Case Report
Urologia
Received: June 27, 2014 Accepted after revision: July 24, 2014 Published online: December 4, 2014
Urol Int 2015;94:240–243 DOI: 10.1159/000366139
Internationalis
Primary Epithelioid Hemangioendothelioma of the Bladder: Case Report and Review of the Literature Bingbing Liu a Chuanshan Zhang a Qin Zhang a Guiqiu Liu a Zhe Ma a Junxia Qi b Qi Xin a Likun Wen a
Departments of a Pathology and b Radiology, 3rd Central Hospital, Tianjin Medical University, Tianjin, PR China
Key Words Bladder tumor · Epithelioid hemangioendothelioma
Abstract Epithelioid hemangioendothelioma (EHE) is a rare tumor of the urinary system. Only three cases of EHE of the bladder have been reported to date, and the biological properties of the tumor in this location remain poorly characterized. We report a case of primary EHE of the urinary bladder in a 58-year-old woman who was treated by transurethral resection and review the existing literature on the diagnosis and treatment of EHE of the bladder. © 2015 S. Karger AG, Basel
with this disease. This study was approved by the Ethics Committee of 3rd Central Hospital, Tianjin, China. Written informed consent was obtained from the patient. Case Report A 58-year-old woman without a family history of malignant tumors was admitted to our hospital with a 3-day history of painless gross hematuria that settled gradually. Physical examination of the abdomen, heart, lungs, head and neck were all unremarkable. Urinalysis showed urine protein of 1+, urine occult blood of 1+, red blood cell count of 23/μl and white blood cell count of 7/μl. Other laboratory results, including complete blood count, routine blood
Introduction
Epithelioid hemangioendothelioma (EHE) is a rare endothelial vascular neoplasm that was first identified in soft tissues by Weiss and Enzinger [1]. Although EHE can theoretically develop anywhere in the body, it has most commonly been described in soft tissues, liver, bone and lungs [2]. To the best of our knowledge, only three cases of EHE of the bladder have been reported to date [3–5]. Here, we report a case of primary EHE of the bladder and review the literature on the diagnosis and treatment of patients © 2014 S. Karger AG, Basel 0042–1138/14/0942–0240$39.50/0 E-Mail [email protected] www.karger.com/uin
Fig. 1. Computed tomography scan of the abdomen showed a 2-cm pediculate mass on the right lateral wall of the bladder with a thickened wall. The tumor showed soft tissue density.
Chuanshan Zhang Department of Pathology 3rd Central Hospital Tianjin 300170 (PR China) E-Mail zhangchuanshan @ 163.com
Color version available online
a
c
b
Fig. 2. a The tumor cells varied from epithelioid to spindle-shaped, with abundant eosinophilic cytoplasm and vesicular nuclei. b Some of the cells showed intracytoplasmic lumina containing erythrocytes. c Distinct vascular channels lying in a fibromyxoid stroma with
Color version available online
hyalinization could also be seen.
a
c
b
Fig. 3. Tumor cells showed strong immunopositivity for vimentin, CD34 (a), CD31 (b) and factor VIII (c).
chemistry, kidney and liver function tests and chest radiograph, were within normal limits. Computed tomography of the abdomen showed a 2-cm pediculate mass on the right lateral wall of the bladder with a thickened wall. The tumor showed soft tissue density. No perivesical infiltration or lymphadenopathy was detected (fig. 1). Enhanced computed tomography was not performed. Since the tumor was single and pediculate, complete tumor resection was performed using transurethral resection and the tissue was sent to the Department of Pathology for histopathologic evaluation. Grossly, the resected specimen was a small pack of tissue (2 × 2 × 1 cm). Microscopically, histological examination showed a mesenchymal tumor. The tumor cells varied from epithelioid to spindle-shaped, with abundant eosinophilic cytoplasm and vesicular nuclei (fig. 2a). Some of the cells showed intracytoplasmic lumina containing erythrocytes (fig. 2b). Distinct vascular channels lying in a fibromyxoid stroma with hyalinization were also observed (fig. 2c). Mitotic figures and necrosis were not evident. Both epithelioid-looking cells and spindle-shaped cells showed strong immunopositivity for vimentin, CD34, CD31 and factor VIII (fig. 3). The tumor cells were immunonegative for CK, S-100, EMA and desmin. The Ki-67 labeling index was
Urologia
Received: June 27, 2014 Accepted after revision: July 24, 2014 Published online: December 4, 2014
Urol Int 2015;94:240–243 DOI: 10.1159/000366139
Internationalis
Primary Epithelioid Hemangioendothelioma of the Bladder: Case Report and Review of the Literature Bingbing Liu a Chuanshan Zhang a Qin Zhang a Guiqiu Liu a Zhe Ma a Junxia Qi b Qi Xin a Likun Wen a
Departments of a Pathology and b Radiology, 3rd Central Hospital, Tianjin Medical University, Tianjin, PR China
Key Words Bladder tumor · Epithelioid hemangioendothelioma
Abstract Epithelioid hemangioendothelioma (EHE) is a rare tumor of the urinary system. Only three cases of EHE of the bladder have been reported to date, and the biological properties of the tumor in this location remain poorly characterized. We report a case of primary EHE of the urinary bladder in a 58-year-old woman who was treated by transurethral resection and review the existing literature on the diagnosis and treatment of EHE of the bladder. © 2015 S. Karger AG, Basel
with this disease. This study was approved by the Ethics Committee of 3rd Central Hospital, Tianjin, China. Written informed consent was obtained from the patient. Case Report A 58-year-old woman without a family history of malignant tumors was admitted to our hospital with a 3-day history of painless gross hematuria that settled gradually. Physical examination of the abdomen, heart, lungs, head and neck were all unremarkable. Urinalysis showed urine protein of 1+, urine occult blood of 1+, red blood cell count of 23/μl and white blood cell count of 7/μl. Other laboratory results, including complete blood count, routine blood
Introduction
Epithelioid hemangioendothelioma (EHE) is a rare endothelial vascular neoplasm that was first identified in soft tissues by Weiss and Enzinger [1]. Although EHE can theoretically develop anywhere in the body, it has most commonly been described in soft tissues, liver, bone and lungs [2]. To the best of our knowledge, only three cases of EHE of the bladder have been reported to date [3–5]. Here, we report a case of primary EHE of the bladder and review the literature on the diagnosis and treatment of patients © 2014 S. Karger AG, Basel 0042–1138/14/0942–0240$39.50/0 E-Mail [email protected] www.karger.com/uin
Fig. 1. Computed tomography scan of the abdomen showed a 2-cm pediculate mass on the right lateral wall of the bladder with a thickened wall. The tumor showed soft tissue density.
Chuanshan Zhang Department of Pathology 3rd Central Hospital Tianjin 300170 (PR China) E-Mail zhangchuanshan @ 163.com
Color version available online
a
c
b
Fig. 2. a The tumor cells varied from epithelioid to spindle-shaped, with abundant eosinophilic cytoplasm and vesicular nuclei. b Some of the cells showed intracytoplasmic lumina containing erythrocytes. c Distinct vascular channels lying in a fibromyxoid stroma with
Color version available online
hyalinization could also be seen.
a
c
b
Fig. 3. Tumor cells showed strong immunopositivity for vimentin, CD34 (a), CD31 (b) and factor VIII (c).
chemistry, kidney and liver function tests and chest radiograph, were within normal limits. Computed tomography of the abdomen showed a 2-cm pediculate mass on the right lateral wall of the bladder with a thickened wall. The tumor showed soft tissue density. No perivesical infiltration or lymphadenopathy was detected (fig. 1). Enhanced computed tomography was not performed. Since the tumor was single and pediculate, complete tumor resection was performed using transurethral resection and the tissue was sent to the Department of Pathology for histopathologic evaluation. Grossly, the resected specimen was a small pack of tissue (2 × 2 × 1 cm). Microscopically, histological examination showed a mesenchymal tumor. The tumor cells varied from epithelioid to spindle-shaped, with abundant eosinophilic cytoplasm and vesicular nuclei (fig. 2a). Some of the cells showed intracytoplasmic lumina containing erythrocytes (fig. 2b). Distinct vascular channels lying in a fibromyxoid stroma with hyalinization were also observed (fig. 2c). Mitotic figures and necrosis were not evident. Both epithelioid-looking cells and spindle-shaped cells showed strong immunopositivity for vimentin, CD34, CD31 and factor VIII (fig. 3). The tumor cells were immunonegative for CK, S-100, EMA and desmin. The Ki-67 labeling index was
