Response of metastatic pseudomyogenic hemangioendothelioma to radiotherapy: a case report and literature review of management of this rare disease

Pseudomyogenic hemangioendothelioma (PMH) is a vascular tumor with a low tendency to metastasize, typically affecting middle-aged men and presenting as nodules in the lower extremities. This report presents the case of a 59-year-old male who developed a painful right temporal mass and temporomandibular joint pain and was found to have metastatic PMH involving bony and muscle sites in the head. Radiotherapy (4000 cGy in 10 fractions) was used to treat all tumors, resulting in significant tumor regression, symptom relief, and local control at 21 months. He did not receive systemic therapy. A systematic review of 30 reports on PMH treatment revealed that radiotherapy use is rare and inconsistently reported; however, this case demonstrates the effectiveness of modest radiation doses for local control. These findings highlight the importance of personalized treatment strategies for managing rare tumors like PMH, particularly with limited established treatment options.