Abstract
Background : The epithelioid hemangioendothelioma (EHE) is a rare malignant tumor of vascular endothelial cells which shows epithelioid features histologically. We report herein on a case of EHE which recurred in pleural fluid after an operation on the primary bone tumor, which could be diagnosed with pleural fluid cytology.
Case : A 70-year-old woman was referred to our hospital with pain of her right foot. A right cuboidal bone tumor was identified on MRI. Two years after wide local resection of the bone tumor, chest pain and pleural effusion appeared. Aspiration cytology of the pleural fluid and an excisional biopsy of the pleura were performed. Cytological findings revealed that, nuclei of the tumor cells were enlarged, oval, eccentric, hyperchromatic, grooved, and occasionally multinucleated. The tumor cells had abundant cytoplasm with frequent intracytoplasmic vacuoles. The immunocytochemistry findings showed that, tumor cells were CD31 and CD34 positive. Based on these findings, recurrence of EHE was cytologically diagnosed. Pleural metastasis of EHE was histologically confirmed by the excisional biopsy of the pleura.
Conclusion : EHE cells in pleural fluid showed an epithelioid appearance similar to poorly differentiated adenocarcinoma or malignant mesothelioma. However, EHE could be cytologically diagnosed based on the clinical history and an immunocytochemical analysis in addition to its characteristic cytological features.
