The Diagnostic Dilemma of Incidentally Detected Pulmonary Nodules: A Fatal Case of Pulmonary Epithelioid Hemangioendothelioma.

Pulmonary epithelioid hemangioendothelioma (PEH) is a rare, low- to intermediate-grade malignant vascular tumour. We present a 63-year-old woman with incidentally identified bilateral pulmonary nodules, which demonstrated indolent features on PET-CT (SUVmax 1.8). She returned 4 years later with progressive dyspnoea, a pleural effusion, and radiologic evidence of disease progression. Histopathological examination of a biopsy specimen confirmed PEH, with tumour cells showing positivity for CD31 and a Ki-67 proliferation index of 20%. Despite treatment with a gemcitabine and carboplatin regimen, she developed pleural metastases and succumbed to her disease within a year of diagnosis. This case underscores the potential for aggressive progression in PEH, the prognostic value of the Ki-67 index and the critical need for early histopathological confirmation and more effective therapies.