Epithelioid hemangioendothelioma on PET/CT scan

Česká verzia

Authors: Renata Koukalová ^1,2; Jiří Šedo ³; Dagmar Krákorová Adámková ³; Zuzana Šimková ¹; Pavel Fabian ⁴; Petr Szturz ⁵
Authors place of work: Oddělení nukleární medicíny, MOU Brno ¹; LF MU Brno ²; Klinika komplexní onkologické péče MOÚ a LF MU Brno ³; Oddělení onkologické patologie, MOÚ Brno ⁴; Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland ⁵
Published in the journal: Klin Onkol 2021; 34(3): 235-240
Category: Původní práce
doi: https://doi.org/10.48095/ccko2021235

Summary

Background: At present, lung cancer ranks among the most frequent malignant diseases. However, according to literature data, mesenchymal lung tumors are very rare, representing less than 0.5% of all malignant lung tumours. Epithelioid hemangioendothelioma of the lungs belongs to this group of uncommon entities. Case report: We present a case of a 45-year-old male with a history of increasing dyspnoea and abdominal and back pains, developing over the past several months. Vertebral lesions were found on imaging studies. PET/ CT following ¹⁸F-fluorodeoxyglucose administration (FDG) showed a large FDG-positive malignant infiltration affecting the thorax, abdominal cavity, and bones. The extension and other characteristics of the mass on PET/ CT did not correspond to any of the common oncologic diseases. With its spread in a plaque-like form predominantly in the right hemithorax and on the surface of the liver, the disease closely resembled malignant mesothelioma. The primary tumour origin could not be clearly identified on PET/ CT scans but they allowed us to choose a suitable site to obtain tissue for pathologic examination. Based on a CT-guided bone biopsy of the 7^th right rib, the diagnosis was concluded as epithelioid hemangioendothelioma. Despite an early initiation of systemic treatment, the patient succumbed to the disease only 15 days after the diagnosis, due to superior vena cava syndrome and progressive pleural effusion leading to respiratory insufficiency. Conclusions: Given the extremely low prevalence of epithelioid hemangioendothelioma and its heterogeneous manifestation, it is impossible to base the diagnosis solely on disease symptoms, laboratory findings, and imaging modalities. In this respect, pathologic examination has a crucial role. For the same reason, there is a lack of recommendations for the standard-of-care systemic therapy of metastatic disease.

Keywords:

epithelioid hemangioendothelioma – PET/ CT– treatment

Zdroje

Skřičková J, Kolek V et al. Základy moderní pneumoonkologie. Praha: Maxdorf 2012.
Mehta SR, Das A, Barnard N et al. Metastatic pulmonary epithelioid hemangioendothelioma: a case report and review of the literature. Respir Med Case Rep 2012; 7: 17–20. doi: 10.1016/ j.rmcr.2012.09.003.
Sardaro A, Bardoscia L, Petruzzelli MF et al. Epithelioid hemangioendothelioma: an overview and update on a rare vascular tumor. Oncol Rev 2014; 8(2): 259. doi: 10.4081/ oncol.2014.259.
Lau K, Massad M, Pollak C et al. Clinical patterns and outcome in epithelioid hemangioendothelioma with or without pulmonary involvement: insights from an internet registry in the study of a rare cancer. Chest 2011; 140(5): 1312–1318. doi: 10.1378/ chest.11-0039.
Lau K, Massad M, Weinberg G et al. Clinical patterns and outcome in epithelioid hemangioendothelioma with or without pulmonary involvement. Chest 2011; 140(5): 1312–1318. doi: 10.1378/ chest.11-0039.
Amin RM, Hiroshima K, Kokubo T et al. Risk factors and independent predictors of survival in patients with pulmonary epithelioid haemangioendothelioma. Review of the literature and a case report. Respirology 2006; 11(6): 818–825. doi: 10.1111/ j.1400-1843.2006.00923.x.
Lee YJ, Chung MJ, Jeong KC. Pleural epithelioid hemangioendothelioma. Yonsei Med J 2008; 49(6): 1036–1040. doi: 10.3349/ ymj.2008.49.6.1036.
Radzikowska E, Szczepulska-Wójcik E, Roszkowski K et al. Pulmonary epithelioid hemangioendothelioma – interferon 2-alpha treatment – case report. Pneumol Allergol Pol 2008; 76(4): 281–285.
Mascarelli PE, Iredell JR, Breitschwerdt EB et al. Bartonella species bacteremia in two patients with epithelioid hemangioendothelioma. J Clin Microbiol 2011; 49(11): 4006–40012. doi: 10.1128/ JCM.05527-11.
Teo SK, Chiang SC, Tan KK. Intravascular bronchioloalveolar tumor: a 20 year survival. Med J Aust 1985; 142(3): 220–222.
Miettinen M, Collan Y, Vilkko P et al. Intravascular bronchioloalveolar tumor. Cancer 1987; 60(10): 2471–2475. doi: 10.1002/ 1097-0142(19871115)60:10<2471::aid-cncr2820601021>3.0.co;2-8.
Gomez-Arellano LI, Ferrari-Caballo T, Dominguez-Malagon HR. Multicentric epithelioid hemangioendothelioma of bone. Report of a case with radiologic-pathologic correlation. Annals Diagn Pathol 2012; 16(1): 43–47. doi: 10.1016/ j.anndiagpath.2011.08.001.
Crotty EJ, McAdams HP, Erasmus JJ et al. Epithelioid hemangioendothelioma of the pleura: clinical and radiologic features. Am J Roentgenol 2000; 175(6): 1545–1549. doi: 10.2214/ ajr.175.6.1751545.
Bagan P, Hassan M, Barthes FL et al. Prognostic factors and surgical indications of pulmonary epithelioid hemangioendothelioma: a review of the literature. Ann Thorac Surg 2006; 82(6): 2010–2013. doi: 10.1016/ j.athoracsur.2006.06.068.
Schattenberg T, Kam R, Pfannschmidt J et al. Pulmonary epithelioid hemangioendothelioma: report of three cases. Surg Today 2008; 38(9): 844–849. doi: 10.1007/ s00595-007-3712-4.
Albano D, Bosio G, Tironi A et al. 18F-FDG PET/ CT in pleural epithelioid hemangioendothelioma. Asia Ocean J Nucl Med Biol 2017; 5(1): 70–74. doi: 10.22038/ aojnmb.2016.7971.
Woo JH, Kim TJ, Lee KS et al. Epithelioid hemangioendothelioma in the thorax: clinicopathologic, CT, PET, and prognostic features. Medicine (Baltimore) 2016; 95(30): e4348. doi: 10.1097/ MD.0000000000004 348.
Nizami I, Mohammed S, Abouzied ME. Pulmonary epitheloid hemangioendothelioma PET CT findings and review of literature. Ann Saudi Med 2014; 34(5): 447–449. doi: 10.5144/ 0256-4947.2014.447.
Mehrabi A, Kashfi A, Fonouni H et al. Primary malignant hepatic epithelioid hemangioendothelioma: a comprehensive review of the literature with emphasis on the surgical therapy. Cancer 2006; 107(9): 2108–2121. doi: 10.1002/ cncr.22225.
Lamar JM, Motilal Nehru V, Weinberg G. Epithelioid hemangioendothelioma as a model of YAP/ TAZ-driven cancer: insights from a rare fusion sarcoma. Cancers 2018; 10(7): 229. doi: 10.3390/ cancers10070229.