Clinicopathological features of epithelioid hemangioma of 43 patients with long‐term follow‐up: A two‐center retrospective study

Epithelioid hemangioma (EH) is a rare angioproliferative disorder for which histopathology is the main approach to diagnosis. The tendency to recur is of concern to clinicians and patients. The factors associated with recurrence have been sporadically reported and a large-scale cohort study has been lacking. This study aims to investigate the clinicopathological characteristics and long-term clinical outcomes of EH patients from two tertiary care hospitals. A two-center retrospective cohort study of 43 patients with a diagnosis of EH between 2013 and 2023 was evaluated at follow-up. A comprehensive and detailed review of clinical and pathological data with long-term follow-up was performed. Information on prognosis was available for 43, and 8 (8/43, 18.6%) experienced local recurrence. Facial (Cramer's V = 0.405, P = 0.029) and multiple (relative risk [RR] 4.306, 95% confidence interval [CI] 1.213, 15.282, Phi = 0.369, P = 0.016) lesions, subcutaneous involvement (RR 5.063, 95% CI 1.157, 22.151, Phi = 0.374, P = 0.014), and the presence of lymphoid follicles (RR 9.750, 95% CI 3.853, 24.671, Phi = 0.670, P < 0.001) were associated with higher recurrence rates. According to the presence or absence of well-differentiated angiogenesis, EH can be pathologically classified into vascular, cellular, and intermediate types, while the depth, degree, and pattern of inflammation, tissue eosinophilia, eosinophilic microabscesses, and hobnail endothelial cells differed significantly between cellular and vascular types. The characteristics of EH are distinguished by different pathological subtypes. This study provides insight into the clinicopathological features and outcome of EH to assist clinicians in the diagnosis and management of this rare condition.