Combination Therapy of Malignant Hemangioendothelioma with Radiation and Methotrexate

Malignant hemangioendothelioma is a rare metastasizing, perivascular tumor, sporadic cases of which have been described in the world literature. Clarity of classification and thereby understanding of this lesion must be credited to Stout who gathered a series of cases (1) and gave a basic pathologic description in his classic article in the Atlas of Tumor Pathology of the Armed Forces Institute of Pathology (2). He points out that by special staining technics it can be seen that the tumor cells collect just outside the endothelial wall, completely blocking endothelial channels, thereby explaining the bluish raised nature of the lesions, as well as their tendency to widespread metastasis. Thus, this tumor differs from the pericytoma, which is truly a tumor of the endothelial lining. Earlier treatment of sporadic cases by irradiation (3–6) has generally been inconclusive. Case IV, reported below, is such an instance. Other agents have been tried in an attempt to control the tumor, but its rarity has not all...