Outpatient presentation with an enlarging and increasingly painful right thigh lump.
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T1 and T2 MRI of the right thigh demonstrating multiple foci compatible with an inflammatory process favoring cysticercosis or sarcoidosis.
Magnetic resonance imaging (MRI) revealed multiple foci compatible with an inflammatory process favoring cysticercosis. Subsequent biopsy, however, was performed which revealed epithelioid hemangioendothelioma. He was discussed at in a multidisciplinary meeting and was commenced on chemotherapy. He is currently being followed up in outpatients.
Epithelioid hemangioendotheliomas are rare vascular tumors, that represents less than 1% of all vascular tumors (1, 2).
Epithelioid hemangioendotheliomas in the thigh are extremely rare. These tumors are most commonly encountered in the liver, lung, and bone (1, 2). They typically occur in patients aged between 20 and 40 (1). They are usually incidentally diagnosed and over 50% of patients are asymptomatic. Most frequently, epithelioid hemangioendotheliomas show low to intermediate signal intensity on T2-weighted images (1, 2).
Epithelioid hemangioendothelioma is an important differential diagnosis to consider in a patient with increasing deep tissue pain. A histological diagnosis is of paramount importance as the radiological signs may not be consistent (1).
- 1. Sardaro A, Bardoscia L, Petruzzelli MF, Portaluri M. Epithelioid hemangioendothelioma: an overview and update on a rare vascular tumor. Oncology reviews. 2014 Sep 23;8(2).
- 2. Breugem SJ, Tytgat LG, Schaap GR. Epithelioid hemangioendothelioma of the upper thigh in a child. Current Orthopaedic Practice. 2010 Sep 1;21(5):518-20.