68 Ga-DOTA-E-[c(RGDfK)]2 positron emission tomography–computed tomography in the evaluation of hepatic hemangioendothelioma epithelioid

Hemangioendothelioma epithelioid is a rare tumor that originates in soft tissues. Imaging evaluation with conventional modalities (tomography and magnetic resonance) is difficult. Novel radiotracers which capably evaluate angiogenesis may have a higher impact on the therapeutic decisions. A 45-year-old man underwent workup for thrombosis and was diagnosed with hemangioendothelioma epithelioid based on the results of liver pathology and immunohistochemistry. The decision of the multidisciplinary board was to begin with thalidomide. After 4 months, progression of disease was documented and right hepatectomy was performed. A 68 Ga-DOTA-E-[c(RGDfK)]2 positron emission tomography–computed tomography scan showed residual lesions. After documented angiogenesis by 68 Ga-DOTA-E-[c(RGDfK)]2 positron emission tomography–computed tomography, nintedanib was administrated. And 1 year later, progression of the disease was documented by positron emission tomography–computed tomography. Ipilimumab plus nivolumab was started and partial response and excellent clinical response were documented. Molecular imaging with 68 Ga-DOTA-E-[c(RGDfK)]2 positron emission tomography–computed tomography is a good biomarker of the response of hemangioendothelioma epithelioid, and ipilimumab plus nivolumab therapy demonstrated a good response.