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Parisi X, Peric M, Bennett AE, Al-Ibraheemi A, Sun Y. Primary Adrenal Epithelioid Angiosarcoma: A Case Report. Int J Surg Pathol 2024; 32:515-522. [PMID: 37461274 DOI: 10.1177/10668969231188907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Primary adrenal angiosarcomas are exceedingly rare with a rapidly progressive clinical course and a poor outcome. Establishing the diagnosis can be challenging, and it is complicated by the fact that there are no characteristic clinical or imaging features that are pathognomonic for angiosarcoma. Histologically, they can overlap with other more commonly encountered adrenal tumors. Herein, we present an otherwise healthy 41-year-old woman diagnosed with a primary adrenal epithelioid angiosarcoma. We aim to expand the knowledge of the sparse literature existing on primary adrenal angiosarcomas to help better understand the diagnostic features, clinical behavior, and management of these rare tumors.
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Affiliation(s)
- Xenia Parisi
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Masa Peric
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Andrew E Bennett
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Yue Sun
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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2
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Li B, Zhang C, Zhao L, Chen N, Hu Y, Li Z, Kang S, Blake A, Xiao S. Diverse clinical presentations of pseudomyogenic hemangioendothelioma associated with EGFL7::FOSB fusion: a second case. Histopathology 2024; 84:708-712. [PMID: 38012540 DOI: 10.1111/his.15108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/08/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Bin Li
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Changliang Zhang
- Molecular Genetics Laboratory, Suzhou Sano Precision Medicine Ltd, Suzhou, China
| | - Lina Zhao
- Molecular Genetics Laboratory, Suzhou Sano Precision Medicine Ltd, Suzhou, China
| | - Nan Chen
- Molecular Genetics Laboratory, Suzhou Sano Precision Medicine Ltd, Suzhou, China
| | - Yongbin Hu
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhiyuan Li
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Suya Kang
- Department of Pathology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Angella Blake
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sheng Xiao
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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3
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Warmke LM, Collier CD, Davis JL. NR1D1::MAML1 epithelioid and spindle cell sarcoma mimicking pseudomyogenic hemangioendothelioma in core biopsy: A case report and review of the literature. Genes Chromosomes Cancer 2023; 62:655-662. [PMID: 37326138 DOI: 10.1002/gcc.23186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023] Open
Abstract
Epithelioid and spindle cell sarcomas with NR1D1::MAML1/2 gene fusions are rare and emerging entities. Only six cases of NR1D1-rearranged mesenchymal tumors have previously been reported in the literature; they are often characterized by an epithelioid morphology, at least focal pseudogland formation, prominent cytoplasmic vacuoles, and focal to diffuse immunohistochemical expression of keratin. We herein report the first case of an NR1D1::MAML1 epithelioid and spindle cell sarcoma with dual immunohistochemical expression of ERG and FOSB, mimicking a pseudomyogenic hemangioendothelioma (PHE) on core biopsy. The sarcoma arose in the left forearm of a 64-year-old man. Initial biopsy showed a mesenchymal neoplasm composed of epithelioid and spindle cells dispersed in myxoid stroma with scattered stromal neutrophils. The morphologic features, combined with the dual immunohistochemical expression of ERG and FOSB, initially mimicked PHE, representing an important potential diagnostic pitfall. The patient subsequently underwent a radical resection, which showed a much more diffuse epithelioid appearance with nested architecture and pseudogland formation. Next-generation sequencing was performed on the resection specimen, which revealed an NR1D1::MAML1 gene fusion, confirming the final diagnosis. Given the fully malignant potential of this tumor, knowledge and recognition of this rare entity are essential to ensure proper management, prevent misdiagnosis, and further characterize the clinical course of this emerging entity. Comprehensive molecular testing can help to identify these rare tumors and exclude the possibility of epithelioid mimics, including PHE.
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Affiliation(s)
- Laura M Warmke
- Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Christopher D Collier
- Department of Orthopedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jessica L Davis
- Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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4
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Jang YC, Hung WC, Su TC, Wu WP. Primary pulmonary epithelioid hemangioendothelioma. BMJ Case Rep 2023; 16:e254915. [PMID: 37709495 PMCID: PMC10503352 DOI: 10.1136/bcr-2023-254915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
Pulmonary epithelioid hemangioendothelioma (PEH) is a rare tumour of vascular origin with low to intermediate malignancy. Typical radiological finding on CT is multiple small nodules in bilateral lungs, and some will have punctate calcifications and pleural thickening. The diagnosis of PEH is confirmed by histopathological findings and positive immunohistochemistry staining. We report a case of a woman in her 50s with a medical history of lung adenocarcinoma. Later, regular chest CT during a routine cancer follow-up revealed multiple small pulmonary nodules and increased sizes of these nodules on serial images, initially misdiagnosed as multiple lung metastases. The histopathological diagnosis was made on a pulmonary wedge resection. Finally, PEH was diagnosed on the basis of positive immunohistochemical staining for CD31, ERF and TFE3. In the current study, the clinicopathological features and review of the literature were investigated. Our case highlights the importance of a histological diagnosis to avoid misdiagnosis.
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Affiliation(s)
- Yong Ching Jang
- Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan
| | - Wei-Chien Hung
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
| | - Tzu-Cheng Su
- Department of Pathology, Changhua Christian Hospital, Changhua, Taiwan
| | - Wen-Pei Wu
- Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
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5
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Chen X, Wang Y, Che G, Shen C. An extremely rare case of pulmonary epithelioid hemangioendothelioma. Thorac Cancer 2023; 14:2519-2522. [PMID: 37488675 PMCID: PMC10447165 DOI: 10.1111/1759-7714.15051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/26/2023] Open
Abstract
Epithelioid emangioendothelioma (EHE) is a rare tumor originating from vascular endothelial cells, which belongs to malignant vascular tumors with low to moderate differentiation and potential metastatic ability and its incidence rate is less than one in a million. We herein report a rare case of EHE of pulmonary origin and a review of the literature concerning the clinical and pathological features of this disease. The patient underwent left upper lobectomy to completely extirpate the lesion by video-assisted thoracic surgery. Our findings suggest the difficulty of making a diagnosis before surgery and that more cases need to be reported in order to facilitate the preoperative diagnosis of such a rare tumor.
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Affiliation(s)
- Xi Chen
- Department of Integrated Care Management CenterWest‐China Hospital, Sichuan University/West China School of Nursing, Sichuan UniversityChengduChina
| | - Yun Wang
- Department of Thoracic SurgeryWest‐China Hospital, Sichuan UniversityChengduChina
| | - Guowei Che
- Department of Thoracic SurgeryWest‐China Hospital, Sichuan UniversityChengduChina
| | - Cheng Shen
- Department of Thoracic SurgeryWest‐China Hospital, Sichuan UniversityChengduChina
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McKean H, Chandra S. A Case Presentation of Metastatic Hepatic Epithelioid Hemangioendothelioma: A Rare Vascular Tumor. S D Med 2023; 76:357-360. [PMID: 37734079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Epithelioid hemangioendothelioma (EHE) is an uncommon vascular tumor that can present in various organs, including the liver. Hepatic EHE (HEHE) may showcase with metastases at initial presentation, as patients have vague symptoms such as right upper quadrant pain leading to the risk of delayed diagnosis. There is no standard treatment. Fortunately, prognosis is good. This remains true for some patients with metastatic disease who are not being actively treated. In this report, we present a unique case of metastatic HEHE in a 65-year-old Caucasian male who has not received treatment and continues to remain in stable condition after his initial diagnosis three years ago.
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Affiliation(s)
- Heidi McKean
- Prairie Center, Avera McKennan Hospital and University Health Center, Sioux Falls, South Dakota
- Avera Medical Group Oncology and Hematology Sioux Falls, South Dakota
- University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Sanyogita Chandra
- University of South Dakota Sanford School of Medicine, Vermillion, South Dakota
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7
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Wong DD, Amanuel R, Chua YJ, Hendry S, Robbins P, Cheah CY, Amanuel B. Myeloid sarcoma: a poorly recognised but important differential diagnosis of epithelioid angiosarcoma. Pathology 2023; 55:734-738. [PMID: 36931918 DOI: 10.1016/j.pathol.2022.12.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/08/2022] [Indexed: 02/23/2023]
Affiliation(s)
- Daniel D Wong
- Anatomical Pathology, PathWest, QEII Medical Centre, Nedlands, WA, Australia; School of Medicine, University of Western Australia, Crawley, WA, Australia.
| | - Rodas Amanuel
- School of Medicine, University of Western Australia, Crawley, WA, Australia; Faculty of Health Science and Medicine, Bond University, Robina, Qld, Australia
| | - Yee Jia Chua
- Anatomical Pathology, Western Diagnostic Pathology, Jandakot, WA, Australia
| | - Shona Hendry
- Anatomical Pathology, PathWest, QEII Medical Centre, Nedlands, WA, Australia
| | - Peter Robbins
- Anatomical Pathology, PathWest, QEII Medical Centre, Nedlands, WA, Australia
| | - Chan Y Cheah
- School of Medicine, University of Western Australia, Crawley, WA, Australia; Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Benhur Amanuel
- Anatomical Pathology, PathWest, QEII Medical Centre, Nedlands, WA, Australia; School of Medicine, University of Western Australia, Crawley, WA, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
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8
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Bu Y, Peng L, Liu M, He L, Wang F, Li B, Niu X, Zhang H. Epithelioid hemangioendothelioma of the retroperitoneal giant type treated with Toripalimab: A case report. Front Immunol 2023; 14:1116944. [PMID: 37006308 PMCID: PMC10063782 DOI: 10.3389/fimmu.2023.1116944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/27/2023] [Indexed: 03/19/2023] Open
Abstract
Epithelioid hemangioendotheliomas (EHEs), low-grade malignant tumors of vascular endothelial cell origin, are characterized by vascular endothelial proliferation. In 2002, the World Health Organization classified EHEs as locally aggressive tumors with the potential to metastasize. Currently, the diagnosis of EHE is based on pathology, histological and immunohistochemical examinations. There are no standard treatment guidelines. We here report a 69-year-old man who presented with left-sided chest and abdominal pain for more than 2 months. Enhanced computed tomography of the thorax and abdomen in another hospital suggested a mass in the left adrenal region that was considered malignant. Positron emission tomography- computed tomography in our hospital suggested a large multi-loculated, hypermetabolic, cystic mass in the left adrenal region that was considered malignant. Accordingly, a puncture biopsy of the mass was performed and the diagnosis of EHE confirmed by pathological examination, including immunohistochemical staining. This patient was treated with the programmed death 1 (PD-1) immune checkpoint inhibitor toripalimab with long-term success. The best response was stable disease (SD) with a progression-free survival (PFS) of more than 13 months. The patient is still alive now. Because the sample size of previous studies was small, further studies are needed to determine the safety and efficacy of toripalimab in the treatment of EHE.
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Affiliation(s)
- Yuqing Bu
- Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Lili Peng
- Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Miaomiao Liu
- Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Liya He
- Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Fayan Wang
- Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei, China
- Department of Medicine, Hebei North University, Zhangjiakou, Hebei, China
| | - Bingjie Li
- Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Xueliang Niu
- Department of Medical Affairs, Shanghai Junshi Biosciences Co., Ltd., Shanghai, China
| | - Hongzhen Zhang
- Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei, China
- Department of Medicine, Hebei North University, Zhangjiakou, Hebei, China
- *Correspondence: Hongzhen Zhang,
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9
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Guo W, Zhou D, Huang H, Chen H, Wu X, Yang X, Ye H, Hong C. Successful chemotherapy with continuous immunotherapy for primary pulmonary endovascular epithelioid hemangioendothelioma: A case report. Medicine (Baltimore) 2023; 102:e32914. [PMID: 36800635 PMCID: PMC9936006 DOI: 10.1097/md.0000000000032914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
RATIONALE Epithelioid hemangioendothelioma (EHE) is a rare, low to moderate-grade malignancy, even less in pulmonary endovascular neoplasm. Patients with pulmonary EHE have no optimal treatment, resulting in poor prognoses. PATIENT CONCERNS We reported a 42-year-old man with multiple mild metabolic uptakes in pulmonary endovascular filling defect with a maximum standardized uptake value of 4.5 by 18-fluorodeoxyglucose/fibroblast associated protein inhibitor-positron emission tomography/ computed tomography. Anticoagulant treatment was not effective with the diagnosis of acute pulmonary embolism. DIAGNOSES A primary endovascular EHE pulmonary endovascular epithelioid hemangioendothelioma was diagnosed by endovascular biopsy with positive stains for molecular CD31, CD34 and CAMTA1, and it had low proliferative capacity characterized by Ki-67 of 5%. The mutation gene MSH2 (p.Y656 in exon 12) (mutation abundance of 0.07%) from peripheral blood indicates the potential benefit of an immune checkpoint inhibitor, pembrolizumab. INTERVENTIONS AND OUTCOMES The patient was treated with tri-weekly paclitaxel (175mg/m2) and carboplatin (AUC 5) chemotherapy regimen. He exerted a remarkable response after 5 cycles (21 days per cycle) and Pembrolizumab (200mg once monthly) as maintenance treatment. LESSONS This case highlights the diagnostic challenge of differentiating endovascular lesions and optimal therapy for pulmonary EHE. Importantly, it indicated that the mutation gene MSH2 (p.Y656) might influence the pathogenesis of EHE.
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Affiliation(s)
- Wenliang Guo
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Daibing Zhou
- Department of Respiratory and Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Houquan Huang
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Haiming Chen
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaofeng Wu
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xin Yang
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Huiling Ye
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Cheng Hong
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- * Correspondence: Cheng Hong, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University. No. 28, Qiaozhong Middle Road, Liwan District, Guangzhou 510010, P.R. China (e-mail: )
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Tabish N, Monaco SE. Epithelioid Vascular Lesions: The Differential Diagnosis and Approach in Cytology and Small Biopsies. Adv Anat Pathol 2022; 29:389-400. [PMID: 35993506 DOI: 10.1097/pap.0000000000000358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Vascular neoplasms are rare tumors with a multitude of clinical presentations and behavior, which make accurate identification and subclassification challenging on limited small biopsies. Within the spectrum of these lesions, the ones with epithelioid morphology, such as epithelioid hemangioendothelioma and epithelioid angiosarcoma, are particularly challenging given the morphologic overlap with nonvascular lesions and the limited cells due to hemodilution on sampling. Herein, we review the differential diagnosis of epithelioid vascular neoplasms, with a focus on the cytomorphology, differential diagnoses, and ancillary studies that pathologists should be aware of when evaluating small biopsies and aspirates, including novel translocations, and associated monoclonal immunohistochemistry antibodies, that can help in the diagnosis of some of these tumors. Awareness of these morphologic and ancillary study findings in these rare tumors will hopefully allow pathologists to recognize and render-specific diagnoses on limited samples of these challenging lesions.
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Affiliation(s)
- Nabil Tabish
- Department of Laboratory Medicine, Geisinger Medical Center, Danville, PA
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Murguía-Pérez M, Enríquez-Brena SZ, Mendoza-Ramírez S, Fosado-Ramos R, García-Mendoza YI, Ramírez-Balderrama L, Verazaluce-Rodríguez BE, Hernández-González MA, Murillo-Ortiz BO. [Aggressive multifocal extensive cutaneous epithelioid haemagioendothelioma. A case report]. Rev Esp Patol 2022; 55:254-258. [PMID: 36154733 DOI: 10.1016/j.patol.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/27/2021] [Accepted: 03/21/2021] [Indexed: 06/16/2023]
Abstract
Epithelioid haemangioendothelioma is a rare vascular tumor, first described in 1975 by Dail and Liebow as a bronchioloalveolar carcinoma. Although it usually behaves like a low-grade neoplasm, cases have been reported in which the tumor shows a high grade of malignancy, spreading rapidly throughout the body. We present the case of a 41-year-old man with dermatosis in the left thigh with rapid extension to the abdomen; the initial differential diagnoses were metastatic carcinoma versus lymphoma. When the histopathology was re-examined, a diagnosis of skin epithelioid hemangioendothelioma was confirmed and treatment with radiotherapy was initiated. This tumour rarely affects the skin; there are only a few previously reported cases.
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Affiliation(s)
- Mario Murguía-Pérez
- Servicio de Anatomía Patológica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; División de Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México.
| | - Sandra Zynzya Enríquez-Brena
- Servicio de Anatomía Patológica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; División de Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México
| | - Saulo Mendoza-Ramírez
- División de Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; Departamento de Anatomía Patológica, Hospital General de México «Dr. Eduardo Liceaga», Ciudad de México, México
| | - Rafael Fosado-Ramos
- Servicio de Anatomía Patológica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; División de Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México
| | - Yunuén Ibiza García-Mendoza
- Servicio de Anatomía Patológica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; División de Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México
| | - Lázaro Ramírez-Balderrama
- Servicio de Anatomía Patológica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; División de Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México
| | - Blanca Elena Verazaluce-Rodríguez
- División de Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; Servicio de Dermatología, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México
| | - Martha Alicia Hernández-González
- Servicio de Anatomía Patológica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; División de Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México
| | - Blanca Olivia Murillo-Ortiz
- Servicio de Anatomía Patológica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; División de Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México; Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Especialidades N̊ 1, Centro Médico Nacional Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México
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Ripa V, Smith F, Goodman JW. Case of metastatic epithelioid haemangioendothelioma from an unknown primary site associated with membranous nephropathy and hypercoagulable state. BMJ Case Rep 2022; 15:e247253. [PMID: 35995459 PMCID: PMC9403116 DOI: 10.1136/bcr-2021-247253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
We report a rare case of metastatic epithelioid haemangioendothelioma from an unknown primary site presenting with axillary lymph node metastases. The patient also had a new-onset membranous glomerulonephritis and thromboembolism, which we postulate were paraneoplastic. The pathogenesis of this rare cancer, the risk of misdiagnosis and membranous glomerulonephritis as a paraneoplastic syndrome are discussed.
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Affiliation(s)
- Valeria Ripa
- Surgery, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Franz Smith
- Surgery, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Jeffrey W Goodman
- Nephrology, Saint Barnabas Medical Center, Livingston, New Jersey, USA
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13
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Graça LL, Almeida Cunha S, Lopes RS, Carvalho L, Prieto D. Thoracic Epithelioid Hemangioendothelioma: clinical demonstration and therapeutic procedures. Port J Card Thorac Vasc Surg 2022; 29:39-44. [PMID: 35780414 DOI: 10.48729/pjctvs.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Indexed: 06/15/2023]
Abstract
Epithelioid hemangioendotheliomais a low to intermediate grade malignant vascular tumors that can involve any organ. About 60-80%of patients are women, patient ages range 7 to 81 years, with a median age of 38 years. Four cases of thoracic epithelioid hemangioendotheliomas with different clinical presentation and disease progression are reported. Cases 1 and 2 are pulmonary epithelioid hemangioendotheliomas diagnosed at different advanced stages and patients died after 6 and 2,5 months of medical treatment, respectively. Case 3 corresponds to pleural epithelioid hemangioendothelioma, submit- ted to left lung decortication and pleuro-pericardial window; patient is free either from symptoms and radiographic manifestations for 10 months of follow-up. Case 4, of mediastinal epithelioid hemangioendothelioma, represented by a mass in the upper left mediastinum adherent to the aortic arch; patient underwent block excision of the mass followed by chemotherapy; subsequent recurrence 41 months later and the patient died 8 months after. The reported 4 cases reveal the heterogeneous clinical presentation of epithelioid hemangioendotheliomas with behavior in between benign and high-grade tumors, raising difficulty in either differentiating from other vascular tumors and previewing clinical outcome.
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Affiliation(s)
- Luís Lourenço Graça
- Cardiothoracic Surgery Department, Centro Hospitalar Universitário de Coimbra, Portugal
| | - Sara Almeida Cunha
- Cardiothoracic Surgery Department, Centro Hospitalar Universitário de Coimbra, Portugal
| | - Rita Susana Lopes
- Pathology Department, Centro Hospitalar Universitário de Coimbra, Portugal
| | - Lina Carvalho
- Cardiothoracic Surgery Department, Centro Hospitalar Universitário de Coimbra, Portugal
| | - David Prieto
- Cardiothoracic Surgery Department, Centro Hospitalar Universitário de Coimbra, Portugal
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14
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Madireddy N, Uppin MS, Uppin SG, Harshavardhana KR, Madhav V, Konatam ML. Hepatic epithelioid hemangioendothelioma-report of three cases of a puzzling tumor. INDIAN J PATHOL MICR 2022; 65:429-432. [PMID: 35435387 DOI: 10.4103/ijpm.ijpm_1112_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
Hepatic epithelioid hemangioendothelioma (EHE) is a rare malignant vascular neoplasm with unpredictable clinical behavior. These lesions are frequently misdiagnosed owing to its non-specific symptomatology, ambiguous radiological features, and overlapping histomorphology. We report three cases of hepatic EHE, of which one was male and two were female patients. While all three patients presented with abdominal pain, the male patient gave an additional history of weight loss and was jaundiced. The radioimaging showed multiple nodules in the liver and two of the patients also had pulmonary metastasis. The biopsies of the liver nodules revealed a tumor composed of spindle, epithelioid, and stellate tumor cells, some with characteristic intracytoplasmic vacuolations/lumina surrounded by myxohyaline stroma. Some of these intracytoplasmic vacuoles/lumina showed erythrocytes, suggesting its vascular origin which was confirmed by CD31 and CD34 positivity. The article highlights the importance of histopathology and IHC in the precise diagnosis of EHE.
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Affiliation(s)
- Nishika Madireddy
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Megha S Uppin
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Shantveer G Uppin
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - K R Harshavardhana
- Department of Radiology and Imageology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Venu Madhav
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Meher Lakshmi Konatam
- Department of Surgical Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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15
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Huang J, Shi W, Li J, Xie H, Hu Y. A case of pseudomyogenic hemangioendothelioma misdiagnosed as low-grade malignant fibrous histiocytoma and review of literature. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2022; 47:390-395. [PMID: 35545333 PMCID: PMC10930068 DOI: 10.11817/j.issn.1672-7347.2022.210177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Indexed: 06/15/2023]
Abstract
Pseudomyogenic hemangioendothelioma (PHE) is a rare angiogenic tumor. Histologically, the morphological characteristics of neoplastic vessels and endothelial differentiation are not obvious, and it is easy to be confused with epithelioid sarcoma, epithelioid hemangioendothelioma and myogenic tumor. PHE usually occurs in arms and legs in young people and has a significant male predominance. The tumor has a predilection for the distal extremities and its typical manifestation is multiple center invasion of a single limb, which can involve all layers of skin and subcutaneous tissues,and is often accompanied by abvious pain. Histologically, PHE is characterized by infiltrative growth of tumor. Most tumor lesions are composed of sheets and loose fascicles of plump spindle or epithelioid cells within a background of variably prominent inflammatory infiltration, which was commonly composed of neutrophils. Some cells may resemble rhabdomyoblasts, and nuclear atypia and mitosis were rare. The tumor cells generally expressed positive cytokeratin (CK), ETS-related gene (ERG), Friend leukemia virus integration 1 (FLI1) and integrase interactor 1(INI1). In some cases, the tumor cells expressed CD31. A case of a young woman was reported in this paper, who presented with a subcutaneous mass with severe pain and was chronologically misdiagnosed with herpes zoster, low-grade malignant fibrous histiocytoma and epithelioid hemangioendothelioma. In this study, the clinical and pathological features, differential diagnosis and the latest progress in therapy of PHE were analyzed based on relevant literature.
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Affiliation(s)
- Jundong Huang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008.
- Hunan Key Laboratory of Aging Biology (Xiangya Hospital), Changsha 410008.
| | - Wei Shi
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008.
- Hunan Key Laboratory of Aging Biology (Xiangya Hospital), Changsha 410008.
| | - Ji Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008
- Hunan Key Laboratory of Aging Biology (Xiangya Hospital), Changsha 410008
| | - Hongfu Xie
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008
- Hunan Key Laboratory of Aging Biology (Xiangya Hospital), Changsha 410008
| | - Yongbin Hu
- Department of Pathology, Xiangya Hospital, Central South University, Changsha 410008, China
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16
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Liţescu M, Abduraim T, Paverman L, Vrabie CD, Dina I, Pleşea IE, Grigorean VT. Epithelioid hemangioendothelioma - an unexpected diagnosis of a mediastinal tumor with extensive local thrombosis. Rom J Morphol Embryol 2022; 63:197-202. [PMID: 36074684 PMCID: PMC9593112 DOI: 10.47162/rjme.63.1.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 08/02/2022] [Indexed: 06/15/2023]
Abstract
Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor and the mediastinal localization is amongst the most infrequent. We present the case of a 37-year-old woman with a history of resected left thyroid tumor that presented to our department for evaluation of a left supraclavicular palpable mass in close contact with local vascular structures, and with heterogeneous contrast enhancement as described by computed tomography (CT) and magnetic resonance imaging (MRI). Considering the history of the patient, the presumptive diagnosis of thyroid tumor recurrence was established, and the patient was referred to surgical department. During procedure, we encountered important bleeding from a ruptured jugular vein branch, which we assumed to be a newly formed tumor blood vessel. After surgery (48 hours postoperatively), the patient developed important local thrombosis that encompassed the left internal jugular vein, left subclavian vein and the left brachiocephalic trunk that partially subsided after anticoagulant therapy. The histological examination revealed the presence of a vascular tumor proliferation of epithelioid endothelial cells that was characteristic of an EHE confirmed later on the immunohistochemical studies as Yes-associated protein 1-transcription factor E3 (YAP1-TFE3) subtype. In addition to the case report, some relevant information from the scarce literature data about mediastinal EHE were reviewed here.
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Affiliation(s)
- Mircea Liţescu
- Departments of Pathology, Carol Davila University of Medicine and Pharmacy, and Fundeni Clinical Institute, Bucharest, Romania;
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17
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Zambrano-Huailla R, Guzmán-Poma R, Cahua-Segura G, Flores-Ezcurra L, Sumire Umeres J, Cebreros Ibarra O, Martel Mory S. Portal hypertension as an uncommon presentation of hepatic epithelioid hemangioendothelioma: a case report. Rev Gastroenterol Peru 2021; 41:103-106. [PMID: 34724691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Hepatic epithelioid hemangioendothelioma (HEHE) is a vascular tumor with a low incidence rate. We report a case of a 26-year-old man who was referred to our hospital with a misdiagnosis of liver cirrhosis. On physical examination, ascites was noted. Chest and abdominal computer tomography scans showed coalescent lesions involving the peripheral liver with heterogeneous contrast enhancement and portal vein dilation due to portal hypertension. Extrahepatic metastasis was not observed. The biopsy with immunohistochemical stains suggested HEHE (Factor VIII, CD31, and CD34). This report describes an uncommon case of HEHE with non-cirrhotic portal hypertension.
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Affiliation(s)
| | - Roxana Guzmán-Poma
- Servicio de Gastroenterología, Hospital III Emergencias Grau. Lima, Perú
| | | | | | - Julia Sumire Umeres
- Servicio de Patología Quirúrgica y Necropsias, Hospital Nacional Guillermo Almenara Irigoyen. Lima, Perú
| | | | - Silvia Martel Mory
- Servicio de Gastroenterología, Hospital III Emergencias Grau. Lima, Perú
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Koukalová R, Šedo J, Adámková DK, Šimková Z, Fabian P, Szturz P. Epithelioid hemangioendothelioma on PET/CT scan. Klin Onkol 2021; 34:235-240. [PMID: 34362258 DOI: 10.48095/ccko2021235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND At present, lung cancer ranks among the most frequent malignant diseases. However, according to literature data, mesenchymal lung tumors are very rare, representing less than 0.5% of all malignant lung tumours. Epithelioid hemangioendothelioma of the lungs belongs to this group of uncommon entities. CASE REPORT We present a case of a 45-year-old male with a history of increasing dyspnoea and abdominal and back pains, developing over the past several months. Vertebral lesions were found on imaging studies. PET/ CT following 18F-fluorodeoxyglucose administration (FDG) showed a large FDG-positive malignant infiltration affecting the thorax, abdominal cavity, and bones. The extension and other characteristics of the mass on PET/ CT did not correspond to any of the common oncologic diseases. With its spread in a plaque-like form predominantly in the right hemithorax and on the surface of the liver, the disease closely resembled malignant mesothelioma. The primary tumour origin could not be clearly identified on PET/ CT scans but they allowed us to choose a suitable site to obtain tissue for pathologic examination. Based on a CT-guided bone bio-psy of the 7th right rib, the dia-gnosis was concluded as epithelioid hemangioendothelioma. Despite an early initiation of systemic treatment, the patient succumbed to the disease only 15 days after the dia-gnosis, due to superior vena cava syndrome and progressive pleural effusion leading to respiratory insufficiency. CONCLUSIONS Given the extremely low prevalence of epithelioid hemangioendothelioma and its heterogeneous manifestation, it is impossible to base the dia-gnosis solely on disease symptoms, laboratory findings, and imaging modalities. In this respect, pathologic examination has a crucial role. For the same reason, there is a lack of recommendations for the standard-of-care systemic therapy of metastatic disease.
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20
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Abstract
RATIONALE Epithelioid hemangioma (EH) of bone is an intermediate vascular tumor that can be locally aggressive. The optimum management of multifocal EH of bone is not well delineated. We described our experience treating one patient with multifocal EH of bone in an effort to document the effect of bisphosphonates in bone EH. PATIENT CONCERNS In this report, a 53-year old male patient presented with back pain which was initially been diagnosed of multiple bone metastatic carcinoma by 18F-FDG PET/CT scan and bone scintigraphy. DIAGNOSIS CT-guided bone biopsy of ilium indicated that puncture tissue had irregular hyperplasia of thick and thin-walled blood vessels, immunohistochemistry revealed positive staining for CD31 and CD34, negative for CAMTA-1, PCK and EMA, which confirmed the diagnosis of multiple EH. INTERVENTIONS The patient was treated with 4 times of intravenous Zometa (zoledronate, 4 mg each time) with average three-month interval. Bone metabolic markers including serum bone specific alkaline phosphatase (BALP) and type I collagen cross-linked C-terminal telopeptide (CTX) levels were closely monitored before and after use of bisphosphonates each time. OUTCOME BALP and CTX were significantly lowered following intravenous Zometa and the back pain improved with integrated therapy including bone graft fusion internal fixation surgery and vertebroplasty. CONCLUSIONS EH of multiple bones responded favorably to intravenous Zometa with improvement of bone metabolic markers. After 1 year on follow-up, the patient was doing well with no significant pain. We suggest that bisphosphonates should be considered in the treatment of multifocal osteolytic EH of bone.
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Affiliation(s)
- Lizhi Tang
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University
| | - Guangwen Chen
- Department of Radiology, Sichuan Provincial People's Hospital, Chengdu, China
| | - Qin Wang
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University
| | - Jobin John
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University
| | - Chunyan Lu
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University
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Taefi A, Matsukuma K, Chak E. Massive Epithelioid Hemangioendothelioma Causing Noncirrhotic Portal Hypertension. Clin Gastroenterol Hepatol 2019; 17:A19. [PMID: 29609064 DOI: 10.1016/j.cgh.2018.03.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 03/27/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Amir Taefi
- Division of Gastroenterology and Hepatology, Sacramento, California
| | - Karen Matsukuma
- Division of Pathology, UC Davis School of Medicine, Sacramento, California
| | - Eric Chak
- Division of Gastroenterology and Hepatology, Sacramento, California
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22
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Spasic S, Brcic I, Freire R, Garcia-Buitrago MT, Rosenberg AE. Epithelioid Hemangioendothelioma of the Bowel in Crohn's Disease: The First Reported Case. Int J Surg Pathol 2019; 27:423-426. [PMID: 30238810 DOI: 10.1177/1066896918801527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND Epithelioid hemangioendothelioma (EHE) is an uncommon malignant endothelial neoplasm that most commonly arises in soft tissue, bone, lung, and liver. Crohn's disease (CD) is an inflammatory bowel disease of unknown etiology that is frequently associated with complications including strictures, fistulas/fissures, and neoplasms. CASE DESCRIPTION A 43-year-old woman with a 6-year history of severe CD presented with anal pain and bleeding. She had prior partial colectomy for a stricture and a diverting ileostomy for perianal fissures and stricture. Colonoscopy showed severe chronic active colitis, stricture at 30 cm of anal verge, and a perianal fistula. The patient underwent total proctocolectomy. The colonic mucosa exhibited segmental ulceration and irregular thickening of the colon wall. Beneath an ulcer of the anal canal within the muscularis propria was a 1.2-cm poorly circumscribed, firm, white-tan mass. The mass was composed of cords and groups of large epithelioid endothelial cells with intracytoplasmic vacuoles enmeshed in a myxohyaline stroma. Immunohistochemically, the tumor cells were positive for ERG, CD31, and CAMTA1 and focally positive for keratin and SMA. Next-generation sequencing revealed a WWTR1-CMATA1 fusion. The morphology, immunoprofile, and molecular genetics were diagnostic of EHE. DISCUSSION Long-standing inflammatory bowel disease is associated with significant risk for developing neoplasms, usually carcinomas, which can be indistinguishable radiologically and clinically from nonneoplastic complications. These tumors are often identified as an incidental finding in specimens resected for clinically severe disease. This is the first report of EHE arising in the bowel affected by CD, and it mimicked mural fibrosis and fissures.
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Affiliation(s)
| | - Iva Brcic
- 2 Medical University of Graz, Austria
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Armas I, Vidoedo J, Afonso LP, Moreira A, Abreu de Sousa J. Epithelioid Hemangioendothelioma Of The Internal Jugular Vein. Rev Port Cir Cardiotorac Vasc 2019; 26:155-157. [PMID: 31476819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Indexed: 06/10/2023]
Abstract
Ephitelioid Hemangioendothelioma (EHE) is a rare type of tumor with vascular and sarcomatous components. There's only another case published of an internal jugular vein (IJV) EHE. A case of a 50 years-old woman with a palpable and pulsatile mass on the left cervical area is reported. Doppler ultrasound and magnetic resonance imaging showed an IVJ' 4 cm mass. Cytology was inconclusive. Surgical treatment was therefore decided and during surgery a mass inside the left IJV, with local nonsuspicious lymph nodes, was confirmed. The mass was resected including a segmental resection of the IJV and one affected tributary vessel. Lymphadenectomy of the adjacent cervical levels was performed. Histologic examination depicted an EHE without metastatic lymph nodes. Tumor was staged as pT1bN0M0 and a multidisciplinary sarcoma group proposed surveillance. Patient remained well, without evidence of disease and without complications in a twenty-four months follow-up period.
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Affiliation(s)
- Isabel Armas
- General Surgery / Unidade Local de Saúde do Nordeste (ULSNE), Portugal
| | - José Vidoedo
- Vascular Surgery / Centro Hospitalar Tâmega e Sousa (CHTS), Portugal
| | - Luís Pedro Afonso
- Patology Department / Instituto Português de Oncologia do Porto (IPO Porto), Portugal
| | - Augusto Moreira
- Surgical Oncology / Instituto Português de Oncologia do Porto (IPO Porto), Portugal
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Sasaki A, Egashira H, Sugimoto H, Seki K, Tsukiyama T, Ichita C, Tokoro S, Takizawa S, Kitagawa I, Teshima S, Kako M. CT-guided Biopsy for the Diagnosis of Pulmonary Epithelioid Hemangioendothelioma Mimicking Metastatic Lung Cancer. Intern Med 2018; 57:3631-3635. [PMID: 30101918 PMCID: PMC6355408 DOI: 10.2169/internalmedicine.1063-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
A 69-year-old male patient presented with multiple lung nodules revealed by chest-computed tomography (CT) during a preoperative examination for an appendiceal tumor. The nodule diameters ranged from 2-10 mm without either pleural thickening or effusions. A fluorine-18-labeled fluorodeoxyglucose (18F-FDG)-positron emission tomography (PET)/CT scan showed a high FDG uptake in the appendiceal tumor, but almost normal standardized uptake values in the bilateral lung nodules. A CT-guided biopsy led to a diagnosis of pulmonary epithelioid hemangioendothelioma, a rare vascular tumor with a radiological presentation similar to that of a metastatic lung tumor. The present case is the first to describe successful treatment using a CT-guided biopsy instead of more conventional methods.
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Affiliation(s)
- Akiko Sasaki
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Hideto Egashira
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | | | - Kenichi Seki
- General Internal Medicine, Shonan Kamakura General Hospital, Japan
| | - Toshitaka Tsukiyama
- Intervention Radiology (IVR) and Radiology, Shonan Kamakura General Hospital, Japan
| | - Chikamasa Ichita
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Shinnosuke Tokoro
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Satoshi Takizawa
- Intervention Radiology (IVR) and Radiology, Shonan Kamakura General Hospital, Japan
| | - Izumi Kitagawa
- General Internal Medicine, Shonan Kamakura General Hospital, Japan
| | | | - Makoto Kako
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Vecchio R, Caputo M, Spadola S, Catalano R, Intagliata E. A rare case of epithelioid hemangiothelioma of the quadriceps. Ann Ital Chir 2018; 7:S2239253X18028578. [PMID: 30004035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Hemangioendotelioma is a group of rare vascular tumors with border-line behavior. They may involve internal organs, limbs, bones and soft tissue. The histological variant epitheliod hemangiothelioma is locally aggressive and has metastatic potential. We present a case of a 41-years old woman affected by epitheliod hemangiothelioma of the right quadriceps. The patient complained of localized pain in the anterior region of the right thigh, which started about 3 months earlier during physical exercise. For the increasing size of the lesion, the patient was referred to our Department. On physical examination, the lesion appeared elastic, fixed to the surrounding tissues and painful under pressure. An ultrasound examination revealed a small avascular lesion and a MRI examination showed an oval formation measuring about 18 mm in diameter of nonspecific significance. A surgical removal of the lesion was performed and diagnosis of epithelioid hemangiothelioma was achieved. A complete removal of the quadriceps muscle was then accomplished. In this paper, clinical and oncologic aspects of this rare tumor are discussed KEY WORDS: Epithelioid hemangiothelioma, Lower limbs tumor, Rare tumors.
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Petrella F, Bonalumi G, Andreini D, De Camilli E, Spaggiari L, Alamanni F. Primary Epithelioid Hemangioendothelioma of the Heart. Am Surg 2018; 84:e199-e200. [PMID: 30219135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Abstract
RATIONALE Epithelioid angiosarcoma (EA) is a rare, highly invasive tumor. The histopathological features of EA are not distinct and less reported in the literature, and most of the medical records are incomplete. PATIENT CONCERNS A 61-year-old woman who came to the hospital because of pain in her right hip. This patient had had surgery for right hip tuberculosis 30 years ago. DIAGNOSES The present study reports a case of primary EA of bone with aneurysmal bone cyst (ABC) that was diagnosed by 3 experienced pathologists. INTERVENTIONS The patients had undergone 2 surgeries; however, an early recurrence of the tumor was caused the death of the patient. OUTCOMES Ten EA cases from other literature were reviewed in this article; all the symptoms were found in different parts of bone, and the case data were relatively complete. The primary clinical features and nonspecific histopathological morphology of the disease were summarized from the 11 cases mentioned in the literature, and the main immunohistochemistry characteristics and diagnostic traps of EA were reviewed. LESSONS Because the tumor has no characteristic diagnostic index in imaging and laboratory examination, the histopathologic features are not typical, especially in the case of obvious secondary lesions. It is easy to miss and misdiagnose. If possible, the diagnosis should be combined with immunohistochemical results.
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Abstract
RATIONALE Primary gastric epithelioid angiosarcoma is a highly aggressive endothelial cell malignancy and may pose a great diagnostic challenge. PATIENT CONCERNS Here we describe the case of a 56-year-old man presented with melena and epigastric dull pain for 2 weeks. DIAGNOSIS Primary gastric epithelioid angiosarcomas: the definitive diagnosis was provided by immunohistochemical analysis with endothelial markers such as cluster of differentiation 31 (CD31), ether-a-go-go-related gene (ERG), and Freund leukemia integration (FLI-1). INTERVENTIONS After gastroscopic biopsy was performed at the bleeding fundus and the results suggested malignant tumor, radical gastrectomy was performed. OUTCOMES Unfortunately, regional lymph node enlargement and distant metastases occurred about 1 month later. The patient did not have the opportunity to undergo chemotherapy or other treatment and died from multiple organ dysfunction syndrome. LESSONS Primary gastric epithelioid angiosarcomas are rare tumors with a high rate of lymph nodes and peripheral organs metastasis. The strong cytokeratin expression in epithelioid angiosarcomas represents a diagnostic pitfall for pathologists. Their clinical behaviors are unpredictable and results with surgical excision alone have been disappointing. Thus, the prognosis is generally considered poor and patients seldom can survive over 1 year after diagnosis.
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Gao L, Wang Y, Jiang Y, Lai X, Wang M, Li J. Intravascular epithelioid hemangioendothelioma of the femoral vein diagnosed by contrast-enhanced ultrasonography: A care-compliant case report. Medicine (Baltimore) 2017; 96:e9107. [PMID: 29245342 PMCID: PMC5728957 DOI: 10.1097/md.0000000000009107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
RATIONALE Intravascular epithelioid hemangioendothelioma (EHE) is a rare endothelial tumor with an intermediate grade of malignancy. We present a case of one woman affected by EHE of the femoral vein. Contrast-enhanced ultrasonography played a role in diagnosing EHE and helped differentiate it from thrombosis. To our knowledge, this is the first reported contrast-enhanced ultrasonography of intravascular EHE in the imaging literature. PATIENT CONCERNS A 46-year-old woman presented to our hospital due to pain and swelling in her right lower limb since 5 years prior to her presentation. DIAGNOSES The patient was misdiagnosed as having thrombosis by ultrasound. Contrast-enhanced ultrasonography showed solid lesions with visible blood supply, suggesting angiogenic tumors. INTERVENTIONS The patient was treated by complete surgical removal of the mass and postoperative radiotherapy. Pathological examination confirmed the diagnosis of EHE. OUTCOMES During follow-up, there were no signs of local or distant relapse. LESSONS Intravenous EHE may be misdiagnosed as thrombosis by ultrasound and contrast-enhanced ultrasonography can help make the differential diagnosis.
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Abstract
Epithelioid hemangioendothelioma (EHE) is a rare indolent vascular tumor which occurs at liver, lung, bone, and so on. However, the etiology of EHE is evasive.These patients were enrolled at the First Affiliated Hospital of Xi'an Jiaotong University from January 2011 to December 2015. Retrospective analysis is done by demographic data of clinical manifestations, laboratory parameters, CT imaging, histological, and immunohistochemical features in 9 cases in Shaanxi.Of the patients, 8 were females (88.9%) and 1 were males (11.1%). The age ranged from 34 to 71 years (mean 49 years; median 49 years). Anatomical sites of primary lesions were as follows: liver (n = 6, 66.7%), upper extremities (n = 1, 11.1%), sublingual gland (n = 1, 11.1%), and spine (n = 1, 11.1%). Metastatic disease was diagnosed in 5 cases (55.6%) with occurrence in lung (n = 4, 44.4%), bone (n = 2, 22.2%), upper extremities (n = 1, 11.1%), pleura (n = 1, 11.1%), and spleen (n = 1, 11.1%). Tumor size ranged from 0.5 to 6.8 cm (mean 3 cm). The most tumors were composed of highly cellular areas with small and prominent nucleoli in vesicular nuclei, and ERG (100%) was the most frequently positive in these cases, followed by CD31 (88.9%) and CD34 (77.8%) via histology and immunohistochemistry techniques.EHE is a very rare in Shaanxi. It is significant to find its clinical, radiological, and pathological characters, helping for EHE early diagnosis and treatment, reducing misdiagnosis and improving life quality.
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Affiliation(s)
| | - Jing Xue
- Department of Respiratory, the First Affiliated Hospital of Xi’an Jiaotong University
| | - Lin Xu
- Department of Endocrinology, the Affiliated Guangren Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Zhihong Shi
- Department of Respiratory, the First Affiliated Hospital of Xi’an Jiaotong University
| | - Bo Zhou
- Department of Respiratory, the First Affiliated Hospital of Xi’an Jiaotong University
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Abstract
RATIONAL Epithelioid hemangioendothelioma (EHE) is a rare neoplasm commonly known to arise from the soft tissue, lung, and liver. EHE arising from right innominate vein (RIV) has scarcely been reported in English literature. PATIENT CONCERNS Herein, we present a rare case of EHE of RIV in a 51-year-old woman with right-lower chest pain for 4 days. Computed tomography of the chest revealed a spherical mass with calcification and fatty foci located in the anterior mediastinum, thus a presumptive diagnosis of teratoma was made. DIAGNOSES, INTERVENTIONS, AND OUTCOMES Video-assisted thoracoscopic explorations and resection of mediastinal tumor were then performed. The pathological examination showed that the tumor was EHE. Postoperative radiotherapy was delivered to the patient. Pulmonary metastases were found by chest CT a year after surgery. LESSONS A diagnosis of EHE might be considered, when a mediastinal tumor closely related to veins showing intratumoral calcification and obvious enhancement, despite the presence of a clear boundary and visible fat content.
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Affiliation(s)
- Qi Wan
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jiaxuan Zhou
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yudong Yu
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Qingyu Sun
- Department of Gynaecology and Obstetrics, Health Center of Huanghe Town, Zhangqiu, Shandong, China
| | - Yingying Bao
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Qiang Lei
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Qiao Zou
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yingshi Deng
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xinchun Li
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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Lai Q, Feys E, Karam V, Adam R, Klempnauer J, Oliverius M, Mazzaferro V, Pascher A, Remiszewski P, Isoniemi H, Pirenne J, Foss A, Ericzon BG, Markovic S, Lerut JP. Hepatic Epithelioid Hemangioendothelioma and Adult Liver Transplantation: Proposal for a Prognostic Score Based on the Analysis of the ELTR-ELITA Registry. Transplantation 2017; 101:555-564. [PMID: 28212256 DOI: 10.1097/tp.0000000000001603] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatic epithelioid hemangioendothelioma (HEHE) is a rare vascular tumor which has an intermediate aggressive behavior. Although the value of liver transplantation (LT) is well established, its place in the management of HEHE is still unclear. The aim of this study is to confirm, based on a very large patient cohort, the value of LT in the management of HEHE and to identify risk factors for post-LT recurrence. METHODS The outcome of 149 transplant recipients with HEHE recorded in the European Liver Transplant Registry during the period November 1984 to May 2014 was analyzed. Median post-LT follow-up was 7.6 years (interquartile range, 2.8-14.4). RESULTS Cox regression analysis showed that macrovascular invasion (hazard ratio [HR], 4.8; P < 0.001), pre-LT waiting time of 120 days or less (HR, 2.6; P = 0.01) and hilar lymph node invasion (HR = 2.2; P = 0.03), but not pre-LT extrahepatic disease, were significant risk factors for recurrence. These findings, which were also confirmed in a propensity score analysis, allowed the development of a HEHE-LT score enabling stratification of patients in relation to their risk of tumor recurrence. Patients with a score of 2 or less had a much better 5-year disease-free survival compared to those having a score of 6 or higher (93.9% vs 38.5%; P < 0.001). CONCLUSIONS The analysis of this (largest in the world) HEHE adult liver recipient cohort clearly confirms the value of LT in the treatment of this rare disorder and also permits identification of patients at risk of posttransplant recurrence. Posttransplant follow-up should take the HEHE-LT score into account. Extrahepatic disease localization is reconfirmed not to be a contraindication for LT.
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Affiliation(s)
- Quirino Lai
- 1 Starzl Abdominal Transplant Unit, University Hospitals St. Luc, Université catholique Louvain, Brussels, Belgium. 2 Centre Hépatobiliaire Paul Brousse, Paris, France. 3 Medizinsche Hochschule Hannover, Hannover, Germany. 4 Transplancenter IKEM, Prague, Czech Republic. 5 Istituto Nazionale Tumori, Milano, Italy. 6 Charité Campus Virchow Klinikum, Berlin, Germany. 7 Department of General Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland. 8 UCJ Helsingfors, Helsinki, Finland. 9 Department Abdominal transplantation Surgery, Universitaire Ziekenhuizen Gasthuisberg KULeuven, Belgium. 10 Rikshospitalet, Oslo Universitetssykehus, Oslo, Norway. 11 Karolinska University Hospital, Huddinge, Stockholm, Sweden. 12 University Medical Centre Ljubljana, Ljubljana, Slovenia
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Yang JW, Li Y, Xie K, Dong W, Cao XT, Xiao WD. Spontaneous rupture of hepatic epithelioid hemangioendothelioma: A case report. World J Gastroenterol 2017; 23:185-190. [PMID: 28104995 PMCID: PMC5221283 DOI: 10.3748/wjg.v23.i1.185] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/27/2016] [Accepted: 10/27/2016] [Indexed: 02/06/2023] Open
Abstract
Hepatic epithelioid hemangioendothelioma (HEH) is a rare tumor of vascular endothelial origin. Spontaneous rupture of HEH is a life-threatening complication and is extremely rare. HEH has variable malignant potential, and the clinical diagnosis remains challenging. Here we report a case of HEH with spontaneous rupture. A 44-year-old man presented with constant cutting pains over the right upper abdomen after eating. He had hemoptysis 11 d previously. Diagnostic abdominal puncture demonstrated active bleeding. Chest and abdominal computer tomography scan showed multiple ground-glass nodules over the lungs, multiple low-density intrahepatic nodules and massive hemorrhage. Transcatheter arterial embolization and exploratory laparotomy were performed and subsequent immunohistochemical examination confirmed a diagnosis of HEH.
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Hu HJ, Jin YW, Jing QY, Shrestha A, Cheng NS, Li FY. Hepatic epithelioid hemangioendothelioma: Dilemma and challenges in the preoperative diagnosis. World J Gastroenterol 2016; 22:9247-9250. [PMID: 27895413 PMCID: PMC5107607 DOI: 10.3748/wjg.v22.i41.9247] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 08/09/2016] [Accepted: 08/23/2016] [Indexed: 02/06/2023] Open
Abstract
Hepatic epithelioid hemangioendothelioma (HEHE) is a rare category of vascular tumor with uncertain malignant potential. It commonly presents nonspecific and variable clinical manifestations, ranging from asymptomatic to hepatic failure. In addition, laboratory measurements and imaging features also lack specificity in the diagnosis of HEHE. The aim of the present study is to highlight the dilemma and challenges in the preoperative diagnosis of HEHE, and to enhance awareness of the range of hepatobiliary surgery available in patients with multiple hepatic nodular lesions on imaging. In these patients, HEHE should at least be considered in the differential diagnosis.
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Dutta M, Roy K. Epithelioid hemangioendothelioma of tongue presenting as a papilloangioma in a pregnant woman. Ear Nose Throat J 2016; 95:E43-E45. [PMID: 27551853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Affiliation(s)
- Mainak Dutta
- Department of Otorhinolaryngology and Head-Neck Surgery, Medical College and Hospital, Kolkata, India
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Abstract
The case of a 15-year-old boy with a severe swelling of the 2nd toe in the left foot and a large swelling of the left inguinofemoral region is described. Histologic examination of the foot lesion showed a typical epithelioid hemangioma of bone that extended into the soft tissues, with a secondary location in the groin, suggestive of lymph node involvement. Subsequently, imaging also revealed swelling of iliac and para-aortic lymph nodes, which probably indicates further lymph node spread.. Besides the fact that epithelioid hemangioma of the toe has not been reported yet, our case showed a noncontinuous localization, most likely in draining lymph nodes. This finding suggests metastatic disease, an event that is extremely rare for epithelioid hemangioma. As such, epithelioid hemangioma might be comparable to another benign vascular tumor, the retiform hemangioendothelioma, which occasionally metastasizes to the lymph nodes without systemic spread.
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Affiliation(s)
- Giuseppe Floris
- Department of Pathology, University Hospitals, Catholic University of Leuven, Leuven, Belgium
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Kim EH, Rha SE, Lee YJ, Yoo IR, Jung ES, Byun JY. CT and MR imaging findings of hepatic epithelioid hemangioendotheliomas: emphasis on single nodular type. ACTA ACUST UNITED AC 2015; 40:500-9. [PMID: 25179888 DOI: 10.1007/s00261-014-0229-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To evaluate imaging findings of hepatic epithelioid hemangioendothelioma (HEH), with emphasis on solitary form at the initial presentation. MATERIALS AND METHODS Ten cases of pathologically confirmed HEH were retrospectively reviewed; seven patients had CT and MR images and three had only CT images. Two radiologists assessed the followings in consensus: lesion number, size, location, presence of capsular retraction and calcification, attenuation, signal intensity, and enhancement pattern. RESULTS Initially, HEHs manifested as a single mass (n = 5) or multiple masses (n = 5). One case demonstrated a solitary nodule at first, which subsequently transformed to multifocal nodules on serial follow-up. The maximal diameter of the lesions ranged from 1.8 to 10 cm (mean 4.2 cm). All cases showed predominant subcapsular location. Capsular retraction was seen in multinodular types, but not in solitary types. Two patients had intra-lesional calcifications. HEHs showed minimal enhancement (7/7 patients) on the hepatic arterial phase CT and rim-like enhancement (5/10 patients), minimal enhancement (2/10 patients), multilayered target enhancement (2/10 patients), and peripheral nodular enhancement (1/10 patients) on the portal venous phase CT. On MR images (n = 7), HEHs showed hypointensity on T1-weighted images and hyperintensity on T2-weighted images. Dynamic contrast-enhanced MR images revealed progressive centripetal fill-in enhancement (7/7 patients). On Gd-EOB-DTPA-enhanced hepatobiliary phase images, HEH manifested as homogeneous hypointensity (3/5 patients) and target-shaped hypointensity (2/5 patients). CONCLUSION HEH can manifest as single nodular, multinodular, or diffuse type. Common imaging features of HEH are multiple subcapsular nodules with coalescence, capsular retraction, peripheral, and delayed enhancement. However, HEH can manifest as a solitary subcapsular mass with minimal or rim-like enhancement at early phase and progressive centripetal fill-in enhancement during dynamic phase imaging, representing early stage of HEH. A single nodular type can progress to multifocal nodular type during follow-up.
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Affiliation(s)
- Eu Hyun Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea
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Affiliation(s)
- H T Wong
- Department of Otorhinolaryngology, University of Malaya, Kuala Lumpur, Malaysia.
| | - K S Mun
- Department of Pathology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - A B Zulkiflee
- Department of Otorhinolaryngology, University of Malaya, Kuala Lumpur, Malaysia
| | - N Prepageran
- Department of Otorhinolaryngology, University of Malaya, Kuala Lumpur, Malaysia
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Weaver SM, Kumar AB. Epithelioid hemangioma of the spine: an uncommon cause of spinal cord compression. Acta Neurol Belg 2015; 115:843-5. [PMID: 25672266 DOI: 10.1007/s13760-015-0437-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 01/25/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Sheena M Weaver
- Department of Anesthesiology, Division of Critical Care, Vanderbilt University Medical Center, Nashville, TN, 37212, USA
| | - Avinash B Kumar
- Department of Anesthesiology, Division of Critical Care, Vanderbilt University Medical Center, Nashville, TN, 37212, USA.
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Abstract
The diagnosis of vascular tumors is a challenging area in soft tissue pathology. Epithelioid vascular tumors pose a particular challenge. Due to the epithelioid morphology of the tumor cells, they can be misdiagnosed as a variety of other entities, including metastatic carcinoma or epithelioid sarcoma. Furthermore, it can be difficult to distinguish between different epithelioid vascular tumors. This review focuses on vascular tumors characterized by epithelioid endothelial cells, including epithelioid hemangioma, cutaneous epithelioid angiomatous nodule, epithelioid hemangioendothelioma, epithelioid sarcomalike hemangioendothelioma/pseudomyogenic hemangioendothelioma, and epithelioid angiosarcoma.
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Affiliation(s)
- Jennifer S Ko
- Department of Pathology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Steven D Billings
- Department of Pathology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Xiao L, Hongmei Z, Feng Y, Shuangmei Z, Xiaolin C, Han O, Xinming Z, Chunwu Z. [Hepatic epithelioid hemangioendothelioma: analysis of the correlation of imaging characteristics with histopathological findings]. Zhonghua Zhong Liu Za Zhi 2015; 37:278-282. [PMID: 26462892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To analyze the imaging characteristics of hepatic epithelioid hemangioendothelioma (EHE) and their correlation with histopathological findings. METHODS CT and MRI imaging and histopathological characteristics of five patients with hepatic EHE were retrospectively reviewed and the correlation of their imaging characteristics with pathological findings was analyzed. RESULTS A total of 92 lesions were found in the 5 patients, all presenting with multiple nodules. All the 92 lesions were located within a 2-cm zone heneath the hepatic capsule, i.e., the shortest distance from the horder of lesions to the hepatic capsule. 28 of the 92 lesions showed the "capsular retraction" sign. 36 lesions were found in three patients receiving MRI. 77.8% of the 36 lesions demonstrated the "halo" sign on a fat-suppression T2- weighted image, while 91.7% after contrast enhancement. A peripheral dark rim was found in 91.7% of the lesions on a fat-suppression T2-weighted image. In addition, 36.1% of the lesions showed slight internal or edge enhancement at the hepatohiliary phase. In the two patients receiving CT examination, 7 of 56 lesions demonstrated the "halo" sign. CONCLUSIONS Hepatic EHE may manifest as nodular lesions with predilection of peripheral subcapsular growth and nodular confluence, together with "halo" sign and " capsular retraction". The peripheral dark rim on a fat-suppression T2-weighted image and slight enhancement at the hepatobiliary phase can help to improve the accuracy of diagnosis and differential diagnosis of this hepatic tumor. MRI is superior to CT imaging to denict their intra-lesional characteristics.
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Sanxi A, Yalan B, Qinfeng Z, Xinchao L, Jing Z, Wei Z, Longyun L, Yi X, Wenbing X, Mengzhao W. [Pleural epithelioid hemangioendothelioma: a case report and review of the literature]. Zhonghua Jie He He Hu Xi Za Zhi 2015; 38:174-178. [PMID: 26269304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To explore the etiology, clinical manifestation, diagnosis, differential diagnosis, management and prognosis of pleural epithelioid hemangioendothelioma. METHODS The clinical data of a patient with pleural epithelioid hemangioend othelioma admitted to Peking Union Medical College Hospital were retrospectively analyzed and the related literature was reviewed. We searched databases PubMed, Embase, Ovid, Cochrane, Wanfang and Chinese National Knowledge infrastructure (CNKI) using the keyword "pleural epithelioid hemangioendothelioma" by December 2013. RESULTS The patient was a 40-year-old male presented with chest pain, and his chest CT scan revealed thickening of the left pleura and left pleural effusion. Biopsy of the pleura showed epithelioid tumor cells, and immunohistochemistry was positive for CD31, CD34 and vimentin. From January 1975 to December 2013, 18 related articles were retrieved and 29 cases of pleural epithelioid hemangioendothelioma were reported. Among all 30 cases, there were 20 males and 10 females, ranging from 31 to 82 years old, and the average age was 50. 3 years old. 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 or mass. Histological examinations revealed mainly epithelioid cells. Immunohistochemical stains were positive for vascular endothelial markers. The mean survival time was 8.2 months. CONCLUSIONS Pleural epithelioid hemangioendothelioma is rare and the etiology is unknown. Clinical and imaging manifestations are not specific, and diagnosis is relied on histological findings. It should be differentiated from adenocarcinoma, hemangiosarcoma, mesothelioma and pulmonary epithelioid hemangioendothelioma. There is no effective treatment and its prognosis is poorer than its pulmonary counterpart.
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Chokoeva A, Tchernev G. [Malignant vascular tumors of the vulva]. Akush Ginekol (Sofiia) 2015; 54:48-52. [PMID: 25909132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Due to the increased vascularity as well as the unique anatomical structure, vascular lesions, which occur in the female reproductive system are common observed and diverse by their morphology. The majority of them are benign, including vascular malformations, lesions due to vascular hyperplasia, tumors with significant vascular component and others. Malignant vascular tumors are rare in the area of the vulva accounting about 1% of all vulvar lesions with vascular origin. Kaposi sarcoma, epithelioid hemangioepithelioma and epithelioid angiosarcoma have been reported with vulvar localization. With a view to their rare incidence, nonspecific clinical manifestation and aggressive behavior associated with high mortality, we present the most common malignant tumors of vascular origin arising in the vulva, as we emphasize on their epidemiology and clinical features, differential diagnosis and therapeutic algorithms for this rare type of malignancies.
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Affiliation(s)
- A G Kriger
- Institut khirurgii im. A.V. Vishnevskogo Minzdrava RF, Moskva
| | - V N Dan
- Institut khirurgii im. A.V. Vishnevskogo Minzdrava RF, Moskva
| | - V N Tsygankov
- Institut khirurgii im. A.V. Vishnevskogo Minzdrava RF, Moskva
| | | | - E A Akhtanin
- Institut khirurgii im. A.V. Vishnevskogo Minzdrava RF, Moskva
| | - D V Kalinin
- Institut khirurgii im. A.V. Vishnevskogo Minzdrava RF, Moskva
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Chen F, Hu H, Li J, Yang W. [A case of temporal bone epithelioid hemangioendothelioma]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2014; 49:603-604. [PMID: 25257279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Donfut AL, Lemaitre J, Van de Walle H, Holbrechts S, Carlier P, Winant C, Lebrun E. Primitive pulmonary "malignant epithelioid hemangioendothelioma" versus epithelioid angiosarcoma. A case report and review of the literature. Acta Chir Belg 2014; 114:143-145. [PMID: 25073215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We describe the case of a 56-year-old man presenting a primary pulmonary epithelioid angiosarcoma versus malignant epithelioid hemangioendothelioma still alive, without recurrence at nearly two years after the beginning of the symptoms. The primary pulmonary angiosarcoma is extremely rare, being reported only in a handful of cases. Metastatic involvement of the lung (90%) is far more common than primary pulmonary involvement (10%). Various predisposing condition for the development of angiosarcoma have been described. Early diagnosis is not common, because of the rarity of angiosarcoma in the lung and consequent low index of suspicion. Due to the paucity of cases, there are no defined treatment regimens for this entity. However, there is a tendency for surgical intervention in all reported cases.
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Enbom ET, Abasolo PA, Dixon JR, Nikolaenko LM, French SW, Duane GB. Cytomorphological features of epithelioid hemangioendothelioma in ascitic fluid with radiological, clinical and histopathological correlations. Acta Cytol 2014; 58:211-6. [PMID: 24504057 DOI: 10.1159/000357967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 12/10/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Epithelioid hemangioendothelioma (EHE) is an uncommon vascular soft-tissue tumor. Five cases of EHE in body fluids have been documented in the literature, all of them occurring in pleural effusions. This is the first description of cytomorphological features of EHE cells in ascitic fluid, accompanied by corresponding histopathological findings, clinical, and radiological data. CASE REPORT Our patient presented with several liver masses, peritoneal involvement, bilateral pleural effusions, and massive ascites. EHE was suspected on cytological examination of the ascitic fluid and was confirmed by immunohistochemical studies. Simultaneously, a liver mass was identified and diagnosed on biopsy as EHE, affording accurate histopathological correlation. Cytologically, EHE cells appear relatively bland, often obscured by reactive mesothelial cells, and dispersed singly or clustered. They often possess intracytoplasmic vacuoles, referred to as 'blister' or 'signet ring' cells. High-power examination shows slightly misshapen mildly hyperchromatic nuclei with inconspicuous nucleoli. Immunohistochemically, EHE cells express strong positivity with vascular markers (CD31, CD34 and factor VIII). They are nonreactive with mesothelial markers (calretinin and WT-1). CONCLUSION Recognition of the possibility of EHE cells in fluid by morphology should prompt proper immunohistochemical work-up to ensure an accurate diagnosis and timely patient management.
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Affiliation(s)
- Elena T Enbom
- Department of Pathology and Laboratory Medicine, Harbor-UCLA Medical Center, Torrance, Calif., USA
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Tan GL, Takano A, Cheah FK, Quek RHH, Koh MSY. A 58-year-old Woman with Dry Cough and Pulmonary Nodules. Ann Acad Med Singap 2014; 43:59-61. [PMID: 24557468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Gan Liang Tan
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
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Cobelo-Romero E, Mandia-Mancebo FJ, Feijoo-Lorenzo MA, González-García J. [Solitary bone epithelioid hemangioendothelioma. Case report and literature review]. Acta Ortop Mex 2013; 27:390-395. [PMID: 24716371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We report the case of a 54 year-old male with a solitary bone epithelioid hemangioendothelioma located in the right iliopubic ramus. Clinical manifestations included right inguinal pain without functional limitation. We stress the importance of the anatomopathologic study to make the diagnosis and determine the histologic grade of the malignancy. This helps decide which is the most appropriate treatment and provides the prognosis.
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