Hemangioendotelioma epitelioide com ressecção vascular em membro inferior: relato de caso cirúrgico com revisão da literatura

Abstract

Epithelioid hemangioendothelioma (EHE) is an ultra-rare vascular sarcoma of endothelial origin, characterized by heterogeneous clinical behavior that can range from an indolent course to aggressive evolution with metastatic potential. This report presents a primary case of EHE located in the left femoral neurovascular bundle in a symptomatic patient. Complementary imaging studies demonstrated a solid, well-defined lesion, tightly adherent to the femoral artery, vein, and nerve in the left lower limb of a 59-year-old female patient. Diagnostic confirmation was initially obtained by incisional biopsy with histopathological and immunohistochemical analysis. Conservative treatment was rendered unfeasible by symptom progression. En bloc resection of the lesion was then performed, with joint removal of the femoral artery, vein, and nerve, followed by arterial reconstruction using an autologous reversed great saphenous vein graft from the contralateral limb. The patient had a satisfactory immediate postoperative course, later developing deep venous thrombosis treated with full-dose anticoagulation. Longitudinal follow-up in the 6 months after the surgical approach demonstrated full return to daily activities. The case highlights the role of the integration between imaging methods, histological analysis, and individualized surgical planning for the appropriate management of EHE in larger vascular structures. Early diagnosis and timely surgical intervention can preserve limb function and reduce the risk of serious consequences, including amputation and other vascular complications. The rarity of this pathology and the lack of data in the medical literature justify the relevance of this case report.