Hindawi Publishing Corporation Case Reports in Oncological Medicine Volume 2013, Article ID 243939, 5 pages http://dx.doi.org/10.1155/2013/243939 Case Report Hepatic Epithelioid Hemangioendothelioma and the Danger of Misdiagnosis: Report of a Case Kyriakos Neofytou, 1 Andreas Chrysochos, 1 Nikolas Charalambous, 2 Menelaos Dietis, 1 Christos Petridis, 1 Charalampos Andreou, 1 and Athanasios Petrou 1 1 Department of Surgery, Nicosia Government Hospital, Palaios Dromos Lekosias-Lemesou, No. 215, 2029 Strovolos, Nicosia, Cyprus 2 Department of Radiology, Nicosia Government Hospital, Palaios Dromos Lekosias-Lemesou, No. 215, 2029 Strovolos, Nicosia, Cyprus Correspondence should be addressed to Kyriakos Neofytou; kneophy2@gmail.com Received 15 January 2013; Accepted 1 February 2013 Academic Editors: J. M. Buchanich, R. Palmirotta, and M. Romkes Copyright © 2013 Kyriakos Neofytou et al. his 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. Malignant hepatic epithelioid hemangioendothelioma (HEHE) is a rare malignant tumor of vascular origin. Nonspeciic symptoms and the absence of experience of surgeons, radiologists, and histopathologists due to the rarity of HEHE make the diagnosis of this entity very challenging. Misdiagnosis is not a rare event, and the consequences of such an event are catastrophic. We report a case of a patient sufering from HEHE in which the initial diagnosis was hepatocellular carcinoma (HCC). he presence of normal laboratory values, liver function tests, tumor markers along with the absence of a chronic liver disease, or any other predisposing factors for HCC, was in contrast with the diagnosis of HCC. Clinical suspicion drove us to the repetition of a liver biopsy and the reevaluation of the sample by a more experience histopathology department in liver tumors. he last biopsy conirmed the diagnosis of HEHE, and the patient escaped any unnecessary treatment for a nonexisting HCC. 1. Case Presentation A forty-nine-year old female patient presented with a right upper quadrant pain. Based on her medical history, the patient underwent thyroidectomy 6 months before because of a papillary thyroid cancer that was not invading the thyroid capsule (TNM staging PT1, PNX, PMX Anatomic stage/Prognostic groups 45 years, and older Stage 1). All of the patient laboratory tests were within nor- mal limits including alkaline phosphatase (41 U/L), g- glutamyl transpeptidase (14 U/L), aspartate aminotransferase (16 U/L), alanine aminotransferase (12 U/L), and bilirubin levels (0.44 mg/dL). An abdominal ultrasound was scheduled which showed several hypoechoic solid nodules, regarding both liver lobes, with an irregular echogenic outline and a few of which with multiple calciications. Immediately aterwards, an abdomi- nal computed tomography was performed which conirmed these lesions and the related calciications. Speciically, hypodense lesions were seen with the largest of which in the right liver lobe, with a maximum diameter of 3.7 cm (Figure 1). Based on the above, the hypothesis of secondary liver metastasis was proposed. In the following days, both colonoscopy as well as gastroscopy took place with no pathological indings. Tumor markers including cancer embryonic antigen (CEA), alpha fetoprotein (AFP), and carbohydrate antigen (CA) 19–9 were all within normal limits. hyroglobulin was measured at 0.2 ng/mL. A follow-up neck ultrasound did not reveal any mass or enlarge lymph nodes, and I 131 whole body scan did not demonstrate any thyroid remnant nor any metastasis. As part of the patient diagnostic evaluation, in an attempt to ind the possible primary tumor, a whole body magnetic resonance imaging (MRI) was performed. he results showed no evidence of an extrahepatic disease. Percutaneous liver biopsy from the largest liver lesion, guided under computed tomography, showed massive hepatic necrosis. he patient hepatitis serology was negative