Epithelioid Hemangioendothelioma in a Child
A 9-year-old boy presented with an asymptomatic gradually enlarging nodular lesion since 5 months. Patient's past medical and family history were insignificant. On palpation, the lesion was non-tender, freely mobile and firm in consistency. It measured 3 cm × 2 cm and was situated in left iliac region []. The overlying skin was slightly thickened, reddish blue and attached to the lesion. There were no palpable lymph nodes. Based on the clinical examination, dermatofibroma, hemangioendothelioma and arteriovenous malformation were considered as differentials. The routine investigations were within the normal limits. The lesion was completely excised and sent for histopathological examination.\nMicroscopic examination revealed well-circumscribed tumour localised in the dermis, composed of mass of plump epithelioid shaped endothelial cells arranged in “nest-like” pattern with minimal vascular differentiation. The epithelioid cells showed intracytoplasmic vacuole (Primitive Lumina) and erythrocytes were seen in some of the lumina. Few vascular channels containing erythrocytes were seen on peripheral portions of the tumour. There was no cellular atypia and necrosis [Figures and ]. On Immunohistochemistry, CD 31 was positive, other endothelial markers were not done due to lack of facilities and our patient was not affordable. Other investigations such as chest X-ray, ultrasound abdomen and a whole-body bone scan were performed to exclude multicentric location and distant metastasis, but were found to be normal. Patient is on regular follow-up for the last 10 months with no signs of local recurrence or metastasis.