Pathology of Composite Hemangioendothelioma         

Dr Sampurna Roy MD         

 2022

Composite hemangioendothelioma is the most recently described entity of the Haemangioendothelioma (HE) spectrum.

These are vascular neoplasms with a spectrum of biological potential ranging from benign to low-grade malignancy.

Composite hemangioendothelioma is one of the less commonly encountered variants exhibiting a mixture of elements of other hemangioendothelioma subtypes, such as epithelioid, retiform, and spindle cell.

Local recurrences are common but metastasis is rare.

Site: Hands and feet.

Age: Adults

Microscopic features:   Case Link 

The tumours is composed of a complex admixture of histologic components that varied from tumour to tumour.

There is variation in the proportions of each component as well as the manner in which each component is distributed throughout each lesion.

The predominant histologic components are epithelioid hemangioendothelioma and retiform hemangioendothelioma.

In some cases there are areas of spindle cell hemangioendothelioma.

Angiosarcoma-like elements are also identified. (Occasional association with a history of lymphedema, raises the question of whether this variant of hemangioendothelioma may actually be an angiosarcoma that behaves prognostically better than the conventional type. )

In some cases large granular eosinophilic macrophages have been reported within the blood vessels of the retiform hemangioendothelioma - like areas.