title: Malignant hepatic epithelioid hemangioendothelioma with abdominal pain due to rapid progression.
abstract: Hepatic epithelioid hemangioendothelioma (HEH) is a rare tumor. We report on a patient who underwent hepatectomy for malignant HEH associated with abdominal pain due to rapid progression. An 83-year-old man was admitted to Nippon Medical School Hospital because of acute, severe upper abdominal pain. Seven months before admission, a hepatic tumor, 3 cm in diameter, had been detected in the left lateral sector. The diagnosis was hepatic cavernous hemangioma. Abdominal ultrasonography revealed a heterogeneous hyperechoic tumor with a smooth border, 6 cm in diameter, in the left lateral sector (segment 3). Contrast-enhanced computed tomography of the abdomen showed that the tumor was enhanced from the early to the late phase. Abdominal angiography revealed a cotton wool-like appearance of the tumor. The diagnosis was hepatic cavernous hemangioma. A malignancy could not be ruled out because of the tumor's rapid growth, which had caused abdominal pain. Left hepatectomy was performed. Histopathological examination showed necrosis throughout the tumor. Slightly pleomorphic neoplastic cells with rounded, spindle-like nuclei and scant cytoplasm were sporadically found in vascular channels. Intracytoplasmic lumina occasionally contained red cells. Neoplastic cells were positive for factor VIII-related antigen, CD31, and CD34. The Mib-1 index was high. The tumor was diagnosed as malignant HEH. The postsurgical course was uneventful, and the patient was discharged on postoperative day 11. After 3 months, multiple metastatic tumors appeared in right hepatic lobe. Transcatheter arterial chemoembolization was performed.
authors.affiliation: Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School, Japan. junji0821@nms.ac.jp
authors.forename: Jun-Ichiro
authors.initials: J
authors.lastname: Harada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoshida
authors.forename: Junji
authors.initials: J
authors.lastname: Ueda
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Mamada
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Taniai
authors.forename: Sho
authors.initials: S
authors.lastname: Mineta
authors.forename: Masato
authors.initials: M
authors.lastname: Yoshioka
authors.forename: Youichi
authors.initials: Y
authors.lastname: Kawano
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Shioda
authors.forename: Eiji
authors.initials: E
authors.lastname: Uchida
mesh_terms: D015746:Abdominal Pain / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D000369:Aged, 80 and over; D000792:Angiography; D018450:Disease Progression; D018323:Hemangioendothelioma, Epithelioid / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography