Journal of Pathology and Translational Medicine

Case Reports

Fine Needle Aspiration Cytology of Pulmonary Epithelioid Hemangioendothelioma with Prominent Hyaline Degeneration: A Case Report.: Kang Min Han, Dong Hoon Kim, Na Hye Myong; Korean J Pathol. 2010;44(5):554-557.; DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.5.554

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Pulmonary epithelioid hemangioendothelioma (PEH) is a rare vascular tumor of low to intermediate malignant potential, and PEH can mimic other more common tumor entities pathologically as well as clinically. Compared to its well-recognized histological features, its cytological findings have been reported rarely to be plasmacytoid or epithelioid cells with abundant dense or finely granular cytoplasm, cytoplasmic vacuoles, round nuclei and prominent nucleoli.We report here on the fine needle aspiration cytologic findings of a 38-year-old woman with EH of the lung, that showed in addition to its classical cytomorphology, a somewhat peculiar cytologic finding such as big twig-like rosettoid structures with prominent hyalinized stroma. This tumor was histologically and immunohistochemically proven to be PEH by primary antibodies for CD31, CD34 and vimentin. We emphasize that the accuracy of making a cytologic diagnosis of this rare tumor can be increased by recognizing the peculiar cytologic finding that we report on here.

Citations

Citations to this article as recorded by

Pulmonary epithelioid hemangioendothelioma misconceived as pulmonary metastasis of other malignancies
Gi Tark Noh, Kyoung Ju Lee, Hee Jung Sohn, Kyung Han Lee, Won Seok Heo, Byung Sung Koh, Un Mi Han, Young A Bae
Yeungnam University Journal of Medicine.2016; 33(1): 72. CrossRef
Fine needle aspiration cytology of epithelioid hemangioendothelioma of soft tissue
Shelly Sehgal, Reena Agarwal, Sarika Verma, Ajay Kumar Verma, Sompal Singh
Diagnostic Cytopathology.2013; 41(2): 179. CrossRef

Epithelioid Hemangioendothelioma of Liver: A case report.: Yoo Jin Kim, Jae Hwa Lee, Bang Hur, Man Ha Hur; Korean J Pathol. 1995;29(3):378-384.

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Abstract PDF: Epithelioid hemangioendothelioma of liver is a very rare tumor of vascular origin, the most peculiar feature of which is that it is composed of endothelial cells closely resembling epithelial cells. We present a primary epithelioid hemangioendothelioma of liver in a 40-year-old male. This tumor was composed of an ill-defined yellowish white, 7 x 4cm sized, firm, solid mass and small satellite nodules in the right lobe of liver. Microscopically, two types of tumor cells-dendritic and epithelioid-were identified. The neoplastic cells infiltrated into sinusoids and intrahepatic veins. The background of tumor showed marked sclerotic change and focal proliferation of bile ductules. Confirmation of the endothelial origin of these cells was provided by positive immunoperoxidase staining for factor VIII-related antigen, and by electron mi-croscopic demonstration of Weibel-Palade body. This is the first case of epithelioid heman- gioendothelioma of liver documented in Korea. We report this case in view of its scarcity and distinctive morphologic features that allow differentiation from sclerosing carcinoma and angiosarcoma.

Infantile Hemangioendothelioma of the Liver: Brief case report.: Hyang Jeong Jo, Ki Jung Yun, Jae Kyu Lee, Ji Shin Lee, Hyung Bae Moon; Korean J Pathol. 1997;31(6):586-588.

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Abstract PDF: Infantile hemangioendothelioma of the liver is a common vascular tumor in infancy. The tumor is usually multinodular or diffuse and classified into two types. We present a case of infantile hemangioendothelioma of the liver, which predominantly consists of type 2. A 4-month-old female was admitted for an evaulation of an abdominal distension. A CT scan of the liver showed a multinodular mass. The right lobectomy was done. Grossly, the mass consisted of round nodules ranging from 2cm to 5cm in diameter. Microscopically, the tumor revealed proliferation of small vascular channels lined by endothelial cells. Bizarre cells and mitotic cells were frequently noted. Vesicular nuclei and multilayering of the endothelial cells were also noted.

Composite Epithelioid Hemangioendothelioma in Pleural Effusion Mimicking Metastatic Adenocarcinoma: Cytologic and Immunocytochemical Findings.: Ki Seok Jang, Hong Xiu Han, Moon Hyang Park; Korean J Cytopathol. 2003;14(1):36-41.

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Abstract PDF: Epithelioid hemangioendothelioma is a rare vascular tumor of borderline malignancy which is characterized by the presence of "epithelioid" or "histiocytoid" endothelial cells. Superficial and deep tumors have been recognized in the extremities, head, neck, chest, and mediastinum of adult patients. It may also occur as a primary tumor of liver, bone, and other visceral organs. Few effusion cytologic findings of epithelioid hemangioendothelioma have been reported. We report a case of composite epithelioid hemangioendothelioma with focal epithelioid angiosarcomatous areas of the iliac bone and adjacent soft tissue in a 38-year-old female, which, during its metastatic course, was presented as a pleural effusion. The effusion was cellular with epithelioid cells presenting both singly and in clusters. The tumor cells were round to ovoid showing cytoplasmic vacuolization, variability in cell size, and prominent nucleoli. The effusion smears and cell block sections revealed strong positive staining for CD31 and vimentin, weak positive for CD34 and Factor VIII-related antigen, and negative for cytokeratin, CEA, and calretinin. The cytologic findings in this case were similar to that of metastatic adenocarcinoma or malignant mesothelioma. Therefore, immunocytochemical staining in smear and cell block is a helpful tool to differentiate malignant "epithelioid" cells in effusion.

Composite Hemangioendothelioma: A Case Report.: Young Chae Chu, Suk Jin Choi, In Suh Park, Lucia Kim, Jee Young Han, Joon Mee Kim; Korean J Pathol. 2006;40(2):142-147.

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Abstract PDF: Composite hemangioendothelioma (CHE) is a recently described vascular tumor of low-grade malignancy. We report a case of CHE in an 18-year-old woman who presented with a 2-month history of an enlarging palpable mass in the left axilla. Grossly, the excised tumor was relatively circumscribed, nodular, firm, and soft. It measured 6.0 x 4.5 x 4.0 cm. The cut surface revealed a whitish gray solid area and a dark red to tan cystic area containing necrotic material. Histologically, the tumor demonstrated variably intermixed benign and malignant vascular components. The benign components showed features of an arteriovenous malformation, capillary hemangioma, spindle cell hemangioma and cavernous hemangioma. The malignant components were composed of areas resembling retiform hemangioendothelioma, epithelioid hemangioendothelioma, Kaposiform hemangioendothelioma, and angiosarcoma. The angiosarcoma component showed a mixed epithelioid and spindle shaped cell morphology with moderate differentiation. A nearly imperceptible transition between the benign and malignant components was noted.

Original Article

Infantile Hemangioendothelioma of the Liver: A histological and immunohistochemicalstudy of 4 cases.: Mee Yon Cho, Sun Hee Sung, Soon Hee Jung, Chanil Park; Korean J Pathol. 1995;29(2):145-151.

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Abstract PDF: A pathological study was performed on four cases of infantile hemangioendothelioma of the liver. All the patients were between the age of 1 -5 months and the tumors were typical hemangio-endotheliomas, type 1. The tumors were composed basically of two components; the endothelial cell proliferation and the myxoid matrix. The endothelial cells were cytologically innocuous and formed vascular channels of varying sizes and shapes from capillary to sinusoidal and cavernous vessels. Fibrosis of the matrix, albeit not a major component of the tumor, was found particularly near the center. Immunohistochemically, CD31 was expressed strongly in almost all endothelial cells, in contrast to the stain for von Willebrand factor which was only focally and weakly positive. Alpha-fetoprotein was expressed in hepatocytes within the tumor or in hepatocytes around the tumor. Intratumoral bile duct structures were located mainly at peripheral portion. The results indicated that the type I infantile hemangioendothelioma is a tumor of endothelial cells and myxoid stroma, and that the endothelial cells undergo gradual maturation to form sinusoidal and cavernous vessels in accordance with gradual fibrosis of the myxoid stroma.

Case Reports

Epithelioid Hemangioendothelioma of the Left Middle Finger: A case report.: Mi Kyung Kim, Yong Wook Park, Kye Yong Song; Korean J Pathol. 1992;26(6):601-604.

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Abstract PDF: Epithelioid hemangioendothelioma is a recently described vascular neoplasm characterized by epitheloiod endothelial linings and its borderline biologic behavior. We report a case of epithelioid hemangioendothelioma in a 6-year-old male. The tumor was presented as a non-tender dermal nodule on the left middle finger. The microscopic sections revealed irregular proliferation of vascular channels lined by epithelioid cells with histiocytoid features and frequent intracytoplasmic vacuoles, mimicking so called signet ring cells. Immunohistochemical stainings for factor VIII and vimentin were positive both in epithelioid and vacuolated endothelial cell. Electron microscopic finding reveals abundant intermediate filaments.

Epithelioid Hemangioendothelioma of the Lung: Report of a case.: Gyeong Hoon Kang, Yong Il Kim, Sung Koo Han, Young Soo Shim, Eui Keun Ham, Sang Kook Lee, Sang Sook Lee; Korean J Pathol. 1991;25(6):563-569.

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Abstract PDF: Intravascular bronchioloaveolar tumor is now recognized as a pulmonary form of epithelioid hemangioendothelioma, being manifested with bilateral multiple pulmonary nodules in young women. This 34-year-old woman received two occasions of open lung biopsies with interval of 1 year for diffuse nodular infiltrations in both lung fields. Repeated radiographic study 3 year later showed no significant progression of the pulmonary nodular lesions except for pleural effusion. Two occasions of open lung biopsies disclosed similar multiple discrete nodules which consisted of central acellular areas with lacuna-like ghosts and peripheral cellular zone. The tumor cells grew in micropolypoid fashion with preservation of background alveolar frame-works. Ultrastructure disclosed most of neoplastic cells presenting with the features suggestive of endothelial differentiation, and immunohistochemical study revealed the presence of cellular areas which gave positive reaction to factor VIII-related antigen. We support that this is an additional case of epithelioid hemangioendothelioma of the lung that is manifested with a multicetric intrapulmonary vascular endothelial cell growth featuring a vasoformative tendency and participation of topography-specific histologic modification.

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