A 17-year-old Hispanic female presented to our hospital with complaints of right upper quadrant abdominal pain, vomiting, and fever. Physical exam was positive for hepatomegaly. Abdominal computed tomography showed multiple hypoechoic liver masses. Liver biopsy was done, which was diagnostic for hepatic epithelioid hemangioendothelioma. 1. Introduction Hepatic epitheliod hemangioendothelioma (HEH) is an extremely rare malignancy originating from vascular endothelial cells [1]. HEH was first reported by Ishak et al. in 1984, who reported 32 cases of HEH [2]. Unfortunately, HEH lacks specific clinical signs and laboratory markers. The definitive diagnosis is based on the liver biopsy. Below, we present a case of a 17-year-old female who presented to the hospital with complaints of right upper quadrant abdominal pain. Abdominal imaging revealed multiple liver masses, and biopsy was diagnostic for HEH. We will briefly discuss the available literature on HEH. 2. Case Presentation A 17-year-old Hispanic female presented to the emergency department with complaints of the right upper quadrant abdominal pain. The pain had worsened over the past three days. Initially the pain was intermittent and later progressed to be constant. Review of symptoms was positive for vomiting and fever. No change in bowel habits or urinary pattern was reported. On physical examination, the patient had right lower and upper quadrant tenderness with hepatomegaly two centimeters below the right costal margin. Laboratory tests including complete blood count, comprehensive metabolic panel, lipid panel, and pancreatic enzymes were within normal limits. Abdominal ultrasound was done, which showed multiple hypoechoic masses scattered throughout the liver, measuring up to 2.0？cm in size. Computed tomography (CT) scan showed multiple low attenuation areas in the liver (Figure 1). Liver biopsy was performed, which was consistent with the diagnosis of HEH staining positive for CD31, a known endothelial marker (Figure 2). Skeletal survey and chest CT did not show evidence of metastatic disease. Figure 1: Abdominal CT showing multiple poorly defined low attenuation lesions. Figure 2: Liver biopsy showing scattered epitheliod cells. The tumor cells were stained positive for CD 31. Given the multifocal hepatic disease in this patient, she was not deemed to be a candidate for liver resection. The patient was referred for liver transplantation and is currently on the waiting list. 3. Discussion HEH is a very rare liver tumor originating from vascular endothelial cells [1]. The disease pathogenesis is
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