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Menz A, Lony N, Lennartz M, Dwertmann Rico S, Schlichter R, Kind S, Reiswich V, Viehweger F, Dum D, Luebke AM, Kluth M, Gorbokon N, Hube-Magg C, Bernreuther C, Simon R, Clauditz TS, Sauter G, Hinsch A, Jacobsen F, Marx AH, Steurer S, Minner S, Burandt E, Krech T, Lebok P, Weidemann S. Epithelial Cell Adhesion Molecule (EpCAM) Expression in Human Tumors: A Comparison with Pan-Cytokeratin and TROP2 in 14,832 Tumors. Diagnostics (Basel) 2024; 14:1044. [PMID: 38786342 PMCID: PMC11120328 DOI: 10.3390/diagnostics14101044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/26/2024] [Accepted: 04/30/2024] [Indexed: 05/25/2024] Open
Abstract
EpCAM is expressed in many epithelial tumors and is used for the distinction of malignant mesotheliomas from adenocarcinomas and as a surrogate pan-epithelial marker. A tissue microarray containing 14,832 samples from 120 different tumor categories was analyzed by immunohistochemistry. EpCAM staining was compared with TROP2 and CKpan. EpCAM staining was detectable in 99 tumor categories. Among 78 epithelial tumor types, the EpCAM positivity rate was ≥90% in 60 categories-including adenocarcinomas, neuroendocrine neoplasms, and germ cell tumors. EpCAM staining was the lowest in hepatocellular carcinomas, adrenocortical tumors, renal cell neoplasms, and in poorly differentiated carcinomas. A comparison of EpCAM and CKpan staining identified a high concordance but EpCAM was higher in testicular seminomas and neuroendocrine neoplasms and CKpan in hepatocellular carcinomas, mesotheliomas, and poorly differentiated non-neuroendocrine tumors. A comparison of EpCAM and TROP2 revealed a higher rate of TROP2 positivity in squamous cell carcinomas and lower rates in many gastrointestinal adenocarcinomas, testicular germ cell tumors, neuroendocrine neoplasms, and renal cell tumors. These data confirm EpCAM as a surrogate epithelial marker for adenocarcinomas and its diagnostic utility for the distinction of malignant mesotheliomas. In comparison to CKpan and TROP2 antibodies, EpCAM staining is particularly common in seminomas and in neuroendocrine neoplasms.
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Affiliation(s)
- Anne Menz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.M.); (N.L.); (M.L.); (S.D.R.); (R.S.); (S.K.); (V.R.); (F.V.); (D.D.); (A.M.L.); (M.K.); (N.G.); (C.H.-M.); (C.B.); (T.S.C.); (G.S.); (A.H.); (F.J.); (S.S.); (S.M.); (E.B.); (T.K.); (P.L.); (S.W.)
| | - Nora Lony
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.M.); (N.L.); (M.L.); (S.D.R.); (R.S.); (S.K.); (V.R.); (F.V.); (D.D.); (A.M.L.); (M.K.); (N.G.); (C.H.-M.); (C.B.); (T.S.C.); (G.S.); (A.H.); (F.J.); (S.S.); (S.M.); (E.B.); (T.K.); (P.L.); (S.W.)
| | - Maximilian Lennartz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.M.); (N.L.); (M.L.); (S.D.R.); (R.S.); (S.K.); (V.R.); (F.V.); (D.D.); (A.M.L.); (M.K.); (N.G.); (C.H.-M.); (C.B.); (T.S.C.); (G.S.); (A.H.); (F.J.); (S.S.); (S.M.); (E.B.); (T.K.); (P.L.); (S.W.)
| | - Sebastian Dwertmann Rico
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.M.); (N.L.); (M.L.); (S.D.R.); (R.S.); (S.K.); (V.R.); (F.V.); (D.D.); (A.M.L.); (M.K.); (N.G.); (C.H.-M.); (C.B.); (T.S.C.); (G.S.); (A.H.); (F.J.); (S.S.); (S.M.); (E.B.); (T.K.); (P.L.); (S.W.)
| | - Ria Schlichter
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.M.); (N.L.); (M.L.); (S.D.R.); (R.S.); (S.K.); (V.R.); (F.V.); (D.D.); (A.M.L.); (M.K.); (N.G.); (C.H.-M.); (C.B.); (T.S.C.); (G.S.); (A.H.); (F.J.); (S.S.); (S.M.); (E.B.); (T.K.); (P.L.); (S.W.)
| | - Simon Kind
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.M.); (N.L.); (M.L.); (S.D.R.); (R.S.); (S.K.); (V.R.); (F.V.); (D.D.); (A.M.L.); (M.K.); (N.G.); (C.H.-M.); (C.B.); (T.S.C.); (G.S.); (A.H.); (F.J.); (S.S.); (S.M.); (E.B.); (T.K.); (P.L.); (S.W.)
| | - Viktor Reiswich
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.M.); (N.L.); (M.L.); (S.D.R.); (R.S.); (S.K.); (V.R.); (F.V.); (D.D.); (A.M.L.); (M.K.); (N.G.); (C.H.-M.); (C.B.); (T.S.C.); (G.S.); (A.H.); (F.J.); (S.S.); (S.M.); (E.B.); (T.K.); (P.L.); (S.W.)
| | - Florian Viehweger
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.M.); (N.L.); (M.L.); (S.D.R.); (R.S.); (S.K.); (V.R.); (F.V.); (D.D.); (A.M.L.); (M.K.); (N.G.); (C.H.-M.); (C.B.); (T.S.C.); (G.S.); (A.H.); (F.J.); (S.S.); (S.M.); (E.B.); (T.K.); (P.L.); (S.W.)
| | - David Dum
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.M.); (N.L.); (M.L.); (S.D.R.); (R.S.); (S.K.); (V.R.); (F.V.); (D.D.); (A.M.L.); (M.K.); (N.G.); (C.H.-M.); (C.B.); (T.S.C.); (G.S.); (A.H.); (F.J.); (S.S.); (S.M.); (E.B.); (T.K.); (P.L.); (S.W.)
| | - Andreas M. Luebke
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.M.); (N.L.); (M.L.); (S.D.R.); (R.S.); (S.K.); (V.R.); (F.V.); (D.D.); (A.M.L.); (M.K.); (N.G.); (C.H.-M.); (C.B.); (T.S.C.); (G.S.); (A.H.); (F.J.); (S.S.); (S.M.); (E.B.); (T.K.); (P.L.); (S.W.)
| | - Martina Kluth
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.M.); (N.L.); (M.L.); (S.D.R.); (R.S.); (S.K.); (V.R.); (F.V.); (D.D.); (A.M.L.); (M.K.); (N.G.); (C.H.-M.); (C.B.); (T.S.C.); (G.S.); (A.H.); (F.J.); (S.S.); (S.M.); (E.B.); (T.K.); (P.L.); (S.W.)
| | - Natalia Gorbokon
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.M.); (N.L.); (M.L.); (S.D.R.); (R.S.); (S.K.); (V.R.); (F.V.); (D.D.); (A.M.L.); (M.K.); (N.G.); (C.H.-M.); (C.B.); (T.S.C.); (G.S.); (A.H.); (F.J.); (S.S.); (S.M.); (E.B.); (T.K.); (P.L.); (S.W.)
| | - Claudia Hube-Magg
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.M.); (N.L.); (M.L.); (S.D.R.); (R.S.); (S.K.); (V.R.); (F.V.); (D.D.); (A.M.L.); (M.K.); (N.G.); (C.H.-M.); (C.B.); (T.S.C.); (G.S.); (A.H.); (F.J.); (S.S.); (S.M.); (E.B.); (T.K.); (P.L.); (S.W.)
| | - Christian Bernreuther
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.M.); (N.L.); (M.L.); (S.D.R.); (R.S.); (S.K.); (V.R.); (F.V.); (D.D.); (A.M.L.); (M.K.); (N.G.); (C.H.-M.); (C.B.); (T.S.C.); (G.S.); (A.H.); (F.J.); (S.S.); (S.M.); (E.B.); (T.K.); (P.L.); (S.W.)
| | - Ronald Simon
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.M.); (N.L.); (M.L.); (S.D.R.); (R.S.); (S.K.); (V.R.); (F.V.); (D.D.); (A.M.L.); (M.K.); (N.G.); (C.H.-M.); (C.B.); (T.S.C.); (G.S.); (A.H.); (F.J.); (S.S.); (S.M.); (E.B.); (T.K.); (P.L.); (S.W.)
| | - Till S. Clauditz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.M.); (N.L.); (M.L.); (S.D.R.); (R.S.); (S.K.); (V.R.); (F.V.); (D.D.); (A.M.L.); (M.K.); (N.G.); (C.H.-M.); (C.B.); (T.S.C.); (G.S.); (A.H.); (F.J.); (S.S.); (S.M.); (E.B.); (T.K.); (P.L.); (S.W.)
| | - Guido Sauter
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.M.); (N.L.); (M.L.); (S.D.R.); (R.S.); (S.K.); (V.R.); (F.V.); (D.D.); (A.M.L.); (M.K.); (N.G.); (C.H.-M.); (C.B.); (T.S.C.); (G.S.); (A.H.); (F.J.); (S.S.); (S.M.); (E.B.); (T.K.); (P.L.); (S.W.)
| | - Andrea Hinsch
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.M.); (N.L.); (M.L.); (S.D.R.); (R.S.); (S.K.); (V.R.); (F.V.); (D.D.); (A.M.L.); (M.K.); (N.G.); (C.H.-M.); (C.B.); (T.S.C.); (G.S.); (A.H.); (F.J.); (S.S.); (S.M.); (E.B.); (T.K.); (P.L.); (S.W.)
| | - Frank Jacobsen
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.M.); (N.L.); (M.L.); (S.D.R.); (R.S.); (S.K.); (V.R.); (F.V.); (D.D.); (A.M.L.); (M.K.); (N.G.); (C.H.-M.); (C.B.); (T.S.C.); (G.S.); (A.H.); (F.J.); (S.S.); (S.M.); (E.B.); (T.K.); (P.L.); (S.W.)
| | - Andreas H. Marx
- Department of Pathology, Academic Hospital Fuerth, 90766 Fuerth, Germany;
| | - Stefan Steurer
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.M.); (N.L.); (M.L.); (S.D.R.); (R.S.); (S.K.); (V.R.); (F.V.); (D.D.); (A.M.L.); (M.K.); (N.G.); (C.H.-M.); (C.B.); (T.S.C.); (G.S.); (A.H.); (F.J.); (S.S.); (S.M.); (E.B.); (T.K.); (P.L.); (S.W.)
| | - Sarah Minner
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.M.); (N.L.); (M.L.); (S.D.R.); (R.S.); (S.K.); (V.R.); (F.V.); (D.D.); (A.M.L.); (M.K.); (N.G.); (C.H.-M.); (C.B.); (T.S.C.); (G.S.); (A.H.); (F.J.); (S.S.); (S.M.); (E.B.); (T.K.); (P.L.); (S.W.)
| | - Eike Burandt
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.M.); (N.L.); (M.L.); (S.D.R.); (R.S.); (S.K.); (V.R.); (F.V.); (D.D.); (A.M.L.); (M.K.); (N.G.); (C.H.-M.); (C.B.); (T.S.C.); (G.S.); (A.H.); (F.J.); (S.S.); (S.M.); (E.B.); (T.K.); (P.L.); (S.W.)
| | - Till Krech
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.M.); (N.L.); (M.L.); (S.D.R.); (R.S.); (S.K.); (V.R.); (F.V.); (D.D.); (A.M.L.); (M.K.); (N.G.); (C.H.-M.); (C.B.); (T.S.C.); (G.S.); (A.H.); (F.J.); (S.S.); (S.M.); (E.B.); (T.K.); (P.L.); (S.W.)
- Institute of Pathology, Clinical Center Osnabrueck, 49076 Osnabrueck, Germany
| | - Patrick Lebok
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.M.); (N.L.); (M.L.); (S.D.R.); (R.S.); (S.K.); (V.R.); (F.V.); (D.D.); (A.M.L.); (M.K.); (N.G.); (C.H.-M.); (C.B.); (T.S.C.); (G.S.); (A.H.); (F.J.); (S.S.); (S.M.); (E.B.); (T.K.); (P.L.); (S.W.)
- Institute of Pathology, Clinical Center Osnabrueck, 49076 Osnabrueck, Germany
| | - Sören Weidemann
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.M.); (N.L.); (M.L.); (S.D.R.); (R.S.); (S.K.); (V.R.); (F.V.); (D.D.); (A.M.L.); (M.K.); (N.G.); (C.H.-M.); (C.B.); (T.S.C.); (G.S.); (A.H.); (F.J.); (S.S.); (S.M.); (E.B.); (T.K.); (P.L.); (S.W.)
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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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Malignant Vascular Tumors of the Head and Neck-Which Type of Therapy Works Best? Cancers (Basel) 2021; 13:cancers13246201. [PMID: 34944821 PMCID: PMC8699575 DOI: 10.3390/cancers13246201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/03/2021] [Accepted: 12/07/2021] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Malignant vascular tumors are extremely rare tumors with variable clinical courses, and few data on their clinical management are available. Diagnosis is difficult due to their wide morphologic appearance. The intent of the present review is to demonstrate the current knowledge and management on malignant vascular tumors of the head and neck area. The mainstay of treatment for malignant vascular tumors is surgery, but radiotherapy and chemotherapy are also parts of the treatment concept especially in angiosarcomas. Targeted therapy, antiangiogenetic drugs and immunotherapy have been studied as new treatment options. Abstract Malignant vascular tumors of the head and neck are rare neoplasms with variable clinical presentation, wide age distribution, and variable clinical courses. The heterogeneous presentation of angiosarcomas and epithelioid hemangioendothelioma often leads to misdiagnosis and unsuitable treatment. While risk factors for angiosarcomas are previous radiation, chronic lymphedema, and exposure to arsenic, thorium oxide, or vinyl chloride, there are only limited and retrospective data available on prognostic factors in EHE. In both angiosarcomas and EHE, surgery is the mainstay of treatment. There is limited evidence regarding the role of radiotherapy in EHE, although EHE is considered relatively radiosensitive. In angiosarcomas, adjuvant radiotherapy is recommended according to retrospective case series. A standard medical therapy for metastasized malignant vascular tumors is lacking. Chemotherapy, which is effective in angiosarcoma, is mostly ineffective in EHE. Targeted therapy, antiangiogenetic drugs and immunotherapy have been studied as new treatment options. The goal of this review is to summarize the current data regarding malignant vascular tumors along with their diagnosis and management.
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Ono M, Kasuga Y, Uehara T, Oda Y. Epithelioid hemangioendothelioma of the thyroid: a case report. Surg Case Rep 2017; 3:18. [PMID: 28132160 PMCID: PMC5274636 DOI: 10.1186/s40792-017-0294-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/24/2017] [Indexed: 01/08/2023] Open
Abstract
Background Epithelioid hemangioendothelioma (EHE) of the thyroid is an extremely rare disease; only three cases have been reported in the English literature to date. Here, we describe a case involving a patient with thyroid EHE successfully treated with curative surgery. Case presentation A 74-year-old woman presented with a right thyroid mass. The nodule was approximately 2 cm in size and was diagnosed as an indeterminate lesion by fine needle aspiration cytology. She was treated with thyroid lobectomy. The histopathological and immunohistochemical findings indicated an EHE of the thyroid. At the latest follow-up, 3 years postoperatively, the patient showed no signs of recurrence. Conclusion There is currently no standard therapy for EHE; however, our case suggests that curative resection represents an effective treatment.
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Affiliation(s)
- Mayu Ono
- Department of Breast and Endocrine Surgery, Nagano Matsushiro General Hospital, 183 Matsushiro, Nagano, 381-1231, Japan. .,Present address: Department of Breast and Endocrine Surgery, Iida Municipal Hospital, 438 Yawatamachi, Iida, 812-8582, Japan.
| | - Yoshio Kasuga
- Department of Breast and Endocrine Surgery, Nagano Matsushiro General Hospital, 183 Matsushiro, Nagano, 381-1231, Japan
| | - Takeshi Uehara
- Department of Laboratory Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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A Case of an Epithelioid Hemangioendothelioma Arising from the Innominate Vein Mimicking Cervical Metastatic Lymphadenopathy. Case Rep Surg 2016; 2016:4238575. [PMID: 28058125 PMCID: PMC5183748 DOI: 10.1155/2016/4238575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/30/2016] [Indexed: 11/17/2022] Open
Abstract
Background. Epithelioid hemangioendothelioma (EHE) is a rare tumor usually presenting in soft tissue. EHE is a vascular malignancy of intermediate clinical behavior, with a histologic appearance of endothelial cells growing in nests or cords. Although EHE often originates from a vessel, it is relatively rare for a primary vascular EHE to originate from a large vein or artery. Occurrence in the mediastinum is exceptionally rare. There are no known associations with other malignancies. Case Presentation. We present a case of mediastinal invasive EHE in a 39-year-old female with concurrent papillary thyroid cancer. She initially presented with a thyroid mass found by her primary care provider, with preoperative imaging concerning for extension into the superior mediastinum. Operative exploration revealed a mediastinal mass distinct from her thyroid carcinoma with invasion into the great vessels, requiring off-pump interposition graft bypass for en bloc resection. Final pathology confirmed pT3N1b multifocal papillary thyroid carcinoma with a separate grade 1 pT1b EHE. Review of the literature describes the demographics, updated pathologic outcomes, histologic findings, and reported incidence of EHE. Conclusions. This is the first reported case of thyroid malignancy with separate and concurrent EHE. Surgeons should remain aware of this entity given its variable behavior. Although initially described as an indolent neoplasm, tumors with poor prognostic factors have been shown to be locally aggressive.
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Shah AA, Ohori NP, Yip L, Coyne C, Antonescu CR, Seethala RR. Epithelioid Hemangioendothelioma: a Rare Primary Thyroid Tumor with Confirmation of WWTR1 and CAMTA1 Rearrangements. Endocr Pathol 2016; 27:147-52. [PMID: 27026033 DOI: 10.1007/s12022-016-9428-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We report a rare case of epithelioid hemangioendothelioma as a primary thyroid tumor. To our knowledge, there are only two prior unequivocal cases of primary thyroid epithelioid hemangioendothelioma reported in the English literature. This is the first case in the thyroid with molecular confirmation.
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Affiliation(s)
- Akeesha A Shah
- Department of Pathology, University of Pittsburgh Medical Center, Presbyterian Rm. A609 200 Lothrop St, Pittsburgh, PA, 15213, USA.
| | - N Paul Ohori
- Department of Pathology, University of Pittsburgh Medical Center, Presbyterian Rm. A609 200 Lothrop St, Pittsburgh, PA, 15213, USA
| | - Linwah Yip
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Christopher Coyne
- Division of Endocrinology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Cristina R Antonescu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Raja R Seethala
- Department of Pathology, University of Pittsburgh Medical Center, Presbyterian Rm. A609 200 Lothrop St, Pittsburgh, PA, 15213, USA
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Borchert DH, Massmann A, Kim YJ, Bader CA, Wolf G, Eisele R, Minko P, Bücker A, Glanemann M. Recurrent High-Flow Arterio-Venous Malformation of the Thyroid Gland. Thyroid 2015; 25:1060-3. [PMID: 26061261 DOI: 10.1089/thy.2014.0559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Vascular malformations and hemangiomas of the thyroid gland are rare disorders. The first case of a patient with recurrent high-flow arterio-venous malformation of the right thyroid gland involving the right endolarynx is presented. PATIENT FINDINGS In June 2013, a 42-year-old female patient presented to the surgical department with recurrent hoarseness and a soft, vibrating mass on the right side of her neck. In 1993, she underwent right subtotal hemithyroidectomy with embolization on the day before surgery for a high-flow arterio-venous malformation of the thyroid gland. Diagnostic work-up in 2013 demonstrated a complex recurrent high-flow arterio-venous malformation on the right side of her neck involving the endolarynx. Full function of the right vocal fold could not be ascertained. The lesion was embolized again and excised the following day. Intraoperative gross bleeding and scar tissue prevented visualization and monitoring of the recurrent laryngeal nerve. Gross bleeding was also noted on hemithyroidectomy after embolization in 1993. No therapy was needed for the endolaryngeal part of the lesion. Histology showed large arterio-venous malformations with thyroid tissue. She remains well without signs of recurrence 18 month later but with a definitive voice handicap. SUMMARY This is the first report of a recurrent high-flow arterio-venous malformation originally developing from the right thyroid gland involving the right endolarynx. Counseling, diagnostic, and therapeutic work-up of the patient was possible only with an interdisciplinary team. The endolaryngeal part of the hemangioma dried out after embolization and completion hemithyroidectomy. Her hoarseness has greatly improved but a definitive voice handicap remains. CONCLUSION High-flow arterio-venous malformations of the thyroid gland are a rare disease, and recurrent lesions have not been reported. Interdisciplinary management of these patients is mandatory due to the complex nature of the underlying pathology. Recurrence might develop after long free intervals.
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Affiliation(s)
- D H Borchert
- 1 Department of Surgery, Saarland University Hospitals , Homburg, Germany
| | - A Massmann
- 2 Department of Diagnostic and Interventional Radiology, Saarland University Hospitals , Homburg, Germany
| | - Y J Kim
- 3 Institute of Pathology, Saarland University Hospitals , Homburg, Germany
| | - C A Bader
- 4 Department of Otolaryngology, Saarland University Hospitals , Homburg, Germany
| | - G Wolf
- 4 Department of Otolaryngology, Saarland University Hospitals , Homburg, Germany
| | - R Eisele
- 1 Department of Surgery, Saarland University Hospitals , Homburg, Germany
| | - P Minko
- 2 Department of Diagnostic and Interventional Radiology, Saarland University Hospitals , Homburg, Germany
| | - A Bücker
- 2 Department of Diagnostic and Interventional Radiology, Saarland University Hospitals , Homburg, Germany
| | - M Glanemann
- 1 Department of Surgery, Saarland University Hospitals , Homburg, Germany
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Redaelli D, Guraya SS. Primary hemangioendothelioma of liver; report of a case and review of literature. J Taibah Univ Med Sci 2015. [DOI: 10.1016/j.jtumed.2014.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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9
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Naqvi J, Ordonez NG, Luna MA, Williams MD, Weber RS, El-Naggar AK. Epithelioid hemangioendothelioma of the head and neck: role of podoplanin in the differential diagnosis. Head Neck Pathol 2008; 2:25-30. [PMID: 20614338 PMCID: PMC2807604 DOI: 10.1007/s12105-007-0035-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Accepted: 09/26/2007] [Indexed: 12/30/2022]
Abstract
Epithelioid hemangioendothelioma is an uncommon vascular tumor of soft tissue and bone that may rarely occur in the liver, lung and the head and neck. We present five new cases of epithelioid hemangioendothelioma of the head and neck region diagnosed and managed in one institution in order to define the phenotypic characteristics, podoplanin immunohistochemical staining and the biological outcome. Podoplanin is a transmembrane mucoprotein selectively expressed in lymphatic endothelium and recently in some vascular neoplasms. The patients were comprised of two male and three female patients ranging in age from 4 to 71 years. The lesions were found in the gingiva, submandibular region soft tissue, nasal cavity and tongue, and ranged in size from 0.7 to 2.5 cm. All tumors manifested infiltrative cords and nests of epithelioid cells with occasional spindle morphology in a myxoid stroma. Immunohistochemical analysis of vascular and epithelial markers showed strong and uniform cytoplasmic reactivity for podoplanin and variable intensity and staining of CD31 and lack of cytokeratin staining in tumor cells. Surgical treatment included simple and wide local excisions. Of the three patients with follow-up, one developed lymph node metastasis and one had no evidence of disease 10 months after surgery. The patient with multiple recurrences and LN metastases was additionally treated with chemotherapy and is under consideration for radiation therapy. Hemangioendothelioma of the head and neck is: (1) a low-grade malignancy with a tendency for local recurrence and regional lymph node metastasis, (2) complete excision with negative margins is the treatment of choice for localized disease and (3) podoplanin may be useful in differentiating epithelioid hemangioendothelioma from non-vascular tumors.
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Affiliation(s)
- Jabeen Naqvi
- Department of Pathology, University of Texas, M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 085, Houston, TX 77030 USA
| | - Nelson G. Ordonez
- Department of Pathology, University of Texas, M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 085, Houston, TX 77030 USA
| | - Mario A. Luna
- Department of Pathology, University of Texas, M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 085, Houston, TX 77030 USA
| | - Michelle D. Williams
- Department of Pathology, University of Texas, M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 085, Houston, TX 77030 USA
| | - Randal S. Weber
- Department of Head and Neck Surgery, University of Texas, M. D. Anderson Cancer Center, Houston, TX 77030 USA
| | - Adel K. El-Naggar
- Department of Pathology, University of Texas, M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 085, Houston, TX 77030 USA
- Department of Head and Neck Surgery, University of Texas, M. D. Anderson Cancer Center, Houston, TX 77030 USA
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Abstract
OBJECTIVE To investigate the clinicopathological characteristics and biologic behaviour of epithelioid hemangioendothelioma in the oral cavity. MATERIALS AND METHODS The clinical features and pathological findings of nine cases with intraoral epithelioid hemangioendothelioma were reviewed, including immunohistochemistry study. RESULTS This series comprised seven males and two females aged 6-53 years (mean 28 years). The sites of the tumour included the tongue (n = 4), lip (n = 1), the gingiva and alveoli of the maxilla (n = 1), the gingiva and alveoli of the mandible (n = 1), buccal mucosa (n = 1), and the floor of the mouth (n = 1). A painless solitary mass was the most common presentation and was found in eight cases. On pathology, the tumour grew in short strands, cords or nests of polygonal to slightly spindled epithelioid cells in fibro-myxoid stroma, with formation of intracytoplasmic lumina. Tumour cells were immunoreactive to CD34, FVIIIRAg, and vimentin. Focal-positive cytokeration were observed in three cases. Immunoreactivity for S-100 protein, epithelial membrane antigen (EMA) and human herpesvirus (HHV)-8 was negative in all cases. Two cases recurred after surgical excision, but no patient developed local or distant metastasis. CONCLUSIONS Wide local excision with long-term follow-up seems to be the treatment of choice for intraoral epithelioid hemangioendothelioma because of their unpredictable biological behaviour and recurrence potential.
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Affiliation(s)
- Z J Sun
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, 237 Luo Yu Road, Wuhan 430079, Hubei, China
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Posligua L, Anatelli F, Dehner LP, Pfeifer JD. Primary peritoneal epithelioid hemangioendothelioma. Int J Surg Pathol 2006; 14:257-67. [PMID: 16959716 DOI: 10.1177/1066896906290682] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Epithelioid hemangioendothelioma is an uncommon malignant vascular tumor of intermediate grade that occurs in a variety of organs and soft tissues. Diagnosis of epithelioid hemangioendothelioma is often complicated by the rarity of the tumor, and because the tumor shares many morphologic features with other peritoneal neoplasms. This report presents 3 cases of epithelioid hemangioendotheliomas arising as primary tumors of the peritoneum and reviews 7 previously reported cases to establish the demographic, clinical, morphologic, immunohistochemical, and ultrastructural features of this neoplasm. These cases demonstrate that the light microscopic features are very similar to epithelioid hemangioendothelioma arising at more conventional sites, such as the liver, that immunohistochemical analysis provides a reliable approach for confirming or establishing the diagnosis, and that at least one endothelial marker (either CD31, CD34, or factor VIII) should be positive for a definitive diagnosis. This series identifies the characteristics of peritoneal epithelioid hemangioendothelioma that can be reliably used for diagnosis.
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Affiliation(s)
- Lorena Posligua
- Lauren V. Ackerman Laboratory of Surgical Pathology, Barnes-Jewish Hospital, Washington University Medical Center, St. Louis, Missouri, USA
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Tong GX, Hamele-Bena D, Borczuk A, Monaco S, Khosh MM, Greenebaum E. Fine needle aspiration biopsy of epithelioid hemangioendothelioma of the oral cavity: Report of one case and review of literature. Diagn Cytopathol 2006; 34:218-23. [PMID: 16470861 DOI: 10.1002/dc.20397] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Epithelioid hemangioendothelioma (EHE) is an uncommon vascular tumor with biological behavior intermediate between hemangioma and angiosarcoma. It rarely occurs in the oral cavity. We report a case of an 81-yr-old woman with a 2-mo history of a 2 x 2 cm2 submucosal buccal mass. Fine needle aspiration (FNA) smears were paucicellular and showed mainly single atypical large epithelioid cells in a bloody background. The atypical cells had abundant dense cytoplasm, some with fine vacuoles. Occasionally, cells with large cytoplasmic lumina were seen. Cytology preparations from fresh tissue received for frozen section revealed numerous neoplastic cells with large intracytoplasmic lumina, some of which contained red blood cells. In addition, cells with distinct intranuclear inclusions were present. Histologic sections and immunohistochemical stains confirmed the diagnosis of EHE. Although the histologic features of EHE are well recognized, reports of FNA cytology findings are sparsely existent in the literature as several case reports. The characteristic cytological features of EHE are reviewed in this report. We believe that the diagnosis of this rare tumor can be suggested when an adequate FNA specimen is obtained.
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Affiliation(s)
- Guo-Xia Tong
- Department of Pathology, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
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Hassan I, Barth P, Celik I, Hoffmann S, Langer P, Ramaswamy A, Wagner HJ, Rothmund M, Zielke A. An authentic malignant epithelioid hemangioendothelioma of the thyroid: a case report and review of the literature. Thyroid 2005; 15:1377-81. [PMID: 16405412 DOI: 10.1089/thy.2005.15.1377] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Hemangioendotheliomas of the thyroid are neoplasms that are rarely encountered in the Alpine region in Europe. The endemic goiter in this iodine-deficient region can be considered as a predisposing factor. We report the second case of an epithelioid hemangioendothelioma (EHE) of the thyroid gland and the first clinical case with malignant behavior. A 73-year-old woman with a long history of multinodular goiter presented with a rapidly growing thyroid mass, free of distant metastases. A total thyroidectomy was performed. Histologically the lesion had characteristic epithelioid and spindle cell proliferation in a background of chondromyxoid stroma. Cytoplasmic vacuolization in the epithelioid and spindle cells were present. Tumor cells were positive for factor VIII-related antigen, MNF116, PAN-ceratin, CD 34, and CD 31 and negative for cytokeratin allowing the diagnosis of EHE. Nine months after the primary resection the tumor locally recurred. A palliative resection was performed in a second operation followed by interferon-alpha therapy. The patient rapidly developed a second local relapse and died 13 months after the diagnosis of an EHE had been made. An improvement of the very poor prognosis of this rare tumor may depend on early tumor diagnosis and surgery combined with a multimodal treatment.
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Affiliation(s)
- I Hassan
- Department of Surgery, Philipps-University of Marburg, 35033 Marburg, Germany.
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Tse LL, Chan I, Chan JK. Capsular intravascular endothelial hyperplasia: a peculiar form of vasoproliferative lesion associated with thyroid carcinoma. Histopathology 2001; 39:463-8. [PMID: 11737303 DOI: 10.1046/j.1365-2559.2001.01225.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS Florid vasoproliferative processes are uncommon in the thyroid gland. We report three cases of an unusual vasoproliferation involving the capsular blood vessels of thyroid carcinoma. METHODS AND RESULTS The histological diagnoses of the three cases were made on conventional histological sections. Two cases were minimally invasive follicular carcinomas and one case was an encapsulated variant of papillary carcinoma. Some blood vessels in the tumour fibrous capsule were filled with spindly cellular proliferations forming irregular vascular clefts and papillae. Immunohistochemical studies for CD31, CD34 and muscle-specific actin confirmed that the spindly cells were mostly endothelial cells variably supported by pericytes. CONCLUSION This peculiar intravascular endothelial hyperplasia by itself should not be mistaken for vascular invasion by tumour, but evidence of malignancy must be diligently sought by extensive sampling because the lesion has thus far been consistently associated with malignant thyroid neoplasms.
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Affiliation(s)
- L L Tse
- Department of Pathology, Queen Elizabeth Hospital and Ruttonjee Hospital, Hong Kong.
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Pigadas N, Mohamid W, McDermott P. Epithelioid hemangioendothelioma of the parotid salivary gland. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2000; 89:730-8. [PMID: 10846129 DOI: 10.1067/moe.2000.106299] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Epithelioid hemangioendothelioma is a borderline neoplasm characterized by proliferation of endothelial cells with epithelioid morphology. The tumor, in terms of histology and behavior, occupies an intermediate position between hemangioma and conventional angiosarcoma. It is encountered in a wide variety of sites, such as soft tissues and skin, visceral organs, and bone. This article describes a slowly growing, painful tumor that developed in the parotid gland of a 48-year-old white woman and was treated with a superficial parotidectomy. Microscopically, the lesion consisted of short strands, cords, or small clusters of epithelioid vacuolated cells that exhibited strong immunoreactivity for endothelial cell markers (CD 31, CD 34, and factor VIII-related antigen). Previous reports have presented epithelioid hemangioendotheliomas in the head and neck region but, to our knowledge, this is the first reported case in the parotid salivary gland.
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Affiliation(s)
- N Pigadas
- Chase Farm Hospital, Enfield, Middlesex, United Kingdom
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