A rare case series of composite hemangioendothelioma presenting as bone tumors

Composite hemangioendothelioma (CHE) is a rare neoplastic disorder of vascular origin and consists of admixture of benign, intermediate and malignant vascular histological components. It is first described in 2000 and ever since composite hemangioendothelioma has been described in various soft tissue locations of the body and internal organs in various case reports. Here we present two rare cases of composite hemangioendothelioma of bone and what we believe are the first reported presentation of primary composite hemangioendothelioma in the bones of the lower extremities. Immunohistochemistry in composite hemagioendothelioma shows markers of endothelial origin and many cases have large vacuolated endothelial cells giving a pseudolipoblastic appearance to cells. Treatment is mainly surgical as it a locally aggressive tumor and metastasize is rare. Both of patients in our presentation are treated with lower extremity amputation and it is sometimes unfortunate given composite hemangioendothelioma is known to happen in younger to middle age group such as our patients. This would require psychological counseling and support through the process. Further adjuvant treatments are undefined given the rarity of the diagnosis.