title: Pitfalls in the diagnosis of hepatic epithelioid hemangioendothelioma by FNA and needle core biopsy.
abstract: Epithelioid hemangioendothelioma (EHE) of the liver is an extremely rare tumor that masquerades as an epithelial neoplasm and poses significant diagnostic pitfalls for the cytopathologist. This report describes a 64-year-old woman whom on computerized tomography was found to have multiple peripherally calcified hypodense lesions throughout the liver and an ipsilateral adrenal mass. Fine needle aspiration and needle cores biopsies of the largest liver lesion showed epithelioid cells and spindle cells in fibrous stroma. The epithelioid cells had round or oval, hyperchromatic nuclei with smooth nuclear contours, delicate cytoplasm and indistinct cytoplasmic borders. Rare cells had intracellular vascular lumen containing fragmented or intact red blood cells. The cells were individually dispersed or arranged in nests and vague tubular arrays. No mitotic figures or necrosis were seen. An immunohistochemical profile demonstrated diffuse CD31 and focal CD 34 and nuclear Fli-1 immunoexpression and low Ki-67 proliferative activity (1%) within lesional cells confirming the diagnosis of EHE. The differential diagnosis of EHE which includes cholangiocarcinoma, hepatocellular carcinoma, metastatic carcinoma and melanoma is discussed.
authors.affiliation: Department of Pathology, Northwestern Memorial Hospital, Northwestern University, Chicago, Illinois.
authors.forename: Matthew
authors.initials: M
authors.lastname: Jurczyk
authors.forename: Bing
authors.initials: B
authors.lastname: Zhu
authors.forename: William
authors.initials: W
authors.lastname: Laskin
authors.forename: Xiaoqi
authors.initials: X
authors.lastname: Lin
mesh_terms: D018952:Antigens, CD34 / Q000235:genetics / Q000378:metabolism; D014408:Biomarkers, Tumor / Q000235:genetics / Q000378:metabolism*; D044963:Biopsy, Fine-Needle; D062005:Biopsy, Large-Core Needle; D003951:Diagnostic Errors; D005260:Female; D018323:Hemangioendothelioma, Epithelioid / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D019394:Ki-67 Antigen / Q000235:genetics / Q000378:metabolism; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology; D008875:Middle Aged; D019408:Platelet Endothelial Cell Adhesion Molecule-1 / Q000235:genetics / Q000378:metabolism; D051789:Proto-Oncogene Protein c-fli-1 / Q000235:genetics / Q000378:metabolism
chemical_list: D018952:Antigens, CD34; D014408:Biomarkers, Tumor; C078433:FLI1 protein, human; D019394:Ki-67 Antigen; D019408:Platelet Endothelial Cell Adhesion Molecule-1; D051789:Proto-Oncogene Protein c-fli-1
keywords: cytomorphology; epithelioid hemangioendothelioma; fine needle aspiration; immunohistochemistry; needle core biopsy