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Weekly Chest CasesArchive of Old Cases

Case No : 772 Date 2012-08-14

  • Courtesy of Sang Min Lee, Hyun Ju Lee / Seoul National University Hospital
  • Age/Sex 31 / M
  • Chief Complaintmultiple nodules in both lungs detected on CT
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2012-08-04

Diagnosis With Brief Discussion

Diagnosis
Epithelioid hemangioendothelioma
Radiologic Findings
Chest CT shows multiple well-defined small (less than 1cm) nodules in both lungs. Most of nodules were located in the peripheral portion of the lung. There are also multiple low attenuated lesions in the liver on abdomen CT. Some subcapsular lesions show capsular retraction. The patient underwent VATS biopsy for diagnosis and pulmonary nodules were confirmed as epithelioid hemangioendothelioma.
Brief Review
Epithelioid hemangioendothelioma (formerly known as intravascular bronchioalveolar tumor) is a rare tumor of vascular endothelial origin, with an intermediate course between hemangioma and conventional angiosarcoma (1). Pulmonary epithelioid hemangioendothelioma (PEH) typically occurs as bilateral multiple nodules among young women (1,2).But some cases also develop as a solitary lung nodule or a single cavitary nodule (3). While histological calcification is common, radiologic calcification is not. Differential diagnosis includes metastatic carcinoma, chronic granulomatous disease, or rarely multiple benign tumors such as sclerosing hemangioma. Practically it is important to include PEH as a differential diagnosis when multiple nodules in both lungs are seen in young patients. There is no clear standard for treatment though spontaneous regression and response to chemotherapy and interferon are reported.
References
1.Kitaichi M, Nagai S, Nishimura K, Itoh H, Asamoto H, Izumi T, Dail DH: Pulmonary epithelioid haemangioendothelioma in 21 patients, including three with partial spontaneous regression.EurRespir J 1998, 12:89-96.
2. Cronin P, Arenberg D. Pulmonary Epithelioid Hemangioendothelioma : An Unusual Case and a Review of the Literature. Chest 2004; 125:789-793.
3. Jang KY, Jin GY, Lee YC, Lee HB, Kang MJ, Choi HY, Chung MJ: Pulmonary epithelioid hemangioendothelioma: a tumor presented as a single cavitary mass.J Korean Med Sci 2003, 18:599-602.
Keywords
lung, malignant tumor,

No. of Applicants : 63

▶ Correct Answer : 28/63,  44.4%
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - CHRU lille , France manuel toledano
  • - Kyung Hee Universitiy Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - XiangYa hospital , China Xia Yu
  • - Kurashiki Seijin-byo Center , Japan Akihiro Tada
  • - Teikyo mizonokuchi hospital , Japan Takana Yamakawa
  • - Fukuyama city hospital , Japan Ryotaro Kishi
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Seosan Medical Center , Korea (South) Sang Min Lee
  • - GM InHospital , Korea (South) Ju Won Lee
  • - Asan medical center , Korea (South) Sang Young Oh
  • - Asan Medical Center , Korea (South) Ji Eun Kim
  • - Asan Medical Center , Korea (South) Hye Jeon Hwang
  • - Asan medical center , Korea (South) Hyun Joo Lee
  • - Asan Medical Center , Korea (South) Eunyoung Kim
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - Hanyang University Hospital , Korea (South) Yo Won Choi
  • - Kohka Public Hospital , Japan Akitoshi Inoue
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Okayama university , Japan Mayu Uka
  • - Medicheck health care , Korea (South) Chae Lim
▶ Correct Answer as Differential Diagnosis : 8/63,  12.7%
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - UWO , Canada S Lee
  • - royal melbourne hospital , Australia kimchi kings
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - radiologist, aditya imaging centre , India vivek patel
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - All India Institute of medical sciences , India Justin Moses
  • - Chonnam National University Hospital , Korea (South) So yeon Ki
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