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Mardani P, Shahriarirad R, Nekooeian M, Anbardar MH, Ziaian B, Kamran H, Ayare N, Vafabin M, Fouladi D. Pleural epithelioid hemangioendothelioma in a 39-Year-old female: a case report. J Cardiothorac Surg 2024; 19:118. [PMID: 38475834 DOI: 10.1186/s13019-024-02602-4] [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: 08/05/2023] [Accepted: 03/05/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Epithelioid hemangioendothelioma (EHE) is a rare malignancy of vascular origin which can be primarily be seen in various tissues. EHE originating from the pleura is an even more uncommon subtype which may mimic mesothelioma and pleural carcinomatosis. The prognosis of pleural EHE is poor and there is no consensus on the optimal therapeutic approach. CASE PRESENTATION A 39-year-old middle-eastern female presented with progressive dyspnea and left shoulder discomfort. Chest computed tomography scan revealed a left side pleural effusion and pleural thickening. Pleuroscopy was done and biopsies were taken which were positive for CD31, CD34, CK, factor 8-R-antigen, and vimentin. Patient was diagnosed with pleural epithelioid hemangioendothelioma (PEHE) and chemotherapy was started and underwent extrapleural pneumonectomy 7 months later. Unfortunately, the patient passed away 10 months after diagnosis due to disease complications. CONCLUSIONS Once PEHE is suspected in histology it can be confirmed with immunohistochemistry. Chemotherapy, surgery or a combination of both is currently used as the treatment but the standard treatment remains a question.
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Affiliation(s)
- Parviz Mardani
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Nekooeian
- Health and System Research center, Shiraz University of Medical Sciences, Shiraz, Iran
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Anbardar
- Department of Pathology, Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bizhan Ziaian
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hooman Kamran
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Students Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nazanin Ayare
- Students Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoud Vafabin
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Damoun Fouladi
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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2
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Jang YC, Hung WC, Su TC, Wu WP. Primary pulmonary epithelioid hemangioendothelioma. BMJ Case Rep 2023; 16:e254915. [PMID: 37709495 PMCID: PMC10503352 DOI: 10.1136/bcr-2023-254915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
Pulmonary epithelioid hemangioendothelioma (PEH) is a rare tumour of vascular origin with low to intermediate malignancy. Typical radiological finding on CT is multiple small nodules in bilateral lungs, and some will have punctate calcifications and pleural thickening. The diagnosis of PEH is confirmed by histopathological findings and positive immunohistochemistry staining. We report a case of a woman in her 50s with a medical history of lung adenocarcinoma. Later, regular chest CT during a routine cancer follow-up revealed multiple small pulmonary nodules and increased sizes of these nodules on serial images, initially misdiagnosed as multiple lung metastases. The histopathological diagnosis was made on a pulmonary wedge resection. Finally, PEH was diagnosed on the basis of positive immunohistochemical staining for CD31, ERF and TFE3. In the current study, the clinicopathological features and review of the literature were investigated. Our case highlights the importance of a histological diagnosis to avoid misdiagnosis.
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Affiliation(s)
- Yong Ching Jang
- Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan
| | - Wei-Chien Hung
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
| | - Tzu-Cheng Su
- Department of Pathology, Changhua Christian Hospital, Changhua, Taiwan
| | - Wen-Pei Wu
- Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
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3
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Weissferdt A, Moran CA. Primary epithelioid hemangioendotheliomas and angiosarcomas of the pleura: a clinicopathological and immunohistochemical analysis of 13 cases. Hum Pathol 2023; 138:68-75. [PMID: 37364825 DOI: 10.1016/j.humpath.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/13/2023] [Accepted: 06/21/2023] [Indexed: 06/28/2023]
Abstract
Thirteen cases of primary epithelioid hemangioendotheliomas (EHE) and epithelioid angiosarcomas (EA) of the pleura are presented. The patients were 7 men and 6 women between the ages of 34 and 65 years (mean: 47 years). The patients presented with non-specific symptoms of cough, dyspnea, and chest pain. Diagnostic imaging revealed the presence of either diffuse pleural thickening or pleural nodules involving the serosal surfaces. Open surgical biopsies were obtained in all cases. Histologically, eight tumors were characterized by the presence of a cellular proliferation composed of medium-sized epithelioid cells embedded in a myxohyaline stroma and a variable spindle cell component. Cellular atypia was mild to moderate and mitotic activity ranged from 1 to 2 per 2 mm2. Immunohistochemical stains for vascular markers, including CAMTA1 were positive, confirming a diagnosis of EHE. Five cases of epithelioid angiosarcomas were characterized by a neoplastic cellular proliferation admixed with areas of necrosis and hemorrhage and characterized by medium-sized epithelioid to spindle-shaped cells with eosinophilic cytoplasm, round to oval nuclei and prominent nucleoli. In addition, marked cytologic atypia and a mitotic activity ranging from 3 to 5 per 2 mm2 were identified. Immunohistochemical studies demonstrated positive staining for vascular markers; however, CAMTA1 was negative. Clinical follow-up obtained in eleven cases showed that all patients had died within 30 months post diagnosis. The current study highlights that even though it may be important to histologically separate EHE from EA for academic purposes, primary pleural origin of these tumors appears to portent an aggressive clinical behavior.
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Affiliation(s)
- Annikka Weissferdt
- Department of Pathology, University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Cesar A Moran
- Department of Pathology, University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA
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Rezvani A, Shahriarirad R, Erfani A, Ranjbar K. Primary malignant epithelioid hemangioendothelioma of the pleura: A review and report of a novel case. Clin Case Rep 2022; 10:e6211. [PMID: 35979384 PMCID: PMC9366930 DOI: 10.1002/ccr3.6211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/27/2022] [Accepted: 07/23/2022] [Indexed: 11/06/2022] Open
Abstract
Epithelioid hemangioendothelioma is considered an uncommon tumor originating from vascular tissues. Although this disease is an extremely rare malignant cancer, its pleural subtype is even less common. We discuss a 68‐year‐old man with isolated pleural epithelioid hemangioendothelioma, along with a literature review of all similar cases.
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Affiliation(s)
- Alireza Rezvani
- Bone Marrow Transplantation Center, Nemazi Hospital Shiraz University of Medical Sciences Shiraz Iran
- Thoracic and Vascular Surgery Research Center Shiraz University of Medical Science Shiraz Iran
| | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research Center Shiraz University of Medical Science Shiraz Iran
- Student Research Committee Shiraz University of Medical Sciences Shiraz Iran
| | - Amirhossein Erfani
- Thoracic and Vascular Surgery Research Center Shiraz University of Medical Science Shiraz Iran
- Student Research Committee Shiraz University of Medical Sciences Shiraz Iran
| | - Keivan Ranjbar
- Thoracic and Vascular Surgery Research Center Shiraz University of Medical Science Shiraz Iran
- Student Research Committee Shiraz University of Medical Sciences Shiraz Iran
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5
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Tossan P, Pichon E, Arbion F, Sizaret D, Simionca G, Marchand-Adam S. Hémangioendothéliome épithélioïde pleural, une tumeur rare de diagnostic difficile : à propos d’un cas et revue de la littérature. Rev Mal Respir 2022; 39:398-406. [DOI: 10.1016/j.rmr.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 02/24/2022] [Indexed: 11/26/2022]
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6
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Lavacchi D, Voltolini L, Comin CE, Mazzoni F, Baldi GG, Briganti V, Luvarà S, Bongiolatti S, Antonuzzo L. Primary pleural epithelioid hemangioendothelioma: case report and review of the literature. Anticancer Drugs 2021; 32:1131-1137. [PMID: 34232937 PMCID: PMC9665943 DOI: 10.1097/cad.0000000000001122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/31/2021] [Indexed: 11/26/2022]
Abstract
Epithelioid hemangioendothelioma (EHE) is an extremely rare vascular sarcoma with an unpredictable clinical behavior. Pleural EHEs have been associated with poor response to treatment and reduced survival. To date, no standard treatment for EHE is available. Here we report the case of a 53-year-old man who underwent radical surgery for a symptomatic primary pleural EHE. Clinical presentation was characterized by chronic pain in the left hemithorax with transitory flare, anemia, weight loss and progressive worsening of clinical conditions. After surgery, he resumed active life and normal daily activities and, at 8 months, 18F-FDG PET and computed tomography scan showed no radiological evidence of recurrent disease. Clinical signs of this rare disease, histological features, imaging findings and functional imaging are discussed. We also report a summary of other cases with resected pleural EHE and we briefly review the role of chemotherapeutic, immunomodulatory and antiangiogenic drugs for advanced disease.
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Affiliation(s)
| | | | - Camilla Eva Comin
- Department of Experimental and Clinical Medicine, University of Florence, Florence
| | | | - Giacomo Giulio Baldi
- Department of Medical Oncology, Hospital of Prato, Azienda USL Toscana Centro, Prato
| | | | - Silvia Luvarà
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | | | - Lorenzo Antonuzzo
- Clinical Oncology Unit
- Department of Experimental and Clinical Medicine, University of Florence, Florence
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7
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Askari E, Yaghmaei S, Haseli S, Pouradollah Totkaboni M. Primary Pleural Hemangioendothelioma: A Case Report and Literature Review. Case Rep Oncol 2021; 14:1201-1211. [PMID: 34703437 PMCID: PMC8460936 DOI: 10.1159/000518243] [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: 05/28/2021] [Accepted: 06/26/2021] [Indexed: 12/02/2022] Open
Abstract
Epithelioid hemangioendothelioma (EHE) is a rare tumor of the vascular endothelial cells. It can originate from any tissue; however, it occurs most frequently in the liver and lung. Pleural epithelioid hemangioendothelioma (PEH), EHE developing from pleura, is even more infrequent and less reported in the literature. In the following report, we discuss a 40-year-old man who initially presented with right-sided chest pain. Computed tomography revealed pleural thickening and effusion in his right thoracic cavity. PEH diagnosis was confirmed with immunohistochemistry. In order to provide the readers with an inclusive understanding of the disease, we collected the PEH cases reported in the literature. Despite the scarcity of the reported PEH cases (to our best knowledge), the compiled literature review of the disease enables the readers to grasp a better comprehension of the disease.
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Affiliation(s)
- Elham Askari
- Department of Pathology, Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shekoofeh Yaghmaei
- Department of General Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Haseli
- Department of Radiology, Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mihan Pouradollah Totkaboni
- Department of Pathology, Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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8
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Witte S, Weidema M, Kaal S, Versleijen-Jonkers Y, Flucke U, van der Graaf W, Desar I. The heterogeneity of Epithelioid Hemangioendothelioma (EHE): A case series and review of the literature with emphasis on treatment options. Semin Oncol 2021; 48:111-118. [PMID: 34176654 DOI: 10.1053/j.seminoncol.2021.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 04/07/2021] [Accepted: 04/14/2021] [Indexed: 12/28/2022]
Abstract
Epithelioid hemangioendothelioma (EHE) is an extremely rare vascular sarcoma with a very heterogeneous presentation and prognosis. We here present five cases of EHE emphasizing diversity in presentation, treatment, and prognosis. Furthermore, we present a review of the literature on EHE treatment options.
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Affiliation(s)
- Stijn Witte
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Marije Weidema
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Suzanne Kaal
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Uta Flucke
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Winette van der Graaf
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ingrid Desar
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands.
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9
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Kim SH, Kim YS, Jang MH, Kwon HJ. Mediastinal Epithelioid Hemangioendothelioma Invading Superior Vena Cava: A Case Report and Review of Literature. Curr Med Imaging 2020; 15:349-352. [PMID: 31989887 DOI: 10.2174/1573405614666180124141817] [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: 06/23/2017] [Revised: 01/02/2018] [Accepted: 01/08/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Epithelioid Hemangioendothelioma (EHE) is a rare vascular neoplasm. Common locations of EHE are the bone, soft tissue, liver, and lung, but the mediastinal location is extremely rare. Few cases of mediastinal EHE, invading the Superior Vena Cava (SVC) have been reported. CASE PRESENTATION We report a case of a 21-year-old man with EHE invading the SVC, which was incidentally detected on performing chest radiography. A contrast-enhanced chest Computed Tomography (CT) scan demonstrated a well-defined, oval mass located on the right side of the anterior mediastinum. The mass showed homogeneous enhancement with punctate calcifications, and it invaded the SVC at the confluence area of the right and left brachiocephalic veins. CONCLUSION Mediastinal EHE invading the SVC may present as a homogeneously enhancing mass with punctate calcifications. It should be added to the differential diagnosis of tumors of the mediastinum. Accurate preoperative diagnosis of EHE is critical for surgical planning; therefore, knowledge of the radiologic features of EHE is important.
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Affiliation(s)
- Su Hong Kim
- Department of Radiology, College of Medicine, Yeungnam University, Daegu, Korea
| | - Young Seon Kim
- Department of Radiology, College of Medicine, Yeungnam University, Daegu, Korea
| | - Min Hye Jang
- Department of Pathology, College of Medicine, Yeungnam University, Daegu, Korea
| | - Hee Jung Kwon
- Department of Pathology, College of Medicine, Yeungnam University, Daegu, Korea
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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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Difficulty of treatment for pleural epithelioid hemangioendothelioma: a report of a case. Gen Thorac Cardiovasc Surg 2019; 68:190-193. [DOI: 10.1007/s11748-019-01135-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 04/25/2019] [Indexed: 01/07/2023]
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12
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Wu X, Li B, Zheng C, Hong T, He X. Clinical characteristics of epithelioid hemangioendothelioma: a single-center retrospective study. Eur J Med Res 2019; 24:16. [PMID: 30819247 PMCID: PMC6394028 DOI: 10.1186/s40001-019-0375-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 02/19/2019] [Indexed: 12/12/2022] Open
Abstract
Background Epithelioid hemangioendothelioma (EHE) is a rare malignant vascular neoplasm with increasing incidence. However, its clinical characteristics remain unclear due to its low incidence. This study aimed to investigate the features of EHE. Methods Patients with EHE treated at our institution between January 2000 and June 2018 were enrolled. Data including demographic characteristics, treatment patterns, pathological results, and prognosis were collected, and a retrospective database was constructed for analysis. Results The cohort comprised 33 patients with a mean age of 48.0 ± 16.0 years. Eighteen (54.5%) patients were asymptomatic. The laboratory tests were unremarkable except in five and two patients who had increased CA 125 and CA 19-9, respectively. Twenty-one patients underwent surgery, while 12 patients underwent only biopsy. The postoperative morbidity rate was 28.6% (6/21). The anatomical sites of the primary lesions varied. Immunohistochemical staining was positive for CD34 and CD31 in most patients. Twenty-six patients (78.8%) were followed up at a range of 1–201 months, and 6 patients died during this period. The 1-, 3-, and 5-year cumulative survival rates were 96.2%, 87.0%, and 75.3%, respectively. The patients who had metastases or only underwent biopsy showed significantly higher mortality. Conclusions EHE is a rare malignant vascular tumor that can occur in any site of the body. Surgery is the primary choice of treatment, and pathologic evaluation is the gold standard for diagnosis. Metastases and unresectability are associated with poor prognosis.
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Affiliation(s)
- Xin Wu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Binglu Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
| | - Chaoji Zheng
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Tao Hong
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Xiaodong He
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
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13
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Fan Y, Wang F, Li S, Ye C, Ying Y, Mao H. Pleural Epithelioid Hemangioendothelioma: A Case Report and Literature Review. J Natl Med Assoc 2018; 108:124-9. [PMID: 27372473 DOI: 10.1016/j.jnma.2016.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 05/05/2016] [Accepted: 05/05/2016] [Indexed: 02/05/2023]
Abstract
Epithelioid hemangioendothelioma (EHE) is a rare neoplasm of vascular origin that can arise in multiple and varied tissue sites. Pleural epithelioid hemangioendothelioma (PEH), a subtype of EHE, is particularly less reported. Herein, we describe a case of PEH presented with left-sided back pain in a 68-year-old female, and her chest CT scan revealed thickening of the left pleura and left pleural effusion, the histological diagnosis was confirmed by both conventional examination and immunohistochemistry. A literature search utilizing PubMed, Embase, Ovid and Cochrane, Wanfang and Chinese National Knowledge infrastructure (CNKI) for PEH was conducted to investigate the characteristics of the disease, 26 related articles were retrieved and 40 cases of PEH were reported. According to available literature, the average age at presentation is 51.8 years and the disease occurred more often in men than women. The etiology of the disease remained unknown. Chest pain, cough, and dyspnea were the common symptoms. Computed tomography usually revealed pleural effusion and pleural thickening. Histological examinations revealed mainly epithelioid cells. Immunohistochemical stains were positive for vascular endothelial markers. PEH tends to have more aggressive behavior than tumors in other locations, thus effective treatment has not yet been established until now. Further studies are needed to analyze the prognostic factors, clinical features and treatment of PEH.
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Affiliation(s)
- Yingqi Fan
- Department of Respiratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Faping Wang
- Department of Respiratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Suyun Li
- Department of Respiratory Medicine, First Affiliated Hospital of Henan College of Traditional Chinese Medicine, Zhengzhou 450000, China
| | - Cheng Ye
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Ying Ying
- Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Hui Mao
- Department of Respiratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China.
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14
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Balansay BE, Zhang X, Loftus PD, Aparicio Valenzuela J, Zambrano E, Lee AM. Diagnosing Epithelioid Hemangioendothelioma With Pericardial Involvement. Ann Thorac Surg 2018; 106:e173-e175. [PMID: 29689240 DOI: 10.1016/j.athoracsur.2018.03.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 03/15/2018] [Accepted: 03/20/2018] [Indexed: 12/27/2022]
Abstract
Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor that commonly affects lung, liver, and bone. Among all known EHE cases, only 20% have a pulmonary origin, with metastases to the pericardium occurring in less than 1% of these. Because of its low prevalence, variable presentation, and unknown latency period, a thoracic EHE diagnosis can be easily missed. This case outlines the unique pathologic features of EHE in a patient with cardiovascular disease, provides further insight into diagnosing a rare tumor, and provides a better understanding of the pathophysiology and progression of thoracic EHE.
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Affiliation(s)
- Brianna E Balansay
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Xinyuan Zhang
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Patrick D Loftus
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California.
| | | | - Eduardo Zambrano
- Department of Pathology, Stanford University, Stanford, California
| | - Anson M Lee
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
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15
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New Insights about Pulmonary Epithelioid Hemangioendothelioma: Review of the Literature and Two Case Reports. Case Rep Radiol 2017; 2017:5972940. [PMID: 28884037 PMCID: PMC5573100 DOI: 10.1155/2017/5972940] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/04/2017] [Indexed: 12/14/2022] Open
Abstract
Pulmonary epithelioid hemangioendothelioma (PEH) is a rare neoplasm of vascular origin. There are three different major imaging patterns identified in thoracic manifestation of epithelioid hemangioendothelioma: (1) multiple pulmonary nodules; (2) multiple pulmonary reticulonodular opacities; and (3) diffuse infiltrative pleural thickening. Radiographically, presence of bilateral multiple nodules is the most common pattern of presentation. The diagnosis is made on the basis of histopathological findings and confirmed by positive immunohistochemistry staining. Although the prognostic factors for PEH have not yet been well established, a better prognosis is usually associated with the multinodular pattern. We report two different imagological presentations of this rare disease, based on two institutional experiences, along with a review of the relevant literature.
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16
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Minimally invasive diagnosis of a pericardial mass by CT-guided fine-needle aspiration. Cardiovasc Pathol 2016; 25:275-279. [PMID: 27131516 DOI: 10.1016/j.carpath.2016.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/15/2016] [Accepted: 03/28/2016] [Indexed: 11/20/2022] Open
Abstract
The preferred management of a cardiac mass remains controversial, but it often includes open-chest surgical excision to obtain an adequate tissue sample for histological workup. We herein report a less invasive approach in which an accurate and timely cytological diagnosis of pericardial angiosarcoma was reached by studying a CT-guided fine-needle aspiration cell block. The cell block showed proliferation of atypical cells with occasional mitotic figures, vasoformative features, and immunoreactivity to WT1, vimentin, CD31, CD34, ERG, and Ki67. Recourse to fine-needle aspiration and cell block study is a valuable diagnostic approach to be considered when a cardiac mass is percutaneously accessible.
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Sindhwani G, Khanduri R, Nadia S, Jethani V. Pleural haemangioma: A rare cause of recurrent pleural effusion. Respir Med Case Rep 2015; 17:24-6. [PMID: 27222779 PMCID: PMC4821329 DOI: 10.1016/j.rmcr.2015.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/15/2015] [Indexed: 11/28/2022] Open
Abstract
A middle aged female presented with recurrent unilateral pleural effusion. Thoracoscopy revealed a vascular tumor in the apical region of pleural cavity arising from the chest wall. Biopsy from the tumor showed features of pleural hemangioma. She was successfully managed by surgical excision of the tumor. The case is being presented because of its rarity.
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Affiliation(s)
- G Sindhwani
- Himalayan Institute of Medical Sciences, India
| | - R Khanduri
- Himalayan Institute of Medical Sciences, India
| | - S Nadia
- Himalayan Institute of Medical Sciences, India
| | - V Jethani
- Himalayan Institute of Medical Sciences, India
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18
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Jamy OH, Huber B, Giri S. Pleural epitheliod hemangioendothelioma: What started as a liver fluke and ended up being almost mistaken for malignant mesothelioma. Ann Thorac Med 2015; 10:289-91. [PMID: 26664569 PMCID: PMC4652297 DOI: 10.4103/1817-1737.164297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Epitheliod hemangioendothelioma (EHE) is a rare tumor of vascular origin. The pleural variant has only been reported around 20 times in English literature. It commonly occurs in older men and carries a poor prognosis with average survival lasting from a few weeks to months. Pleural EHE (PEHE) can be a diagnostic challenge due to its rarity as well as similarities to other pleural and vascular tumors. There is currently no standard treatment for EHE. Due to the rarity of this disease, reaching a final diagnosis is challenging. It's clinical, radiological, and pathological resemblance to malignant mesothelioma can cause a delay in diagnosis. Special stains such as CD31, CD34, and factor VIII related antigen can help differentiate between the two. Ordering appropriate stains in a timely manner can help avoid misdiagnosing PEHE.
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Affiliation(s)
- Omer H Jamy
- Department of Medicine, University of Tennessee Health and Science Center, Memphis, TN, USA
| | - Bryan Huber
- Department of Medicine, University of Tennessee Health and Science Center, Memphis, TN, USA
| | - Smith Giri
- Department of Medicine, University of Tennessee Health and Science Center, Memphis, TN, USA
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19
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Ferreiro L, San-José E, Suárez-Antelo J, Abdulkader I, Martínez-de-Alegría A, González-Barcala FJ, Valdés L. Spontaneous bilateral haemothorax as presentation of primary pleural epithelioid haemangioendothelioma. CLINICAL RESPIRATORY JOURNAL 2015; 11:1079-1085. [PMID: 26620871 DOI: 10.1111/crj.12421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 10/05/2015] [Accepted: 11/13/2015] [Indexed: 12/26/2022]
Abstract
Pleural epithelioid haemangioendothelioma (EHE) is a rare tumour that originates in the vascular endothelium with an intermediate degree of malignancy between haemangioma and angiosarcoma. Smoking and asbestos exposure are unproven risk factors and diagnosis is usually confirmed by thoracoscopy, since pleural fluid (PF) cytology is often not conclusive. Immunohistochemistry can also help to confirm the diagnosis. We report an 85-year-old patient with bilateral pleural EHE diagnosed by thoracoscopy, who debuted with a spontaneous bilateral haemothorax, the second described so far, and we conducted a thorough review of the literature to describe the clinical, radiological and prognostic features, as well as the PF, of this rare tumour.
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Affiliation(s)
- Lucía Ferreiro
- Department of Pulmonology, University of Santiago Hospital Complex, Santiago de Compostela, Spain
| | - Esther San-José
- Department of Clinical Analysis, University of Santiago Hospital Complex, Santiago de Compostela, Spain.,Interdisciplinary Pulmonology Research Group, Health Research Institute of Santiago (IDIS), University of Santiago Hospital Complex, Santiago de Compostela, Spain
| | - Juan Suárez-Antelo
- Department of Pulmonology, University of Santiago Hospital Complex, Santiago de Compostela, Spain
| | - Ihab Abdulkader
- Department of Pathology, University of Santiago Hospital Complex, Santiago de Compostela, Spain
| | | | - Francisco-Javier González-Barcala
- Department of Pulmonology, University of Santiago Hospital Complex, Santiago de Compostela, Spain.,Interdisciplinary Pulmonology Research Group, Health Research Institute of Santiago (IDIS), University of Santiago Hospital Complex, Santiago de Compostela, Spain
| | - Luis Valdés
- Department of Pulmonology, University of Santiago Hospital Complex, Santiago de Compostela, Spain.,Interdisciplinary Pulmonology Research Group, Health Research Institute of Santiago (IDIS), University of Santiago Hospital Complex, Santiago de Compostela, Spain
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20
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Thway K, Jordan S, Fisher C, Nicholson AG. Updates in the approach to intrathoracic sarcomas. Histopathology 2015; 67:755-70. [DOI: 10.1111/his.12771] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Khin Thway
- Sarcoma Unit; Royal Marsden Hospital; London UK
| | - Simon Jordan
- Department of Surgery; Royal Brompton Hospital; London UK
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21
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Salijevska J, Watson R, Clifford A, Ritchie AI, Mauri F, Adeboyeku D. Pleural epithelioid hemangioendothelioma: literature summary and novel case report. J Clin Med Res 2015; 7:566-70. [PMID: 26015825 PMCID: PMC4432902 DOI: 10.14740/jocmr2174w] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2015] [Indexed: 12/16/2022] Open
Abstract
Epithelioid hemangioendothelioma (EHE) is a rare malignant cancer of vascular origin that can affect multiple and varied tissue sites. A subtype of EHE, pulmonary epithelioid hemangioendothelioma (PHE), is more unusual with only 200 reported cases. Of these, only 27 have been classified as pleural in origin. Based on available literature, the average age of presentation of pleural PHE is 45.7 years with a male preponderance of 2.375. A summary of all published case reports reveals significant heterogeneity both in presentation and management. Here we add to this knowledge-base with a report of an unusual case of pleural PHE in a 36-year-old female who presented with a 6-week history of chest pain and breathlessness. Significant challenges in the diagnosis and management of patients with pleural PHE exist, including a wide initial differential diagnosis and difficulties in obtaining tissue specimens, coupled with relatively limited treatment options. Early referral to a cardiothoracic center for video-assisted thoracoscopic biopsy is crucial in facilitating a diagnosis and allowing adequate pleural drainage for symptomatic relief.
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Affiliation(s)
- Julita Salijevska
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
- Corresponding Author: Julita Salijevska, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
| | - Robert Watson
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Amy Clifford
- The North West London Hospitals NHS Trust, Northwick Park Hospital, Watford Road, Harrow, Middlesex, HA1 3UJ, UK
| | - Andrew I. Ritchie
- The North West London Hospitals NHS Trust, Northwick Park Hospital, Watford Road, Harrow, Middlesex, HA1 3UJ, UK
| | - Francisco Mauri
- Imperial College Healthcare NHS Trust, The Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - David Adeboyeku
- The North West London Hospitals NHS Trust, Northwick Park Hospital, Watford Road, Harrow, Middlesex, HA1 3UJ, UK
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22
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Wethasinghe J, Sood J, Walmsley R, Milne D, Jafer A, Gordon-Glassford N. Primary pleural epithelioid hemangioendothelioma mimicking as a posterior mediastinal tumor. Respirol Case Rep 2015; 3:75-7. [PMID: 26090117 PMCID: PMC4469146 DOI: 10.1002/rcr2.106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/27/2015] [Accepted: 03/30/2015] [Indexed: 11/12/2022] Open
Abstract
A 41-year-old man with no previous asbestos exposure presented with 6 months of dull right lower chest pain and weight loss. The initial computed tomography (CT) scan was reported as showing a soft tissue thickening in the posterior mediastinum with non-specific nodules in the horizontal and oblique fissures. An endoscopic ultrasound-guided fine needle aspiration from the 12 × 25 mm heterogeneous posterior mediastinal mass was suspicious for a ganglioneuroma. The procedure was complicated by a large hemothorax requiring drainage. A subsequent positron emission tomographic CT revealed a moderately fluorodeoxyglucose avid area of pleural thickening extending from the sixth to ninth thoracic vertebral body in the paraspinal region along with nodules along the right horizontal and oblique fissures. A thoracoscopic biopsy of the pleural lesion confirmed a pleural epithelioid hemangioendothelioma. There was a 5-mm reduction in tumor thickness and improvement in his pain following 54 Gy of radiotherapy.
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Affiliation(s)
- James Wethasinghe
- Department of Respiratory Medicine, Waitemata District Health Board Auckland, New Zealand
| | - Jaideep Sood
- Department of Respiratory Medicine, Waitemata District Health Board Auckland, New Zealand
| | - Russell Walmsley
- Department of Gastroenterology, Waitemata District Health Board Auckland, New Zealand
| | - David Milne
- Department of Radiology, Auckland District Health Board Auckland, New Zealand
| | - Ali Jafer
- Department of Gastroenterology, Waitemata District Health Board Auckland, New Zealand
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Allain G, Hajj-Chahine J, Lacroix C, Tomasi J, Corbi P, Jayle C. Surgical management of an epithelioid hemangioendothelioma of the superior vena cava protruding into the right atrium. J Card Surg 2014; 29:779-81. [PMID: 24893561 DOI: 10.1111/jocs.12370] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Epithelioid hemangioendothelioma (EH) is a rare malignant tumor of vascular origin that often involves soft tissues and visceral organs, and less commonly, large veins. We report a case of EH of the superior vena cava protruding into the right atrium and its surgical management.
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Affiliation(s)
- G Allain
- Department of Cardiothoracic Surgery, University Hospital of Poitiers, Poitiers, France
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24
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Enbom ET, Abasolo PA, Dixon JR, Nikolaenko LM, French SW, Duane GB. Cytomorphological features of epithelioid hemangioendothelioma in ascitic fluid with radiological, clinical and histopathological correlations. Acta Cytol 2014; 58:211-6. [PMID: 24504057 DOI: 10.1159/000357967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 12/10/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Epithelioid hemangioendothelioma (EHE) is an uncommon vascular soft-tissue tumor. Five cases of EHE in body fluids have been documented in the literature, all of them occurring in pleural effusions. This is the first description of cytomorphological features of EHE cells in ascitic fluid, accompanied by corresponding histopathological findings, clinical, and radiological data. CASE REPORT Our patient presented with several liver masses, peritoneal involvement, bilateral pleural effusions, and massive ascites. EHE was suspected on cytological examination of the ascitic fluid and was confirmed by immunohistochemical studies. Simultaneously, a liver mass was identified and diagnosed on biopsy as EHE, affording accurate histopathological correlation. Cytologically, EHE cells appear relatively bland, often obscured by reactive mesothelial cells, and dispersed singly or clustered. They often possess intracytoplasmic vacuoles, referred to as 'blister' or 'signet ring' cells. High-power examination shows slightly misshapen mildly hyperchromatic nuclei with inconspicuous nucleoli. Immunohistochemically, EHE cells express strong positivity with vascular markers (CD31, CD34 and factor VIII). They are nonreactive with mesothelial markers (calretinin and WT-1). CONCLUSION Recognition of the possibility of EHE cells in fluid by morphology should prompt proper immunohistochemical work-up to ensure an accurate diagnosis and timely patient management.
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Affiliation(s)
- Elena T Enbom
- Department of Pathology and Laboratory Medicine, Harbor-UCLA Medical Center, Torrance, Calif., USA
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