title: Epithelioid hemangioendothelioma of the spine: results at seven years of average follow-up in a series of 10 cases surgically treated and a review of literature.
abstract: OBJECTIVE
  To review a series of ten cases with epithelioid hemangioendothelioma of the spine, that have undergone surgery to describe clinical presentation, results and complications associated with surgical treatment; a review of literature reporting the main characteristics of the cases already published has been reported.
  
  
  METHODS
  A review of patients affected by epithelioid hemangioendothelioma surgically treated by the senior author from 1995 to 2012 was carried out. Ten cases were identified and clinical and radiological characteristics, therapy, complications and survival were valued.
  
  
  RESULTS
  Wide margin was achieved in two out of ten cases, marginal margin in seven and intralesional margin in one case. Average intraoperative blood loss was about 2,800 ml. Reported complications were one case of cord injury, one of dural tear, two cases of massive blood loss, a case of reconstruction failure, a wound dehiscence with deep infection, a pneumonia episode and a deep vein thrombosis with pulmonary embolism. Average follow-up was 84.4 months. Two local recurrences, after 32 and 37 months and two deaths for metastasis, after 14 and 36 months, were reported. Although several chemotherapy protocols are available for the treatment of EH of soft tissue, they are not relevant for the bone.
  
  
  CONCLUSIONS
  Wide surgery is probably associated with a better prognosis. Indeed most deaths and local recurrences reported in literature happened after intralesional surgery or chemotherapy/RT alone. The presenting study suggests that the best approach to achieve long-term local control and a major survival could be wide surgery, nevertheless more cases series are necessary to verify survival rate.
authors.affiliation: Oncological Orthopedics Department, Galeazzi Orthopedic Institute, Via Riccardo Galeazzi 4, Milan, Italy. alessandroluzzati@gmail.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Luzzati
authors.affiliation: Oncological Orthopedics Department, Galeazzi Orthopedic Institute, Via Riccardo Galeazzi 4, Milan, Italy. fabio_gagliano@tiscali.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Gagliano
authors.affiliation: Oncological Orthopedics Department, Galeazzi Orthopedic Institute, Via Riccardo Galeazzi 4, Milan, Italy. pergiudoc@fastwebnet.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Perrucchini
authors.affiliation: Oncological Orthopedics Department, Galeazzi Orthopedic Institute, Via Riccardo Galeazzi 4, Milan, Italy. g.scotto1@virgilio.it.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Scotto
authors.affiliation: Oncological Orthopedics Department, Muscular-skeletal Tissue Bank, IFO, Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, Italy. carminezoccali@libero.it.|University of L'Aquila, Via Vetoio 1, L'Aquila, Italy. carminezoccali@libero.it.
authors.forename: Carmine
authors.initials: C
authors.lastname: Zoccali
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D005260:Female; D005500:Follow-Up Studies; D018323:Hemangioendothelioma, Epithelioid / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications; D011379:Prognosis; D013125:Spinal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D016019:Survival Analysis
keywords: En-bloc vertebrectomy; Epithelioid hemangioendothelioma; Spine tumor; Vascular bone tumor; Wide surgery