title: Diffuse hepatic epithelioid hemangioendothelioma developed in a patient with hepatitis C cirrhosis.
abstract: Hepatic epithelioid hemangioendothelioma (HEHE) is an infrequent vascular tumor of endothelial origin that primarily occurs in women in the mid-fifth decade of life without underlying chronic liver disease or cirrhosis. Liver transplant should be the first-line of therapy in patients with large or diffuse unresectable tumors even in the presence of metastatic disease due to the favorable long-term outcome. We report the case of a 48-year-old female who complained of abdominal pain and weight loss. She has a history of cirrhosis secondary to chronic hepatitis C (HCV) and was treated with interferon and ribavirin with sustained virological response. Her work-up revealed multiple confluent infiltrating bilobar liver masses diagnosed as HEHE. She underwent a successful liver transplant without evidence of recurrent HCV infection. She developed cervical spine (C4-C6) HEHE metastases 4 years after transplant. She underwent surgical resection and local radiotherapy after resection with good clinical response. To the best of our knowledge, this is the first report of HEHE that developed in a patient with HCV cirrhosis successfully treated with antiviral therapy before transplant and liver transplant with good allograft function without evidence of recurrent liver tumor or HCV infection but developed metastases to the cervical spine 4 years after transplant.
authors.affiliation: Transplantation Institute, Loma Linda University Medical Center, 25865 Barton Road, Suite 101, Loma Linda, CA 92354, USA.
authors.forename: Pedro W
authors.initials: PW
authors.lastname: Baron
authors.affiliation: Transplantation Institute, Loma Linda University Medical Center, 25865 Barton Road, Suite 101, Loma Linda, CA 92354, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Amankonah
authors.affiliation: Department of Surgery, Loma Linda University Medical Center, 25865 Barton Road, Suite 101, Loma Linda, CA 92354, USA.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Cubas
authors.affiliation: Transplantation Institute, Loma Linda University Medical Center, 25865 Barton Road, Suite 101, Loma Linda, CA 92354, USA.
authors.forename: Arputharaj H
authors.initials: AH
authors.lastname: Kore
authors.affiliation: Transplantation Institute, Loma Linda University Medical Center, 25865 Barton Road, Suite 101, Loma Linda, CA 92354, USA.
authors.forename: Arvand
authors.initials: A
authors.lastname: Elihu
authors.affiliation: Transplantation Institute, Loma Linda University Medical Center, 25865 Barton Road, Suite 101, Loma Linda, CA 92354, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: de Vera
authors.affiliation: Departments of Pathology and Laboratory Medicine, Loma Linda University Medical Center, 25865 Barton Road, Suite 101, Loma Linda, CA 92354, USA.
authors.forename: Mia C N
authors.initials: MC
authors.lastname: Perez