Composite Hemangioendothelioma An Unusual Presentation of a Rare Vascular Tumor

Objectives: Composite hemangioendothelioma (CHE) has been recently recognized as a low- to intermediate-grade vascular tumor. CHEs are rare vascular tumors that are clinically similar to more common vascular tumors but histologically exhibit a composite of hemangioendothelioma variants. We report the first case of a CHE on the scalp and the fifth case to show findings supportive of regional metastasis. Methods: Our patient had a multilobulated, violaceous scalp nodule, which on histologic examination revealed epithelioid, retiform, and spindle-cell components and rare foci of intermediate-grade mitotic activity consistent with CHE. Results: Imaging studies were performed and revealed an abnormal uptake of contrast media in a posterior nec