Pulmonary epithelioid hemangioendothelioma

Abstract

We report two cases of pulmonary epithelioid hemangioendothelioma (PEH). Both patients presented with multiple bilateral pulmonary nodules, <10 mm diameter, on computed tomography (CT). Multiple pulmonary metastases were considered, but no primary malignant lesion was detected by other imaging modalities including (18)F-fl uorodeoxyglucose positron emission tomography ((18)F-FDG-PET)/CT. Moreover, the nodules did not show increased uptake of (18)F-FDG. We performed pulmonary wedge resections by video-assisted thoracoscopic surgery (VATS). Histological and immunohistochemical analysis revealed PEH in both. Positivity for the monoclonal antibody MIB-1 in the tumor cells was 5% in the fi rst case and 5%-10% in the second case. Slow tumor progression was detected with CT in the second case. Although (18)F-FDG PET/CT is effective for screening other malignant lesions, it does not appear to be of direct use in the diagnosis and surgical planning of PEH. Pathological diagnosis by VATS is the most effective method. MIB-1 positivity should be analyzed as to whether it is a prognostic factor of PEH.