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Epithelioid hemangioma of the internal carotid artery: a case report supporting the reactive pathogenesis hypothesis of this vascular tumor. Int J Pediatr Otorhinolaryngol 2014; 78:1186-9. [PMID: 24837865 DOI: 10.1016/j.ijporl.2014.04.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/24/2014] [Accepted: 04/26/2014] [Indexed: 11/20/2022]
Abstract
The pathogenesis of epithelioid hemangioma is intriguing and has remained a controversial topic in the medical literature. Whether its etiology follows a neoplastic or reactive process is unclear, but a history of traumatic insult to the involved region is common. We report a case of epithelioid hemangioma of the internal carotid artery in a child who had undergone cannulization of the internal jugular vein as an infant to receive extracorporeal membrane oxygenation.
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Abstract
Epithelioid hemangioendothelioma is a vascular tumor of low to intermediate malignancy that was initially described in the soft tissue. Since then, epithelioid hemangioendothelioma has been described in various anatomic sites including parenchymal tissues and the bone. In the bone, these tumors must not only be distinguished from other vascular tumors that can arise in this location, primarily epithelioid hemangioma and epithelioid angiosarcoma, but also from metastatic carcinoma. Discussion of the historical context and the pertinent literature on the subject forms the basis of this review.
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Intraosseous angioleiomyoma the tibia: a case report. Pathol Res Pract 2014; 210:321-4. [PMID: 24635970 DOI: 10.1016/j.prp.2014.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 12/03/2013] [Accepted: 01/29/2014] [Indexed: 11/20/2022]
Abstract
Angioleiomyoma (vascular leiomyoma/angiomyoma) is a morphologically distinctive tumor characterized by proliferating smooth muscle cells admixed with prominent vascular elements. The majority of angioleiomyomas involve the superficial soft tissues. Examples of this lesion originating in bone, particularly in the appendicular skeleton, are extremely rare. The present report details the clinicopathologic features of an unusual case of an intraosseous angioleiomyoma arising in the distal tibia. The skeletal tumor exhibited the typical histologic appearance and immunophenotypic features of this entity. Due to its rarity, angioleiomyoma of bone can pose problems in diagnosis. Awareness that angioleiomyoma can present as a primary intraosseous lesion is important so as not to confuse this neoplasm with more commonly encountered bone tumors.
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Surgical treatment and results of 62 patients with epithelioid hemangioendothelioma of bone. J Surg Oncol 2014; 109:791-7. [DOI: 10.1002/jso.23587] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 02/11/2014] [Indexed: 01/16/2023]
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A multidisciplinary approach to the management of atypical osseous epithelioid hemangioendothelioma. Case Rep Oncol Med 2014; 2014:917425. [PMID: 24716052 PMCID: PMC3970260 DOI: 10.1155/2014/917425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 01/11/2014] [Indexed: 11/23/2022] Open
Abstract
Hemangioendothelioma is a rare vascular tumor of intermediate malignant potential. Though epithelioid hemangioendothelioma (EH) is commonly found in soft tissues, it has been known to be present in skeletal tissues. The authors present a case of a 50-year-old woman diagnosed with EH of the iliac bone and acetabulum, who experienced pathological fracture at presentation. This report describes a multidisciplinary approach to the management that includes initial incisional biopsy, curettage, and bone grafting, followed by Intensity Modulated Radiation Therapy. The patient finally underwent hemipelvic resection with allograft reconstruction after recurrence. Histopathological study revealed osseous EH of low mitotic activity that stained positively for CD31, CD34, vimentin, and Factor VIII. Herein, the authors discuss the imaging characteristics, histopathological aspects, cytogenetic findings, and the radiobiological behavior of osseous EH. After an aggressive multidisciplinary intervention, the patient is able to achieve local control with no evidence of distal metastatic disease.
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Boyaci B, Hornicek FJ, Nielsen GP, DeLaney TF, Pedlow FX, Mansfield FL, Carrier CS, Harms J, Schwab JH. Epithelioid hemangioma of the spine: a case series of six patients and review of the literature. Spine J 2013; 13:e7-13. [PMID: 24045160 DOI: 10.1016/j.spinee.2013.06.070] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 04/15/2013] [Accepted: 06/24/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Epithelioid hemangioma (EH) of bone is a benign vascular tumor that can be locally aggressive. It rarely arises in the spine, and the optimum management of EH of the vertebrae is not well delineated. PURPOSE The report describes our experience treating six patients with EH of the spine in an effort to document the treatment of the rare spinal presentation. STUDY DESIGN This study is designed as a retrospective cohort study. PATIENT SAMPLE A continuous series of patients with the diagnosis of EH of the spine who presented at our institution. OUTCOME MEASURES The clinical and radiographic follow-up of the patient population is documented. METHODS The Bone Sarcoma Registry at our institution was used to obtain a list of all patients diagnosed with EH of the spine. Medical records, radiographs, and pathology reports were retrospectively reviewed in all cases. Only biopsy-proven cases were included. RESULTS The six patients included five men and one woman who ranged in age from 20 to 58 years (with an average age of 40 years). The follow-up available for all six patients ranged from 6 to 115 (average 46.8) months. All patients presented with lytic vertebral body lesions. Five patients presented with pain secondary to their tumor, and the tumor in the sixth patient was found incidentally during the workup for a herniated disc. Three patients required surgical management for instability secondary to the destructive nature of their tumors, and two other patients required emergent decompression secondary to spinal cord compression by the tumor. The sixth patient was treated expectantly after biopsy confirmation. Three patients received postoperative radiation therapy as gross tumor remained after surgery. Three patients had gross total resections and did not receive postoperative radiation. Preoperative embolization was used in four patients. One patient continued to have back pain after surgery and radiation and another continued to have ataxia after surgery and radiation. No tumor locally recurred or progressed. CONCLUSIONS Our data suggest that EH of the spine can be locally aggressive and lead to instability and cord compression. Surgery is required in such instances; however, observation should be considered in patients without instability or cord compression.
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Affiliation(s)
- Bilal Boyaci
- Department of Orthopaedic Surgery, Klinikum Langensteinbach, Langensteinbach, Germany
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Active TGF-β signaling and decreased expression of PTEN separates angiosarcoma of bone from its soft tissue counterpart. Mod Pathol 2013; 26:1211-21. [PMID: 23599148 DOI: 10.1038/modpathol.2013.56] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 01/28/2013] [Accepted: 01/28/2013] [Indexed: 12/25/2022]
Abstract
Angiosarcomas constitute a heterogeneous group of highly malignant vascular tumors. Angiosarcoma of bone is rare and poorly characterized. For angiosarcoma of soft tissue, some pathways seem to be involved in tumor development. Our aim was to evaluate the role of these pathways in angiosarcoma of bone. We collected 37 primary angiosarcomas of bone and used 20 angiosarcomas of soft tissue for comparison. Immunohistochemistry was performed on constructed tissue microarrays to evaluate expression of CDKN2A, TP53, PTEN, BCL2, CDK4, MDM2, cyclin D1, β-catenin, transforming growth factor-β (TGF-β), CD105, phospho-Smad1, phospho-Smad2, hypoxia-inducible factor-1α, plasminogen activator inhibitor type 1 (PAI-1), VEGF, CD117 and glucose transporter--1. PIK3CA was screened for hotspot mutations in 19 angiosarcomas. In nearly 55% of the angiosarcoma of bone, the retinoblastoma (Rb) pathway was affected. Loss of CDKN2A expression was associated with a significantly worse prognosis. No overexpression of TP53 or MDM2 was found, suggesting that the TP53 pathway is not important in angiosarcoma of bone. Angiosarcoma of bone showed highly active TGF-β signaling with immunoreactivity for phospho-Smad2 and PAI-1. Although the phosphatidylinositol 3-kinase (PI3K)/Akt pathway seems to be active in both tumor groups, different mechanisms were involved: 41% of angiosarcoma of bone showed a decrease in expression of PTEN, whereas in angiosarcoma of soft tissue overexpression of KIT was found (90%). PIK3CA hotspot mutations were absent. In conclusion, the Rb pathway is involved in tumorigenesis of angiosarcoma of bone. The PI3K/Akt pathway is activated in both angiosarcoma of bone and soft tissue, however, with a different cause; PTEN expression is decreased in angiosarcoma of bone, whereas angiosarcomas of soft tissue show overexpression of KIT. Our findings support that angiosarcomas are a heterogeneous group of vascular malignancies. Both angiosarcoma of bone and soft tissue may benefit from therapeutic strategies targeting the PI3K/Akt pathway. However, interference with TGF-β signaling may be specifically relevant in angiosarcoma of bone.
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Mukherjee S, Mallick J, Pal PC, Chattopadhyay S. Hemangioendothelioma of soft tissue: Cytological dilemma in two cases at unusual sites. J Cytol 2013; 29:89-91. [PMID: 22438631 PMCID: PMC3307467 DOI: 10.4103/0970-9371.93241] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Hemangioendothelioma is a rare vascular tumor of intermediate malignancy. Cytologically, it can simulate a non-vascular malignant tumor. We report two cases of this tumor, which were misdiagnosed at cytology. In the first case, a 27-year-old man presented with an anterior abdominal wall tumor. Fine needle aspiration cytology (FNAC) of the tumor showed polygonal cells with vacuolated cytoplasm in clusters having moderate nuclear atypia in a background of necrosis. A diagnosis of metastatic carcinoma was made. The histological examination showed features of epithelioid hemangioendothelioma. In the second case, a 13-year-old female child presented with unilateral enlargement of the right tonsil. At ultrasound-guided FNAC, a diagnosis of, ‘small round cell tumor, could be consistent with alveolar rhabdomyosarcoma,’ was made. The histological examination showed features of papillary intralymphatic angioendothelioma (Dabska's tumor). We conclude that epithelioid hemangioendothelioma should be considered in the differential diagnosis of metastatic carcinoma and small round cell tumor even at unusual sites.
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Affiliation(s)
- Sumana Mukherjee
- Department of Pathology, Nil Ratan Sircar Medical College, 138, Acharya Jagdish Chandra Bose Road, Sealdah Kolkata, India
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Pseudomyogenic (epithelioid sarcoma-like) hemangioendothelioma: characterization of five cases. Skeletal Radiol 2013; 42:947-57. [PMID: 23381465 DOI: 10.1007/s00256-013-1577-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 10/30/2012] [Accepted: 01/06/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the imaging and histopathology of pseudomyogenic hemangioendothelioma. MATERIALS AND METHODS Five cases of pseudomyogenic hemangioendothelioma, which presented over the last 5 years, were retrieved from the files of the Royal National Orthopaedic Hospital. The imaging and histopathology were reviewed in all cases. Magnetic resonance imaging, which was available from all cases, was assessed for the following features: the number of lesions, location in soft tissue (superficial and or deep/subfascial) and bone, and the signal characteristics and morphology of individual lesions. Immunohistochemistry was performed in all cases to characterize the lesions. RESULTS Four of the five patients had multiple lesions involving a single limb. Bone was involved in 3 of the 5 individuals. All tumors diffusely expressed ERG and cytokeratins AE1/3, but not MNF116. CD31 was weakly positive in 4 cases. INI-1 expression was retained in all cases. Imaging features included ill-defined, infiltrative lesions in subcutaneous fat with extension to the adjacent skin, poor- to well-defined intramuscular nodules and predominantly intracortical focal bone lesions with rare medullary involvement. CONCLUSION Pseudomyogenic hemangioendothelioma represents a distinct recently characterized tumor type presenting in young adults, with a tendency towards multicentric bone and soft tissue involvement.
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Gaur S, Torabi A, O'Neill TJ. Activity of angiogenesis inhibitors in metastatic epithelioid hemangioendothelioma: a case report. Cancer Biol Med 2013; 9:133-6. [PMID: 23691469 PMCID: PMC3643649 DOI: 10.3969/j.issn.2095-3941.2012.02.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 05/10/2012] [Indexed: 12/27/2022] Open
Abstract
This report describes a patient with metastatic epithelioid hemangioendothelioma treated with bevacizumab and nanoparticle albumin-bound paclitaxel. The treatment was well tolerated and led to the stabilization of an aggressive variant of the disease. This case report is the first one that describes the activity of the combination of chemotherapy and bevacizumab in epithelioid hemangioendothelioma. Literature describing the activity of bevacizumab and other agents (thalidomide, lenalidomide, and interferon) believed to possess anti-angiogenic activities is also reviewed.
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Affiliation(s)
- Sumit Gaur
- Divisions of Hematology-Oncology, Texas Tech University Health Science Center, TX 79905, USA
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Errani C, Vanel D, Gambarotti M, Alberghini M, Picci P, Faldini C. Vascular bone tumors: a proposal of a classification based on clinicopathological, radiographic and genetic features. Skeletal Radiol 2012; 41:1495-507. [PMID: 22993209 DOI: 10.1007/s00256-012-1510-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 06/21/2012] [Accepted: 08/19/2012] [Indexed: 02/02/2023]
Abstract
The classification of vascular bone tumors remains challenging, with considerable morphological overlap spanning across benign to malignant categories. The vast majority of both benign and malignant vascular tumors are readily diagnosed based on their characteristic histological features, such as the formation of vascular spaces and the expression of endothelial markers. However, some vascular tumors have atypical histological features, such as a solid growth pattern, epithelioid change, or spindle cell morphology, which complicates their diagnosis. Pathologically, these tumors are remarkably similar, which makes differentiating them from each other very difficult. For this rare subset of vascular bone tumors, there remains considerable controversy with regard to the terminology and the classification that should be used. Moreover, one of the most confusing issues related to vascular bone tumors is the myriad of names that are used to describe them. Because the clinical behavior and, consequently, treatment and prognosis of vascular bone tumors can vary significantly, it is important to effectively and accurately distinguish them from each other. Upon review of the nomenclature and the characteristic clinicopathological, radiographic and genetic features of vascular bone tumors, we propose a classification scheme that includes hemangioma, hemangioendothelioma, angiosarcoma, and their epithelioid variants.
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Affiliation(s)
- Costantino Errani
- Ortopedia Generale, Orthopaedic Service, Istituto Ortopedico Rizzoli, Rizzoli-Sicilia, Bagheria, Italy.
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Errani C, Zhang L, Panicek DM, Healey JH, Antonescu CR. Epithelioid hemangioma of bone and soft tissue: a reappraisal of a controversial entity. Clin Orthop Relat Res 2012; 470:1498-506. [PMID: 21948309 PMCID: PMC3314752 DOI: 10.1007/s11999-011-2070-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 08/26/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND The controversy surrounding diagnosis of an epithelioid hemangioma (EH), particularly when arising in skeletal locations, stems not only from its overlapping features with other malignant vascular neoplasms, but also from its somewhat aggressive clinical characteristics, including multifocal presentation and occasional lymph node involvement. Specifically, the distinction from epithelioid hemangioendothelioma (EHE) has been controversial. The recurrent t(1;3)(p36;q25) chromosomal translocation, resulting in WWTR1-CAMTA1 fusion, recently identified in EHE of various anatomic sites, but not in EH or other epithelioid vascular neoplasms, suggests distinct pathogeneses. QUESTION/PURPOSES We investigated the clinicopathologic and radiologic characteristics of bone and soft tissue EHs in patients treated at our institution with available tissue for molecular testing. PATIENTS AND METHODS Seventeen patients were selected after confirming the pathologic diagnosis and fluorescence in situ hybridization analysis for the WWTR1 and/or CAMTA1 rearrangements. Four patients had multifocal presentation. Most patients with EH of bone were treated by intralesional curettage. None of the patients died of disease and only four patients had a local recurrence. RESULTS Our results, using molecular testing to support the pathologic diagnosis of EH, reinforce prior data that EH is a benign lesion characterized by an indolent clinical course with an occasional multifocal presentation and rare metastatic potential to locoregional lymph nodes. CONCLUSION These findings highlight the importance of distinguishing EH from other malignant epithelioid vascular tumors as a result of differences in their management and clinical outcome. LEVEL OF EVIDENCE Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Bone Neoplasms/diagnosis
- Bone Neoplasms/genetics
- Calcium-Binding Proteins/genetics
- Chromosomes, Human, Pair 1
- Chromosomes, Human, Pair 3
- DNA, Neoplasm/analysis
- Diagnosis, Differential
- Female
- Gene Fusion
- Hemangioendothelioma, Epithelioid/diagnosis
- Hemangioendothelioma, Epithelioid/genetics
- Humans
- In Situ Hybridization, Fluorescence
- Intracellular Signaling Peptides and Proteins/genetics
- Male
- Middle Aged
- Soft Tissue Neoplasms/diagnosis
- Soft Tissue Neoplasms/genetics
- Trans-Activators/genetics
- Transcription Factors
- Transcriptional Coactivator with PDZ-Binding Motif Proteins
- Translocation, Genetic
- Vascular Neoplasms/diagnosis
- Vascular Neoplasms/genetics
- Young Adult
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Affiliation(s)
- Costantino Errani
- Department of Surgery, Memorial Sloan-Kettering Cancer Center,
New York, NY USA
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - Lei Zhang
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - David M. Panicek
- Department of Radiology, Memorial Sloan-Kettering Cancer Center,
New York, NY USA
| | - John H. Healey
- Department of Surgery, Memorial Sloan-Kettering Cancer Center,
New York, NY USA
| | - Cristina R. Antonescu
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
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Kerry G, Marx O, Kraus D, Vogel M, Kaiser A, Ruedinger C, Steiner HH. Multifocal epithelioid hemangioendothelioma derived from the spine region: case report and literature review. Case Rep Oncol 2012; 5:91-8. [PMID: 22539920 PMCID: PMC3337738 DOI: 10.1159/000336947] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor with malignant biological behavior. It arises from endothelial cells, usually within soft tissues, and can occur in almost all locations. Case Report We report a unique case of a 25-year-old man who presented with sudden attacks of severe back pain followed by acute non-traumatic paraplegia. Emergency diagnostics revealed a pathologic fracture of the T7 vertebra with tumor tissue invasion of the spinal canal. Furthermore, multifocal metastases were found. Results To achieve en bloc resection, interdisciplinary surgical approaches were indicated. Despite multimodal therapy concepts, including radiotherapy and chemotherapy as well as endovascular embolization, the patient died within 8 weeks. Conclusion Prognosis of EHE is unpredictable and mainly determined by its location. The lesions are potentially aggressive; therefore, en bloc resection should be attempted whenever possible. However, as shown in the literature, only 15% of patients are suitable for total resection.
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Affiliation(s)
- G Kerry
- Department of Neurosurgery, Klinikum Nuernberg, Nuremberg, Germany
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Abstract
Epithelioid hemangioma is a rare tumor that can have bone involvement. Its clinically and radiographically aggressive appearance mimics a malignant neoplasm. Although epitheliod hemangioma has been described as having an aggressive appearance on magnetic resonance imaging (MRI) and plain radiographs, this is the first reported case of pathologic fracture associated with this lesion to our knowledge. This article describes a case of epithelioid hemangioma involving the distal humerus, which initially presented with progressive pain and fracture of the lateral condyle. The aggressive appearance on plain radiographs and MRI suggested a malignant bone tumor. This preliminary diagnosis was confirmed due to the presence of local lymph node spread on positron emission tomography/computed tomography. After a core needle biopsy revealed nondiagnostic tissue, rather than performing a wide resection based on a presumptive malignant diagnosis, we followed the standard diagnostic algorithm and performed an open biopsy with temporary internal stabilization. The tissue sample was adequate and revealed a diagnosis of epithelioid hemangioma. Based on this finding, we were able to proceed with surgical management, including curettage of the lesion, placement of a bone graft, and internal fixation, rather than a wide resection with elbow joint replacement. This article emphasizes the need for careful adherence to the diagnostic algorithm for musculoskeletal tumors. In doing so, a definitive diagnosis was reached, and our patient was able to resume his occupation as a laborer without the restrictions that would have accompanied elbow arthroplasty.
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Gómez-Arellano LI, Ferrari-Carballo T, Domínguez-Malagón HR. Multicentric epithelioid hemangioendothelioma of bone. Report of a case with radiologic-pathologic correlation. Ann Diagn Pathol 2011; 16:43-7. [PMID: 22154336 DOI: 10.1016/j.anndiagpath.2011.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 08/03/2011] [Indexed: 11/26/2022]
Abstract
Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor of uncertain biologic behavior. Most cases come out as a single lesion of the soft tissue but also may appear in the lung, liver, and other locations. Epithelioid hemangioendothelioma of bone is an extremely rare tumor and more prevalent in the second and third decades of life; its behavior is uncertain, it most commonly is unifocal, and it affects preferentially lower extremities. In this work, we present the clinical, radiologic, and pathologic findings of a 19-year-old man with a multicentric EHE of bone that involved 3 vertebrae and developed lung metastasis.
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Pakos EE, Grimer RJ, Peake D, Spooner D, Carter SR, Tillman RM, Abudu S, Jeys L. The ‘other’ bone sarcomas. ACTA ACUST UNITED AC 2011; 93:1271-8. [DOI: 10.1302/0301-620x.93b9.27166] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We aimed to identify the incidence, outcome and prognostic factors associated with spindle cell sarcomas of bone (SCSB). We studied 196 patients with a primary non-metastatic tumour treated with the intent to cure. The results were compared with those of osteosarcoma patients treated at our hospital during the same period. The overall incidence of SCSB was 7.8% of all patients with a primary bone sarcoma. The five- and ten-year survival rates were 67.0% and 60.0%, respectively, which were better than those of patients with osteosarcoma treated over the same period. All histological subtypes had similar outcomes. On univariate analysis, factors that were significantly associated with decreased survival were age > 40 years, size > 8 cm, the presence of a pathological fracture, amputation, involved margins and a poor response to pre-operative chemotherapy. Multivariate analyses showed that age > 65 years, amputation and involved margins were all statistically significant prognostic factors. Involved margins and poor response to pre-operative chemotherapy were associated with an increased risk of local recurrence. SCSB has a better prognosis than osteosarcoma when matched for age. Most prognostic factors for osteosarcoma also seem to apply to SCSB. Patients with SCSB should be treated in the same way as patients of the same age with osteosarcoma.
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Affiliation(s)
- E. E. Pakos
- University of Ioannina, P.O. Box 1186, 45110 Ioannina, Greece
| | - R. J. Grimer
- University Hospital, Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK
| | - D. Peake
- University Hospital, Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK
| | - D. Spooner
- University Hospital, Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK
| | - S. R. Carter
- Royal Orthopaedic Hospital, Department of Oncology, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
| | - R. M. Tillman
- Royal Orthopaedic Hospital, Department of Oncology, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
| | - S. Abudu
- Royal Orthopaedic Hospital, Department of Oncology, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
| | - L. Jeys
- Royal Orthopaedic Hospital, Department of Oncology, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
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Errani C, Zhang L, Shao SY, Hajdu M, Singer S, Maki RG, Healey JH, Antonescu CR. A novel WWTR1-CAMTA1 gene fusion is a consistent abnormality in epithelioid hemangioendothelioma of different anatomic sites. Genes Chromosomes Cancer 2011; 50:644-53. [PMID: 21584898 PMCID: PMC3264678 DOI: 10.1002/gcc.20886] [Citation(s) in RCA: 343] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 04/04/2011] [Indexed: 12/11/2022] Open
Abstract
The classification of epithelioid vascular tumors remains challenging, as there is considerable morphological overlap between tumor subtypes, across the spectrum from benign to malignant categories. A t(1;3)(p36.3;q25) translocation was reported in two cases of epithelioid hemangioendothelioma (EHE), however, no follow-up studies have been performed to identify the gene fusion or to assess its prevalence in a larger cohort of patients. We undertook a systematic molecular analysis of 17 EHE, characterized by classic morphological and immunophenotypic features, from various anatomical locations and with different malignant potential. For comparison, we analyzed 13 epithelioid hemangiomas, five epithelioid angiosarcomas, and four epithelioid sarcoma-like EHE. A fluorescence in situ hybridization (FISH) positional cloning strategy, spanning the cytogenetically defined regions on chromosomes 1p36.3 and 3q25, confirmed rearrangements in two candidate genes from these loci in all EHE cases tested. None of the other benign or malignant epithelioid vascular tumors examined demonstrated these abnormalities. Subsequent reverse transcription-polymerase chain reaction (RT-PCR) confirmed in three EHE the WWTR1-CAMTA1 fusion product. CAMTA1 and WWTR1 have been previously shown to play important roles in oncogenesis. Our results demonstrate the presence of a WWTR1-CAMTA1 fusion in all EHE tested from bone, soft tissue, and visceral location (liver, lung) in keeping with a unique and specific pathological entity. Thus, FISH or RT-PCR analysis for the presence of WWTR1-CAMTA1 fusion may serve as a useful molecular diagnostic tool in challenging diagnoses.
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Affiliation(s)
- Costantino Errani
- Department of Pathology, Sloan-Kettering Cancer Center, New York, NY, USA
- Department of Orthopaedic Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
- Visiting Research Fellow from the Musculoskeletal Oncology Department, Istituto Ortopedico Rizzoli, Via Pupilli nr. 1, Bologna, Italy
| | - Lei Zhang
- Department of Pathology, Sloan-Kettering Cancer Center, New York, NY, USA
| | - Sung Yun Shao
- Department of Pathology, Sloan-Kettering Cancer Center, New York, NY, USA
| | - Mihai Hajdu
- Department of Pathology, Sloan-Kettering Cancer Center, New York, NY, USA
| | - Samuel Singer
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Robert G Maki
- Department of Medicine/Pediatrics, Mount Sinai School of Medicine, New York, NY, USA
| | - John H Healey
- Department of Orthopaedic Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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68
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Calderaro J, Guedj N, Dauzac C, Wassef M, Guigui P, Bedossa P. [A case of epithelioid hemangioma of the spine]. Ann Pathol 2011; 31:312-5. [PMID: 21839359 DOI: 10.1016/j.annpat.2011.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 04/17/2011] [Accepted: 05/08/2011] [Indexed: 10/17/2022]
Abstract
Epithelioid hemangioma is a rare and benign vascular tumor, most often occurring in the skin. Numerous other localizations, including bones, have been reported. The overall favorable clinical outcome of cutaneous epithelioid hemangioma is now well documented, but it still remains debated in osseous localization, as local recurrences and metastases have been described. We report a case of epithelioid hemangioma of the spine occurring in a 25-year-old male, and discuss main differential diagnoses. Recent studies tend to demonstrate that osseous epithelioid hemangioma, as cutaneous epithelioid hemangioma, should be considered as a benign tumor. Histologically, epithelioid hemangioma consists of a vascular proliferation with diffuse or lobular pattern and features vascular spaces lined by epitheliod endothelial cells with numerous lymphocytes and eosinophils. The main differential diagnosis is represented by epithelioid hemangioendothelioma, the surgical treatment of which must be more aggressive. Precise histological diagnosis is essential for accurate clinical management and to avoid overtreatment.
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Affiliation(s)
- Julien Calderaro
- Service d'anatomie et cytologie pathologiques, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France
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69
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Ma J, Wang L, Mo W, Yang X, Xiao J. Epithelioid hemangioendotheliomas of the spine: clinical characters with middle and long-term follow-up under surgical treatments. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 20:1371-6. [PMID: 21512841 DOI: 10.1007/s00586-011-1798-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Revised: 03/03/2011] [Accepted: 04/08/2011] [Indexed: 01/04/2023]
Abstract
Epithelioid hemangioendothelioma, an aggressive vascular tumor has the rarity of morbidity that arises in the spine. There were few cases reported in literatures in recent years, and little was known about this disease. A review study of the patient files in our constitutions between 1996 and 2006 showed that five patients were treated for spinal epithelioid hemangioendothelioma. Although only five patients, this study attempts to bring more informations about this rare lesion. This patient group included two males and three females. The lesions located in the cervical (case 1) or thoracic (case 2-4) or lumbar spine (case 5). Treatments included: laminectomy and cytoreductive surgery followed by external beam irradiation (one patient), expanded resection in piece meal with postoperative external beam irradiation (three patients), and total en bloc resection alone (one patient). Reconstruction of the spinal stability was performed in four patients. Follow-up period ranged from 25 to 72 months, averaged 47.4 months. The neurologic function of patients got a satisfactory progress except the paraplegic patient at diagnosis. The patient who received laminectomy and cytoreductive surgery followed by external beam irradiation still presented with tumor local progress, metastasis, and she died at 34 months after operation. No local recurrence or distant metastasis was detected in the other four patients. Epithelioid hemangioendothelioma of the spine is so rare in clinic as a primary aggressive vascular tumor. Based on our experience, a valid expanded resection of the tumor with adjunct radiation therapy or total en bloc excision may present with acceptable results.
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Affiliation(s)
- Junming Ma
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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70
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Arena V, Pennacchia I, Carbone A, Vecchio FM. Epithelioid hemangioendothelioma of the bone and intestinal infarction: an unusual association. Colorectal Dis 2011; 13:e69-70. [PMID: 21054745 DOI: 10.1111/j.1463-1318.2010.02486.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- V Arena
- Institute of Pathology, Catholic University of the Sacred Heart, Rome, Italy.
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71
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Verbeke SLJ, Bertoni F, Bacchini P, Sciot R, Fletcher CDM, Kroon HM, Hogendoorn PCW, Bovée JVMG. Distinct histological features characterize primary angiosarcoma of bone. Histopathology 2011; 58:254-64. [DOI: 10.1111/j.1365-2559.2011.03750.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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72
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Liu Q, Miao J, Lian K, Huang L, Ding Z. Multicentric epithelioid hemangioendothelioma involving the same lower extremity: a case report and review of literature. Int J Med Sci 2011; 8:558-63. [PMID: 21960748 PMCID: PMC3180772 DOI: 10.7150/ijms.8.558] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Accepted: 09/12/2011] [Indexed: 11/19/2022] Open
Abstract
Epithelioid hemangioendothelioma (EH) is an uncommon low-grade malignant soft-tissue tumor; no case has been previously reported where multicentric epithelioid hemangioendothelioma occurred in the same lower extremity at different sites. We report a case involving the common peroneal nerve and subsequently the long bone and the short bones of the same lower extremity, and also review the literature. After establishing case of several lesions, we reviewed the histopathology properly and followed up the patient for a long time with serial whole body assessment to pick up any subsequent lesions.
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Affiliation(s)
- Qingjun Liu
- Department of Orthopaedic Surgery, the Affiliated Southeast Hospital of Xiamen University, Orthopaedic Trauma Center of PLA, Zhangzhou, 363000, PR China
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73
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Thevenin F, Feydy A, Drapé JL, Anract P, Guerini H, Campagna R, Pluot E, Larousserie F. [Intraosseous epitheloid hemangioma of the femur]. ACTA ACUST UNITED AC 2010; 91:1158-60. [PMID: 21178882 DOI: 10.1016/s0221-0363(10)70164-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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74
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Contreras Ibáñez J, Muriel Cueto P, Cano Gómez C. Angiosarcoma epitelioide vertebral primario. Rev Esp Cir Ortop Traumatol (Engl Ed) 2010. [DOI: 10.1016/j.recot.2010.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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75
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Contreras Ibáñez J, Muriel Cueto P, Cano Gómez C. Primary spinal epitheliod angiosarcoma. Rev Esp Cir Ortop Traumatol (Engl Ed) 2010. [DOI: 10.1016/s1988-8856(10)70267-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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76
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Gill R, O'Donnell RJ, Horvai A. Utility of immunohistochemistry for endothelial markers in distinguishing epithelioid hemangioendothelioma from carcinoma metastatic to bone. Arch Pathol Lab Med 2009; 133:967-72. [PMID: 19492891 DOI: 10.5858/133.6.967] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2008] [Indexed: 11/06/2022]
Abstract
CONTEXT Epithelioid hemangioendothelioma (EHE) is a rare vascular neoplasm of intermediate malignancy. Epithelioid hemangioendothelioma often presents a difficult diagnostic problem, especially in bone, because the epithelioid morphology and radiographic features raise the possibility of metastatic carcinoma. The current trend of small biopsies obtained with computed tomography-guided techniques exacerbates the problem. The markedly different treatment for EHE and metastatic carcinoma underscores the need for specific markers that can differentiate between these 2 entities. OBJECTIVE To determine the relative utility of endothelial markers in differentiating EHE from metastatic carcinoma, with emphasis on bone biopsies. DESIGN We used immunohistochemistry in formalin-fixed paraffin-embedded tissue to compare the utility of Fli-1, CD34, CD31, podoplanin, and keratin cocktail in 13 EHEs and 13 morphologically similar carcinomas metastatic to bone. Immunohistochemical data were evaluated using Fisher exact test, and specificity and sensitivity were calculated. RESULTS Significant proportions of EHEs were positive for Fli-1 (100%), CD34 (85%), and CD31 (100%) compared with metastatic carcinoma (Fli-1, 15%; CD34, 15%; CD31, 38%) (P < .001, P = .005, and P = .01, respectively). However, these markers were not 100% specific for EHE. Cytokeratin cocktail stained significantly more metastatic carcinomas (100%) than EHEs (38%) (P = .01) but was not 100% specific. No significant difference was observed regarding immunostaining for podoplanin between the tumor types. CONCLUSIONS Fli-1 is most helpful in distinguishing EHE from metastatic carcinoma. However, the absence of complete specificity of any of the endothelial markers for EHE, or of keratin cocktail for carcinoma, suggests that these markers are best used in combination.
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Affiliation(s)
- Ryan Gill
- Department of Laboratory Medicine, University of California, San Francisco, USA
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77
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Abstract
The clinical and pathologic features of 50 epithelioid hemangiomas of bone are analyzed. There were 29 males and 21 females who ranged in age from 10 to 75 (mean 35) years. The tumors arose in long tubular bones (40%), short tubular bones of the distal lower extremity (18%), flat bones (18%), vertebrae (16%), and small bones of the hands (8%). Nine patients (18%) had involvement of more than 1 bone. Radiographically, the lesions were lucent and well marginated. Microscopically, the neoplasms had a lobular architecture and were composed of epithelioid endothelial cells that formed obvious vascular lumina or grew in solid sheets. No hyalinized or solid appearing extracellular myxoid matrix was present. Thirty-five patients were treated with curettage, 13 patients had a local resection and 2 patients only had a biopsy. One patient had local lymph node involvement. Three patients were treated with surgery and radiation therapy. Follow-up information revealed that 4 patients experienced a local recurrence; and 1 patient developed limited involvement of a regional lymph node. Epithelioid hemangioma of bone is a benign lesion that may be multifocal and affect separate tissue and is successfully treated with curettage or marginal en bloc excision.
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78
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Vascular lesions of bone in children, adolescents, and young adults. A clinicopathologic reappraisal and application of the ISSVA classification. Virchows Arch 2008; 454:161-79. [DOI: 10.1007/s00428-008-0709-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Revised: 11/10/2008] [Accepted: 11/19/2008] [Indexed: 10/21/2022]
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79
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Ortiz J, Villabona C, Bengoechea O, Gómez Alfonso FJ, Villabona V, Bullón A. Primary epithelioid angiosarcoma of the thyroid: an infrequent malignant thyroid tumor. ACTA ACUST UNITED AC 2008; 55:181-3. [PMID: 22975456 DOI: 10.1016/s1575-0922(08)70661-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Accepted: 11/26/2007] [Indexed: 11/28/2022]
Abstract
We present a case of epithelioid angiosarcoma of the thyroid, a rare and aggressive tumor, in a 74-year-old woman with a chronic euthyroid goiter. The tumor, which involved most of the glandular surface of the thyroid, showed an infiltrating histological pattern, with epithelioid cells displaying a tendency to form vascular lights. Immunohistochemical analysis (CD31 and factor VIII) confirmed the angiomatous nature of the neoplasm and enabled us to establish the differential diagnosis with other malignant processes that can also affect this anatomical area.
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Affiliation(s)
- Javier Ortiz
- Servicio de Anatomía Patológica. Hospital Universitario de Salamanca. Salamanca. España.
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80
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Koch M, Nielsen GP, Yoon SS. Malignant tumors of blood vessels: angiosarcomas, hemangioendotheliomas, and hemangioperictyomas. J Surg Oncol 2008; 97:321-9. [PMID: 18286475 DOI: 10.1002/jso.20973] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Sarcomas that arise from or resemble the components of blood vessels are uncommon and include angiosarcomas, hemangioendotheliomas, and hemangiopericytomas. This article reviews the management of these three types of sarcomas. Diagnosis can sometimes be difficult, with the diagnosis of hemangiopericytoma versus solitary fibrous tumor currently in debate. Each of these sarcomas subtypes has certain unique clinical traits. The mainstay of treatment is surgical resection, sometimes combined with radiation therapy. Adjuvant chemotherapy is unproven but can be considered. For patients with advanced disease, various chemotherapeutic regimens may result in meaningful responses in a minority of patients.
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Affiliation(s)
- Moritz Koch
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
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81
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The place of liver transplantation in the treatment of hepatic epitheloid hemangioendothelioma: report of the European liver transplant registry. Ann Surg 2008; 246:949-57; discussion 957. [PMID: 18043096 DOI: 10.1097/sla.0b013e31815c2a70] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatic epitheloid hemangioendothelioma (HEHE) is a rare low-grade vascular tumor. Its treatment algorithm is still unclear mainly due to a lack of larger clinical experiences with detailed long-term follow-up. MATERIAL AND METHODS Fifty-nine patients, reported to the European Liver Transplant Registry, were analyzed to define the role of liver transplantation (LT) in the treatment of this disease. Eleven (19%) patients were asymptomatic. Eighteen (30.5%) patients had pre-LT surgical [hepatic (7 patients) and extrahepatic (3 patients)] and/or systemic or locoregional (10 patients) medical therapy. Ten (16.9%) patients had extrahepatic disease localization before or at the time of LT. Follow-up was complete for all patients with a median of 92.5 (range, 7-369) from moment of diagnosis and a median of 78.5 (range, 1-245) from the moment of LT. RESULTS HEHE was bilobar in 96% of patients; 86% of patients had more than 15 nodules in the liver specimen. Early (<3 months) and late (>3 months) post-LT mortality was 1.7% (1 patient) and 22% (14 patients). Fourteen (23.7%) patients developed disease recurrence after a median time of 49 months (range, 6-98). Nine (15.3%) patients died of recurrent disease and 5 are surviving with recurrent disease. One-, 5-, and 10- year patient survival rates from moment of transplantation for the whole series are 93%, 83%, 72%. Pre-LT tumor treatment (n = 18) (89%, 89%, and 68% 1-, 5-, and 10-year survival rates from moment of LT vs. 95%, 80%, and 73% in case of absence of pre-LT treatment), lymph node (LN) invasion (n = 18) (96%, 81%, and 71% 1-, 5-, and 10-year survival rates vs. 83%, 78%, and 67% in node negative patients) and extrahepatic disease localization (n = 10) (90%, 80%, and 80% 1-, 5-, and 10-year survival rates vs. 94%, 83%, and 70% in case of absence of extrahepatic disease) did not significantly influence patient survival whereas microvascular (n = 24) (96%, 75%, 52% 1-, 5-, and 10-year survival vs. 96%, 92%, 85% in case of absence of microvascular invasion) and combined micro- and macrovascular invasion (n = 28) (90%, 72%, and 54% 1-,5-, and 10-year survival vs. 96%, 92%, and 85% in case of absence of vascular invasion, P = 0.03) did. Disease-free survival rates at 1, 5, and 10 years post-LT are 90%, 82%, and 64%. Disease-free survival is not significantly influenced by pre-LT treatment, LN status, extrahepatic disease localization, and vascular invasion. CONCLUSIONS The results of the largest reported transplant series in the treatment of HEHE are excellent. Preexisting extrahepatic disease localization as well as LN involvement are not contraindications to LT. Microvascular or combined macro-microvascular invasion significantly influence survival after LT. LT therefore should be offered as a valid therapy earlier in the disease course of these, frequently young, patients. Recurrent (allograft) disease should be treated aggressively as good long-term survivals can be obtained. Long-term prospective follow-up multicenter studies as well as the evaluation of antiangiogenic drugs are necessary to further optimize the treatment of this rare vascular hepatic disorder.
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82
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Shivaram GM, Pai RK, Ireland KB, Stevens KJ. Temporal progression of skeletal cystic angiomatosis. Skeletal Radiol 2007; 36:1199-204. [PMID: 17912518 DOI: 10.1007/s00256-007-0378-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Revised: 07/31/2007] [Accepted: 08/14/2007] [Indexed: 02/02/2023]
Abstract
Cystic angiomatosis is a rare, benign, multifocal disorder of bone and viscera, in which angiomatous deposits of both vascular and lymphatic elements result in bone lysis and organ dysfunction. We report on a case of late-onset cystic angiomatosis in a Caucasian woman who first presented at age 35 years with a lytic expansile lesion of the proximal humerus, initially diagnosed as low-grade hemangio-endothelioma. This was treated with injection of cement and prophylactic pinning. However, the lesion continued to grow, and, 5 years later, she was discovered to have disseminated bony involvement, initially thought to represent metastatic disease. However, further investigation revealed a diagnosis of cystic angiomatosis, and the patient was treated with bisphosphonates. Follow-up over a 15-year period since her initial presentation at age 35 years has shown osteosclerotic conversion of many of the lesions, with development of numerous pathologic stress fractures that have failed to heal, despite operative intervention.
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Affiliation(s)
- Giridhar M Shivaram
- Department of Radiology, Stanford University School of Medicine, Room S-062A, Grant Building, 300 Pasteur Drive, Stanford, CA 94305-5105, USA
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83
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Maclean FM, Schatz J, McCarthy SW, Scolyer RA, Stalley P, Bonar SF. Epithelioid and spindle cell haemangioma of bone. Skeletal Radiol 2007; 36 Suppl 1:S50-7. [PMID: 16688448 DOI: 10.1007/s00256-006-0135-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2005] [Revised: 03/10/2006] [Accepted: 03/28/2006] [Indexed: 02/02/2023]
Abstract
A case of epithelioid and spindle cell haemangioma of bone occurring in the proximal femur is presented. The tumour had typical microscopic features with a striking lobular pattern comprising spindled and epithelioid areas with admixed inflammatory cells. The case represents only the eighth reported example of this rare tumour, which appears to fit in the spectrum of epithelioid haemangioma. This is the first case to involve the proximal portion of a long bone. A review of the classification and features of similar vascular tumours of bone is presented.
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Affiliation(s)
- Fiona M Maclean
- Douglass Hanly Moir Pathology, 95 Epping Road, Macquarie Park 2113, Australia.
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84
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Abraham JA, Hornicek FJ, Kaufman AM, Harmon DC, Springfield DS, Raskin KA, Mankin HJ, Kirsch DG, Rosenberg AE, Nielsen GP, Desphpande V, Suit HD, DeLaney TF, Yoon SS. Treatment and outcome of 82 patients with angiosarcoma. Ann Surg Oncol 2007; 14:1953-67. [PMID: 17356953 DOI: 10.1245/s10434-006-9335-y] [Citation(s) in RCA: 204] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2006] [Accepted: 12/07/2006] [Indexed: 12/20/2022]
Abstract
BACKGROUND Angiosarcomas are an uncommon type of malignancy that are generally thought to behave usually in a locally aggressive fashion; they often metastasize to distant sites. METHODS Patients with a diagnosis of angiosarcoma treated at our institution between 1980 and 2006 were analyzed for patient demographics, tumor characteristics, multimodality treatment, and outcomes. RESULTS A total of 82 patients were divided into those with primary and advanced disease. Overall, the median age was 65 (range, 22-91) years, and 44% of patients were women. Median size of tumors was 3.8 cm, and 76% of tumors were intermediate or high grade. Tumors were located throughout the body: 32 cutaneous, 22 deep soft tissues or organs, 10 radiation or lymphedema field, 8 bone, and 7 nonirradiated breast. Of 46 patients with primary disease, all patients underwent surgical resection, 67% received radiotherapy, and 27% received chemotherapy. Five-year disease-specific survival was 60%, and negative prognostic factors included intermediate or high grade, and tumors arising in a radiated or lymphedema field. Of 36 patients with advanced disease, 36% underwent a palliative operation, 78% received radiation, and 58% received chemotherapy. Median survival was just 7.3 months, and cutaneous tumors predicted a better prognosis compared with other sites. CONCLUSIONS Primary angiosarcomas treated with aggressive surgical resection and the addition of radiation for close margins or worrisome pathologic features can result in long-term survival in most patients. The role of adjuvant chemotherapy is unclear. Patients with advanced disease have a poor prognosis, but there can be dramatic responses to chemotherapy in a minority of patients.
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Affiliation(s)
- John A Abraham
- Orthopedic Oncology, Department of Orthopedics, Massachusetts General Hospital, Yawkey 7B-7926, 55 Fruit Street, Boston, Massachusetts 02114, USA
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85
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Abstract
AbstractContext.—Epithelioid and epithelial neoplasms seen in bone are rare and include epithelioid variants of vascular lesions, osteoblastoma, osteosarcoma, chordoma, and chondroblastoma as well as adamantinoma and metastatic carcinoma.Objective.—To provide an overview of tumors with epithelioid histology and address the clinical context and diagnostic issues.Data Sources.—Pertinent literature is reviewed with emphasis on recent and controversial issues.Conclusions.—The differential diagnosis in epithelioid/ epithelial lesions of bone is limited. The primary consideration in many cases is distinguishing primary from metastatic lesions.
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Affiliation(s)
- Andrea T Deyrup
- Department of Pathology, Emory University, Atlanta, GA, USA.
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86
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Chirieac LR, Rice DC, Raymond AK. Epithelioid hemangioendothelioma in a patient with unusual involvement of the rib and intercostal lymph nodes. J Thorac Cardiovasc Surg 2007; 132:1488-9. [PMID: 17140992 DOI: 10.1016/j.jtcvs.2006.07.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2006] [Revised: 06/23/2006] [Accepted: 07/12/2006] [Indexed: 12/19/2022]
Affiliation(s)
- Lucian R Chirieac
- Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, Tex, USA.
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87
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Kimura T, Mukai M, Kaneko Y, Hirakata M, Okamoto S, Sakamoto M, Okada Y, Ikeda Y. Unusual hemangioendothelioma of the liver with epithelioid morphology associated with marked eosinophilia: Autopsy case. Pathol Int 2006; 56:694-701. [PMID: 17040294 DOI: 10.1111/j.1440-1827.2006.02032.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Vascular neoplasms characterized by epithelioid endothelial cells consist of several different entities from benignity to high-grade malignancy. Because of histological overlap between them, there is substantial difficulty in classifying them correctly. The present patient, a 33-year-old man, presented with hepatomegaly, striking eosinophilia and elevated serum interleukin-5 level. Biopsy and autopsy revealed an unusual epithelioid vascular tumor in the liver, which is histologically distinct from epithelioid hemangioma, epithelioid hemangioendothelioma, or epithelioid angiosarcoma. The tumor cells had vasoformative and partly solid growth with no severe nuclear atypia and very low mitotic activity, and the histological features were similar to those of the entity recognized as hemangioendothelioma of bone. Organs other than the liver, for example the testes and bone, were also involved. This tumor should be considered in the differential diagnosis of severe eosinophilia.
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Affiliation(s)
- Tokuhiro Kimura
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
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88
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Gupta A, Saifuddin A, Briggs TWR, Flanagan AM. Subperiosteal hemangioendothelioma of the femur. Skeletal Radiol 2006; 35:793-6. [PMID: 16421750 DOI: 10.1007/s00256-005-0060-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2005] [Revised: 11/02/2005] [Accepted: 11/08/2005] [Indexed: 02/02/2023]
Abstract
Primary neoplastic vascular lesions of bone are rare, and include haemangiomas, haemangioendothelioma, epithelioid haemangioendothelioma and angiosarcoma. These lesions may be multicentric, and when they involve bone are typically intraosseous and lytic. Radiological findings are not always specific. We report a case of haemangioendothelioma localised to the subperiosteum of the femur, a site not previously described for this lesion. The nomenclature for vascular neoplasms in bone is discussed.
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Affiliation(s)
- Ajay Gupta
- Department of Orthopaedic Oncology, The Royal National Orthopaedic Hospital NHS Trust, HA7 4LP, Stanmore, Middlesex, UK
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89
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Bruegel M, Waldt S, Weirich G, Woertler K, Rummeny EJ. Multifocal epithelioid hemangioendothelioma of the phalanges of the hand. Skeletal Radiol 2006; 35:787-92. [PMID: 16132980 DOI: 10.1007/s00256-005-0943-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2005] [Revised: 04/15/2005] [Accepted: 04/15/2005] [Indexed: 02/02/2023]
Abstract
Epithelioid hemangioendothelioma (EH) of bone is a rare vascular neoplasm characterized by epithelioid endothelial cells and a variable biologic behaviour. The principal sites of occurrence of this osteolytic tumor are the lower extremity and the axial skeleton. Approximately half of the cases present with multifocal disease. The latter feature can be helpful in suggesting the diagnosis of a vascular tumor; on the other hand, it strengthens the need for a skeletal survey or whole-body MRI/CT. We report on the clinical, histologic and radiologic features-including CT and MRI findings-of EH in a case of multifocal disease of the phalanges of the hand, a very uncommon anatomic site of affliction.
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Affiliation(s)
- Melanie Bruegel
- Department of Radiology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Strasse 22, 81675, Munich, Germany.
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90
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Gokhan GA, Akyuz M, Gurer IE, Tuncer R. Epithelioid hemangioendothelioma derived from the spine region: Case report and review of the literature. Wien Klin Wochenschr 2006; 118:358-61. [PMID: 16855926 DOI: 10.1007/s00508-006-0582-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2005] [Accepted: 01/05/2006] [Indexed: 10/24/2022]
Abstract
Epithelioid hemangioendotheliomas (EHE) are rare vascular tumors which generally originate from soft tissues and visceral organs. Primary bone EHEs, especially those occurring in the spine region, are extremely rare. Our case is that of a 30-year-old man who was admitted to hospital with low back pain, difficulty in walking, post-voiding urinary incontinence and numbness in the caudal area. X-ray showed a lytic process affecting the vertebra L2 and collapse of L1. Vertebrectomy of L1 and gross total tumor resection were performed. Histopathological and immunohistochemical findings of the tumor tissue supported the diagnosis of EHE. The case, which to the best of our knowledge is only the fifth such reported case, is presented with its clinicopathological findings and a review of the literature.
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Affiliation(s)
- Guzide Ayse Gokhan
- Department of Pathology, Akdeniz University Faculty of Medicine, Antalya, Turkey.
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91
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Hisaoka M, Okamoto S, Aoki T, Yokoyama K, Hashimoto H. Spinal epithelioid hemangioendothelioma with epithelioid angiosarcomatous areas. Skeletal Radiol 2005; 34:745-9. [PMID: 15877225 DOI: 10.1007/s00256-005-0911-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2005] [Revised: 02/15/2005] [Accepted: 02/15/2005] [Indexed: 02/02/2023]
Abstract
Epithelioid hemangioendothelioma is a distinctive vascular tumor rarely involving bones. We report a case of epithelioid hemangioendothelioma in the cervical spine with angiosarcomatous areas. A 50-year-old female presented with dizziness while walking. A mixed sclerotic and osteolytic or destructive lesion was radiographically disclosed in her upper cervical vertebrae. Histologically, a laminectomy specimen exhibited areas of ordinary epithelioid hemangioendothelioma together with foci of more atypical epithelioid cell proliferation, closely resembling epithelioid angiosarcoma. This phenomenon has been exceptionally described in cases with skeletal lesions, which are typically of low-grade malignancy.
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Affiliation(s)
- Masanori Hisaoka
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
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92
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Shah ZK, Peh WCG, Shek TWH, Wong JWK, Chien EP. Hemangioendothelioma with an epithelioid phenotype arising in hemangioma of the fibula. Skeletal Radiol 2005; 34:750-4. [PMID: 15834563 DOI: 10.1007/s00256-005-0912-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2004] [Revised: 02/11/2005] [Accepted: 02/14/2005] [Indexed: 02/02/2023]
Abstract
The classification of certain vascular bone tumors that show an epithelioid cytologic appearance remains confusing, with overlap in features of epithelioid hemangioma, hemangioendothelioma and epithelioid hemangioendothelioma. Radiographs of a 27-year-old woman who presented with ankle pain showed an expanded lytic-sclerotic lesion in the distal left fibula. Magnetic resonance imaging showed an intramedullary lesion with a small lateral intracortical component. The lesion was hypo- to isointense to muscle on T1-weighted images and heterogeneously hyperintense on T2-weighted images. Initial incisional biopsy was inconclusive. Open biopsy showed hemangioendothelioma with epithelioid morphology, and the lesion was completely resected with reconstruction using a peroneal fibular rotation graft. Examination of the resected specimen showed focal hemangioendothelioma with an epithelioid phenotype arising in a hemangioma. This case illustrates the difficulty and pitfalls of making the correct diagnosis on the basis of a small biopsy specimen.
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Affiliation(s)
- Zarine K Shah
- Department of Diagnostic Radiology, Changi General Hospital, Singapore
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93
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Adler B, Naheedy J, Yeager N, Nicol K, Klamar J. Multifocal epithelioid hemangioendothelioma in a 16-year-old boy. Pediatr Radiol 2005; 35:1014-8. [PMID: 15912411 DOI: 10.1007/s00247-005-1492-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2004] [Revised: 04/02/2005] [Accepted: 04/12/2005] [Indexed: 10/25/2022]
Abstract
We report on a 16-year-old white male presenting with a 4-month history of syncopal episodes and occasional headaches. The CT and MRI studies revealed numerous lytic lesions of the skull base and cervical spine; subsequently, similar lesions were demonstrated in all areas of the skeleton, and CT showed numerous lesions in the lungs, liver, and kidneys. Excisional biopsy from several sites confirmed the diagnosis of epithelioid hemangioendothelioma. We conclude that epithelioid hemangioendothelioma should be added to the differential diagnosis for lytic lesions of bone that are clustered in the same anatomic region and that might also present with visceral involvement.
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Affiliation(s)
- Brent Adler
- Department of Radiology, Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
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