Epithelioid hemangioendothelioma: A rare mimicker of post-traumatic hematoma

ABSTRACT

Vascular tumors of intermediate malignancy occupy a perplexing space in oncology; too aggressive to be dismissed, yet too indolent to follow the predictable trajectory of high-grade sarcomas. Among them, epithelioid hemangioendothelioma (EHE) stands out for its rarity, histological subtlety, and unpredictable clinical course. Frequently, its bland cytology, low mitotic activity, and deceptively benign patterns obscure its malignant potential, leading to diagnostic uncertainty. In the present case, the diagnostic challenge was evident, as the lesion presented clinically as a subcutaneous swelling resembling a hematoma. Histopathological examination demonstrated polygonal endothelial cells with intracytoplasmic vacuoles containing erythrocytes indicative of a vascular origin. Definitive diagnosis was achieved through immunohistochemical confirmation, showing positivity for CD31, CD34, and FLI-1. This report aims to highlight the diagnostic nuances, potential for misinterpretation, and therapeutic dilemmas associated with EHE, thereby reinforcing the need for vigilance in evaluating seemingly “low-risk” atypical subcutaneous swellings.