Primary hepatic epithelioid hemangioendothelioma: a case report

Abstract

Epithelioid hemangioendothelioma is a low-grade malignant tumor of vascular origin. The rarity of hepatic epithelioid hemangioendothelioma (HEHE) makes the diagnosis and treatment of this entity challenging. We report a case of a 69-year-old female patient who suffered from HEHE and complained of abdominal distension pain with dizziness and appetite loss for more than half a month. Enhanced computed tomography of the upper abdomen indicated multiple space-occupying lesions in the liver. The pathological results of color ultrasound puncture suggested HEHE. We performed transcatheter arterial chemoembolization and relevant examinations according to the patient's condition and their choice. We followed the patient for 5 years and found that she developed recurrent intrahepatic metastasis of the tumor. Computed tomography was performed again after 3 months of treatment with anlotinib and the tumor did not show any progression. HEHE is a relatively rare hepatic malignant tumor derived from vascular endothelial cells, with a low incidence, atypical clinical manifestations, and a difficult diagnosis that can only be confirmed with pathological results. Currently, appropriate treatment methods should be selected according to the specific conditions of the patient.

Keywords: Hepatic epithelioid hemangioendothelioma; anlotinib; glucose metabolism; liver transplantation; metastasis; transcatheter arterial chemoembolization.

Figure 1.

Enhanced computed tomography showing multiple liver space-occupying lesions.

Figure 2.

Positron emission tomography-computed tomography shows multiple intrahepatic space-occupying lesions and increased glucose metabolism. No increased glucose metabolism was observed in the lungs or skull.

Figure 3.

Immunohistochemical findings. Hematoxylin and eosin staining is shown (200×, top right panel; 400×, bottom left panel). Immunohistochemical staining of ERG (top left panel) and Friend leukemia virus integration 1 (bottom right panel) is also shown.

Figure 4.

Enhanced computed tomography showing recurrent intrahepatic metastasis of the tumor at a 5-year follow-up.

Figure 5.

Enhanced computed tomography showing no tumor progression 3 months after starting anlotinib.