Testing & Diagnosis for Epithelioid hemangioendothelioma in Children

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How do doctors diagnose EHE?

Diagnosing EHE is a process that happens in a few stages, in part because the skin lesions associated with EHE are often confused with more common skin conditions. Most often, the first step will be a complete medical history and thorough physical exam. Additional tests may include:

  • Blood tests—to assess your child's liver and kidney function, blood electrolytes and blood cells. Note that there is no blood test that can diagnose or monitor EHE.
  • Imaging studies— Depending on where the tumor is located, your doctor may recommend one of the following scans:
  • Magnetic resonance imaging (MRI) — This high-resolution scan shows the size of your child’s tumor and its relationship to nearby muscles, nerves, bones and other blood vessels. MRI provides the best available pictures and does so without radiation exposure.
  • Computerized tomography scan (also called a CT or CAT scan) –A CT scan also shows detailed images of the area around your child’s tumor, including the bones, muscles, fat and organs. CT imaging may offer advantages over MRI in some circumstances, though CT scans utilize radiation.
  • X-ray (also called a plain film) – Traditional X-rays are also helpful for lesions on your child’s bones, and use less radiation than CT scans.
  • PET scan – A PET scan is a whole body scan (except for the brain). A small amount of radioactive glucose (sugar) allows our nuclear medicine radiologists to see active tumors throughout the body. Some EHE tumors take up more sugar than surrounding tissues and can be monitored with PET scans.
  • Biopsy—This is a simple surgical or interventional radiology procedure where a doctor removes a small tissue sample from the tumor. Your child will be sedated or asleep (under anesthesia) for this procedure. Examining the tumor's cells under a microscope allows the physician to determine definitively whether your child has EHE. A biopsy is always necessary to confirm a diagnosis of EHE.

Certain characteristics of your child’s EHE may determine whether it is aggressive and requires more aggressive treatment, including:

  • its location
  • the appearance of a biopsy under a microscope
  • whether the tumor has changed in size and/or spread to other tissues

After we complete all necessary tests, our experts meet to review and discuss what they have learned about your child's condition. Then we will meet with you and your family to discuss the results and outline the best treatment options for EHE.

Epithelioid hemangioendothelioma: Reviewed by Cameron Trenor III, MD
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