Diagnostic and therapeutic understanding of multiple foci hepatic epithelioid haemangioendothelioma: A case report.

Hepatic epithelioid hemangioendothelioma (HEHE) is a rare, low-grade malignant liver tumour. Due to the small number of reported cases and available literature, the understanding of this condition has remained limited. Surgical resection is an important treatment option that substantially prolongs patient survival. This case report discusses a 23-year-old male patient diagnosed with HEHE who presented with multiple tumours, including nine lesions distributed across six different segments of the liver. Prior to surgery, the anatomical locations of the lesions in relation to the liver vasculature were mapped using three-dimensional liver reconstruction. Intraoperative ultrasound (IOUS) was performed to ensure the complete excision of all lesions. At three months post-surgery, follow-up imaging revealed abnormally enhanced nodules in the S4 segment of the liver, which were considered new lesions. After consultation with a multidisciplinary team, the new liver lesions were treated with microwave ablation (MWA) following a puncture biopsy. Given the lack of standardised treatment guidelines for HEHE, this case illustrates the clinical manifestations, laboratory test results and imaging features of multifocal HEHE. Furthermore, it underscores the application of techniques including three-dimensional reconstruction, IOUS and MWA in building diagnostic and therapeutic experiences for HEHE, providing a clinical basis and reference for standardised management in the future.