Background : Hepatic epithelioid haemangioendothelioma (HEHE) is a rare malignant vascular tumour. It’s unique tumour biology behaves on a spectrum of aggressiveness between haemangiomas and angiosarcomas. First described in 1982 by Weiss and Enzinger, it has a reported incidence of 1-2 cases per 1 million. It’s rarity, multifocal disease combined with usually a young female population makes management challenging. Liver resection and liver transplant have been well described as effective treatment options with good long-term outcomes.r

Methods : Case report: a 26-year-old female presented to the emergency department with acute severe abdominal pain. An ultrasound revealed an indeterminate liver lesion in segment VII measuring 10x10x16mm. Her pain resolved and an outpatient CT multiphase revealed three hypodense nonenhancing lesion within the right lobe of the liver and one 4mm hypodense nodule in segment II. No other metastatic lesions or primary malignancy were identified. Endoscopy and colonoscopy were normal. A diagnostic laparoscopy and excisional biopsy was performed. At laparoscopy, multiple liver lesions were evident but there was no metastatic disease. Successful excisional biopsy of a segment VII lesion using intra-operative ultrasound demonstrated HEHE on histopathology.

Results : Given the multifocal disease, a multidisciplinary team decision opted to proceed for liver transplant in which she is currently being worked up for.

Conclusions : HEHE is a rare neoplasm that warrants a multidisciplinary approach. Liver resection and liver transplant have been reported successfully in the literature. This case highlights the complexities in managing HEHE and should encourage clinicians to report their experience.