This case highlights the potential for aggressive behavior and metastasis in epithelioid hemangioendothelioma, emphasizing the need for wide margin resection even when arising within a benign lesion like a lipoma.
Rare epithelioid hemangioendothelioma within lipoma metastasized; hypothesis-generating and should not yet change practice.
BACKGROUND: A malignant epithelioid hemangioendothelioma (EH) developed within a peripheral intramuscular lipoma. It was seen as a painful calf mass. At the time of biopsy and en bloc resection, lung metastases were observed. METHODS: Radiologic, histologic, immunohistochemical, and ultrastructural features of the neoplasm are described, and the literature pertaining to EH is reviewed. RESULTS: The features of this tumor permitted its classification as a malignant EH. CONCLUSIONS: This case illustrates the potential for aggressive behavior in an EH, often considered to be a low-grade malignant neoplasm. Because such tumors can metastasize, they should be removed with wide margins whenever possible. This malignant neoplasm was located within a benign intramuscular lipoma, demonstrating the diagnostic problem that may exist in such a complex lesion.
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Zagzag et al. (1993) studied this question.
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