Epithelioid hemangioendothelioma of spine: A case report with review of literatures

Neurosurgical Management of Spinal Epithelioid Hemangioendothelioma: Systematic Review and Illustrative Case Presentation

BACKGROUND

Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor predominantly arising in soft tissue. We report a rare case of thoracic spinal EHE with pulmonary metastasis.

METHODS

Case report and systematic review of spinal EHE.

RESULTS

A 36-year-old man presented with bilateral lower extremity weakness, progressive paresthesia, and urinary incontinence. He underwent open surgical resection of the tumor and decompression of the spinal cord, with subsequent improvement in neurologic function. Systematic review identified 84 cases of spinal EHE, 73 of which were primary, and 14 of which developed extra-spinal metastases.

CONCLUSION

EHE is an exceedingly rare tumor that may present with a wide swath of clinical symptoms. At present, no guidelines or formal treatment recommendations have been established. Surgical debulking has demonstrated efficacy as a front-line treatment, particularly in the setting of compressive neurologic dysfunction; data regarding adjuvant chemoradiation are less consistently reported, mandating further study.

Establishment and Validation of a Nomogram Prognostic Model for Epithelioid Hemangioendothelioma

Background. Epithelioid hemangioendothelioma (EHE) is an ultrarare vascular sarcoma. At present, the epidemiological and clinical characteristics and prognostic factors are still unclear. Our study attempted to describe clinical features, investigate the prognostic indicators, and establish the nomogram prediction model based on the Surveillance, Epidemiology, and End Results (SEER) database for EHE patients. Methods. The patients diagnosed with EHE from 1986 to 2018 were collected from the SEER database and were randomly divided into a training group and a validation group at a ratio of 7 : 3. The Cox proportional hazard models were used to determine the independent factors affecting prognosis and establish a nomogram prognostic model to predict the survival rates for patients with EHE. The accuracy and discriminative ability of the model were measured using the concordance index, receiver operating characteristic curves, and calibration curves. The clinical applicability and application value of the model were evaluated by decision curve analysis. Results. The overall age-adjusted incidence of EHE was 0.31 patients per 1,000,000 individuals, with a statistically significant difference per year. Overall survival at 1, 5, and 10 years for all patients was 76.5%, 57.4%, and 48.2%, respectively. Multivariate Cox regression analysis identified age, tumour stage, degree of tissue differentiation, surgical treatment, chemotherapy, and radiotherapy as independent factors affecting prognosis ( $P<0.05$ ). The C-index values for our nomogram model of training group and validation group were 0.752 and 0.753, respectively. The calibration curve was in good agreement with the actual observation results, suggesting that the prediction model has good accuracy. The decision curve analysis indicated a relatively large net benefit. Conclusions. The nomogram model may play an important role in predicting the survival rate for EHE patients, with good concordance and accuracy, and can be applied in clinical practice.

Epithelioid hemangioendothelioma of the spine: an analysis of imaging findings

Background

Epithelioid hemangioendothelioma (EHE) is a low-grade malignant vascular neoplasm with the potential to metastasize. Primary EHE of the spine is very rare and an accurate diagnosis is crucial to treatment planning. We aim to investigate the imaging and clinical data of spinal EHE to improve the understanding of the disease.

Methods

We retrospectively analyzed the imaging manifestations and clinical data of 12 cases with pathologically confirmed spinal EHE. The imaging features analyzed included number, locations, size, border, density, signal, majority of the lesions, expansile osteolysis, residual bone trabeculae, sclerotic rim, vertebral compression, enhancement.

Results

Patients included 5 female and 7 male patients (mean age: 43.0 ± 19.6 years; range 15–73 years). Multiple lesions were noted in 1 case and single lesion was noted in 11 cases. The lesions were located in the thoracic, cervical, lumbar, and sacral vertebrae in 7, 3, 1, and 1 cases, respectively. They were centered in the vertebral body and posterior elements in 9 and 3 cases, respectively. Residual bone trabeculae, no sclerotic margin, and surrounding soft-tissue mass were noted in 11 cases, each, and mild expansile osteolysis and vertebral compression were noted in 10 and 6 cases, respectively. MRI was performed for 11 patients, all of whom showed isointensity on T1WI, hyperintensity or slight hyperintensity on T2WI, and hyperintensity on fat-suppressed T2WI. A marked enhancement pattern was noted in 10 cases.

Conclusion

Spinal EHE tend to develop in the thoracic vertebrae. EHE should be considered when residual bone trabeculae can be seen in the bone destruction area, accompanied by pathological compression fracture, no sclerotic rim, and high signal intensity for a vascular tumor on T2WI.