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- Case Report -

A Case of a Pulmonary Epithelioid Hemangioendothelioma Presenting with Multiple Nodular Shadows

Hiroyuki Tsuchida¹, Masayuki Tanahashi¹, Eriko Suzuki¹, Naoko Yoshii¹, Takuya Watanabe¹, Kensuke Chiba¹, Shogo Yobita¹, Kensuke Iguchi¹, Suiha Uchiyama^1
1Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Japan

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Background. Pulmonary epithelial hemangioendothelioma is a relatively rare low-grade tumor, and there is no established treatment for this disease. In slowly progressing cases, most patients are followed up without any treatment. Case. The patient in the present case was a 70-year-old man. Chest computed tomography (CT) taken during a chest injury revealed multiple pulmonary nodules. The patient did not complain of any respiratory symptoms. ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) showed no abnormal accumulation throughout the entire body, and did not demonstrate the presence of any lung lesions; however, CT images taken approximately six months later revealed a slight increase in multiple lung nodules. We identified granulomatous disease, an infectious nodule, and the possibility of multiple lung metastases from an unknown primary cancer and performed thoracoscopic partial lung resection to obtain a diagnosis. The lesion was elastic and hard, and the cut surface was a solid yellowish-white. No invasion of the surrounding area was observed. A pulmonary epithelial hemangioendothelioma was diagnosed because immunohistochemical staining of factor VIII-related antigen was positive in the pathological examination. There is no established treatment for this disease; thus, we decided to follow the patient without any treatment. Conclusion. Although it is a rare disease, pulmonary epithelioid hemangioendothelioma should be considered in the differential diagnosis of cases with multiple diffuse pulmonary nodules on CT. In this case, careful follow-up will be required in the future.
key words: Pulmonary epithelioid hemangioendothelioma (PEH), Epithelioid hemangioendothelioma (EHE), Intravascular bronchioloalveolar tumor (IVBAT), Multiple nodular shadows

Received: July 9, 2020
Accepted: August 11, 2020

JJLC 60 (7): 979-984, 2020