# A case of an incidentally discovered epithelioid haemangioendothelioma

## TL;DR

A rare case of epithelioid haemangioendothelioma is reported in a patient with non-Hodgkin’s lymphoma, highlighting challenges in managing malignant pleural effusions.

## Contribution

This case report highlights the rare coexistence of non-Hodgkin’s lymphoma and epithelioid haemangioendothelioma, focusing on the management of malignant pleural effusions.

## Key findings

- Epithelioid haemangioendothelioma was diagnosed in a patient with non-Hodgkin’s lymphoma.
- Treatment with pazopanib and pleural interventions failed to resolve recurrent malignant pleural effusions.
- The patient continues to experience severe breathlessness, impacting quality of life.

## Abstract

We report a case of a 73-year-old male with non-Hodgkin’s lymphoma who underwent a restaging CT during treatment, which raised concern for a coexisting pathology. Consequently, a CT-guided biopsy was performed and a diagnosis of a second malignancy, an epithelioid haemangioendothelioma (EHE), was made. This is an exceptionally rare finding, given that the estimated incidence of EHE is only 0.4 cases per million per year. The patient has multifocal disease, with multiple pulmonary nodules and paravertebral/intercostal masses. Treatment with pazopanib was initiated early on due to the patient’s significant systemic symptoms and recurrent malignant pleural effusions (MPEs). Definitive pleural interventions, including talc pleurodesis and indwelling pleural catheter placement, were provided but were ultimately unsuccessful, and the effusion became loculated. The patient continues to suffer from extreme breathlessness. Given the significant impact on the quality of life of patients, this report delves into the complex management of MPEs in EHE.