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Weekly Chest CasesArchive of Old Cases

Case No : 649 Date 2010-04-05

  • Courtesy of Gong-yong Jin / Chonbuk National University Hospital
  • Age/Sex 48 / F
  • Chief ComplaintCough
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Epitheloid hemangioendothelioma
Radiologic Findings
Chest CT shows a 3 cm, mild enhanced mass with a calcification in RLL. PET/CT shows a hypermetabolic mass in RLL and focal hypermetabolic nodule in left 8th rib. Abdomen CT shows multiple, variable sized, hypodense mass with calcification in liver.

Pathology

Gross examination
-- Discrete, circumscribed, firm gray-white nodules that may resemble amyloid or cartilage.

Histologic analysis
-- Hyalinized center and a cellular advancing edge that extends into alveolar spaces, bronchioles, vessels, and lymphatic vessels
-- Moderate atypia, necrosis, and mitoses

H& E stain

CD 34

Brief Review
Epithelioid hemangioendothelioma
-- Rare vascular tumor of borderline or low-grade malignancy
many organ systems, including liver, bone, and soft tissues simultaneously or sequentially

Pulmonary EHE
-- All age groups (12-61 yrs), 40% under 30yrs [4]
usually asymptomatic, mild cough, dyspnea, chest pain, or weight loss [5,6]

Clinical course
-- Many, benign fashion
-- Others, highly malignant
-- Poor prognosis: severe symptoms, airway, vascular, and pleural involvement [5,6]

Radiologoic Findings

-- Presence of multiple perivascular nodules in both lungs
-- well- or ill-defined margins
-- Size : up to 2 cm, most ≤1cm in diameter in relation to small and medium-sized vessels and bronchi
-- Calcification, not common [1]
-- Hilar lymph node enlargement (9%)
-- Metastatic LN : a/w interlobular septal thickening
-- Pleural effusions(10%) [2]
References
1. Luburich P, Carmen Ayuso M, Picado C, et al. CT of pulmonary epithelioid hemangioendothelioma. J Comp Assist Tomogr 1994; 18:562?65
2. Ross GJ, Violi L, Friedman AC, et al. Intravascular bronchioloalveolar tumor: CT and pathologic correlation. J Comp Assist Tomogr 1989; 13:240?43
3. Colby TV, Koss MN, Travis WD. Miscellaneous mesenchymal tumors. In: Tumors of the lower respiratory tract. Atlas of tumor pathology. 3rd series, fascicle 13. Washington, DC: Armed
4. Ledson MJ, Convery R, Carty A, Evans CC. Epithelioid hemangioendothelioma: case report. Thorax 1999; 54:560?61.
5. Carter EJ, Bradburne RM, Jhung JW, et al. Alveolar haemorrhage with epithelioid haemangioendothelioma. Am Rev Respir Dis 1990; 142: 700?01.
6. Kradin RL, Mark EJ. Hemoptysis in a 20-yearold man with multiple pulmonary nodules. Mas춖achusetts General Hospital Case Records, case 6-2000. N Engl J Med 2000; 342:572?78.
Keywords
Lung, Malignant tumor,

No. of Applicants : 104

▶ Correct Answer : 15/104,  14.4%
  • - care hospital , India Chary D
  • - Song-do Hospital , Korea (South) Ji-young Yun
  • - Gangnam Severance Hospital , Korea (South) Min Jeong Kim
  • - Dong-A university hospital , Korea (South) Sang-yun Lee
  • - Chonbuk National University Hospital , Korea (South) Jisoo Song
  • - Osaka University , Japan Osamu Honda
  • - Samsung Medical Center , Korea (South) Eun Kim
  • - SMC , Korea (South) Jihoon Cha
  • - Osaka University , Japan Hiromitsu Sumikawa
  • - Department of Radiology, Zhongshan Hospital, Fudan University,Shanghai, People , China Sheng-Xiang RAO
  • - All India Institute of medical sciences , India Justin Moses
  • - McGill University Health Center , Canada Alexandre Semionov
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Chonnam university hospital , Korea (South) Minyoung Jung
  • - Chonnam national university hosipital , Korea (South) Byung chan Lee
▶ Correct Answer as Differential Diagnosis : 7/104,  6.7%
  • - MEDISURGE HOSPITAL AHEMDABAD , India jignesh dubal
  • - Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Hotel-Dieu Montreal , Canada nicolas gautier
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - Saga University , Japan Ryoko Egashira
  • - Chonnam National University Hwasoon Hospiral , Korea (South) You Ri Choi
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