Synchronous Hepatic Epithelioid Hemangioendothelioma and Hepatocellular Carcinoma

We would like to report the first case in English literature, to the best of our knowledge, of a synchronous hepatic epithelioid hemangioendothelioma (HEHE) and hepatocellular carcinoma (HCC), as well as to address the current trends and challenges in the management of HEHE. An otherwise well 58-year-old man was referred to his local hepatology service with elevated serum g-GT levels. Imaging revealed bilobar liver lesions consistent with HEHE, a discrete left lobe lesion suspected as HCC, and multiple pulmonary nodules. Biopsies confirmed HEHE with pulmonary metastases. After multidisciplinary team discussions, the patient was admitted under our team and underwent an uneventful laparoscopic left lateral hepatectomy for suspected HCC, which was confirmed histologically. As part of a watch-and-wait approach to metastatic HEHE, in the first follow-up (3 months postoperatively) the patient was clinically fine and the surveillance CT scan did not show recurrent disease. By presenting this case, we aim to raise awareness that this rare entity can coexist with others, potentially complicating their management. (Medicine 94(34):e1377) Abbreviations: BCLC = Barcelona Clinic Liver Cancer, CT = computed tomography, EUS = endoscopic ultrasonography, GI = gastrointestinal, HCC = hepatocellular carcinoma, HEHE = hepatic epithelioid hemangioendothelioma, LR = liver resection, MRI = magnetic resonance imaging, OLT = orthotopic liver transplantation, US = ultrasonography. Surg), Christopher c (Hons), MBBS, Dinesh Sharma, MB, BS, MS, FRCSEd, FRCS consensus management guidelines. This report presents the first case of HEHE in synchrony with another primary liver malignancy and discusses its presentation and management in light of relatively limited evidence. MATERIALS AND METHODS A generally well, independent and asymptomatic 58-yearold man was referred to his local hepatology service for further investigation of elevated serum g-GT levels. His history was notable for asthma and systemic hypertension, which were treated with tiotropium, seretide, amlodipine, and indapamide. In addition to excessive long-term alcohol consumption of 2 pints of beer daily, he had stopped smoking tobacco 25 years previously and had a biparental history of diabetes mellitus. Clinical examination was remarkable for ascites, hepatosany stigmata of chronic liver disease, peripheral edema, or encephalopathy.