Opinion statement
Epithelioid hemangioendothelioma (EHE) is an extremely rare sarcoma, as such it can pose a clinical dilemma based solely on its rarity. Also, the spectrum of disease varies greatly between an indolent disease and aggressive disease with widespread metastases. In our clinical practice, the primary focus has been to get a handle on the aggressive nature of the disease, which will then dictate how urgently one needs to treat the patient. Pathological review with immunohistochemistry and molecular characterization is paramount. Our treatment strategy is watch-and-wait versus active therapy on clinical trial or based on results of prior clinical trials. There is evidence to support the use of chemotherapeutics and targeted therapies specifically focusing on anti-angiogenesis. The current landscape of oncology with the emergence and excitement of immunotherapy could also translate in a role for immunotherapy in this disease. While rare, there is certainly no reason that research and trials for patients with EHE should not remain on utmost importance for those of us who specialize in the treatment of sarcomas.
Similar content being viewed by others
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance, •• Of major importance
Sardaro A, Bardoscia L, Petruzzelli MF, Portaluri M. Epithelioid hemangioendothelioma: an overview and update on a rare vascular tumor. Oncol Rev. 2014;8(2):259.
Weiss SW, Enzinger FM. Epithelioid hemangioendothelioma: a vascular tumor often mistaken for a carcinoma. Cancer. 1982;50(5):970–81.
Tanas MR, Sboner A, Oliveira AM, Erickson-Johnson MR, Hespelt J, Hanwright PJ, et al. Identification of a disease-defining gene fusion in epithelioid hemangioendothelioma. Sci Transl Med. 2011;3(98):98ra82.
Doyle LA. Sarcoma classification: an update based on the 2013 World Health Organization classification of tumors of soft tissue and bone. Cancer. 2014;120(12):1763–74.
Amin RMS, Hiroshima K, Kokubo T, Nishikawa M, Narita M, Kuroki M, 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):818–25.
Lau K, Massad M, Pollak C, Rubin C, Yeh J, Wang J, 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):1312–8.
Kitaichi M, Nagai S, Nishimura K, Itoh H, Asamoto H, Izumi T, et al. Pulmonary epithelioid haemangioendothelioma in 21 patients, including three with partial spontaneous regression. Eur Respir J. 1998;12(1):89–96.
Bagan P, Hassan M, Le Pimpec BF, Peyrard S, Souilamas R, Danel C, et al. Prognostic factors and surgical indications of pulmonary epithelioid hemangioendothelioma: a review of the literature. Ann Thorac Surg. 2006;82(6):2010–3.
Gómez-Arellano LI, Ferrari-Carballo T, Domínguez-Malagón HR. Multicentric epithelioid hemangioendothelioma of bone. Report of a case with radiologic-pathologic correlation. Ann Diagn Pathol. 2012;16(1):43–7.
Larochelle O, Perigny M, Lagace R, Dion N, Giguere C. Best cases from the AFIP: epithelioid hemangioendothelioma of bone. Radiographics : a review publication of the Radiological Society of North America, Inc. 2006;26(1):265–70.
Albakr A, Schell M, Drew B, Cenic A. Epithelioid hemangioendothelioma of the spine: Case report and review of the literature. J Spine Surg. 2017;3(2):250–9.
Ma J, Wang L, Mo W, Yang X, Xiao J. Epithelioid hemangioendotheliomas of the spine: clinical characters with middle and long-term follow-up under surgical treatments. Eur Spine J. 2011;20(8):1371–6.
Woo JH, Kim TJ, Lee KS, Kim TS, Kim BT. Epithelioid hemangioendothelioma in the thorax: clinicopathologic, CT, PET, and prognostic features. Medicine (Baltimore). 2016;95(30):e4348.
Gan LU, Chang R, Jin H, Yang LI. Typical CT and MRI signs of hepatic epithelioid hemangioendothelioma. Oncol Lett. 2016;11(3):1699–706.
Errani C, Zhang L, Panicek DM, Healey JH, Antonescu CR. Epithelioid hemangioma of bone and soft tissue: a reappraisal of a controversial entity. Clin Orthop Relat Res. 2012;470(5):1498–506.
Rosengarten D, Kramer MR, Amir G, Fuks L, Berkman N. Pulmonary epithelioid hemangioendothelioma. Isr Med Assoc J: IMAJ. 2011;13(11):676–9.
Deyrup AT, Tighiouart M, Montag AG, Weiss SW. Epithelioid hemangioendothelioma of soft tissue: a proposal for risk stratification based on 49 cases. Am J Surg Pathol. 2008;32(6):924–7.
Flucke U, Vogels RJ, de Saint Aubain Somerhausen N, Creytens DH, Riedl RG, van Gorp JM, et al. Epithelioid hemangioendothelioma: clinicopathologic, immunhistochemical, and molecular genetic analysis of 39 cases. Diagnostic Pathology. 2014;9(1):131.
•• Anderson T, Zhang L, Hameed M, Rusch V, Travis WD, Antonescu CR. Thoracic epithelioid malignant vascular tumors: a clinicopathologic study of 52 cases with emphasis on pathologic grading and molecular studies of WWTR1-CAMTA1 fusions. Am J Surg Pathol. 2015;39(1):132–9. This large series which included 52 patients help us better understand the pathology and molecular profile of these rare tumors
Murali R, Zarka MA, Ocal IT, Tazelaar HD. Cytologic features of epithelioid hemangioendothelioma. Am J Clin Pathol. 2011;136(5):739–46.
Gill R, O'Donnell RJ, Horvai A. Utility of immunohistochemistry for endothelial markers in distinguishing epithelioid hemangioendothelioma from carcinoma metastatic to bone. Arch Pathol Lab Med. 2009;133(6):967–72.
Errani C, Zhang L, Shao SY, Hajdu M, Singer S, Maki RG, et al. A novel WWTR1-CAMTA1 gene fusion is a consistent abnormality in epithelioid hemangioendothelioma of different anatomic sites. Genes Chromosom Cancer. 2011;50(8):644–53.
Tanas MR, Ma S, Jadaan FO, Ng CKY, Weigelt B, Reis-Filho JS, et al. Mechanism of action of a WWTR1(TAZ)-CAMTA1 fusion oncoprotein. Oncogene. 2015;35:929.
Thway K, Mentzel T, Perrett CM, Calonje E. Multicentric visceral epithelioid hemangioendothelioma, with extremity dermal deposits, unusual late recurrence on the nasal bridge and TFE3 gene rearrangement. Hum Pathol 2017.
Doyle LA, Fletcher CD, Hornick JL. Nuclear expression of CAMTA1 distinguishes epithelioid hemangioendothelioma from histologic mimics. Am J Surg Pathol. 2016;40(1):94–102.
Antonescu CR, Le Loarer F, Mosquera J-M, Sboner A, Zhang L, Chen C-L, et al. Novel YAP1-TFE3 fusion defines a distinct subset of epithelioid hemangioendothelioma. Genes Chromosom Cancer. 2013;52(8):775–84.
Lee SJ, Yang WI, Chung WS, Kim SK. Epithelioid hemangioendotheliomas with TFE3 gene translocations are compossible with CAMTA1 gene rearrangements. Oncotarget. 2016;7(7):7480–8.
Kanemura S, Kuribayashi K, Moriya Y, Shimizu S, Tsujimura T, Nakano T. Pemetrexed for epithelioid haemangioendothelioma of the pleura. Respirol Case Rep. 2016;4(6):e00191.
Pinet C, Magnan A, Garbe L, Payan MJ, Vervloet D. Aggressive form of pleural epithelioid haemangioendothelioma: complete response after chemotherapy. Eur Respir J. 1999;14(1):237.
Merikas E, Grapsa D, Dikoudi E, Gkiozos I, Boura P, Charpidou A, et al. Epithelioid hemangioendothelioma treated with bevacizumab: a case series. Cancer Treat Commun. 2015;4(Supplement C):59–64.
Gaur S, Torabi A, O’Neill TJ. Activity of angiogenesis inhibitors in metastatic epithelioid hemangioendothelioma: a case report. Cancer Biol Med. 2012;9(2):133–6.
Belmont L, Zemoura L, Couderc LJ. Pulmonary epithelioid haemangioendothelioma and bevacizumab. J Thoracic Oncol : Off Publ Int Assoc Study Lung Cancer. 2008;3(5):557–8.
Kim YH, Mishima M, Miyagawa-Hayashino A. Treatment of pulmonary epithelioid hemangioendothelioma with bevacizumab. J Thorac Oncology: Off Publ Int Assoc Study Lung Cancer. 2010;5(7):1107–8.
Mizota A, Shitara K, Fukui T. Bevacizumab chemotherapy for pulmonary epithelioid hemangioendothelioma with severe dyspnea. J Thorac Oncol : Off Publ Int Assoc Study Lung Cancer. 2011;6(3):651–2.
Lau A, Malangone S, Green M, Badari A, Clarke K, Elquza E. Combination capecitabine and bevacizumab in the treatment of metastatic hepatic epithelioid hemangioendothelioma. Ther Adv Med Oncol. 2015;7(4):229–36.
Salech F, Valderrama S, Nervi B, Rodriguez JC, Oksenberg D, Koch A, et al. Thalidomide for the treatment of metastatic hepatic epithelioid hemangioendothelioma: a case report with a long term follow-up. Ann Hepatol. 2011;10(1):99–102.
Mascarenhas RC, Sanghvi AN, Friedlander L, Geyer SJ, Beasley HS, Van Thiel DH. Thalidomide inhibits the growth and progression of hepatic epithelioid hemangioendothelioma. Oncology. 2004;67(5–6):471–5.
Raphael C, Hudson E, Williams L, Lester JF, Savage PM. Successful treatment of metastatic hepatic epithelioid hemangioendothelioma with thalidomide: a case report. J Med Case Rep. 2010;4:413.
Kassam A, Mandel K. Metastatic hepatic epithelioid hemangioendothelioma in a teenage girl. J Pediatr Hematol Oncol. 2008;30(7):550–2.
Bolke E, Gripp S, Peiper M, Budach W, Schwarz A, Orth K, et al. Multifocal epithelioid hemangioendothelioma: case report of a clinical chamaeleon. Eur J Med Res. 2006;11(11):462–6.
Pallotti MC, Nannini M, Agostinelli C, Leoni S, Scioscio VD, Mandrioli A, et al. Long-term durable response to lenalidomide in a patient with hepatic epithelioid hemangioendothelioma. World J Gastroenterol: WJG. 2014;20(22):7049–54.
Zheng Z, Wang H, Jiang H, Chen E, Zhang J, Xie X. Apatinib for the treatment of pulmonary epithelioid hemangioendothelioma: a case report and literature review. Medicine. 2017;96(45):e8507.
Kobayashi N, Shimamura T, Tokuhisa M, Goto A, Ichikawa Y. Sorafenib monotherapy in a patient with Unresectable hepatic epithelioid Hemangioendothelioma. Case Rep Oncol. 2016;9(1):134–7.
• Semenisty V, Naroditsky I, Keidar Z, Bar-Sela G. Pazopanib for metastatic pulmonary epithelioid hemangioendothelioma-a suitable treatment option: case report and review of anti-angiogenic treatment options. BMC Cancer. 2015;15:402. Although only a case report, this paper provides a review of antiangiogenic agents for the treatment of this disease
Mao X, Liang Z, Chibhabha F, Ou W, Li N, Xu P, et al. Clinico-radiological features and next generation sequencing of pulmonary epithelioid hemangioendothelioma: a case report and review of literature. Thorac Cancer. 2017;8(6):687–92.
Lerut JP, Orlando G, Adam R, Schiavo M, Klempnauer J, Mirza D, et al. The place of liver transplantation in the treatment of hepatic epitheloid hemangioendothelioma: report of the European liver transplant registry. Ann Surg. 2007;246(6):949–57. discussion 57
Agrawal N, Parajuli S, Zhao P, Satoskar R, Laurin J, Azumi N, et al. Liver transplantation in the management of hepatic epithelioid hemangioendothelioma: a single-center experience and review of the literature. Transplant Proc. 2011;43(7):2647–50.
Fang C, Zhang W, Zheng S. Liver transplantation for hepatic epithelioidhemangioendothelioma: a casereport and literature review. Int J Clin Exp Med. 2017;10(6):9693–6.
Saste A, Cabrera Fernandez DF, Gulati R, Gamalski S. A trimodality approach in the management of metastatic low-grade epithelioid hemangioendothelioma of the bone. BMJ Case Rep 2015;2015.
Stacchiotti S, Provenzano S, Dagrada G, Negri T, Brich S, Basso U, et al. Sirolimus in advanced epithelioid hemangioendothelioma: a retrospective case-series analysis from the Italian rare cancer network database. Ann Surg Oncol. 2016;23(9):2735–44.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Ari Rosenberg and Mark Agulnik declare they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
This article is part of the Topical Collection on Sarcoma
Rights and permissions
About this article
Cite this article
Rosenberg, A., Agulnik, M. Epithelioid Hemangioendothelioma: Update on Diagnosis and Treatment. Curr. Treat. Options in Oncol. 19, 19 (2018). https://doi.org/10.1007/s11864-018-0536-y
Published:
DOI: https://doi.org/10.1007/s11864-018-0536-y