The presence of a nodule on the primary lesion, clinically palpable lymph nodes, the level of tumor invasion, and lymph node metastases were found to be significant prognostic factors in the 35 EMPD cases at our institution.

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cells are small, have small amounts of eosinophilic cytoplasm, and proliferate in cords, nests and sheets, in fibromyxoid matrix that is almost always associated with various amounts of ossification. In addition, immunohistochemical positivity of vascular endothelial markers such as ERG is useful in the differentiation of ossifying EHE from ossifying fibromyxoid tumor because the component cells of the latter are negative for such markers. The overall prognosis of EHE is unclear, and the variety of clinical behavior suggests intermediate malignancy of this neoplasm. 1 We speculate that ossifying EHE behaves as a completely benign neoplasm because the bony shell may limit its infiltrating growth; however, careful follow up may be needed. REFERENCES1 Clarke LE, Lee R, Militello G, Elenitsas R, Junkins-Hopkins J. Cutaneous epithelioid hemangioendothelioma. J Cutan Pathol 2008; 35: 236-240. 2 Weiss SW, Enzinger FM. Epithelioid hemangioendothelioma: a vascular tumor often mistaken for a carcinoma. Cancer 1982; 5: 970-981. 3 Weidner N. Atypical tumor of the mediastinum: epithelioid hemangioendothelioma containing metaplastic bone and osteoclastlike giant cells. Ultrastruct Pathol 1991; 15: 481-488. 4 Kiryu H, Hashimoto H, Hori Y. Ossifying epithelioid hemangioendothelioma. J Cutan Pathol 1996; 23: 558-561. 5 Miettinen M, Finnell V, Fetsch JF. Ossifying fibromyxoid tumor of soft parts-a clinicopathologic and immunohistochemical study of 104 cases with long-term follow-up and a critical review of the literature.