of a 53-year-old man who underwent radical surgery for a symptomatic primary pleural EHE. Clinical presentation was characterized by chronic pain in the left hemithorax with transitory flare, anemia, weight loss and progressive worsening of clinical conditions. After surgery, he resumed active life and normal daily activities and, at 8 months, 18F-FDG PET and computed tomography scan showed no radiological evidence of recurrent disease. Clinical signs of this rare disease, histological features, imaging findings and functional imaging are discussed. We also report a summary of other cases with resected pleural EHE and we briefly review the role of chemotherapeutic, immunomodulatory and antiangiogenic drugs for advanced disease.
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Affiliation(s)
| | | | - Camilla Eva Comin
- Department of Experimental and Clinical Medicine, University of Florence, Florence
| | | | - Giacomo Giulio Baldi
- Department of Medical Oncology, Hospital of Prato, Azienda USL Toscana Centro, Prato
| | | | - Silvia Luvarà
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | | | - Lorenzo Antonuzzo
- Clinical Oncology Unit
- Department of Experimental and Clinical Medicine, University of Florence, Florence
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12
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Askari E, Yaghmaei S, Haseli S, Pouradollah Totkaboni M. Primary Pleural Hemangioendothelioma: A Case Report and Literature Review. Case Rep Oncol 2021; 14:1201-1211. [PMID: 34703437 PMCID: PMC8460936 DOI: 10.1159/000518243] [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: 05/28/2021] [Accepted: 06/26/2021] [Indexed: 12/02/2022] Open
Abstract
Epithelioid hemangioendothelioma (EHE) is a rare tumor of the vascular endothelial cells. It can originate from any tissue; however, it occurs most frequently in the liver and lung. Pleural epithelioid hemangioendothelioma (PEH), EHE developing from pleura, is even more infrequent and less reported in the literature. In the following report, we discuss a 40-year-old man who initially presented with right-sided chest pain. Computed tomography revealed pleural thickening and effusion in his right thoracic cavity. PEH diagnosis was confirmed with immunohistochemistry. In order to provide the readers with an inclusive understanding of the disease, we collected the PEH cases reported in the literature. Despite the scarcity of the reported PEH cases (to our best knowledge), the compiled literature review of the disease enables the readers to grasp a better comprehension of the disease.
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Affiliation(s)
- Elham Askari
- Department of Pathology, Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shekoofeh Yaghmaei
- Department of General Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Haseli
- Department of Radiology, Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mihan Pouradollah Totkaboni
- Department of Pathology, Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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13
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Tumor and tumorlike conditions of the pleura and juxtapleural region: review of imaging findings. Insights Imaging 2021; 12:97. [PMID: 34236561 PMCID: PMC8266978 DOI: 10.1186/s13244-021-01038-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/11/2021] [Indexed: 01/09/2023] Open
Abstract
Pleural lesions form a diagnostic challenge for the radiologist. Whereas lesions can be initially detected on chest radiographs, CT and MRI imaging are the imaging modalities of choice for further characterization. In a number of cases, imaging findings can be relatively specific. In general unfortunately, imaging findings are rather aspecific. Evolution and extrathoracic imaging findings are important clues toward the diagnosis.
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14
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Abstract
Staging of malignant pleural mesothelioma has been challenging because of a paucity of cases and poor survival. At least 5 staging systems were proposed before 1990 until the first consensus system was published in 1995. This system used tumor, node, metastasis designations and borrowed heavily from parenchymal lung cancer descriptors. With the establishment of a database to collect cases from 1995 to 2013, evidence-based revisions to the 1995 staging classification were published in 2016. With improving imaging technology, clinical staging will become more refined and, it is hoped, more useful for prognostication even without operative resection.
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Affiliation(s)
- Caleb J Euhus
- Department of Surgery, Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - R Taylor Ripley
- Department of Surgery, Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
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15
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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.
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16
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Fjaellegaard K, Petersen JK, Stamp IM, Hoegholm A, Clementsen PF, Bodtger U. Pleural epithelioid hemangioendothelioma mimicking pleural empyema: A case report. Respir Med Case Rep 2020; 31:101194. [PMID: 32837903 PMCID: PMC7434324 DOI: 10.1016/j.rmcr.2020.101194] [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: 07/07/2020] [Accepted: 08/11/2020] [Indexed: 11/06/2022] Open
Abstract
Malignant pleural effusion is an important and difficult differential diagnosis to pleural empyema. Epithelioid hemangioendothelioma is an uncommon vascular tumor, which typically occurs in liver, lung or bone. We present an extremely rare case of primary pleural epithelioid hemangioendothelioma mimicking pleural empyema. We conclude, that pleural epithelioid hemangioendothelioma should be kept in mind as a differential diagnosis in patients suspected of empyema.
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Affiliation(s)
- Katrine Fjaellegaard
- Department of Respiratory Medicine, Zealand University Hospital Naestved, Naestved, Denmark
- Department of Internal Medicine, Zealand University Hospital Roskilde, Roskilde, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Jesper Koefod Petersen
- Department of Respiratory Medicine, Zealand University Hospital Naestved, Naestved, Denmark
- Department of Internal Medicine, Zealand University Hospital Roskilde, Roskilde, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Inger Merete Stamp
- Department of Pathology, Zealand University Hospital Naestved, Naestved, Denmark
| | - Asbjorn Hoegholm
- Department of Respiratory Medicine, Zealand University Hospital Naestved, Naestved, Denmark
| | - Paul Frost Clementsen
- Department of Internal Medicine, Zealand University Hospital Roskilde, Roskilde, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Uffe Bodtger
- Department of Respiratory Medicine, Zealand University Hospital Naestved, Naestved, Denmark
- Department of Internal Medicine, Zealand University Hospital Roskilde, Roskilde, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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17
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Abstract
CONTEXT - Pleural pathology has been dominated by discussions relating to the diagnosis, prognosis, etiology, and management of malignant mesothelioma. However, there exists a diverse group of other neoplasms that involve the pleura; the most common by far is metastatic carcinoma, usually of pulmonary origin. Other metastatic tumors of varied histogenesis do occur but are less common. Primary pleural neoplasms other than diffuse malignant mesothelioma are either uncommon or rare and have received less attention. OBJECTIVE - To provide a review of those diverse tumors that can involve the pleura other than mesothelioma in order to facilitate their accurate diagnosis. DATA SOURCES - Review of relevant literature published via PubMed and other search engines. CONCLUSIONS - A wide variety of tumors can involve the pleura. In most cases, the approach of considering the morphologic features with appropriate immunohistochemistry, in the correct clinical context, allows for a confident diagnosis. For a number of those soft tissue tumors that are well recognized in the pleura, such as solitary fibrous tumor, desmoid-type fibromatosis, synovial sarcoma, and epithelioid hemangioendothelioma, novel markers now exist based on an understanding of the individual tumors' molecular characteristics. Primary pleural lymphomas are rare with poor prognosis. They represent localized specific diffuse large B-cell lymphomas, with either post-germinal center B-cell or plasma cell lineage, arising in the context of either immunodeficiency or immune sequestration and with viral infection.
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Affiliation(s)
| | - Matthew Richard Pugh
- From the Department of Cellular Pathology, Cardiff and Vale University Local Health Board, School of Medicine, Cardiff University, Cardiff, Wales
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18
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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.
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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.
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19
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Difficulty of treatment for pleural epithelioid hemangioendothelioma: a report of a case. Gen Thorac Cardiovasc Surg 2019; 68:190-193. [DOI: 10.1007/s11748-019-01135-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 04/25/2019] [Indexed: 01/07/2023]
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20
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Fan Y, Wang F, Li S, Ye C, Ying Y, Mao H. Pleural Epithelioid Hemangioendothelioma: A Case Report and Literature Review. J Natl Med Assoc 2018; 108:124-9. [PMID: 27372473 DOI: 10.1016/j.jnma.2016.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 05/05/2016] [Accepted: 05/05/2016] [Indexed: 02/05/2023]
Abstract
Epithelioid hemangioendothelioma (EHE) is a rare neoplasm of vascular origin that can arise in multiple and varied tissue sites. Pleural epithelioid hemangioendothelioma (PEH), a subtype of EHE, is particularly less reported. Herein, we describe a case of PEH presented with left-sided back pain in a 68-year-old female, and her chest CT scan revealed thickening of the left pleura and left pleural effusion, the histological diagnosis was confirmed by both conventional examination and immunohistochemistry. A literature search utilizing PubMed, Embase, Ovid and Cochrane, Wanfang and Chinese National Knowledge infrastructure (CNKI) for PEH was conducted to investigate the characteristics of the disease, 26 related articles were retrieved and 40 cases of PEH were reported. According to available literature, the average age at presentation is 51.8 years and the disease occurred more often in men than women. The etiology of the disease remained unknown. Chest pain, cough, and dyspnea were the common symptoms. Computed tomography usually revealed pleural effusion and pleural thickening. Histological examinations revealed mainly epithelioid cells. Immunohistochemical stains were positive for vascular endothelial markers. PEH tends to have more aggressive behavior than tumors in other locations, thus effective treatment has not yet been established until now. Further studies are needed to analyze the prognostic factors, clinical features and treatment of PEH.
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Affiliation(s)
- Yingqi Fan
- Department of Respiratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Faping Wang
- Department of Respiratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Suyun Li
- Department of Respiratory Medicine, First Affiliated Hospital of Henan College of Traditional Chinese Medicine, Zhengzhou 450000, China
| | - Cheng Ye
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Ying Ying
- Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Hui Mao
- Department of Respiratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China.
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21
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New Insights about Pulmonary Epithelioid Hemangioendothelioma: Review of the Literature and Two Case Reports. Case Rep Radiol 2017; 2017:5972940. [PMID: 28884037 PMCID: PMC5573100 DOI: 10.1155/2017/5972940] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/04/2017] [Indexed: 12/14/2022] Open
Abstract
Pulmonary epithelioid hemangioendothelioma (PEH) is a rare neoplasm of vascular origin. There are three different major imaging patterns identified in thoracic manifestation of epithelioid hemangioendothelioma: (1) multiple pulmonary nodules; (2) multiple pulmonary reticulonodular opacities; and (3) diffuse infiltrative pleural thickening. Radiographically, presence of bilateral multiple nodules is the most common pattern of presentation. The diagnosis is made on the basis of histopathological findings and confirmed by positive immunohistochemistry staining. Although the prognostic factors for PEH have not yet been well established, a better prognosis is usually associated with the multinodular pattern. We report two different imagological presentations of this rare disease, based on two institutional experiences, along with a review of the relevant literature.
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22
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Apolinário D, Silva J, Loureiro AI, Noya R, Carvalho L. Beyond a pleural effusion: Primary pleuropulmonary sarcomas and the challenge of diagnosis. REVISTA PORTUGUESA DE PNEUMOLOGIA 2016; 22:298-9. [PMID: 27156074 DOI: 10.1016/j.rppnen.2016.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/17/2016] [Indexed: 11/15/2022] Open
Affiliation(s)
- D Apolinário
- Pulmonology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal.
| | - J Silva
- Pulmonology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - A I Loureiro
- Pulmonology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - R Noya
- Pulmonology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - L Carvalho
- Pathological Anatomy Department, Faculdade de Medicina da Universidade de Coimbra/Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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23
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Woo JH, Kim TJ, Lee KS, Kim TS, Kim BT. Epithelioid hemangioendothelioma in the thorax: Clinicopathologic, CT, PET, and prognostic features. Medicine (Baltimore) 2016; 95:e4348. [PMID: 27472721 PMCID: PMC5265858 DOI: 10.1097/md.0000000000004348] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Little is known about prognostic factors in epithelioid hemangioendothelioma (EHE). We aimed to identify prognostic factors among various clinicopathologic and imaging features of thoracic EHEs.Forty-two patients (male:female = 20:22; median age, 49 years) of EHEs with (n = 19) and without (n = 23) thoracic involvement were included. We reviewed electronic medical records for clinical information and computed tomography (CT) features for thoracic involvement. Differences in demographics and survival outcomes of patients with and without thoracic involvement were assessed. We also estimated overall survival.The most common pattern of thoracic involvement was multiple pulmonary nodules (n = 10), followed by parenchymal tumor with pleural invasion (n = 4), reticulonodular opacities (n = 3), and diffuse pleural thickening (n = 2). No significant difference in survival was found between the thoracic EHE group and nonthoracic EHE group (P = 0.68). Among 4 different thoracic involvement types, the lung multinodular pattern tended to demonstrate longer median survival (8.5 months) than other patterns, whereas the shortest median survival (1 month) was observed for the nodule/mass with pleural involvement pattern (P = 0.038).CT manifestations of thoracic EHEs are classified into 4 patterns, of which lung multinodular pattern is associated with longer survival. Survival is not different between patients with and without thoracic involvement.
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Affiliation(s)
- Jung Han Woo
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Tae Jung Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Kyung Soo Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine
- Correspondence: Kyung Soo Lee, Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), 50, Ilwon-Dong, Kangnam-Gu, Seoul 135-710, Korea (e-mail: )
| | - Tae Sung Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Byung-Tae Kim
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abstract
Computed tomography is the first-line modality for evaluation of chest diseases primarily because of its spatial resolution. Magnetic resonance (MR) imaging is used as a problem-solving tool to answer key questions that are vital to optimal patient management. MR has the potential to provide qualitative, quantitative, anatomic, and functional information without the use of ionizing radiation or nephrotoxic contrast administration. With new advances in proton MR techniques, MR imaging can overcome some of the inherent problems associated with imaging the lung. This article describes novel MR applications for evaluation of the pleura and pleural diseases.
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25
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Ferreiro L, San-José E, Suárez-Antelo J, Abdulkader I, Martínez-de-Alegría A, González-Barcala FJ, Valdés L. Spontaneous bilateral haemothorax as presentation of primary pleural epithelioid haemangioendothelioma. CLINICAL RESPIRATORY JOURNAL 2015; 11:1079-1085. [PMID: 26620871 DOI: 10.1111/crj.12421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 10/05/2015] [Accepted: 11/13/2015] [Indexed: 12/26/2022]
Abstract
Pleural epithelioid haemangioendothelioma (EHE) is a rare tumour that originates in the vascular endothelium with an intermediate degree of malignancy between haemangioma and angiosarcoma. Smoking and asbestos exposure are unproven risk factors and diagnosis is usually confirmed by thoracoscopy, since pleural fluid (PF) cytology is often not conclusive. Immunohistochemistry can also help to confirm the diagnosis. We report an 85-year-old patient with bilateral pleural EHE diagnosed by thoracoscopy, who debuted with a spontaneous bilateral haemothorax, the second described so far, and we conducted a thorough review of the literature to describe the clinical, radiological and prognostic features, as well as the PF, of this rare tumour.
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Affiliation(s)
- Lucía Ferreiro
- Department of Pulmonology, University of Santiago Hospital Complex, Santiago de Compostela, Spain
| | - Esther San-José
- Department of Clinical Analysis, University of Santiago Hospital Complex, Santiago de Compostela, Spain.,Interdisciplinary Pulmonology Research Group, Health Research Institute of Santiago (IDIS), University of Santiago Hospital Complex, Santiago de Compostela, Spain
| | - Juan Suárez-Antelo
- Department of Pulmonology, University of Santiago Hospital Complex, Santiago de Compostela, Spain
| | - Ihab Abdulkader
- Department of Pathology, University of Santiago Hospital Complex, Santiago de Compostela, Spain
| | | | - Francisco-Javier González-Barcala
- Department of Pulmonology, University of Santiago Hospital Complex, Santiago de Compostela, Spain.,Interdisciplinary Pulmonology Research Group, Health Research Institute of Santiago (IDIS), University of Santiago Hospital Complex, Santiago de Compostela, Spain
| | - Luis Valdés
- Department of Pulmonology, University of Santiago Hospital Complex, Santiago de Compostela, Spain.,Interdisciplinary Pulmonology Research Group, Health Research Institute of Santiago (IDIS), University of Santiago Hospital Complex, Santiago de Compostela, Spain
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26
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Sayah M, VandenBussche C, Maleki Z. Epithelioid hemangioendothelioma in pleural effusion. Diagn Cytopathol 2015; 43:751-5. [PMID: 26183575 DOI: 10.1002/dc.23315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 04/29/2015] [Accepted: 06/22/2015] [Indexed: 11/10/2022]
Abstract
Epithelioid hemangioendothelioma (EHE) is a rare mesenchymal tumor of vascular origin with variable morphological features and unpredictable biological behavior. EHE occasionally involves the pleural fluid. However, the cytomorphology of EHE found in pleural fluid has not been well characterized in the literature. Herein we describe a case of EHE, initially presenting as multiple liver lesions plus several small nodular densities at the bases of the lungs followed by bilateral pleural effusions.
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Affiliation(s)
- Maryam Sayah
- University of Texas Southwestern Medical Center, Dallas, Texas
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27
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Salijevska J, Watson R, Clifford A, Ritchie AI, Mauri F, Adeboyeku D. Pleural epithelioid hemangioendothelioma: literature summary and novel case report. J Clin Med Res 2015; 7:566-70. [PMID: 26015825 PMCID: PMC4432902 DOI: 10.14740/jocmr2174w] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2015] [Indexed: 12/16/2022] Open
Abstract
Epithelioid hemangioendothelioma (EHE) is a rare malignant cancer of vascular origin that can affect multiple and varied tissue sites. A subtype of EHE, pulmonary epithelioid hemangioendothelioma (PHE), is more unusual with only 200 reported cases. Of these, only 27 have been classified as pleural in origin. Based on available literature, the average age of presentation of pleural PHE is 45.7 years with a male preponderance of 2.375. A summary of all published case reports reveals significant heterogeneity both in presentation and management. Here we add to this knowledge-base with a report of an unusual case of pleural PHE in a 36-year-old female who presented with a 6-week history of chest pain and breathlessness. Significant challenges in the diagnosis and management of patients with pleural PHE exist, including a wide initial differential diagnosis and difficulties in obtaining tissue specimens, coupled with relatively limited treatment options. Early referral to a cardiothoracic center for video-assisted thoracoscopic biopsy is crucial in facilitating a diagnosis and allowing adequate pleural drainage for symptomatic relief.
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Affiliation(s)
- Julita Salijevska
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
- Corresponding Author: Julita Salijevska, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
| | - Robert Watson
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Amy Clifford
- The North West London Hospitals NHS Trust, Northwick Park Hospital, Watford Road, Harrow, Middlesex, HA1 3UJ, UK
| | - Andrew I. Ritchie
- The North West London Hospitals NHS Trust, Northwick Park Hospital, Watford Road, Harrow, Middlesex, HA1 3UJ, UK
| | - Francisco Mauri
- Imperial College Healthcare NHS Trust, The Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - David Adeboyeku
- The North West London Hospitals NHS Trust, Northwick Park Hospital, Watford Road, Harrow, Middlesex, HA1 3UJ, UK
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28
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Wethasinghe J, Sood J, Walmsley R, Milne D, Jafer A, Gordon-Glassford N. Primary pleural epithelioid hemangioendothelioma mimicking as a posterior mediastinal tumor. Respirol Case Rep 2015; 3:75-7. [PMID: 26090117 PMCID: PMC4469146 DOI: 10.1002/rcr2.106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/27/2015] [Accepted: 03/30/2015] [Indexed: 11/12/2022] Open
Abstract
A 41-year-old man with no previous asbestos exposure presented with 6 months of dull right lower chest pain and weight loss. The initial computed tomography (CT) scan was reported as showing a soft tissue thickening in the posterior mediastinum with non-specific nodules in the horizontal and oblique fissures. An endoscopic ultrasound-guided fine needle aspiration from the 12 × 25 mm heterogeneous posterior mediastinal mass was suspicious for a ganglioneuroma. The procedure was complicated by a large hemothorax requiring drainage. A subsequent positron emission tomographic CT revealed a moderately fluorodeoxyglucose avid area of pleural thickening extending from the sixth to ninth thoracic vertebral body in the paraspinal region along with nodules along the right horizontal and oblique fissures. A thoracoscopic biopsy of the pleural lesion confirmed a pleural epithelioid hemangioendothelioma. There was a 5-mm reduction in tumor thickness and improvement in his pain following 54 Gy of radiotherapy.
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Affiliation(s)
- James Wethasinghe
- Department of Respiratory Medicine, Waitemata District Health Board Auckland, New Zealand
| | - Jaideep Sood
- Department of Respiratory Medicine, Waitemata District Health Board Auckland, New Zealand
| | - Russell Walmsley
- Department of Gastroenterology, Waitemata District Health Board Auckland, New Zealand
| | - David Milne
- Department of Radiology, Auckland District Health Board Auckland, New Zealand
| | - Ali Jafer
- Department of Gastroenterology, Waitemata District Health Board Auckland, New Zealand
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29
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Nickell LT, Lichtenberger JP, Khorashadi L, Abbott GF, Carter BW. Multimodality Imaging for Characterization, Classification, and Staging of Malignant Pleural Mesothelioma. Radiographics 2014; 34:1692-706. [DOI: 10.1148/rg.346130089] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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30
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The computed tomographic findings of pulmonary epithelioid hemangioendothelioma. Radiol Med 2014; 119:705-13. [PMID: 24715271 DOI: 10.1007/s11547-013-0376-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 07/30/2013] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of this study is to analyse the computed tomographic (CT) findings of pulmonary epithelioid haemangioendothelioma (EHE). MATERIALS AND METHODS The CT features and clinical presentations of six patients (five women, one man; mean age, 53 years) with pathology-proven pulmonary EHE were reviewed. Noncontrast CT images were available for three patients and enhanced CT images for three patients. The image characteristics included the number of tumours, tumour location and size, tumour margins, the presence of calcification/necrosis/cavity, the presence of perivascular location, the presence of pleural lesions, tumour homogeneity at contrast-enhanced CT, tumour enhancement relative to the adjacent muscle and the presence of extrapulmonary lesions. RESULTS Multiple nodules/masses with irregular margin were shown in all cases, and reticulonodular opacities and ground-glass opacities were found in one case. Overall, the six cases showed 178 nodules/masses, 90 % (160/178) of which were <1 cm in diameter. The average size of the largest nodules/masses in each case was 2.7 cm. The nodules/masses were mostly (93 %, 166/178) located in the subpleural region (<2 cm from the pleura). A total of 48 % (86/178) of nodules/masses showed punctate calcification in four of six cases. All nodules/masses showed perivascular location. Pleural indentation was shown in all cases, as well as pleural-thickening in five cases and pleural effusion in two cases. On contrast-enhanced CT, EHE showed a mildly heterogeneous hyperdense appearance. CONCLUSIONS With predilection for subpleural and perivascular location, typical pulmonary EHE appears as multiple irregular nodules with punctate calcification and pleural indentation.
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31
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Pleural epithelioid hemangioendothelioma harboring CAMTA1 rearrangement. Lung Cancer 2014; 83:411-5. [PMID: 24461304 DOI: 10.1016/j.lungcan.2013.12.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 12/30/2013] [Indexed: 12/25/2022]
Abstract
Pleural epithelioid hemangioendothelioma (EHE) is a very rare disease with adverse clinical outcomes. Recently, CAMTA1 rearrangement has been introduced as a consistent genetic abnormality in EHEs of different anatomical locations. We report a 71-year-old man with pleural EHE harboring CAMTA1 rearrangement confirmed by fluorescence in situ hybridization on paraffin embedded tissue.
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32
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Sekiya M, Yoshimi K, Muraki K, Suzuki K, Dambara T, Uekusa T, Takahashi K. Solitary fibrous tumor of the pleura: ultrasonographic imaging findings of 3 cases. Respir Investig 2013; 51:200-204. [PMID: 23978647 DOI: 10.1016/j.resinv.2013.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 03/28/2013] [Accepted: 04/01/2013] [Indexed: 06/02/2023]
Abstract
Solitary fibrous tumor (SFT) of the pleura is a rare tumor of mesenchymal origin. Although radiographic findings of thoracic computed tomography and magnetic resonance imaging in the evaluation of SFTs of the pleura have been documented, the value of ultrasonography is uncertain. We presented the ultrasonographic findings of 3 pathologically proven cases of SFTs arising from the visceral pleura. In all the cases, thoracic ultrasonography demonstrated homogeneous, hypoechoic, hemicycle, extrapulmonary lesions, which showed respiratory movement with the adjacent lung, consistent with pedunculated tumors. Preoperative thoracic ultrasonography could be useful in the evaluation of patients with pleural tumors, especially SFTs.
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Affiliation(s)
- Mitsuaki Sekiya
- Department of Respiratory Medicine, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan.
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Yu L, Gu T, Xiu Z, Shi E, Zhao X. Primary Pleural Epithelioid Hemangioendothelioma Compressing the Myocardium. J Card Surg 2013; 28:266-8. [PMID: 23551388 DOI: 10.1111/jocs.12094] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Lei Yu
- Department of Cardiac Surgery; The First Affiliated Hospital of China Medical University; Shenyang P.R. China
| | - Tianxiang Gu
- Department of Cardiac Surgery; The First Affiliated Hospital of China Medical University; Shenyang P.R. China
| | - Zongyi Xiu
- Department of Cardiac Surgery; The First Affiliated Hospital of China Medical University; Shenyang P.R. China
| | - Enyi Shi
- Department of Cardiac Surgery; The First Affiliated Hospital of China Medical University; Shenyang P.R. China
| | - Xiaoqi Zhao
- Department of Cardiac Surgery; The First Affiliated Hospital of China Medical University; Shenyang P.R. China
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34
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Bansal A, Chawla M, Cohen PJ, Kwon JS. Pleural epithelioid hemangioendothelioma. Lung 2012; 190:469-70. [PMID: 22392541 DOI: 10.1007/s00408-012-9377-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 01/19/2012] [Indexed: 02/07/2023]
Affiliation(s)
- Aditya Bansal
- Division of Pulmonary, Critical Care and Sleep Medicine, Bridgeport Hospital, 267 Grant St, Bridgeport, CT 06610, USA.
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35
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Epithelioid hemangioendotheliomas of the lung and pleura: Report of three cases. FORMOSAN JOURNAL OF SURGERY 2011. [DOI: 10.1016/j.fjs.2011.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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36
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Márquez-Medina D, Samamé-Pérezvargas JC, Tuset-DerAbrain N, Montero-Fernández A, Taberner-Bonastre T, Porcel JM. Pleural epithelioid hemangioendothelioma in an elderly patient. A case report and review of the literature. Lung Cancer 2011; 73:116-9. [PMID: 21592613 DOI: 10.1016/j.lungcan.2011.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 03/23/2011] [Accepted: 04/04/2011] [Indexed: 12/28/2022]
Abstract
Pleural epithelioid hemangioendothelioma is a really rare tumor of vascular origin and potentially aggressive behavior. We report the case of an 85 years old male patient diagnosed of pleural epithelioid hemangioendothelioma, taking advantage to review exhaustively literature and therapy for the disease.
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Affiliation(s)
- Diego Márquez-Medina
- Medical Oncology Department, Arnau de Vilanova University Hospital of Lleida, Spain.
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Kim EY, Kim TS, Han J, Choi JY, Kwon OJ, Kim J. Thoracic epithelioid hemangioendothelioma: imaging and pathologic features. Acta Radiol 2011; 52:161-6. [PMID: 21498344 DOI: 10.1258/ar.2010.100292] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The purpose of this article is to review the imaging features of thoracic epithelioid hemangioendotheliomas with pathologic correlation. The thoracic manifestation of epithelioid hemangioendotheliomas is one of three different CT patterns: multiple pulmonary nodules, multiple pulmonary reticulonodular opacities, or diffuse infiltrative pleural thickening. Without any evidence of histological malignancy, malignant features (multiplicity of pulmonary nodules, hepatic or bone involvement, lymphangitic tumor spread, and infiltrative pleural masses) are characteristic of these infrequent tumors.
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Affiliation(s)
- Eun Young Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
- Department of Radiology, Gachon University Gil Hospital, Incheon
| | - Tae Sung Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | | | | | - O Jung Kwon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Jhingook Kim
- Department of Thoracic Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
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Liu JX, Shiau MC, Nonaka D. An 80-year-old man with shortness of breath and large right-sided pleural effusion. Chest 2011; 138:1247-52. [PMID: 21051402 DOI: 10.1378/chest.09-2439] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- James X Liu
- Department of Medicine, New York University School of Medicine, 334 E 26 St, New York, NY 10016, USA.
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André ST, Valente C, Paiva B, Pêgo A, Carvalho L, Luís AS. [Epithelioid hemangioendothelioma of the pleura - A rare presentation of a clinical case]. REVISTA PORTUGUESA DE PNEUMOLOGIA 2010; 16:477-82. [PMID: 20635062 DOI: 10.1016/s0873-2159(15)30044-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Epithelioid Hemangioendothelioma (EHE) is a vascular tumour with rare pleural presentation. As there are a small number of cases described in the literature the authors present the case of a 65 -year -old woman, who was admitted to the Emergency Department for a right -sided chest pain, which progressed over 7 months, after a thoracic trauma. The chest X -ray showed signs of a moderate right -sided pleural effusion. A pleural -pulmonary biopsy carried out by toracotomy established the histological diagnosis of EHE of the pleura. Due to the locally advanced stage of the tumour, chemotherapy with carboplatin and etoposide was prescribed and the patient died 6 months later. This case confirms that pleural EHE has an aggressive behaviour, similar to an angiossarcoma, with a median survival of only a few months after diagnosis.
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Affiliation(s)
- Sónia Traqueia André
- Faculdade de Medicina, Universidade de Coimbra, Departamento de Ciências Pneumológicas e Alergológicas dos Hospitais da Universidade de Coimbra, Coimbra.
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Lazarus A, Fuhrer G, Malekiani C, McKay S, Thurber J. Primary pleural epithelioid hemangioendothelioma (EHE)--two cases and review of the literature. CLINICAL RESPIRATORY JOURNAL 2010; 5:e1-5. [PMID: 21159132 DOI: 10.1111/j.1752-699x.2010.00221.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION We present two cases with symptoms of progressively worsening cough, dyspnea, decreased exercise tolerance and right-sided back pain in the first case and upper respiratory symptoms characterized by cough and a low grade fever in the second case. METHODS Report of two cases. RESULTS The initial chest X-ray in both the cases showed pleural effusion. Further imaging with computed tomography of the chest confirmed the effusion in both cases. Thoracentesis was done in both of them revealed an exudative effusion that did not reveal any infection or malignancy. Both cases underwent surgical biopsy and the diagnosis of primary pleural epithelioid hemangioendothelioma was made. CONCLUSIONS Both the cases had progressive clinical deterioration despite chemotherapy with Taxol and Bevacizumab in one case and carboplatin, etoposide, and bevacizumab, in the second case. Both developed metastatic disease to lungs and died.
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Affiliation(s)
- Angeline Lazarus
- Uniformed Services University, National Naval Medical Center, Bethesda, MD, USA.
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Azcárate Perea L, Oliveros Acebes E, Moreno Mata N, Salomón Pérez R, Vilalta Castel E, González Aragoneses F. [Pulmonary epithelioid hemangioendothelioma]. Arch Bronconeumol 2009; 45:466-8. [PMID: 19403224 DOI: 10.1016/j.arbres.2009.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Accepted: 01/13/2009] [Indexed: 11/24/2022]
Abstract
Epithelioid hemangioendothelioma is a multifocal tumor that rarely metastasizes. It is difficult to diagnose and is most often an incidental finding in young asymptomatic women. It has a heterogeneous radiologic pattern. The most important diagnostic information is histologic confirmation of Weibel-Palade bodies or immunohistochemistry based on specific tumor markers such as factor VIII and CD34. We report the case of a 73-year-old woman in whom multiple pulmonary nodules detected by chance in a radiograph were subsequently diagnosed as epithelioid hemangioendothelioma.
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Affiliation(s)
- Leire Azcárate Perea
- Servicio de Cirugía Torácica, Hospital General Universitario Gregorio Marañon, Madrid, España.
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Chen TT, Lai CT, Wu CL, Wang TY, Shih BF, Hung CL, Kuo LK, Weng YL, Lee SY. Cardiac tamponade caused by epithelioid haemangioendothelioma. BMJ Case Rep 2009; 2009:bcr09.2008.0955. [PMID: 21686542 DOI: 10.1136/bcr.09.2008.0955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Epithelioid haemangioendothelioma (EHE) is a tumour of vascular endothelial origin. The rarity of EHE has limited the complete understanding of the disease. Here, a unique case of EHE complicated with cardiac tamponade with an unusual initial presentation, scoliosis, is reported. The discordant findings between a Tc99m bone scan and 2-fluoro-2-deoxy-d-glucose positron emission tomography (FDP PET) also serve to impart another lesson about investigating bone metastasis in EHE.
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Affiliation(s)
- Tzu-Tao Chen
- Mackay Memorial Hospital, Division of Pulmonary and Critical Care Medicine, 92 Sec 2, Chung-Shan North Rd, Taipei, 104, Taiwan
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Abstract
Epithelioid hemangioendothelioma (EHE) is a rare tumor of vascular origin. While it can be found in any tissue, it is most often found in lung and liver and usually has an intermediate behavior. EHEs originating from pleural tissue have been less frequently described than those from other sites. Furthermore, to date, all of the cited pleural EHEs were described as highly aggressive. In the present report, we describe a rare case of pleural EHE extending to lung and bone in a 31-year-old woman. The histological diagnosis was confirmed by both conventional examination and immunohistochemistry. Her disease stabilized during the 4th course of adriamycin (45 mg/m(2), day 1-3), dacarbazine (300 mg/m(2), day 1-3) and ifosfamide (2,500 mg/m(2), day 1-3) with mesna, and she survived for 10 months after the diagnosis.
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Affiliation(s)
- Young Joo Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Moon Jae Chung
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Cheon Jeong
- Department of Internal Medicine, National Health Insurance Cooperation Ilsan Hospital, Goyang, Korea
| | - Chang Hoon Hahn
- Department of Internal Medicine, National Health Insurance Cooperation Ilsan Hospital, Goyang, Korea
| | - Ki Pyo Hong
- Department of Chest Surgery, National Health Insurance Cooperation Ilsan Hospital, Goyang, Korea
| | - Yee-Jeong Kim
- Department of Pathology, National Health Insurance Cooperation Ilsan Hospital, Goyang, Korea
| | - Yong Tai Kim
- Department of Internal Medicine, National Health Insurance Cooperation Ilsan Hospital, Goyang, Korea
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Bahrami A, Allen TC, Cagle PT. Pulmonary epithelioid hemangioendothelioma mimicking mesothelioma. Pathol Int 2008; 58:730-4. [DOI: 10.1111/j.1440-1827.2008.02301.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Guinee DG, Allen TC. Primary pleural neoplasia: entities other than diffuse malignant mesothelioma. Arch Pathol Lab Med 2008; 132:1149-70. [PMID: 18605768 DOI: 10.5858/2008-132-1149-ppneot] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2007] [Indexed: 11/06/2022]
Abstract
CONTEXT Overwhelmingly, the most common neoplasm involving the pleura is metastatic carcinoma. In contrast, diffuse malignant mesothelioma occurs relatively rarely; however, it is nonetheless the most common neoplasm primary to the pleura. Metastatic carcinoma and diffuse malignant mesothelioma each have their own prognostic and therapeutic characteristics. Other primary pleural neoplasms occur uncommonly or rarely, with their own prognostic and therapeutic characteristics. OBJECTIVE To review primary pleural neoplasms other than diffuse malignant mesothelioma, to better ensure correct diagnosis and optimal assessment of prognosis and treatment. DATA SOURCES Literature review and primary material from the authors' institutions. CONCLUSIONS A nonexhaustive group of uncommon to rare benign and malignant primary pleural neoplasms--other than diffuse malignant mesothelioma--are presented, of which one must be aware in order to maintain an appropriate index of suspicion to include them in the differential diagnosis of a pleural tumor.
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Affiliation(s)
- Donald G Guinee
- Department of Pathology, Virginia Mason Medical Center, Seattle, WA, USA
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Celikel C, Yumuk PF, Basaran G, Yildizeli B, Kodalli N, Ahiskali R. Epithelioid hemangioendothelioma with multiple organ involvement. APMIS 2007; 115:881-8. [PMID: 17614859 DOI: 10.1111/j.1600-0463.2007.apm_727.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Epithelioid hemangioendothelioma is a rare vascular neoplasm of uncertain malignant potential. Various reports document metastatic or concurrent epithelioid hemangioendothelioma in several sites, most commonly with combined lung and liver involvement. The concurrent involvement of multiple sites at presentation may cause diagnostic problems because epithelioid hemangioendothelioma can mimic other neoplastic processes. Although it is a chemo-resistant disease, chemotherapy is usually advised for patients with metastatic or concurrent involvement. Here we document the presentation, treatment, and outcome of two cases with concurrent involvement of the lung and liver.
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Affiliation(s)
- Cigdem Celikel
- Department of Pathology, Marmara University School of Medicine, Istanbul, Turkey
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Saqi A, Nisbet L, Gagneja P, Leslie KO. Primary pleural epithelioid hemangioendothelioma with rhabdoid phenotype: report and review of the literature. Diagn Cytopathol 2007; 35:203-8. [PMID: 17351942 DOI: 10.1002/dc.20620] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Epithelioid hemangioendothelioma (EHE) is a rare malignant vascular tumor described in diverse locations including lung and liver. Relative to these sites, primary EHE of the serous cavities is uncommon. EHE in the serous cavities mimics mesothelioma and adenocarcinoma clinically, radiographically, cytologically, and histologically. EHEs have plasmacytoid epithelioid cells with cytoplasmic vacuoles. In addition to these features, we noted eccentric nuclei with abundant eosinophilic cytoplasm and nuclei displaced peripherally by globular cytoplasmic inclusions imparting a "rhabdoid" phenotype. These cells were often seen surrounding a hyaline core. Rhabdoid features are not unique to a single entity, and a comprehensive immunohistochemical panel is essential. We report the occurrence of pleural EHE with rhabdoid features presenting in a pleural effusion, and review the literature of primary serosal EHEs.
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Affiliation(s)
- Anjali Saqi
- Department of Pathology, New York Presbyterian Hospital, Weill Cornell Medical Center, 520 East 70th Street, New York, NY 10021, USA.
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49
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Einsfelder B, Kuhnen C. [Epithelioid hemangioendothelioma of the lung (IVBAT)--clinicopathological and immunohistochemical analysis of 11 cases]. DER PATHOLOGE 2006; 27:106-15. [PMID: 16421704 DOI: 10.1007/s00292-006-0817-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Epithelioid hemangioendothelioma (EHE) of the lungs (syn.: intravascular bronchioloalveolar tumor/IVBAT) is a neoplasm with a vascular line of differentiation. This study provides a clinicopathological analysis of 11 cases of this tumor. There were 7 female and 4 male patients. Patients' age ranged from 33 to 83 years (mean: 49.8, median: 48 years) showing 2 peaks (third/fourth and sixth/eighth decades). The typical radiological appearance revealed multiple bilateral lung nodules from 0.5 to 2 cm. In 2 cases, a striking perivascular and intravascular growth pattern associated to pulmonary veins was evident. All tumors were characterized by epithelioid tumor cells with nests, cords and strands embedded in a sclerosing, hyaline matrix with alveolar, bronchiolar and vascular extension. Necrosis was identified in 8 tumors and ossification in 2 tumors. The mitotic index was below one mitosis in 10 HPF. By immunohistochemistry, all tumors were positive for CD 31, CD 34, and vimentin, 60% positive for factor VIII, and negative for pancytokeratin and calretinin. Follow-up was available for 8 patients with a range of 6 to 105 months (mean: 51.5 months, median: 52 months): 3 patients died (2 certainly from their tumors), 4 are alive disease-free, and one is alive with metastases. EHE of the lungs (IVBAT) represents an intermediate-grade, malignant, mesenchymal neoplasm with a characteristic histological appearance and immunohistochemical profile.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/analysis
- Biopsy
- Cell Transformation, Neoplastic/pathology
- Endothelium, Vascular/pathology
- Female
- Hemangioendothelioma, Epithelioid/diagnosis
- Hemangioendothelioma, Epithelioid/mortality
- Hemangioendothelioma, Epithelioid/pathology
- Humans
- Lung/pathology
- Lung Neoplasms/diagnosis
- Lung Neoplasms/mortality
- Lung Neoplasms/pathology
- Male
- Middle Aged
- Mitotic Index
- Necrosis
- Neoplasm Invasiveness
- Neoplasms, Multiple Primary/diagnosis
- Neoplasms, Multiple Primary/mortality
- Neoplasms, Multiple Primary/pathology
- Ossification, Heterotopic/diagnosis
- Ossification, Heterotopic/pathology
- Prognosis
- Pulmonary Veins/pathology
- Survival Analysis
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Affiliation(s)
- B Einsfelder
- Institut für Pathologie der Ruhr-Universität Bochum, Berufsgenossenschaftliche Kliniken Bergmannsheil
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50
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Posligua L, Anatelli F, Dehner LP, Pfeifer JD. Primary peritoneal epithelioid hemangioendothelioma. Int J Surg Pathol 2006; 14:257-67. [PMID: 16959716 DOI: 10.1177/1066896906290682] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Epithelioid hemangioendothelioma is an uncommon malignant vascular tumor of intermediate grade that occurs in a variety of organs and soft tissues. Diagnosis of epithelioid hemangioendothelioma is often complicated by the rarity of the tumor, and because the tumor shares many morphologic features with other peritoneal neoplasms. This report presents 3 cases of epithelioid hemangioendotheliomas arising as primary tumors of the peritoneum and reviews 7 previously reported cases to establish the demographic, clinical, morphologic, immunohistochemical, and ultrastructural features of this neoplasm. These cases demonstrate that the light microscopic features are very similar to epithelioid hemangioendothelioma arising at more conventional sites, such as the liver, that immunohistochemical analysis provides a reliable approach for confirming or establishing the diagnosis, and that at least one endothelial marker (either CD31, CD34, or factor VIII) should be positive for a definitive diagnosis. This series identifies the characteristics of peritoneal epithelioid hemangioendothelioma that can be reliably used for diagnosis.
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Affiliation(s)
- Lorena Posligua
- Lauren V. Ackerman Laboratory of Surgical Pathology, Barnes-Jewish Hospital, Washington University Medical Center, St. Louis, Missouri, USA
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