Hindawi Publishing Corporation Case Reports in Medicine Volume 2011, Article ID 262674, 6 pages doi:10.1155/2011/262674 Case Report Primary Pulmonary Epithelioid Hemangioendothelioma: A Rare Cause of PET-Negative Pulmonary Nodules Riccardo Cazzuffi, 1 Nunzio Calia, 1 Franco Ravenna, 1 Claudio Pasquini, 1 Sara Saturni, 1 Giorgio Narciso Cavallesco, 2 Francesco Quarantotto, 2 Rosa Rinaldi, 3 Annaluisa Cogo, 1 Gaetano Caramori, 1, 4 and Alberto Papi 1 1 Sezione di Malattie dell’Apparato Respiratorio, Dipartimento di Medicina Clinica e Sperimentale, Universit` a di Ferrara, Italy 2 Dipartimento di Scienze Chirurgiche, Anestesiologiche e Radiologiche, Modulo di Chirurgia Toracica, Universit` a di Ferrara, Italy 3 Sezione di Anatomia, Istologia e Citologia Patologica, Dipartimento di Medicina Sperimentale e Diagnostica, Universit` a di Ferrara, Italy 4 Centro per lo Studio delle Malattie Infiammatorie Croniche delle Vie Aeree e Patologie Fumo Correlate dell’Apparato Respiratorio (CEMICEF; formerly Centro di Ricerca su Asma e BPCO), Universit` a di Ferrara, Via Savonarola 9, 44121 Ferrara, Italy Correspondence should be addressed to Gaetano Caramori, gaetano.caramori@unife.it Received 11 February 2011; Accepted 16 May 2011 Academic Editor: A. Curt Copyright © 2011 Riccardo Cazzuffi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We report here a case of primary pulmonary epithelioid hemangioendothelioma diagnosed in a 67-year-old Caucasian man, presenting with exertion dyspnoea, dry cough, and multiple bilateral pulmonary nodules revealed by computed tomography. At the 18F-fluorodeoxyglucose positron emission tomography, these nodules were negative. The histopathological diagnosis was made on a pulmonary wedge resection (performed during video-thoracoscopic surgery). 1. Introduction Pulmonary epithelioid hemangioendothelioma (PEH) is a rare, low- to intermediate-grade tumor of endothelial origin [1] with around 120 cases reported in the literature [2]. At the onset, the patients are usually asymptomatic or present with nonspecific symptoms (such as weight loss, fatigue, dyspnoea, cough, and chest pain). Chest imaging usually shows the presence of multiple, bilateral small pulmonary lesions. The diagnosis usually requires a lung biopsy. The treatment is still not standardized. Surgery is suggested in presence of a solitary nodule or few unilateral nodules. In- stead if the lesions are unresectable or multiple and bilateral several chemotherapy protocols have been used. The prog- nosis is variable with a median survival of 4-5 years. 2. Case Report A 67-year-old Caucasian man, lifelong nonsmoker, with no prior history of lung diseases, was referred to our university hospital for the presence, in the last 3 months, of exertion dyspnoea (grade 1 according to the Medical Research Coun- cil scale [3]) and dry cough. He had worked as an employee without occupational exposures of clinical relevance. His past medical history was characterized by an herniated lum- bar disc, systemic arterial hypertension (treated with calcium blockers), diabetes mellitus (treated with oral hypoglycaemic agents), and polycythemia vera (diagnosed in 2007 and treat- ed from 2008 with hydroxyurea). Physical examination was unremarkable. Arterial blood gases analysis performed with the patient breathing room air demonstrated normal val- ues (pH 7.40, PaCO 2 43 mmHg, PaO 2 91 mmHg, and bicar- bonate level 26 mmoL/L). Routine laboratory tests were within the normal range except for those listed in Table 1. Serum levels of neoplastic markers were within normal range, including carcinoembryonic antigen (2.7 ng/mL), prostate-specific antigen (3.75 ng/mL), and CA19.9 (15 U/ mL). Also the serum levels of angiotensin-converting en- zyme (11 IU/mL) and β 2 microglobulin (2.50 mg/mL) were within normal limits.