Complete metabolic response to therapy of hepatic epithelioid hemangioendothelioma evaluated with 18F-fluorodeoxyglucose positron emission tomography/contrast-enhanced computed tomography: A CARE case report

R.G. Giancipoli, S. Monti, O. Basturk, D. Klimstra, M.L. Keohan, O. Schillaci, G. Corrias, P. Sawan, L. Mannelli

Research output: Contribution to journalArticle

Abstract

RATIONALE: Hepatic epithelioid hemangioendothelioma (EHE) is a rare malignant vascular tumor of endothelial origin with a highly variable clinical presentation and natural history. Given its vascular origin, new therapies with inhibitors of vascular endothelial growth factor (VEGF) have been introduced in the treatment of these patients and have shown promising results. Few reports have described the role of F-Fluorodeoxyglucose positron emission tomography/contrast-enhanced computed tomography (F-FDG PET/CT) in the evaluation of this tumor after treatment with anti-angiogenic agents. Our case reports how F-FDG PET-CT scan was critical in the assessment of this tumor after treatment with an anti-angiogenic agent, Pazopanib, demonstrating complete metabolic response. PATIENT CONCERNS: A 30-year-old man with no previous significant medical history presented with pain in the right upper quadrant for over a year. DIAGNOSES: Multiple hepatic masses were found on abdominal ultrasound. Liver biopsy confirmed the diagnosis of epithelioid hemangioendothelioma. F-FDG PET/CT was performed for staging. Multiple FDG-avid hepatic, splenic, and lymph nodes lesions were detected on F-FDG PET/CT. A subsequent spleen biopsy confirmed splenic involvement. Immunohistochemistry was positive for CD31, CD34, and ERG, supporting the diagnosis of epithelioid hemangioendothelioma. INTERVENTIONS: A 1-year cyclophosphamide treatment was provided followed by Pazopanib for 17 months. OUTCOMES: Six years after the first F-FDG PET/CT, F-FDG PET/CT performed for restaging demonstrated complete metabolic response to therapy. Follow-up CT demonstrated no interval changes in size of some of the treated lesions. LESSON: F-FDG PET/CT is useful for baseline assessment and posttreatment follow-up of this rare cancer.
Original languageEnglish
Pages (from-to)e12795
JournalMedicine
Volume97
Issue number42
DOIs
Publication statusPublished - 2018

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Epithelioid Hemangioendothelioma
Fluorodeoxyglucose F18
Positron-Emission Tomography
Tomography
Liver
Blood Vessels
Neoplasms
Therapeutics
Biopsy
Natural History
Cyclophosphamide
Vascular Endothelial Growth Factor A
Spleen
Lymph Nodes
Immunohistochemistry
Pain

Keywords

  • angiogenesis inhibitor
  • antineoplastic agent
  • fluorodeoxyglucose f 18
  • pazopanib
  • pyrimidine derivative
  • radiopharmaceutical agent
  • sulfonamide
  • adult
  • case report
  • diagnostic imaging
  • hemangioendothelioma
  • human
  • liver tumor
  • male
  • positron emission tomography-computed tomography
  • procedures
  • treatment outcome
  • Adult
  • Angiogenesis Inhibitors
  • Antineoplastic Agents
  • Fluorodeoxyglucose F18
  • Hemangioendothelioma, Epithelioid
  • Humans
  • Liver Neoplasms
  • Male
  • Positron Emission Tomography Computed Tomography
  • Pyrimidines
  • Radiopharmaceuticals
  • Sulfonamides
  • Treatment Outcome

Cite this

Complete metabolic response to therapy of hepatic epithelioid hemangioendothelioma evaluated with 18F-fluorodeoxyglucose positron emission tomography/contrast-enhanced computed tomography: A CARE case report. / Giancipoli, R.G.; Monti, S.; Basturk, O.; Klimstra, D.; Keohan, M.L.; Schillaci, O.; Corrias, G.; Sawan, P.; Mannelli, L.

In: Medicine, Vol. 97, No. 42, 2018, p. e12795.

Research output: Contribution to journalArticle

Giancipoli, R.G. ; Monti, S. ; Basturk, O. ; Klimstra, D. ; Keohan, M.L. ; Schillaci, O. ; Corrias, G. ; Sawan, P. ; Mannelli, L. / Complete metabolic response to therapy of hepatic epithelioid hemangioendothelioma evaluated with 18F-fluorodeoxyglucose positron emission tomography/contrast-enhanced computed tomography: A CARE case report. In: Medicine. 2018 ; Vol. 97, No. 42. pp. e12795.
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T1 - Complete metabolic response to therapy of hepatic epithelioid hemangioendothelioma evaluated with 18F-fluorodeoxyglucose positron emission tomography/contrast-enhanced computed tomography: A CARE case report

AU - Giancipoli, R.G.

AU - Monti, S.

AU - Basturk, O.

AU - Klimstra, D.

AU - Keohan, M.L.

AU - Schillaci, O.

AU - Corrias, G.

AU - Sawan, P.

AU - Mannelli, L.

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PY - 2018

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N2 - RATIONALE: Hepatic epithelioid hemangioendothelioma (EHE) is a rare malignant vascular tumor of endothelial origin with a highly variable clinical presentation and natural history. Given its vascular origin, new therapies with inhibitors of vascular endothelial growth factor (VEGF) have been introduced in the treatment of these patients and have shown promising results. Few reports have described the role of F-Fluorodeoxyglucose positron emission tomography/contrast-enhanced computed tomography (F-FDG PET/CT) in the evaluation of this tumor after treatment with anti-angiogenic agents. Our case reports how F-FDG PET-CT scan was critical in the assessment of this tumor after treatment with an anti-angiogenic agent, Pazopanib, demonstrating complete metabolic response. PATIENT CONCERNS: A 30-year-old man with no previous significant medical history presented with pain in the right upper quadrant for over a year. DIAGNOSES: Multiple hepatic masses were found on abdominal ultrasound. Liver biopsy confirmed the diagnosis of epithelioid hemangioendothelioma. F-FDG PET/CT was performed for staging. Multiple FDG-avid hepatic, splenic, and lymph nodes lesions were detected on F-FDG PET/CT. A subsequent spleen biopsy confirmed splenic involvement. Immunohistochemistry was positive for CD31, CD34, and ERG, supporting the diagnosis of epithelioid hemangioendothelioma. INTERVENTIONS: A 1-year cyclophosphamide treatment was provided followed by Pazopanib for 17 months. OUTCOMES: Six years after the first F-FDG PET/CT, F-FDG PET/CT performed for restaging demonstrated complete metabolic response to therapy. Follow-up CT demonstrated no interval changes in size of some of the treated lesions. LESSON: F-FDG PET/CT is useful for baseline assessment and posttreatment follow-up of this rare cancer.

AB - RATIONALE: Hepatic epithelioid hemangioendothelioma (EHE) is a rare malignant vascular tumor of endothelial origin with a highly variable clinical presentation and natural history. Given its vascular origin, new therapies with inhibitors of vascular endothelial growth factor (VEGF) have been introduced in the treatment of these patients and have shown promising results. Few reports have described the role of F-Fluorodeoxyglucose positron emission tomography/contrast-enhanced computed tomography (F-FDG PET/CT) in the evaluation of this tumor after treatment with anti-angiogenic agents. Our case reports how F-FDG PET-CT scan was critical in the assessment of this tumor after treatment with an anti-angiogenic agent, Pazopanib, demonstrating complete metabolic response. PATIENT CONCERNS: A 30-year-old man with no previous significant medical history presented with pain in the right upper quadrant for over a year. DIAGNOSES: Multiple hepatic masses were found on abdominal ultrasound. Liver biopsy confirmed the diagnosis of epithelioid hemangioendothelioma. F-FDG PET/CT was performed for staging. Multiple FDG-avid hepatic, splenic, and lymph nodes lesions were detected on F-FDG PET/CT. A subsequent spleen biopsy confirmed splenic involvement. Immunohistochemistry was positive for CD31, CD34, and ERG, supporting the diagnosis of epithelioid hemangioendothelioma. INTERVENTIONS: A 1-year cyclophosphamide treatment was provided followed by Pazopanib for 17 months. OUTCOMES: Six years after the first F-FDG PET/CT, F-FDG PET/CT performed for restaging demonstrated complete metabolic response to therapy. Follow-up CT demonstrated no interval changes in size of some of the treated lesions. LESSON: F-FDG PET/CT is useful for baseline assessment and posttreatment follow-up of this rare cancer.

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KW - antineoplastic agent

KW - fluorodeoxyglucose f 18

KW - pazopanib

KW - pyrimidine derivative

KW - radiopharmaceutical agent

KW - sulfonamide

KW - adult

KW - case report

KW - diagnostic imaging

KW - hemangioendothelioma

KW - human

KW - liver tumor

KW - male

KW - positron emission tomography-computed tomography

KW - procedures

KW - treatment outcome

KW - Adult

KW - Angiogenesis Inhibitors

KW - Antineoplastic Agents

KW - Fluorodeoxyglucose F18

KW - Hemangioendothelioma, Epithelioid

KW - Humans

KW - Liver Neoplasms

KW - Male

KW - Positron Emission Tomography Computed Tomography

KW - Pyrimidines

KW - Radiopharmaceuticals

KW - Sulfonamides

KW - Treatment Outcome

U2 - 10.1097/MD.0000000000012795

DO - 10.1097/MD.0000000000012795

M3 - Article

VL - 97

SP - e12795

JO - Medicine (United States)

JF - Medicine (United States)

SN - 0025-7974

IS - 42

ER -