Spontaneous rupture of hepatic epithelioid hemangioendothelioma: A case report

Abstract

Hepatic epithelioid hemangioendothelioma (HEH) is a rare tumor of vascular endothelial origin. Spontaneous rupture of HEH is a life-threatening complication and is extremely rare. HEH has variable malignant potential, and the clinical diagnosis remains challenging. Here we report a case of HEH with spontaneous rupture. A 44-year-old man presented with constant cutting pains over the right upper abdomen after eating. He had hemoptysis 11 d previously. Diagnostic abdominal puncture demonstrated active bleeding. Chest and abdominal computer tomography scan showed multiple ground-glass nodules over the lungs, multiple low-density intrahepatic nodules and massive hemorrhage. Transcatheter arterial embolization and exploratory laparotomy were performed and subsequent immunohistochemical examination confirmed a diagnosis of HEH.

Keywords: Hepatic epithelioid hemangioendothelioma; Spontaneous rupture.

Figure 1

Computer tomography. A: Venous phase image revealed multiple low-density intrahepatic nodules in both lobes, and part of nodules showed inhomogeneous enhancement; B: The maximum lesion was located in the right lobe under the hepatic capsule; C: Computer tomography scan after transcatheter arterial embolization revealed massive hematocoelia.

Figure 2

Histopathologic findings of hepatic epithelioid hemangioendothelioma. Carcinoma cells appeared nest-like or papillary around the blood vessels, the nuclei were round or ovoid (hematoxylin-eosin staining; magnification × 200).

Figure 3

Immunohistochemical examination of hepatic epithelioid hemangioendothelioma. A: Specimen stained positive for CD31 (magnification × 200); B: Specimen stained positive for CD34 (magnification × 200); C: Specimen stained positive for FVIII (magnification × 200); D: Ki-67 proliferation index is less than 40% (magnification × 100).