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'''Hemangioendotheliomas''' is a rare group of mesenchymal vascular neoplasms. Hemangioendotheliomas commonly present with an enlarging mass and have been reported in the [[head]] and [[neck]], [[lungs]], [[lymph nodes]], [[pleura]], [[retroperitoneum]], or [[stomach]]. Hemangioendotheliomas may be [[benign]] or [[malignant]], and tend to occur around medium to large venous structures. Hemangioendothelioma may be classified into 4 groups: epitheloid hemangioendothelioma (most common), kaposiform hemangioendothelioma, retiform hemangioendothelioma, and [[infantile hemangioendothelioma]]. The prevalence of hemangioendothelioma is approximately 1 per 100,000 individuals worldwide. | '''Hemangioendotheliomas''' is a rare group of mesenchymal vascular neoplasms. Hemangioendotheliomas commonly present with an enlarging mass and have been reported in the [[head]] and [[neck]], [[lungs]], [[lymph nodes]], [[pleura]], [[retroperitoneum]], or [[stomach]]. Hemangioendotheliomas may be [[benign]] or [[malignant]], and tend to occur around medium to large venous structures. Hemangioendothelioma may be classified into 4 groups: epitheloid hemangioendothelioma (most common), kaposiform hemangioendothelioma, retiform hemangioendothelioma, and [[infantile hemangioendothelioma]]. The prevalence of hemangioendothelioma is approximately 1 per 100,000 individuals worldwide. | ||
The majority of patients with hemangioendothelioma are symptomatic at the time of diagnosis.<ref name="pmid3303234">{{cite journal |vauthors=Weiss SW, Ishak KG, Dail DH, Sweet DE, Enzinger FM |title=Epithelioid hemangioendothelioma and related lesions |journal=Semin Diagn Pathol |volume=3 |issue=4 |pages=259–87 |year=1986 |pmid=3303234 |doi= |url=}}</ref> Early clinical features of hemangioendothelioma are often unspecific, such as: abdominal pain, mass, weight loss, or fatigue. On CT, characteristic findings of hepatic hemangioendothelioma, may include: multiple hypo-attenuating lesions in both hepatic lobes, | The majority of patients with hemangioendothelioma are symptomatic at the time of diagnosis.<ref name="pmid3303234">{{cite journal |vauthors=Weiss SW, Ishak KG, Dail DH, Sweet DE, Enzinger FM |title=Epithelioid hemangioendothelioma and related lesions |journal=Semin Diagn Pathol |volume=3 |issue=4 |pages=259–87 |year=1986 |pmid=3303234 |doi= |url=}}</ref> Early clinical features of hemangioendothelioma are often unspecific, such as: [[abdominal pain]], mass, [[weight loss]], or [[fatigue]]. On CT, characteristic findings of hepatic hemangioendothelioma, may include: multiple hypo-attenuating lesions in both hepatic lobes, coalesce to form larger confluent hypo-attenuating regions in a peripheral or subcapsular distribution, halo or target pattern of enhancement in larger lesions, subcapsular lesion (with capsular retraction), and located in a predominantly peripheral. Surgical [[resection]], [[radiotherapy]], and [[chemotherapy]] are often the treatment of choice for hemangioendothelioma. | ||
==Historical Perspective== | ==Historical Perspective== | ||
*Hemangioendothelioma was first described by Sharon Weiss, an American pathologist, in 1986.<ref name="wiki> Hemangioendothelioma. Wikipedia. https://en.wikipedia.org/wiki/Hemangioendothelioma Accessed on April 22, 2016</ref> | *Hemangioendothelioma was first described by Sharon Weiss, an American pathologist, in 1986.<ref name="wiki">Hemangioendothelioma. Wikipedia. https://en.wikipedia.org/wiki/Hemangioendothelioma Accessed on April 22, 2016</ref> | ||
==Classification== | ==Classification== | ||
| Line 34: | Line 34: | ||
:*No hallmark features | :*No hallmark features | ||
:*Size may range up to 18 cm | :*Size may range up to 18 cm | ||
*On microscopic histopathological analysis, characteristic findings of hemangioendothelioma, include:<ref name="wiki> Hemangioendothelioma. Wikipedia. https://en.wikipedia.org/wiki/Hemangioendothelioma Accessed on April 22, 2016</ref><ref name="wjkjki> Hemangioendothelioma. Libre Pathology. https://librepathology.org/wiki/Infantile_hepatic_hemangioendothelioma Accessed on April 22, 2016</ref> | *On microscopic histopathological analysis, characteristic findings of hemangioendothelioma, include:<ref name="wiki">Hemangioendothelioma. Wikipedia. https://en.wikipedia.org/wiki/Hemangioendothelioma Accessed on April 22, 2016</ref><ref name="wjkjki">Hemangioendothelioma. Libre Pathology. https://librepathology.org/wiki/Infantile_hepatic_hemangioendothelioma Accessed on April 22, 2016</ref> | ||
:*Large epithelioid perivascular cells | :*Large epithelioid perivascular cells | ||
:*Abundant pale eosinophilic cytoplasm | :*Abundant pale eosinophilic cytoplasm | ||
| Line 53: | Line 53: | ||
:*Arranged in a glomeruloid pattern | :*Arranged in a glomeruloid pattern | ||
*On immunohistochemistry, characteristic findings of hemangioendothelioma, include:<ref name="pmid3303234">{{cite journal |vauthors=Weiss SW, Ishak KG, Dail DH, Sweet DE, Enzinger FM |title=Epithelioid hemangioendothelioma and related lesions |journal=Semin Diagn Pathol |volume=3 |issue=4 |pages=259–87 |year=1986 |pmid=3303234 |doi= |url=}} | *On immunohistochemistry, characteristic findings of hemangioendothelioma, include:<ref name="pmid3303234">{{cite journal |vauthors=Weiss SW, Ishak KG, Dail DH, Sweet DE, Enzinger FM |title=Epithelioid hemangioendothelioma and related lesions |journal=Semin Diagn Pathol |volume=3 |issue=4 |pages=259–87 |year=1986 |pmid=3303234 |doi= |url=}}</ref> | ||
:*Positive CD31 | :*Positive [[CD31]] | ||
:*Positive CD34 | :*Positive [[CD34]] | ||
:*Positive Factor VIII | :*Positive [[Factor VIII]] | ||
==Causes== | ==Causes== | ||
*There are no established causes for hemangioendothelioma.<ref name="wjkjki> Hemangioendothelioma. Libre Pathology. https://librepathology.org/wiki/Infantile_hepatic_hemangioendothelioma Accessed on April 22, 2016</ref> | *There are no established causes for hemangioendothelioma.<ref name="wjkjki">Hemangioendothelioma. Libre Pathology. https://librepathology.org/wiki/Infantile_hepatic_hemangioendothelioma Accessed on April 22, 2016</ref> | ||
==Differentiating Hemangioendothelioma from Other Diseases== | ==Differentiating Hemangioendothelioma from Other Diseases== | ||
*Hemangioendothelioma must be differentiated from other diseases that cause a hypervascular mass, or abdominal pain, such as:<ref name="pmid3303234">{{cite journal |vauthors=Weiss SW, Ishak KG, Dail DH, Sweet DE, Enzinger FM |title=Epithelioid hemangioendothelioma and related lesions |journal=Semin Diagn Pathol |volume=3 |issue=4 |pages=259–87 |year=1986 |pmid=3303234 |doi= |url=}}</ref><ref name="radio>Hemangioendothelioma. Radiopedia. http://radiopaedia.org/articles/epithelioid-haemenagioendothelioma Accessed on April 22, 2016</ref> | *Hemangioendothelioma must be differentiated from other diseases that cause a hypervascular mass, or abdominal pain, such as:<ref name="pmid3303234">{{cite journal |vauthors=Weiss SW, Ishak KG, Dail DH, Sweet DE, Enzinger FM |title=Epithelioid hemangioendothelioma and related lesions |journal=Semin Diagn Pathol |volume=3 |issue=4 |pages=259–87 |year=1986 |pmid=3303234 |doi= |url=}}</ref><ref name="radio">Hemangioendothelioma. Radiopedia. http://radiopaedia.org/articles/epithelioid-haemenagioendothelioma Accessed on April 22, 2016</ref> | ||
:*Hepatoblastoma | :*[[Hepatoblastoma]] | ||
:*Hemangioma | :*[[Hemangioma]] | ||
:*Angiosarcoma | :*[[Angiosarcoma]] | ||
:*Colangiocarcinoma | :*[[Gallbladder cancer|Colangiocarcinoma]] | ||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
* The prevalence of hemangioendothelioma is approximately 1 per 100,000 individuals worldwide. | * The prevalence of hemangioendothelioma is approximately 1 per 100,000 individuals worldwide.<ref name="radio">Hemangioendothelioma. Radiopedia. http://radiopaedia.org/articles/epithelioid-haemenagioendothelioma Accessed on April 22, 2016</ref> | ||
* Hemangioendothelioma is very rare. | * Hemangioendothelioma is very rare. | ||
| Line 83: | Line 83: | ||
==Risk Factors== | ==Risk Factors== | ||
*Common risk factors in the development of hemangioendothelioma, include:<ref name="pmid3303234">{{cite journal |vauthors=Weiss SW, Ishak KG, Dail DH, Sweet DE, Enzinger FM |title=Epithelioid hemangioendothelioma and related lesions |journal=Semin Diagn Pathol |volume=3 |issue=4 |pages=259–87 |year=1986 |pmid=3303234 |doi= |url=}}</ref> | *Common risk factors in the development of hemangioendothelioma, include:<ref name="pmid3303234">{{cite journal |vauthors=Weiss SW, Ishak KG, Dail DH, Sweet DE, Enzinger FM |title=Epithelioid hemangioendothelioma and related lesions |journal=Semin Diagn Pathol |volume=3 |issue=4 |pages=259–87 |year=1986 |pmid=3303234 |doi= |url=}}</ref> | ||
:*Oral contraceptives | :*[[Oral contraceptive|Oral contraceptives]] | ||
:*Polyvinyl chloride | :*[[Polyvinyl chloride]] | ||
== Natural History, Complications and Prognosis== | == Natural History, Complications and Prognosis== | ||
| Line 90: | Line 90: | ||
*Early clinical features of hemangioendothelioma are often unspecific (eg. abdominal pain, mass, weight loss, or fatigue). | *Early clinical features of hemangioendothelioma are often unspecific (eg. abdominal pain, mass, weight loss, or fatigue). | ||
*If left untreated, the majority of patients with hemangioendothelioma may progress to develop metastases. | *If left untreated, the majority of patients with hemangioendothelioma may progress to develop metastases. | ||
*Common complications of hemangioendothelioma, include:<ref name="wjkjki> Hemangioendothelioma. Libre Pathology. https://librepathology.org/wiki/Infantile_hepatic_hemangioendothelioma Accessed on April 22, 2016</ref> | *Common complications of hemangioendothelioma, include:<ref name="wjkjki">Hemangioendothelioma. Libre Pathology. https://librepathology.org/wiki/Infantile_hepatic_hemangioendothelioma Accessed on April 22, 2016</ref> | ||
:*Hepatic failure | :*[[Hepatic failure]] | ||
:*Multi-organ failure | :*Multi-organ failure | ||
:* | :*[[Heart failure]] | ||
*Prognosis is generally poor, and the 5-year survival rate of patients with hemangioendothelioma is approximately 55%.<ref name="radio>Hemangioendothelioma. Radiopedia. http://radiopaedia.org/articles/epithelioid-haemenagioendothelioma Accessed on April 22, 2016</ref> | *Prognosis is generally poor, and the 5-year survival rate of patients with hemangioendothelioma is approximately 55%.<ref name="radio">Hemangioendothelioma. Radiopedia. http://radiopaedia.org/articles/epithelioid-haemenagioendothelioma Accessed on April 22, 2016</ref> | ||
== Diagnosis == | == Diagnosis == | ||
=== Symptoms === | === Symptoms === | ||
*Hemangioendothelioma is usually asymptomatic. | *Hemangioendothelioma is usually asymptomatic. | ||
*Symptoms of hemangioendothelioma may include the following:<ref name="wjkjki> Hemangioendothelioma. Libre Pathology. https://librepathology.org/wiki/Infantile_hepatic_hemangioendothelioma Accessed on April 22, 2016</ref> | *Symptoms of hemangioendothelioma may include the following:<ref name="wjkjki">Hemangioendothelioma. Libre Pathology. https://librepathology.org/wiki/Infantile_hepatic_hemangioendothelioma Accessed on April 22, 2016</ref> | ||
:*Abdominal pain | :*Abdominal pain | ||
:*Fatigue | :*Fatigue | ||
| Line 105: | Line 105: | ||
=== Physical Examination === | === Physical Examination === | ||
*Patients with hemangioendothelioma usually may be well-appearing. | *Patients with hemangioendothelioma usually may be well-appearing. | ||
*Physical examination may be remarkable for:<ref name="radio>Hemangioendothelioma. Radiopedia. http://radiopaedia.org/articles/epithelioid-haemenagioendothelioma Accessed on April 22, 2016</ref> | *Physical examination may be remarkable for:<ref name="radio">Hemangioendothelioma. Radiopedia. http://radiopaedia.org/articles/epithelioid-haemenagioendothelioma Accessed on April 22, 2016</ref> | ||
'''Palpation''' | '''Palpation''' | ||
:*Abdominal large mass | :*Abdominal large mass | ||
| Line 114: | Line 114: | ||
===Imaging Findings=== | ===Imaging Findings=== | ||
*On CT, characteristic findings of hemangioendothelioma, include:<ref name="radio>Hemangioendothelioma. Radiopedia. http://radiopaedia.org/articles/epithelioid-haemenagioendothelioma Accessed on April 22, 2016</ref> | *On CT, characteristic findings of hemangioendothelioma, include:<ref name="radio">Hemangioendothelioma. Radiopedia. http://radiopaedia.org/articles/epithelioid-haemenagioendothelioma Accessed on April 22, 2016</ref> | ||
'''Hepatic Hemangioendothelioma''' | '''Hepatic Hemangioendothelioma''' | ||
:*Multiple hypo-attenuating lesions in both hepatic lobes | :*Multiple hypo-attenuating lesions in both hepatic lobes | ||
| Line 123: | Line 123: | ||
:*Honeycomb appearance | :*Honeycomb appearance | ||
*On MRI, characteristic findings of hemangioendothelioma, include:<ref name="radio>Hemangioendothelioma. Radiopedia. http://radiopaedia.org/articles/epithelioid-haemenagioendothelioma Accessed on April 22, 2016</ref><ref name="wjkjki> Hemangioendothelioma. Libre Pathology. https://librepathology.org/wiki/Infantile_hepatic_hemangioendothelioma Accessed on April 22, 2016</ref> | *On MRI, characteristic findings of hemangioendothelioma, include:<ref name="radio">Hemangioendothelioma. Radiopedia. http://radiopaedia.org/articles/epithelioid-haemenagioendothelioma Accessed on April 22, 2016</ref><ref name="wjkjki">Hemangioendothelioma. Libre Pathology. https://librepathology.org/wiki/Infantile_hepatic_hemangioendothelioma Accessed on April 22, 2016</ref> | ||
'''Hepatic Hemangioendothelioma''' | '''Hepatic Hemangioendothelioma''' | ||
:*T1: hypointense lesions relative to normal liver parenchyma on unenhanced T1-weighted images | :*T1: hypointense lesions relative to normal liver parenchyma on unenhanced T1-weighted images | ||
| Line 133: | Line 133: | ||
*There is no treatment for hemangioendothelioma; the mainstay of therapy is supportive care. | *There is no treatment for hemangioendothelioma; the mainstay of therapy is supportive care. | ||
*Common therapies for hemangioendothelioma, may include: | *Common therapies for hemangioendothelioma, may include: | ||
:*Interferon | :*[[Interferon]] | ||
:*Sorafenib (kinase inhibitor) | :*[[Sorafenib]] (kinase inhibitor) | ||
:*Corticosteroids | :*[[Corticosteroids]] | ||
:*Paclitaxel | :*[[Paclitaxel]] | ||
:*Thalidomide | :*[[Thalidomide]] | ||
:*Doxorubicin | :*[[Doxorubicin]] | ||
*Radiation therapy for hemangioendothelioma remains unclear. | *Radiation therapy for hemangioendothelioma remains unclear. | ||
=== Surgery === | === Surgery === | ||
*Surgery is the mainstay of therapy for hemangioendothelioma.<ref name="wjkjki> Hemangioendothelioma. Libre Pathology. https://librepathology.org/wiki/Infantile_hepatic_hemangioendothelioma Accessed on April 22, 2016</ref> | *Surgery is the mainstay of therapy for hemangioendothelioma.<ref name="wjkjki">Hemangioendothelioma. Libre Pathology. https://librepathology.org/wiki/Infantile_hepatic_hemangioendothelioma Accessed on April 22, 2016</ref> | ||
*The recurrence rate after surgery of hemangioendothelioma is approximately 40%. | *The recurrence rate after surgery of hemangioendothelioma is approximately 40%. | ||
*Infantile hepatic hemangioendothelioma has a good prognosis.<ref name="wjkjki> Hemangioendothelioma. Libre Pathology. https://librepathology.org/wiki/Infantile_hepatic_hemangioendothelioma Accessed on April 22, 2016</ref> | *Infantile hepatic hemangioendothelioma has a good prognosis.<ref name="wjkjki">Hemangioendothelioma. Libre Pathology. https://librepathology.org/wiki/Infantile_hepatic_hemangioendothelioma Accessed on April 22, 2016</ref> | ||
=== Prevention === | === Prevention === | ||
Revision as of 21:04, 22 April 2016
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]
Synonyms and keywords: Infantile hemangioendothelioma; Kaposiform hemangioendothelioma; Retiform hemangioendothelioma; Epithelioid hemangioendothelioma; Dabska tumor
Overview
Hemangioendotheliomas is a rare group of mesenchymal vascular neoplasms. Hemangioendotheliomas commonly present with an enlarging mass and have been reported in the head and neck, lungs, lymph nodes, pleura, retroperitoneum, or stomach. Hemangioendotheliomas may be benign or malignant, and tend to occur around medium to large venous structures. Hemangioendothelioma may be classified into 4 groups: epitheloid hemangioendothelioma (most common), kaposiform hemangioendothelioma, retiform hemangioendothelioma, and infantile hemangioendothelioma. The prevalence of hemangioendothelioma is approximately 1 per 100,000 individuals worldwide. The majority of patients with hemangioendothelioma are symptomatic at the time of diagnosis.[1] Early clinical features of hemangioendothelioma are often unspecific, such as: abdominal pain, mass, weight loss, or fatigue. On CT, characteristic findings of hepatic hemangioendothelioma, may include: multiple hypo-attenuating lesions in both hepatic lobes, coalesce to form larger confluent hypo-attenuating regions in a peripheral or subcapsular distribution, halo or target pattern of enhancement in larger lesions, subcapsular lesion (with capsular retraction), and located in a predominantly peripheral. Surgical resection, radiotherapy, and chemotherapy are often the treatment of choice for hemangioendothelioma.
Historical Perspective
- Hemangioendothelioma was first described by Sharon Weiss, an American pathologist, in 1986.[2]
Classification
- Hemangioendothelioma may be classified into 4 groups:[1]
- Epithelioid hemangioendothelioma (most common)
- Kaposiform hemangioendothelioma
- Retiform hemangioendothelioma
- Infantile hemangioendothelioma
- Type I
- Multiple vascular channels
- Formed by an immature endothelial lining
- Stromal separation from bile ductules
- Type II:
- Disorganized appearance and hypercellular
- There are no bile ductules
Pathophysiology
- The pathogenesis of hemangioendothelioma is characterized by epithelioid-like features.[1]
- Hemangioendotheliomas tend to occur around medium to large venous structures.[1]
- There are no genetic mutations associated with the development of hemangioendothelioma.
- On gross pathology, characteristic findings of hemangioendothelioma, include:
- No hallmark features
- Size may range up to 18 cm
- On microscopic histopathological analysis, characteristic findings of hemangioendothelioma, include:[2][3]
- Large epithelioid perivascular cells
- Abundant pale eosinophilic cytoplasm
- Cytoplasmic vacuolation (some cells) (also known as "blister cells") - key feature.
- May form lumen and have red blood cells within
- Vesicular nucleus with prominent nucleolus in some cells
- Tuft-like projections into capillaries
Papillary intralymphatic hemangioendothelioma
- Papillary tufts
- Central hyaline core lined by hobnail-like endothelial cells protruding into the lumina
Retiform hemangioendothelioma
- Infiltrative neoplasm composed of elongated arborizing vessels
- Arranged in an anastomosing pattern
- Lined by a single layer of "hobnail-like" endothelial cells (protrude within the narrow lumina)
Kaposiform hemangioendothelioma
- Composed of several solid poorly circumscribed nodules
- Nodules composed of a mixture of small capillaries and solid lobules
- Arranged in a glomeruloid pattern
- On immunohistochemistry, characteristic findings of hemangioendothelioma, include:[1]
- Positive CD31
- Positive CD34
- Positive Factor VIII
Causes
- There are no established causes for hemangioendothelioma.[3]
Differentiating Hemangioendothelioma from Other Diseases
- Hemangioendothelioma must be differentiated from other diseases that cause a hypervascular mass, or abdominal pain, such as:[1][4]
Epidemiology and Demographics
- The prevalence of hemangioendothelioma is approximately 1 per 100,000 individuals worldwide.[4]
- Hemangioendothelioma is very rare.
Age
- Patients of all age groups may develop hemangioendothelioma.
Gender
- Hemangioendothelioma affects men and women equally.
Race
- There is no racial predilection for hemangioendothelioma.
Risk Factors
- Common risk factors in the development of hemangioendothelioma, include:[1]
Natural History, Complications and Prognosis
- The majority of patients with hemangioendothelioma are symptomatic at the time of diagnosis.[1]
- Early clinical features of hemangioendothelioma are often unspecific (eg. abdominal pain, mass, weight loss, or fatigue).
- If left untreated, the majority of patients with hemangioendothelioma may progress to develop metastases.
- Common complications of hemangioendothelioma, include:[3]
- Hepatic failure
- Multi-organ failure
- Heart failure
- Prognosis is generally poor, and the 5-year survival rate of patients with hemangioendothelioma is approximately 55%.[4]
Diagnosis
Symptoms
- Hemangioendothelioma is usually asymptomatic.
- Symptoms of hemangioendothelioma may include the following:[3]
- Abdominal pain
- Fatigue
Physical Examination
- Patients with hemangioendothelioma usually may be well-appearing.
- Physical examination may be remarkable for:[4]
Palpation
- Abdominal large mass
- Hepatomegaly
Laboratory Findings
- There are no specific laboratory findings associated with hemangioendothelioma.
Imaging Findings
- On CT, characteristic findings of hemangioendothelioma, include:[4]
Hepatic Hemangioendothelioma
- Multiple hypo-attenuating lesions in both hepatic lobes
- That coalesce to form larger confluent hypo-attenuating regions in a peripheral or subcapsular distribution
- Halo or target pattern of enhancement in larger lesions
- Subcapsular lesion often present with capsular retraction
- Located in a predominantly peripheral distribution, with coalescence as individual nodules.
- Honeycomb appearance
Hepatic Hemangioendothelioma
- T1: hypointense lesions relative to normal liver parenchyma on unenhanced T1-weighted images
- T2: heterogeneously increased signal intensity
- C+ (Gd): some lesions demonstrate either a peripheral halo or a target-type enhancement pattern after administration of a gadolinium-based contrast agent, with occasional observation of a thin peripheral hypointense rim
Treatment
Medical Therapy
- There is no treatment for hemangioendothelioma; the mainstay of therapy is supportive care.
- Common therapies for hemangioendothelioma, may include:
- Interferon
- Sorafenib (kinase inhibitor)
- Corticosteroids
- Paclitaxel
- Thalidomide
- Doxorubicin
- Radiation therapy for hemangioendothelioma remains unclear.
Surgery
- Surgery is the mainstay of therapy for hemangioendothelioma.[3]
- The recurrence rate after surgery of hemangioendothelioma is approximately 40%.
- Infantile hepatic hemangioendothelioma has a good prognosis.[3]
Prevention
- There are no primary preventive measures available for hemangioendothelioma.
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Weiss SW, Ishak KG, Dail DH, Sweet DE, Enzinger FM (1986). "Epithelioid hemangioendothelioma and related lesions". Semin Diagn Pathol. 3 (4): 259–87. PMID 3303234.
- ↑ 2.0 2.1 Hemangioendothelioma. Wikipedia. https://en.wikipedia.org/wiki/Hemangioendothelioma Accessed on April 22, 2016
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Hemangioendothelioma. Libre Pathology. https://librepathology.org/wiki/Infantile_hepatic_hemangioendothelioma Accessed on April 22, 2016
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Hemangioendothelioma. Radiopedia. http://radiopaedia.org/articles/epithelioid-haemenagioendothelioma Accessed on April 22, 2016