Grossly, epithelial hemangioendothelioma that arises from vessels will be firm with a white-red color, attached to the surrounding soft tissues, and have a smooth or infiltrative border which may resemble an organizing thrombus.  Epithelioid hemangioendothelioma which does not arise from a vessel will be hard, grey-white, and have a smooth or infiltrative border.

Vascular differentiation in epitheliod hemangioendothelioma is at the cellular level. Epitheliod hemangioendothelioma is characterized by short strands or solid nests of rounded to spindled cells  with eosinophilic cytoplasm and rounded nuclei- the epithelioid endothelioid cell. Seperate vascular channels are rarely seen, instead the cells produce intracellular lumina seen as clear spaces or vacuoles in the cytoplasm.

The case history for the following photomicrographs of EH is as follows:
A 69yo male presented with a two yr HX of burning radicular pain in a thoracic distribution. Eventually the PT developed signs of cord compression. Surgery was performed to alleviate the compression and a tumor was found which appeared to arise from the lateral pedicle of T6.  The tumor did not appear to invade the dura or adjacent nerve roots. While obtaining the biopsy, the surgeon noted that the lesion was very vascular.

 
 

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