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Case Reports
. 2022 Nov 17:40:101769.
doi: 10.1016/j.rmcr.2022.101769. eCollection 2022.

Successful surgical treatment of epithelioid hemangioendothelioma involving multiple liver lesions and bilateral lung nodules

Takatora Akizawa  1   2 , Tomotaka Nishizawa  1   2 , Sho Yamada  1   2 , Hiroki Ota  1 , Gen Kida  1 , Yuta Tsukahara  1 , Tomohiko Nakamura  1 , Tomohiro Oba  1 , Hideaki Yamakawa  1 , Rie Kawabe  1 , Shintaro Sato  1 , Keiichi Akasaka  1 , Masako Amano  1 , Mitsuru Maki  3 , Akiko Adachi  4 , Haruyuki Ishii  2 , Hidekazu Matsushima  1
Affiliations
Case Reports

Successful surgical treatment of epithelioid hemangioendothelioma involving multiple liver lesions and bilateral lung nodules

Takatora Akizawa et al. Respir Med Case Rep. .

Abstract

Epithelioid hemangioendothelioma (EHE) affects many organs, particularly lung and liver, and typically presents as multiple lesions. Treatment for EHE is not yet standardized, but surgery is appropriate when lesions are resectable. In our patient, radiography revealed multiple bilateral pulmonary nodules, and CT showed several liver tumors. The liver masses and those in the right lung were removed during the initial surgery; pathology of hepatic specimens confirmed the diagnosis of EHE. During the second operation, the left lung nodules were excised, and all were EHEs. Surgical removal of multiorgan multinodular EHE is a viable treatment option, especially for young patients.

Keywords: Epithelioid hemangioendothelioma (EHE); Liver; Lung; Surgical treatment.

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Figures

Fig. 1A
Fig. 1A
Chest radiographs obtained at presentation showed multiple nodule shadows in both lung fields but predominantly in the right.
Fig. 1B
Fig. 1B
Chest CT showed multiple nonspecific nodular shadows.
Fig. 1C
Fig. 1C
Abdominal CT revealed multiple nodules scattered throughout the liver.
Fig. 2
Fig. 2
Eight months after the laparoscopic evaluation, follow-up CT showed both new and residual lesions in the liver, and repeat chest CT showed enlargement of the pulmonary nodules.
Fig. 3A
Fig. 3A
Pathologically, lesion margins were round, square, or polyhedral, and tumors contained proliferating epithelial-like cells with abundant cytoplasm covering the vitreous interstitium.
Fig. 3B
Fig. 3B
The centers of tumors were prominent, with vitreous interstitium or a cartilage-like matrix, often accompanied by necrosis. Immunohistochemistry yielded positive staining for CD31, CD34.
Fig. 3C
Fig. 3C
The centers of tumors were prominent, with vitreous interstitium or a cartilage-like matrix, often accompanied by necrosis. Immunohistochemistry yielded positive staining for CD31, CD34.
Fig. 3D
Fig. 3D
The Ki-67 index, which indicates the expression rate of the Ki-67 protein and thus the proliferative capacity of the tumor cells, was 4.6%.
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