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Villanueva-Castro E, Ramírez-Aragón S, Del Pino-Camposeco J, Canela-Calderon O, Ponce-Gómez JA, Arriada-Mendicoa JN. Spinal Cord Syndrome Due to Extramedullary Epithelioid Hemangioendothelioma of the Thoracic Spine: A Case Report and Literature Review. Cureus 2024; 16:e58571. [PMID: 38765371 PMCID: PMC11102575 DOI: 10.7759/cureus.58571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
We report a 48-year-old male patient with spinal epithelioid hemangioendothelioma in T3 and T4 who began with symptoms of paresthesia in the lower limbs and distal weakness of the right lower limb, back pain, increased limitation in walking, urinary incontinence, and constipation. A safe maximum resection was performed, finding residual disease during the PET/CT scan, so it was decided to treat with radiotherapy, and there was a good response to this treatment. A literature review of epithelioid hemangioendothelioma of the thoracic spine was done which showed a mean age of presentation of 41 years and a male-female ratio of 1:0.53. The main symptom was pain, which was present in 100% of the patients, and wide surgery was performed in 56.8% of the patients, intralesional surgery in 31.8%, and biopsy in 11.4%. A total of 46.6% of patients received radiation therapy, and only 6.6% received chemotherapy. The patients had an average follow-up of 38 months. We recommend that extension studies such as PET/CT scans be performed after surgical resection. This can serve as a follow-up with hemangioendothelioma epithelioma patients about metastatic disease or residual disease that will guide us in giving adjuvant treatments, such as radiotherapy or chemotherapy, for better control of the disease.
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Affiliation(s)
- Eliezer Villanueva-Castro
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | | | - Jorge Del Pino-Camposeco
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Obet Canela-Calderon
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Juan Antonio Ponce-Gómez
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
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2
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Haughey AM, Moloney BM, O'Brien CM. Epithelioid Haemangioendothelioma; Not simply a hepatic pathology. Clin Imaging 2023; 102:42-52. [PMID: 37541086 DOI: 10.1016/j.clinimag.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/26/2023] [Accepted: 07/16/2023] [Indexed: 08/06/2023]
Affiliation(s)
- Aoife M Haughey
- Department of Medical Imaging, JDMI University Health Network, University of Toronto, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada
| | - Brian M Moloney
- The Christie NHS Foundation Trust, Wilmslow Rd, Manchester M20 4BX, United Kingdom
| | - Ciara M O'Brien
- Department of Medical Imaging, JDMI University Health Network, University of Toronto, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada. ciara.o'
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3
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Vazzano JL, Patton A, Tinoco G, Iwenofu OH. Primary Intranodal Epithelioid Hemangioendothelioma with Molecular Confirmation. Int J Surg Pathol 2022; 30:557-563. [PMID: 35098778 DOI: 10.1177/10668969211070174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Epithelioid hemangioendothelioma (EHE) is a rare low-grade malignant vascular tumor with indolent biology, characterized by reciprocal t(1;3)(p36.6;q25) with resultant WWTR1::CAMTA1 gene fusion in the vast majority of cases, regardless of anatomic location. Only a small subset, exhibiting well formed vasoformative features will contain YAP1::TFE3 gene fusion. Primary intranodal EHE is exquisitely rare. We report a case in a 54-year-old male with persistent left groin mass with discomfort for nine months. A CT of the abdomen and pelvis showed a minimally enlarged left inguinal lymph node measuring 2.8 cm with no other masses or lymphadenopathy. PET/CT and MRI imaging of the abdomen showed no evidence of disease elsewhere. Sections showed an epithelioid vasoformative neoplasm, centrally necrotic and involving a lymph node. The cells were arranged in anastomosing cords with intracytoplasmic lumens, resembling "signet ring cells". By immunohistochemistry, the tumor cells were positive for vimentin, CD31, CD34, ERG and CAMTA1; and negative for AE1/3, CAM 5.2, KRT7, KRT20, desmin, actin, HMB-45 and S-100. Ki-67 proliferation index was estimated at <1%. Molecular studies including next generation sequencing (NGS) revealed the presence of WWTR1::CAMTA1 gene fusion, and fluorescence in situ hybridization for CAMTA1 (1p36.23) and WWTR1 (3p25.1) showed fusion signals, diagnostic of EHE. We highlight a rare occurrence of EHE in a lymph node exhibiting morphologic mimicry with metastatic carcinoma.
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Affiliation(s)
- Jennifer L Vazzano
- 12306The Ohio State University Wexner Medical Center, James Cancer Hospital and Richard Solove Research Institute, Columbus, OH
| | - Ashley Patton
- 12306The Ohio State University Wexner Medical Center, James Cancer Hospital and Richard Solove Research Institute, Columbus, OH
| | - Gabriel Tinoco
- The Ohio State Wexner Medical Center and James Cancer Hospital, Columbus, OH
| | - O Hans Iwenofu
- 12306The Ohio State University Wexner Medical Center, James Cancer Hospital and Richard Solove Research Institute, Columbus, OH
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4
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Kimura H, Yamamoto N, Hayashi K, Higuchi T, Tsuchiya H. Multifocal Epithelioid Hemangioendothelioma Complicated with Disseminated Intravascular Coagulation. Case Rep Oncol 2021; 14:1490-1496. [PMID: 34899241 PMCID: PMC8613615 DOI: 10.1159/000519212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/23/2021] [Indexed: 11/19/2022] Open
Abstract
Epithelioid hemangioendothelioma (EHE) is a rare malignant vascular neoplasm that requires long-term management. Several reports describe disseminated intravascular coagulation (DIC) associated with angiosarcoma, but no association with EHE has been reported. We encountered a patient with DIC complicated by multifocal EHE. The patient was an 83-year-old woman with spinal lesions, small lung nodules, and a soft tissue mass in the right buttock. The tumor was biopsied and diagnosed as EHE. The patient received pain control therapy without antitumor therapy. One month later, DIC developed with tumor progression. DIC subsided with nafamostat mesylate infusion, and oral apixaban was administered. DIC was managed for 5 months until the patient died of brain metastases. This is the first report of a patient with DIC complicated by EHE. It should be noted that progression of EHE can cause DIC. We were able to manage DIC using anticoagulant agents.
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Affiliation(s)
- Hiroaki Kimura
- Department of Orthopaedic Surgery, Kanazawa Red Cross Hospital, Kanazawa, Japan
| | - Norio Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Katsuhiro Hayashi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Takashi Higuchi
- Department of Orthopaedic Surgery, Kanazawa Red Cross Hospital, Kanazawa, Japan.,Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
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5
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Zhao HG, Zhang KW, Hou S, Dai YY, Xu SB. Femoral epithelioid hemangioendothelioma detected with magnetic resonance imaging and positron emission tomography/computed tomography: A case report. World J Clin Cases 2021; 9:1353-1358. [PMID: 33644202 PMCID: PMC7896691 DOI: 10.12998/wjcc.v9.i6.1353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/03/2020] [Accepted: 12/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Epithelioid hemangioendothelioma (EHE) is an uncommon low-grade aggressive vascular tumor. It can occur in almost all locations, but is rarely encountered in bone.
CASE SUMMARY We report a 23-year-old man who presented with left hip pain with no obvious cause. X-ray revealed bone destruction in the left femoral neck with sclerosis at the edges of the lesions. Magnetic resonance imaging (MRI) showed bone destruction in the medullary cavity of the left femoral head and neck. 18F-deoxyglucose-positron emission tomography/computed tomography (PET/CT) imaging showed bone destruction in the left ischium, acetabulum, and left femoral head neck, accompanied by increased radioactive uptake; the maximum standard uptake value was 4.2. Histopathologic examination revealed spindle-shaped mesenchymal tissue hyperplasia with scattered epithelioid cells. The patient underwent left femoral head replacement surgery. No signs of recurrence were observed as of the 18-mo follow-up.
CONCLUSION The definitive diagnosis of femoral EHE can be established aided by the MRI and PET/CT findings.
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Affiliation(s)
- Hong-Guang Zhao
- Department of Nuclear Medicine, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Ke-Wei Zhang
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Sen Hou
- Department of Nuclear Medicine, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Yu-Yin Dai
- Department of Nuclear Medicine, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Song-Bai Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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A rare cardiac tumor presenting with myxoma: Primary cardiac hemangioendothelioma. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:110-113. [PMID: 33768989 PMCID: PMC7970082 DOI: 10.5606/tgkdc.dergisi.2021.20695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/05/2020] [Indexed: 11/21/2022]
Abstract
Epithelioid hemangioendothelioma is a rare malignant vascular tumor which originates from the vascular endothelial or dendritic cells and has a moderate malignancy between benign hemangioma and malignant hemangiosarcoma, arising from vascular structures. Radical resection of epithelioid hemangioendothelioma is recommended, due to both its malignant nature and the adverse effects of associated complications on mortality and morbidity. In this article, we present a rare case of primary cardiac epithelioid hemangioendothelioma accompanied by a left atrial myxoma which was treated by resection.
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Mani H, Bellizzi A, Miller B, Milhem M, Monga V. A rare case series of composite hemangioendothelioma presenting as bone tumors. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2020. [DOI: 10.1016/j.cpccr.2020.100026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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8
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Chen PK, Lin QT, Feng YZ, Weng ZP, Cai XR. Epithelioid hemangioendothelioma of spine: A case report with review of literatures. Radiol Case Rep 2020; 15:2687-2692. [PMID: 33117468 PMCID: PMC7581828 DOI: 10.1016/j.radcr.2020.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/10/2020] [Accepted: 10/10/2020] [Indexed: 01/07/2023] Open
Abstract
Primary epithelioid hemangioendothelioma of the spine is the extremely rare malignant vascular neoplasm with an unpredictable outcome. A case of epithelioid hemangioendothelioma with multiple lytic lesions of thoracolumbar spine and other bones in a 29-year-old male patient is reported. A review of the published data regarding this rare neoplasm is also presented. The features of epithelioid hemangioendothelioma include the occurrence in the young male patient, multiple osteolytic lesions with thin sclerotic rim and hypermetabolic activities. However, its imaging features are not specific. Positron emission tomography/computed tomography is essential for identification of the lesions and subsequent follow-up for treatment.
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Affiliation(s)
- Ping-Kang Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, No.613 West Huangpu Avenue, Tianhe District, Guangzhou 510630, Guangdong, China
| | - Qi-Ting Lin
- Medical Imaging Center, First Affiliated Hospital of Jinan University, No.613 West Huangpu Avenue, Tianhe District, Guangzhou 510630, Guangdong, China
| | - You-Zhen Feng
- Medical Imaging Center, First Affiliated Hospital of Jinan University, No.613 West Huangpu Avenue, Tianhe District, Guangzhou 510630, Guangdong, China
| | - Ze-Ping Weng
- Department of Pathology, First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China
| | - Xiang-Ran Cai
- Medical Imaging Center, First Affiliated Hospital of Jinan University, No.613 West Huangpu Avenue, Tianhe District, Guangzhou 510630, Guangdong, China
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Kim E, Williams R, Rivera-Begeman A. Tibial epithelioid hemangioendothelioma. HUMAN PATHOLOGY: CASE REPORTS 2020. [DOI: 10.1016/j.ehpc.2020.200403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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10
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Zeng Y, Leng X, Chen P, Luo J, Zhou Z. Imaging Diagnosis of Epithelioid Hemangioendothelioma in Thoracic Vertebrae and Liver. Ann Thorac Surg 2019; 109:e407-e410. [PMID: 31794741 DOI: 10.1016/j.athoracsur.2019.10.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/09/2019] [Accepted: 10/11/2019] [Indexed: 01/02/2023]
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. EHE in bone, especially in thoracic vertebrae, is an extremely rare occurrence and signifies a challenge for the imaging diagnosis. This paper presents a rare case of EHE occurring in thoracic vertebrae and liver revealed by fluoride-18-fluorodeoxyglucose-positron emission tomography and magnetic resonance imaging to provide a better understanding of its clinical application and further insight into diagnosing a rare thoracic tumor.
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Affiliation(s)
- Yuping Zeng
- Department of Radiology, Guangzhou Universal Medical Imaging Diagnostic Center, Guangzhou, China
| | - Xiaoming Leng
- Department of Radiology, Guangzhou Universal Medical Imaging Diagnostic Center, Guangzhou, China
| | - Ping Chen
- Department of Radiology, Guangzhou Universal Medical Imaging Diagnostic Center, Guangzhou, China
| | - Jiandong Luo
- Department of Radiology, Guangzhou Universal Medical Imaging Diagnostic Center, Guangzhou, China
| | - Zhiyang Zhou
- Department of Radiology, Guangzhou Universal Medical Imaging Diagnostic Center, Guangzhou, China.
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11
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Cosgun T, Kaba E, Ayalp K, Elbegi IC, Toker A. Haemangioendothelioma: a disease with surgical options from robotic surgery to open superior vena cava replacement. Interact Cardiovasc Thorac Surg 2019; 29:449-452. [PMID: 31115437 DOI: 10.1093/icvts/ivz109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/24/2019] [Accepted: 04/07/2019] [Indexed: 12/29/2022] Open
Abstract
Epithelioid haemangioendothelioma is a malignant tumour of vascular origin that can occur in the mediastinum. Operative treatment techniques may vary depending on the localization. Our goal was to focus on different surgical techniques, ranging from simple stapling of the vascular structure to replacement of the superior vena cava.
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Affiliation(s)
- Tugba Cosgun
- Thoracic Surgery Department, Demiroglu Bilim University, Istanbul, Turkey
| | - Erkan Kaba
- Thoracic Surgery Department, Demiroglu Bilim University, Istanbul, Turkey
| | - Kemal Ayalp
- Thoracic Surgery Department, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Ipek Coban Elbegi
- Pathology Department, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Alper Toker
- Thoracic Surgery Department, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
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12
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Lin H, Cheng Y, Zhang C. [Research Progress of Pulmonary Epithelioid Hemangioendothelioma]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:470-476. [PMID: 31315787 PMCID: PMC6712264 DOI: 10.3779/j.issn.1009-3419.2019.07.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Epithelioid hemangioendothelioma (EHE) is a rare vascular neoplasm that develops from vascular endothelial cells. It has been reported to occur many sites of body, but the most common EHE presentations are soft tissue (limbs), bone, liver and lung. Compared with other pulmonary tumors, pulmonary epithelioid hemangioendothelioma (P-EHE) is relatively rare. According to a literature review, more than 100 cases have been described all over the world. Due to the low incidence of P-EHE, lack of specificity in clinical symptoms and radiological findings, it is often misdiagnosed. Meanwhile, many patients do not receive appropriate treatment, resulting in poor prognosis in some cases. Histology and immunohistochemical methods are essential for diagnosis. However, there is no established standard treatment for P-EHE, because of the rarity of the disease. When the lesions are small and limited in number, surgical is the best treatment, achieving the purpose of diagnosis and treatment at the same time. This article tries to present the etiopathogenesis, clinical manifestations, diagnosis, treatment and prognosis of P-EHE.
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Affiliation(s)
- Hang Lin
- Department of Thoracic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yuanda Cheng
- Department of Thoracic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Chunfang Zhang
- Department of Thoracic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
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13
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Cousin S, Le Loarer F, Crombé A, Karanian M, Minard-Colin V, Penel N. [Epithelioid hemangioendothelioma]. Bull Cancer 2018; 106:73-83. [PMID: 30527817 DOI: 10.1016/j.bulcan.2018.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/28/2018] [Accepted: 11/01/2018] [Indexed: 12/14/2022]
Abstract
We describe herein the inaugural manifestations, the radiological and histological diagnosis criteria for and the outcome of epithelioid hemangioendothelioma (EHE). Most of EHE (90%) display a specific reciprocal chromosomic translocation t(1;3)(p36;q23-25), which is associated with the synthesis of fusion protein WWTR1/CAMTA1. EHE are low-grade vascular sarcomas. EHE could be initially localized or multifocal. At localized stage, EHE are best treated with focal treatments. At multifocal stage, the upfront strategy is watchful follow-up. Some multifocal EHE display very indolent course with spontaneous stable disease for years or decades. In case of progressive multifocal EHE, there is no consensual treatment. Diagnostic and clinical management of EHE requires interdisciplinary expertise from labeled centers.
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Affiliation(s)
- Sophie Cousin
- Institut Bergonié, département d'oncologie médicale, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - François Le Loarer
- Institut Bergonié, département d'anatomopathologie, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - Amandine Crombé
- Institut Bergonié, département d'imagerie médicale, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - Marie Karanian
- Centre Léon Bérard, département d'anatomopathologie, 28, Promenade Léa et Napoléon Bullukian, 69008 Lyon, France
| | - Véronique Minard-Colin
- Institut Gustave Roussy, département d'oncologie pédiatrique, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| | - Nicolas Penel
- Centre Oscar Lambret, département d'oncologie médicale, 3, rue Frédéric Combemale, 59000 Lille, France; Hôpital Claude Huriez, service d'oncologie médicale, rue Michel Polonowski, 59000 Lille, France.
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Abstract
OPINION STATEMENT Epithelioid hemangioendothelioma (EHE) is an extremely rare sarcoma, as such it can pose a clinical dilemma based solely on its rarity. Also, the spectrum of disease varies greatly between an indolent disease and aggressive disease with widespread metastases. In our clinical practice, the primary focus has been to get a handle on the aggressive nature of the disease, which will then dictate how urgently one needs to treat the patient. Pathological review with immunohistochemistry and molecular characterization is paramount. Our treatment strategy is watch-and-wait versus active therapy on clinical trial or based on results of prior clinical trials. There is evidence to support the use of chemotherapeutics and targeted therapies specifically focusing on anti-angiogenesis. The current landscape of oncology with the emergence and excitement of immunotherapy could also translate in a role for immunotherapy in this disease. While rare, there is certainly no reason that research and trials for patients with EHE should not remain on utmost importance for those of us who specialize in the treatment of sarcomas.
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Abstract
An epithelioid hemangioendothelioma (EHE) is a rare vascular tumor of the head and neck region, which carries a risk of recurrence and metastasis. Its etiology is still unclear. It frequently involves the lungs, liver, and bones. Rarely, it may manifest in other parts of the body. Pathologic immunohistochemical investigations are essential to make the definite diagnosis. As it is uncommon, there is no standardized protocol for the treatment of EHE. Herein, the authors report a rare patient with of an EHE localized in the head and neck region.
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16
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[Epithelioid hemangioendothelioma of the spine: A case report]. Cancer Radiother 2017; 21:222-225. [PMID: 28478891 DOI: 10.1016/j.canrad.2016.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 11/21/2016] [Accepted: 11/23/2016] [Indexed: 11/20/2022]
Abstract
with intensity modulation. During the follow-up, a second inoperable spinal location necessitated a new sequence of radiotherapy in modulation of intensity with integrated boost. The patient was alive at 24 months of follow-up without evidence of local relapse or distance. This observation is followed by a discussion with review of the literature on other epithelioid hemangioendothelioma cases treated with radiation.
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17
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Zhang H, Fu Y, Ye Z. Bone multicentric epithelioid hemangioendothelioma of the lower and upper extremities with pulmonary metastases: A case report. Oncol Lett 2015; 9:2177-2180. [PMID: 26137035 DOI: 10.3892/ol.2015.3018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 02/17/2015] [Indexed: 01/07/2023] Open
Abstract
The present study reports a rare case of bone multicentric epithelioid hemangioendothelioma (EH) involving the upper and lower extremities simultaneously, with visceral involvement of the lung. Osteolytic lesions were first identified in the right distal femur and proximal tibia. Slight increased radionuclide uptake was observed in the right shoulder joint on bone scintigraphy, however, this was ignored, as no clinical symptoms were present. The patient was initially misdiagnosed with multifocal chondroblastoma, and an extra-articular curettage of lesions was performed in the proximal tibia and medial femoral condyle, which was filled with bone cement. The histopathological diagnosis was corrected post-operatively following immunohistochemical analysis, which indicated EH, and subsequently, an amputation of the right leg at thigh level was performed. In addition, multiple lytic lesions in the right shoulder joint and pulmonary metastases were identified on whole-body radiological examination. Radiotherapy was administered to the right shoulder joint, however, the patient refused chemotherapy or further surgery. At 15 months after the initial surgery, the patient currently remains alive. This case indicates that an improved understanding with regard to the clinical features of this disease may prevent misdiagnosis and improve EH treatment.
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Affiliation(s)
- Hua Zhang
- Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China
| | - Yanbiao Fu
- Department of Pathology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China
| | - Zhaoming Ye
- Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China
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18
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Sardaro A, Bardoscia L, Petruzzelli MF, Portaluri M. Epithelioid hemangioendothelioma: an overview and update on a rare vascular tumor. Oncol Rev 2014; 8:259. [PMID: 25992243 PMCID: PMC4419652 DOI: 10.4081/oncol.2014.259] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 09/18/2014] [Accepted: 09/30/2014] [Indexed: 12/12/2022] Open
Abstract
Epithelioid hemangioendothelioma is a rare vascular tumor, described for the first time in 1975 by Dail and Liebow as an aggressive bronchoalveolar cell carcinoma. The etiology is still a dilemma. Studies about suggestive hypothesis are ongoing. Most of the times it affects lung, liver and bones, although this kind of tumor may involve the head and neck area, breast, lymph nodes, mediastinum, brain and meninges, the spine, skin, abdomen and many other sites. Because of its heterogeneous presentation, as it represents less than 1% of all the vascular tumors, it is often misdiagnosed and not suitably treated, leading to a poor prognosis in some cases. Over 50-76% of the patients are asymptomatic. A small number of them complains respiratory symptoms. Bone metastases might cause pathological fractures or spine compression, if they arise in vertebrae. Imaging is necessary to determine morphological data, the involvement of surrounding tissues, and potentially the cleavage plan. It is important to recognize the expression of vascular markers (Fli-1 and CD31 are endothelial-specific markers), and the microscopic evidence of vascular differentiation to make a correct diagnosis, as many pulmonary diseases show multiple nodular lesions. Because of its rarity, there is no standard for treatment. We focused on radiotherapy as a good therapeutic option: despite the poor prognosis, evidence is in favor of radiotherapy which offers local pain control with good tolerance and better quality of life at least at a one-year follow-up in most of cases. Further studies are needed to establish the standard radiation dose to be used for locoregional control of such a complex and extremely rare disease.
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Affiliation(s)
- Angela Sardaro
- Department of Interdisciplinary Medicine, Section of Diagnostic Imaging and Radiotherapy, University Aldo Moro, Bari
| | - Lilia Bardoscia
- Department of Interdisciplinary Medicine, Section of Diagnostic Imaging and Radiotherapy, University Aldo Moro, Bari
| | - Maria Fonte Petruzzelli
- Department of Interdisciplinary Medicine, Section of Diagnostic Imaging and Radiotherapy, University Aldo Moro, Bari
| | - Maurizio Portaluri
- Department of Radiotherapy, A. Perrino Hospital, Brindisi
- Clinical Physiology Institute, National Research Council (IFC-CNR), Pisa-Lecce, Italy
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Abstract
Epithelioid mesenchymal malignancies represent a major diagnostic challenge. Epithelioid morphology can be observed in a variety of soft tissue neoplasms, however there exist specific subtypes in which an epithelioid apperance constitutes the most distinctive morphological feature. Moving from epithelioid sarcoma of Enzinger (the prototype of sarcoma with epithelioid morphology), this review will focus on the most relevant entities: namely epithelioid haemangioendothelioma and angiosarcoma, pseudomyogenic haemangioendothelioma, epithelioid malignant peripheral nerve sheath tumour, epithelioid sclerosing fibrosarcoma, epithelioid pleomorphic liposarcoma, alveolar soft part sarcoma, and undifferentiated soft tissue sarcoma with epithelioid morphology. Differential diagnoses and major pitfalls will be discussed in detail.
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