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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.
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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
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Plumby MC, Bacaj P, Lindsey BA. Unicentric epithelioid hemangioendothelioma of the calcaneus: a case report and review of literature. Clin Sarcoma Res 2018; 8:5. [PMID: 29632658 PMCID: PMC5887220 DOI: 10.1186/s13569-018-0092-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background This review of the literature combined with a clinical case will allow the illustration of a favorable outcome of this variable low grade malignancy, display a role for limb salvage surgery with intralesional treatment, and offer a clinical example of epithelioid hemangioendothelioma, a rare malignancy. Case presentation The case report presents a case of solitary epithelioid hemangioendothelioma (EHE) of the calcaneus in a 60-year-old male. Primary vascular tumors of the bone are rare; however, EHE is one of the most common primary malignant vascular tumors to occur in bone. A review of the literature found few cases that involved the calcaneus; those cases found that involved the calcaneus were either part of a multifocal or metastatic disease process. Our case presents a 45-month clinical follow-up of solitary EHE in the calcaneus treated with surgical excision by curettage and cementing. Conclusion This case has clinical follow-up greater than 2 years post-operatively and could be a guide for treatment of a rare disorder with a substantial paucity of literature.
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Affiliation(s)
- Mark C Plumby
- 1Department of Orthopaedics, West Virginia University, PO Box 9196, Morgantown, WV 26506-9196 USA
| | - Patrick Bacaj
- 2Department of Pathology, West Virginia University, PO Box 9203, Morgantown, WV 26506-9203 USA
| | - Brock A Lindsey
- 1Department of Orthopaedics, West Virginia University, PO Box 9196, Morgantown, WV 26506-9196 USA
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Roy M, Yadav R, Kumar T. Multifocal Osseous Epithelioid Hemangioendothelioma Involving
Extremities and Spine with Visceral Metastasis. Indian J Med Paediatr Oncol 2018. [DOI: 10.4103/ijmpo.ijmpo_31_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractEpithelioid hemangioendothelioma (EH) is a rare locally aggressive intermediate grade malignant vasoformative tumor. Bone is a rarer primary site accounting for less than 1% of all malignant bone tumors. Multicentricity and/or multifocality are a relatively frequent occurrence, most commonly clustered in the bones of lower extremities. The axial skeleton is less commonly affected, and concomitant visceral involvement is rarer. We report a unique case of a 20-year-old male who presented with multiple lytic lesions in the skull vault, vertebral bones, bilateral proximal femur, and both radii and humerii with metastasis to the lungs and liver. A final diagnosis of EH was established on biopsy from the right iliac bone. He initially received multiagent chemotherapy and is currently on antiangiogenic therapy. On follow-up positron emission tomography–computerized tomography done 6 months later, marked reduction in fluoro-D-glucose avidity of the hepatic and most skeletal lesions was noted.
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Affiliation(s)
- Maitrayee Roy
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajni Yadav
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Tarun Kumar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Bisbinas I, Karabouta Z, Lampridis V, Georgiannos D, Badekas A. Multifocal Epithelioid Hemangioendothelioma of the Foot and Ankle Developing a Postoperative Infection-Long-term Outcome: A Case Report. J Foot Ankle Surg 2017; 56:638-642. [PMID: 28139401 DOI: 10.1053/j.jfas.2016.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Indexed: 02/03/2023]
Abstract
A case of rare epithelioid hemangioendothelioma with multiple foot and ankle lytic lesions in a 41-year-old male is reported. The patient presented to our hospital after having received treatment elsewhere and developing a local postoperative infection. After thorough investigations and establishing the diagnosis, we initially treated the local infection and highlighted the potential risk of malignancy. Finally, respecting the patient's wishes, he was treated with consideration mostly of the pending foot and ankle fractures rather than the risk of malignancy. At 9.5 years postoperatively, the patient was clinically well and asymptomatic, without clinical, laboratory, or radiologic signs of malignancy, and the previous infection might have even played a remote role in that outcome. A review of the published data regarding the treatment of this unpredictable neoplasm is also presented.
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Affiliation(s)
- Ilias Bisbinas
- Colonel and Consultant, A' Department of Orthopaedics and Trauma Surgery, 424 Military General Hospital, Thessaloniki, Greece.
| | - Zacharoula Karabouta
- Consultant, Department of Paediatrics, AHEPA General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios Lampridis
- Captain and Consultant, A' Department of Orthopaedics and Trauma Surgery, 424 Military General Hospital, Thessaloniki, Greece
| | - Dimitrios Georgiannos
- Lieutenant Colonel and Consultant, A' Department of Orthopaedics and Trauma Surgery, 424 Military General Hospital, Thessaloniki, Greece
| | - Athanasios Badekas
- Consultant, Department of Orthopaedics and Trauma, Metropolitan Hospital, Athens, Greece
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Multifocal epithelioid hemangioendothelioma of the lower limbs detected by 18F-FDG PET/MRI. Clin Nucl Med 2015; 39:e402-4. [PMID: 24445271 DOI: 10.1097/rlu.0000000000000339] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 38-year-old man underwent surgical excision of a 1.5-cm subcutaneous nodule of the left leg. Histologic evaluation demonstrated the presence of an epithelioid hemangioendothelioma (EHE). The patient underwent 18F-FDG PET/MRI for staging. This examination demonstrated the presence of several soft tissue and bone lesions in the left lower limb without evidence of distant metastatic disease. The final diagnosis was multifocal EHE of the left lower limb. In this case, 18F-FDG PET/MRI has been very useful in the correct staging of this rare presentation of EHE of the lower limbs.
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Avadhani V, Loftus PA, Meltzer D, Wang B, Tabaee A. Epithelioid Hemangioendothelioma of the Maxillary Sinus. Head Neck Pathol 2015; 10:229-32. [PMID: 25963905 PMCID: PMC4838968 DOI: 10.1007/s12105-015-0633-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 05/02/2015] [Indexed: 01/12/2023]
Abstract
The clinical course and pathologic features of a 72 year old female who presented with epistaxis are presented. Radiographic findings were notable for a large, soft tissue lesion filling the maxillary sinus with significant bony erosion and expansion. The patient was ultimately diagnosed with epithelioid hemangioendothelioma (EHE) and underwent endoscopic resection. She has no evidence of local, regional or distant recurrence 14 months post-surgery. The rarity of this neoplasm, the unusual anatomic location and non-specific symptoms present diagnostic and management challenges. Epithelioid vascular tumors encompass a spectrum of benign and malignant tumors. EHE itself is thought to have an intermediate malignant behavior pattern, though cases with indolent behavior have been reported. Differentiation of EHE from other lesions has historically based on histopathology. Additionally, recent studies have described a recurrent genetic fusion WWTR1-CAMTA1 in EHE, involving t(1;3) (p36;q25). This represents the second reported case of EHE arising in a paranasal sinus. The histopathologic findings of this lesion are reviewed.
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Affiliation(s)
- Vaidehi Avadhani
- Department of Pathology and Laboratory Medicine, Mount Sinai Beth Israel, New York, NY, USA
| | - Patricia Anne Loftus
- Department of Otorhinolaryngology - Head and Neck Surgery, Albert Einstein College of Medicine, New York, NY, USA
| | - Daniel Meltzer
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Beverly Wang
- Department of Pathology and Laboratory Medicine, Mount Sinai Beth Israel, New York, NY, USA
| | - Abtin Tabaee
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, 10 Union Square East, New York, NY, 10003, USA.
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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.
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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
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Sardaro A, Bardoscia L, Petruzzelli MF, Portaluri M. Epithelioid hemangioendothelioma: an overview and update on a rare vascular tumor. Oncol Rev 2014; 8:259. [PMID: 25992243 PMCID: PMC4419652 DOI: 10.4081/oncol.2014.259] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 09/18/2014] [Accepted: 09/30/2014] [Indexed: 12/12/2022] Open
Abstract
Epithelioid hemangioendothelioma is a rare vascular tumor, described for the first time in 1975 by Dail and Liebow as an aggressive bronchoalveolar cell carcinoma. The etiology is still a dilemma. Studies about suggestive hypothesis are ongoing. Most of the times it affects lung, liver and bones, although this kind of tumor may involve the head and neck area, breast, lymph nodes, mediastinum, brain and meninges, the spine, skin, abdomen and many other sites. Because of its heterogeneous presentation, as it represents less than 1% of all the vascular tumors, it is often misdiagnosed and not suitably treated, leading to a poor prognosis in some cases. Over 50-76% of the patients are asymptomatic. A small number of them complains respiratory symptoms. Bone metastases might cause pathological fractures or spine compression, if they arise in vertebrae. Imaging is necessary to determine morphological data, the involvement of surrounding tissues, and potentially the cleavage plan. It is important to recognize the expression of vascular markers (Fli-1 and CD31 are endothelial-specific markers), and the microscopic evidence of vascular differentiation to make a correct diagnosis, as many pulmonary diseases show multiple nodular lesions. Because of its rarity, there is no standard for treatment. We focused on radiotherapy as a good therapeutic option: despite the poor prognosis, evidence is in favor of radiotherapy which offers local pain control with good tolerance and better quality of life at least at a one-year follow-up in most of cases. Further studies are needed to establish the standard radiation dose to be used for locoregional control of such a complex and extremely rare disease.
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Affiliation(s)
- Angela Sardaro
- Department of Interdisciplinary Medicine, Section of Diagnostic Imaging and Radiotherapy, University Aldo Moro, Bari
| | - Lilia Bardoscia
- Department of Interdisciplinary Medicine, Section of Diagnostic Imaging and Radiotherapy, University Aldo Moro, Bari
| | - Maria Fonte Petruzzelli
- Department of Interdisciplinary Medicine, Section of Diagnostic Imaging and Radiotherapy, University Aldo Moro, Bari
| | - Maurizio Portaluri
- Department of Radiotherapy, A. Perrino Hospital, Brindisi
- Clinical Physiology Institute, National Research Council (IFC-CNR), Pisa-Lecce, Italy
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Sardaro A, Bardoscia L, Petruzzelli MF, Nikolaou A, Detti B, Angelelli G. Pulmonary epithelioid hemangioendothelioma presenting with vertebral metastases: a case report. J Med Case Rep 2014; 8:201. [PMID: 24942542 PMCID: PMC4070622 DOI: 10.1186/1752-1947-8-201] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 04/07/2014] [Indexed: 01/02/2023] Open
Abstract
Introduction Epithelioid hemangioendothelioma is a rare vascular tumor that has an epithelioid and histiocytoid appearance, originates from vascular endothelial or pre-endothelial cells and comprises less than 1% of all vascular tumors. It was described for the first time in 1975 as pulmonary epithelioid hemangioendothelioma, because initially it was believed to be an aggressive form of bronchoalveolar cell carcinoma with a remarkable propensity to invade adjacent blood vessels and small airways. Only a few cases have been reported in the literature to date. Tumor cells expressing Fli-1 and CD31 have been identified as relatively specific endothelial markers. Epithelioid hemangioendothelioma may affect multiple organs and may vary considerably in its clinical and radiological presentation. More than 50% to 76% of pulmonary epithelioid hemangioendothelioma patients are asymptomatic. They are usually incidentally diagnosed on the basis of abnormal chest radiography during routine physical examinations. Hematologic and gastrointestinal disorders and weakness or numbness may also be observed, in addition to respiratory symptoms, in cases of disseminated pulmonary epithelioid hemangioendothelioma. Pain and swelling, pathological fractures, spine compression or paresthesia, loss of muscular strength and paraplegia may be present when bone metastases occur. Because of the rarity of this disease, there is no standard for treatment. Case presentation A 46-year-old Caucasian woman presented to our institution in November 2009 with metastases of pulmonary epithelioid hemangioendothelioma from the L3 and L4 vertebrae. A course of radiotherapy at a dosage of 3,000cGy delivered in individual doses of 200cGy/day for 5 days/wk to the L3 and L4 vertebrae led to the disappearance of the patient’s lumbar pain without any detectable side effects. Percussion of the patient’s vertebral spine was negative, and no radiological progression of bone disease was found at her 1-year follow-up examination. Conclusion Since epithelioid hemangioendothelioma was first correctly defined, several research groups have reported their experiences with epithelioid hemangioendothelioma irradiation. Further studies are needed to establish a standard radiation dose to be used for such a complex and extremely rare disease. In our present case, a radiotherapy dosage of 3,000cGy delivered in individual doses 200cGy/day for 5 days/wk allowed us to reach our goals: local pain control with good tolerance and better quality of life by the 1-year follow-up examination.
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Affiliation(s)
- Angela Sardaro
- Azienda Ospedaliero-Universitaria Policlinico di Bari, Dipartimento Interdisciplinare di Medicina, Sezione di Diagnostica per Immagini e Radioterapia, Università degli Studi di Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italia.
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Bisbinas I, Karabouta Z, Georgiannos D, Lampridis V, Badekas A. Multifocal epithelioid hemangioendothelioma of the foot and ankle: a case report. J Orthop Surg (Hong Kong) 2014; 22:122-5. [PMID: 24781630 DOI: 10.1177/230949901402200130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report on a 41-year-old man with multiple epithelioid hemangioendothelioma of the left foot and ankle. The patient was treated with curettage and fixation with 2 separate plates, but later developed local infection. Owing to the potential for malignancy, below-knee amputation was suggested, but the patient declined and was treated symptomatically with close monitoring. The patient underwent removal of the plates, excision of the distal fourth of the fibula, intralesional curettage of all lesions, and fusion of the ankle and subtalar joints with a retrograde intramedullary nail. After 5.5 years, the patient had recovered well and had no evidence of malignancy. The tumour was considered definitively benign.
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Affiliation(s)
- Ilias Bisbinas
- A' Department in Orthopaedics and Trauma Surgery, 424 Military General Hospital, Thessaloniki, Greece
| | - Zacharoula Karabouta
- Department of Paediatrics, AHEPA General Hospital, Aristotle University of Thessaloniki, Greece
| | - Dimitrios Georgiannos
- A' Department in Orthopaedics and Trauma Surgery, 424 Military General Hospital, Thessaloniki, Greece
| | - Vasileios Lampridis
- A' Department in Orthopaedics and Trauma Surgery, 424 Military General Hospital, Thessaloniki, Greece
| | - Athanasios Badekas
- Orthopaedic and Trauma Department, Metropolitan Hospital, Athens, Greece
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Li H, Shah D, Shah A, Qiu X, Cao D. Ileal malignant hemangioendothelioma as a hypervascular lesion on computed tomography scan. Int J Surg Case Rep 2013; 5:19-21. [PMID: 24394857 PMCID: PMC3907202 DOI: 10.1016/j.ijscr.2013.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 09/09/2013] [Accepted: 09/09/2013] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Malignant epithelioid hemangioendothelioma (EHE) is an uncommon and grave vascular tumor. EHE is frequently angiocentric and is associated with a medium sized vessel, especially a vein. No definite etiological associations have been ascribed to this tumor so far, except an association with oral contraceptives in EHE of liver. PRESENTATION OF CASE A 47 year old man presented with the complaint of intermittent black stool over the past two weeks. Occasionally, he experienced pain in left lower abdomen. On Computed Tomography (CT), it showed hypervascular lesion in the ileum with persistent enhancement. An exploratory laparotomy was performed with short segmental resection and functional end-to-end anastomosis. It was diagnosed finally with the histopathological and immunohistochemical analysis as a malignant EHE. DISCUSSION EHE is an uncommon endothelial tumor that most frequently arises in soft tissue, liver, lung and skeleton. It behaves biologically in between benign epithelioid hemangioma and the more aggressive epithelioid angiosarcoma. Although a standard systemic treatment for malignant EHE has not been fully established, complete surgical excision is strongly recommended if feasible. CONCLUSION EHE has a variable presentation and CT is helpful in identifying ileal EHE timely in the early stage, even when there is no obvious mass formation, however the diagnosis can be confirmed only after histopathological and immunohistochemical studies.
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Affiliation(s)
- Hang Li
- Department of Radiology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, PR China.
| | - Deepa Shah
- Department of Internal Medicine, China-Japan Union Hospital of Jilin University, Changchun 130021, Jilin Province, PR China.
| | - Abhishek Shah
- Department of Radiology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, PR China.
| | - Xiang Qiu
- Department of Radiology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, PR China.
| | - Dianbo Cao
- Department of Radiology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, PR China.
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Primary Epithelioid Hemangioendothelioma of the Kidney: The First Case Report in a Child and Literature Review. Urology 2013; 82:925-7. [DOI: 10.1016/j.urology.2013.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 03/26/2013] [Accepted: 04/01/2013] [Indexed: 11/21/2022]
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