hemangioendothelioma

Summary

Summary: A neoplasm derived from blood vessels, characterized by numerous prominent endothelial cells that occur singly, in aggregates, and as the lining of congeries of vascular tubes or channels. Hemangioendotheliomas are relatively rare and are of intermediate malignancy (between benign hemangiomas and conventional angiosarcomas). They affect men and women about equally and rarely develop in childhood. (From Stedman, 25th ed; Holland et al., Cancer Medicine, 3d ed, p1866)

Top Publications

  1. Sari N, Yalcin B, Akyuz C, Haliloglu M, Buyukpamukcu M. Infantile hepatic hemangioendothelioma with elevated serum alpha-fetoprotein. Pediatr Hematol Oncol. 2006;23:639-47 pubmed
    Infantile hemangioendothelioma is the most common hepatic vascular tumor in infants less than 6 months of age, with a prevalence of 1%...
  2. Lu M, Greer M. Hypervascular multifocal hepatoblastoma: dynamic gadolinium-enhanced MRI findings indistinguishable from infantile hemangioendothelioma. Pediatr Radiol. 2007;37:587-91 pubmed
    ..report we describe a neonate with multifocal hypervascular hepatoblastoma indistinguishable from infantile hemangioendothelioma on dynamic gadolinium-enhanced MRI...
  3. Lu C, Ko S, Liang C, Kuo H, Tiao M. Infantile hepatic hemangioendothelioma presenting as early heart failure: report of two cases. Chang Gung Med J. 2002;25:405-10 pubmed
    Hepatic hemangioendothelioma is rare. We report on hepatic hemangioendotheliomas in 2 young infants, with initial manifestations of respiratory distress and congestive heart failure...
  4. Chiu Y, Drolet B, Blei F, Carcao M, Fangusaro J, Kelly M, et al. Variable response to propranolol treatment of kaposiform hemangioendothelioma, tufted angioma, and Kasabach-Merritt phenomenon. Pediatr Blood Cancer. 2012;59:934-8 pubmed publisher
    Propranolol is a non-selective beta-adrenergic antagonist successfully used in a case of kaposiform hemangioendothelioma (KHE) associated with Kasabach-Merritt phenomenon (KMP)...
  5. Levchenko T, Bratt A, Arbiser J, Holmgren L. Angiomotin expression promotes hemangioendothelioma invasion. Oncogene. 2004;23:1469-73 pubmed
    ..However, time-lapse photography showed a significant increase in random motility in MAE-Amot cells. We conclude that angiomotin may promote angiogenesis by both stimulating invasion as well as stabilizing established tubes...
  6. Gordillo G, Onat D, Stockinger M, Roy S, Atalay M, Beck F, et al. A key angiogenic role of monocyte chemoattractant protein-1 in hemangioendothelioma proliferation. Am J Physiol Cell Physiol. 2004;287:C866-73 pubmed
    ..This study has produced the first in vivo evidence of a complete response for any neoplasm, specifically a vascular proliferative lesion, to anti-MCP-1 therapy in animals with intact immune systems...
  7. Garcia Monaco R, Giachetti A, Peralta O, Napoli N, Lobos P, Gioseffi L, et al. Kaposiform hemangioendothelioma with Kasabach-Merritt phenomenon: successful treatment with embolization and vincristine in two newborns. J Vasc Interv Radiol. 2012;23:417-22 pubmed publisher
    Kaposiform hemangioendothelioma (KHE) is a rare vascular tumor and has a high mortality in newborns when associated with Kasabach-Merritt syndrome (KMS)...
  8. Deb G, Donfrancesco A, Ilari I, De Sio L, Milano G, Ghitti C, et al. Hemangioendothelioma: successful therapy with interferon-alpha: a study in Association with the Italian Pediatric Haematology/Oncology Society (AIEOP). Med Pediatr Oncol. 2002;38:118-9 pubmed
  9. Fahrtash F, McCahon E, Arbuckle S. Successful treatment of kaposiform hemangioendothelioma and tufted angioma with vincristine. J Pediatr Hematol Oncol. 2010;32:506-10 pubmed publisher
    Kaposiform hemangioendothelioma (KHE) and tufted angioma (TA) are rare, locally aggressive vascular tumors. Although currently classified as separate entities, they are becoming increasingly recognized as a spectrum of the same pathology...

More Information

Publications63

  1. Birchler M, Schmid S, Holzmann D, Stallmach T, Gysin C. Kaposiform hemangioendothelioma arising in the ethmoid sinus of an 8-year-old girl with severe epistaxis. Head Neck. 2006;28:761-4 pubmed
    ..It occurs primarily in boys and is usually self-limiting. Trauma and nose picking are among the most common causes. In general, epistaxis can be easily treated with anterior nasal packing or electrocoagulation...
  2. Balazs A, Athanassaki I, Gunn S, Tatevian N, Huang S, Haymond M, et al. Rapid resolution of consumptive hypothyroidism in a child with hepatic hemangioendothelioma following liver transplantation. Ann Clin Lab Sci. 2007;37:280-4 pubmed
    We report a unique case of a 3-mo-old female with consumptive hypothyroidism and liver hemangioendothelioma who required pharmacological doses of thyroid hormones and was cured following liver transplantation...
  3. Ibarra R, Kesava P, Hallet K, Bogaev C. Hemangioendothelioma of the temporal bone with radiologic findings resembling hemangioma. AJNR Am J Neuroradiol. 2001;22:755-8 pubmed
    ..Only four cases have been reported involving the temporal bone. A 5-year-old child with grade II hemangioendothelioma of the right temporal bone is presented, and the radiologic findings on different imaging studies are ..
  4. Drucker A, Pope E, Mahant S, Weinstein M. Vincristine and corticosteroids as first-line treatment of Kasabach-Merritt syndrome in kaposiform hemangioendothelioma. J Cutan Med Surg. 2009;13:155-9 pubmed
    ..Recently, there have been increasing reports of the use of the chemotherapeutic drug vincristine in these patients...
  5. Halefoglu A. Magnetic resonance imaging of infantile hemangioendothelioma. Turk J Pediatr. 2007;49:77-81 pubmed
    Infantile hemangioendothelioma is the most common benign hepatic tumor during infancy and also follows a benign course. During the routine physical examination of a 10-month-old female patient, masses of the liver were incidentally found...
  6. Morais P, Magina S, Mateus M, Trindade E, Jesus J, Azevedo F. Efficacy and safety of propranolol in the treatment of parotid hemangioma. Cutan Ocul Toxicol. 2011;30:245-8 pubmed publisher
    ..Additionally, hepatic ultrasonography revealed a hemangioendothelioma located at right lobe...
  7. Lee T, Barshes N, Agee E, O Mahony C, Karpen S, Carter B, et al. Resolution of medically resistant hypothyroidism after liver transplantation for hepatic hemangioendothelioma. J Pediatr Surg. 2006;41:1783-5 pubmed
    Hepatic hemangioendothelioma (HHE) is a rare vascular tumor in neonates and may cause high-output cardiac failure and coagulopathy, and rarely has been associated with hypothyroidism...
  8. Guven A, Aygun C, Ince H, Aydin M, Pinarli F, Baysal K, et al. Severe hypothyroidism caused by hepatic hemangioendothelioma in an infant of a diabetic mother. Horm Res. 2005;63:86-9 pubmed
    ..Here we report an infant of a diabetic mother with hypothyroidism caused by liver hemangioendothelioma. Consumptive hypothyroidism should be an indicator to search for a vascular tumor in infants...
  9. Lyons L, North P, Mac Moune Lai F, Stoler M, Folpe A, Weiss S. Kaposiform hemangioendothelioma: a study of 33 cases emphasizing its pathologic, immunophenotypic, and biologic uniqueness from juvenile hemangioma. Am J Surg Pathol. 2004;28:559-68 pubmed
    Kaposiform hemangioendothelioma (KH) is a rare tumor of childhood often associated with Kasabach-Merritt phenomenon (KMP) and occasionally lymphangiomatosis...
  10. Brasanac D, Janic D, Boricic I, Jovanovic N, Dokmanovic L. Retroperitoneal kaposiform hemangioendothelioma with tufted angioma-like features in an infant with Kasabach-Merritt syndrome. Pathol Int. 2003;53:627-31 pubmed
    ..Histological examination revealed a combination of venous (cavernous) malformation, kaposiform hemangioendothelioma and tufted angioma-like areas...
  11. Yoon H, Lee J, Moon H, Seo J, Im H, Goo H. Successful treatment of retroperitoneal infantile hemangioendothelioma with Kasabach-Merritt syndrome using steroid, alpha-interferon, and vincristine. J Pediatr Hematol Oncol. 2009;31:952-4 pubmed publisher
    Infantile hemangioendothelioma (IHE) is a rare benign vascular tumor with potentially life-threatening complications. Various therapeutic options have been recommended according to the site, extent, and behavior of the IHE...
  12. Moon S, Kwon H, Park K, Yun W, Jung S. Clinical experience with infantile hepatic hemangioendothelioma. World J Surg. 2009;33:597-602 pubmed publisher
    Infantile hepatic hemangioendothelioma (IHHE) is a rare disorder with only a few series reported in the medical literature. We reviewed our treatment experience with IHHE over 17 years.
  13. Cardinal J, de Vera M, Marsh J, Steel J, Geller D, Fontes P, et al. Treatment of hepatic epithelioid hemangioendothelioma: a single-institution experience with 25 cases. Arch Surg. 2009;144:1035-9 pubmed publisher
    To examine treatment of hepatic epithelioid hemangioendothelioma (EHE), a rare vascular tumor with a variable course. Treatment modalities at our institution include liver resection, transplantation, and catheter-based therapies.
  14. Mac Moune Lai F, To K, Choi P, Leung P, Kumta S, Yuen P, et al. Kaposiform hemangioendothelioma: five patients with cutaneous lesion and long follow-up. Mod Pathol. 2001;14:1087-92 pubmed
    Kaposiform hemangioendothelioma is a rare locally aggressive vascular tumor of the skin, deep soft tissue, and bone in children, characterized by infiltrating nodules and sheets of spindle cells, and unmistakable resemblance to Kaposi's ..
  15. Lalaji T, Haller J, Burgess R. A case of head and neck kaposiform hemangioendothelioma simulating a malignancy on imaging. Pediatr Radiol. 2001;31:876-8 pubmed
    Kaposiform hemangioendothelioma (KH) is an endothelial-derived spindle cell neoplasm often associated with Kasabach-Merritt syndrome. Most cases arise in infancy and childhood and are soft-tissue tumors...
  16. Reis Filho J, Paiva M, Lopes J. Congenital composite hemangioendothelioma: case report and reappraisal of the hemangioendothelioma spectrum. J Cutan Pathol. 2002;29:226-31 pubmed
    Composite hemangioendothelioma is the most recently described entity of the hemangioendothelioma (HE) spectrum. To the best of our knowledge, only eight cases of this entity have been hitherto described...
  17. Hermans D, van Beynum I, van der Vijver R, Kool L, de Blaauw I, van der Vleuten C. Kaposiform hemangioendothelioma with Kasabach-Merritt syndrome: a new indication for propranolol treatment. J Pediatr Hematol Oncol. 2011;33:e171-3 pubmed publisher
    Kaposiform hemangioendothelioma is a rare vascular tumor in children. Especially, in association with the Kasabach-Merritt Phenomenon it can be life threatening...
  18. Gordillo G, Fang H, Park H, Roy S. Nox-4-dependent nuclear H2O2 drives DNA oxidation resulting in 8-OHdG as urinary biomarker and hemangioendothelioma formation. Antioxid Redox Signal. 2010;12:933-43 pubmed publisher
    ..In a murine model of hemangioendothelioma, we previously showed that MCP-1 is required for its development and that the expression of MCP-1 in EOMA ..
  19. Brennan J, Midha R, Ang L, Perez Ordonez B. Epithelioid hemangioendothelioma of the spine presenting as cervical myelopathy: case report. Neurosurgery. 2001;48:1166-9 pubmed
    We report the first case in the literature of cervical myelopathy caused by progressive cord compression as a result of epithelioid hemangioendothelioma of the cervical vertebra.
  20. Hornick J, Fletcher C. Pseudomyogenic hemangioendothelioma: a distinctive, often multicentric tumor with indolent behavior. Am J Surg Pathol. 2011;35:190-201 pubmed publisher
    ..Although the precise nosologic status of this tumor type is uncertain, we propose the interim designation "pseudomyogenic hemangioendothelioma."
  21. Sevinir B, Ozkan T. Infantile hepatic hemangioendothelioma: clinical presentation and treatment. Turk J Gastroenterol. 2007;18:182-7 pubmed
    ..Hepatic hemangioendotheliomas are rare tumors in childhood. We report our 10-years' experience in a tertiary health center...
  22. Abuzallouf S, Wong R, Mintz A, Provias J. Hemangioendothelioma of the spinal cord with intramedullary extension. Med Princ Pract. 2005;14:354-7 pubmed
    ..Hemangioendotheliomas (HE) are vascular neoplasms that rarely involve the neuraxis. We report a rare case in the literature of intradural HE of the spinal cord with intramedullary extension...
  23. Langrehr J, Petersen I, Pfitzmann R, Lopez Hanninen E. [Malignant epithelioid hemangioendothelioma of the liver. Results of surgical treatment strategies]. Chirurg. 2005;76:1161-7 pubmed
    Malignant epithelioid hemangioendothelioma is a rare vascular tumor described mostly in soft tissue, lungs, or liver...
  24. Stoffman M, Kim J. Masson's vegetant hemangioendothelioma: case report and literature review. J Neurooncol. 2003;61:17-22 pubmed
    Masson's vegetant intravascular hemangioendothelioma has only been reported intracranially in 12 patients. The pathological diagnosis is important given its benign natural history...
  25. Martinez A, Robinson M, Alexis J. Kaposiform hemangioendothelioma associated with nonimmune fetal hydrops. Arch Pathol Lab Med. 2004;128:678-81 pubmed
    We describe the case of a 31-week fetus who died in utero with an invasive retroperitoneal kaposiform hemangioendothelioma. This rare vascular neoplasm usually presents as a localized violaceous skin lesion in infants and behaves in a ..
  26. Fukunaga M, Suzuki K, Saegusa N, Folpe A. Composite hemangioendothelioma: report of 5 cases including one with associated Maffucci syndrome. Am J Surg Pathol. 2007;31:1567-72 pubmed
    Composite hemangioendothelioma (HE) is a low-grade malignant vascular tumor showing varying combinations of benign, low-grade malignant, and malignant vascular components...
  27. O Regan G, Irvine A, Yao N, O Marcaigh A, Sheridan Pereira M, Phelan E, et al. Mediastinal and neck kaposiform hemangioendothelioma: report of three cases. Pediatr Dermatol. 2009;26:331-7 pubmed publisher
    Kaposiform hemangioendothelioma is an aggressive vascular tumor, named for its striking histologic resemblance to Kaposi sarcoma and locally invasive growth...
  28. Jothilakshmi K, Matthai J, Paul S, Singal A. Symptomatic hepatic hemangioendothelioma in a newborn. Indian Pediatr. 2006;43:908-10 pubmed
    A case of hepatic hemangioendothelioma presenting as congestive cardiac failure in a neonate is reported. There was also evidence of platelet consumption...
  29. Fernandez S, Cook G, Arber D. Metastasizing splenic littoral cell hemangioendothelioma. Am J Surg Pathol. 2006;30:1036-40 pubmed
    ..A single prior description of a littoral cell hemangioendothelioma showed nuclear atypia and necrosis, and this is the first case report of a splenic littoral cell ..
  30. Zhang G, Lu Q, Yin H, Wen H, Su Y, Li D, et al. A case of retiform-hemangioendothelioma with unusual presentation and aggressive clinical features. Int J Clin Exp Pathol. 2010;3:528-33 pubmed
    Retiform hemangioendothelioma (RH) is an extremely rare low-grade angiosarcoma mainly involving the skin and subcutaneous tissue. Clinically patients often present with an asymptomatic slow-growing solitary nodular or plaque-like lesion...
  31. Kalpatthi R, Germak J, Mizelle K, Yeager N. Thyroid abnormalities in infantile hepatic hemangioendothelioma. Pediatr Blood Cancer. 2007;49:1021-4 pubmed
    We report an infant with hepatic hemangioendothelioma (HAE) associated with compensated hypothyroidism. The hepatic lesions regressed with steroid therapy and his thyroid function normalized with high doses of thyroxine supplement.
  32. Tan D, Kraybill W, Cheney R, Khoury T. Retiform hemangioendothelioma: a case report and review of the literature. J Cutan Pathol. 2005;32:634-7 pubmed
    Retiform hemangioendothelioma (RH) is a rare, recently described vascular neoplasm of low malignant potential.
  33. Warmann S, Bertram H, Kardorff R, Sasse M, Hausdorf G, Fuchs J. Interventional treatment of infantile hepatic hemangioendothelioma. J Pediatr Surg. 2003;38:1177-81 pubmed
    b>Hemangioendothelioma is the most frequent liver tumor in infancy. Untreated symptomatic patients with heart failure have a high mortality rate...
  34. Chen C, Kong M, Yang C, Hung I. Hepatic hemangioendothelioma in children: analysis of thirteen cases. Acta Paediatr Taiwan. 2003;44:8-13 pubmed
    Hepatic hemangioendothelioma (HE) is a tumor that presents in infancy and toddler. It manifests hepatomegaly, abdominal mass, jaundice, abdominal distention, or high output cardiac failure...
  35. Park E, Seo J, Lee S, Choi H, Lee S. Infantile hemangioendothelioma treated with high dose methylprednisolone pulse therapy. J Korean Med Sci. 2001;16:127-9 pubmed
    Infantile hemangioendothelioma is a severe disease with a high mortality. It is characterized by multiple hemangioma affecting the skin and visceral organs...
  36. Stiles J, Amaya C, Rains S, Diaz D, Pham R, Battiste J, et al. Targeting of beta adrenergic receptors results in therapeutic efficacy against models of hemangioendothelioma and angiosarcoma. PLoS ONE. 2013;8:e60021 pubmed publisher
    ..Using a panel of hemangioendothelioma and angiosarcoma cell lines, we demonstrate that beta adrenergic inhibition blocks cell proliferation and ..
  37. Chisholm K, Chang K, Truong M, Kwok S, West R, Heerema McKenney A. ?-Adrenergic receptor expression in vascular tumors. Mod Pathol. 2012;25:1446-51 pubmed publisher
    ..Absent to weak expression of all three receptors was seen in glomus tumor, hobnail hemangioendothelioma, pyogenic granuloma, and reactive vascular proliferations...
  38. Requena L, Kutzner H. Hemangioendothelioma. Semin Diagn Pathol. 2013;30:29-44 pubmed publisher
    b>Hemangioendothelioma is the term used to name those vascular neoplasms that show a borderline biological behavior, intermediate between entirely benign hemangiomas and highly malignant angiosarcomas...
  39. Semino L, Pagella F, Delù G, Todeschini A, Luinetti O, Zappoli F, et al. Endoscopic treatment of ethmoidal hemangioendothelioma: case report and review of the literature. Am J Otolaryngol. 2006;27:287-90 pubmed
    b>Hemangioendothelioma (HE) is a rare vascular tumor of endothelial cell origin that usually involves long bone or soft tissue. However, there are cases of head and neck involvement...
  40. Lopez V, Marti N, Pereda C, Martin J, Ramón D, Mayordomo E, et al. Successful management of Kaposiform hemangioendothelioma with Kasabach-Merritt phenomenon using vincristine and ticlopidine. Pediatr Dermatol. 2009;26:365-6 pubmed publisher
    Kaposiform hemangioendothelioma is a rare locally aggressive vascular tumor that usually occurs in skin and retroperitoneum of infants and young children...
  41. Ganguly R, Mukherjee A. Infantile hemangioendothelioma: A case report and discussion. Pathol Res Pract. 2010;206:53-8 pubmed publisher
    ..The patient had no skin lesions. We report this case and provide a literature review because of the unusual presentation and the overall rarity of this entity...
  42. Bhutoria B, Konar A, Chakrabarti S, Das S. Retiform hemangioendothelioma with lymph node metastasis: a rare entity. Indian J Dermatol Venereol Leprol. 2009;75:60-2 pubmed
    Retiform hemangioendothelioma (RH) is a rare, recently described, unique kind of low grade angiosarcoma. The tumor is characterized by distinctive arborizing blood vessels that mimic the appearance of rete testis...
  43. Rodriguez J, Becker N, O Mahony C, Goss J, Aloia T. Long-term outcomes following liver transplantation for hepatic hemangioendothelioma: the UNOS experience from 1987 to 2005. J Gastrointest Surg. 2008;12:110-6 pubmed
    Hepatic hemangioendothelioma (HEH) is a vascular neoplasm with intermediate malignant potential. Outcomes after liver transplantation have only been reported as small, single-institution experiences...
  44. Riley M, Burtelow M, Garcia M, Garcia M, Lucile S, Cox K, et al. Hepatic infantile hemangioendothelioma with unusual manifestations. J Pediatr Gastroenterol Nutr. 2006;42:109-13 pubmed
  45. Cooper J, Edwards S, Holmes J. Kaposiform haemangioendothelioma: case report and review of the literature. Br J Plast Surg. 2002;55:163-5 pubmed
    ..We report an otherwise well 26-year-old woman who presented with a KHE of the left thigh, and briefly review the literature. We believe this to be the second reported case of KHE in the UK and the first in an adult patient...
  46. Mortele K, Vanzieleghem B, Mortelé B, Benoit Y, Ros P. Solitary hepatic infantile hemangioendothelioma: dynamic gadolinium-enhanced MR imaging findings. Eur Radiol. 2002;12:862-5 pubmed
    We report the MRI findings of a solitary hepatic infantile hemangioendothelioma (IHE) diagnosed in a 14-day-old girl...
  47. Ayling R, Davenport M, Hadzic N, Metcalfe R, Buchanan C, Howard E, et al. Hepatic hemangioendothelioma associated with production of humoral thyrotropin-like factor. J Pediatr. 2001;138:932-5 pubmed
    We report on 7 patients referred for treatment of hepatic hemangioendothelioma with increased thyrotropin levels. The serum thyroxine level was decreased in 4 and increased in 2...
  48. Kim T, Lee Y, Song Y, Park C, Shim S, Kang C, et al. Infantile hemangioendothelioma with elevated serum alpha fetoprotein: report of 2 cases with immunohistochemical analysis. Hum Pathol. 2010;41:763-7 pubmed publisher
    Infantile hemangioendothelioma is the most common benign mesenchymal tumor of the liver presenting during the first 6 months of life...
  49. Ioannidou D, Panayiotides J, Krasagakis K, Stefanidou M, Manios A, Tosca A. Retiform hemangioendothelioma presenting as bruise-like plaque in an adult woman. Int J Dermatol. 2006;45:53-5 pubmed
  50. Ohori N, Yousem S, Sonmez Alpan E, Colby T. Estrogen and progesterone receptors in lymphangioleiomyomatosis, epithelioid hemangioendothelioma, and sclerosing hemangioma of the lung. Am J Clin Pathol. 1991;96:529-35 pubmed
    ..g., breast). However, two mesenchymal proliferations of lung, lymphangioleiomyomatosis and epithelioid hemangioendothelioma (EHE), and one epithelial tumor, sclerosing hemangioma (SH), have a significant female predilection and may ..
  51. Blei F, Karp N, Rofsky N, Rosen R, Greco M. Successful multimodal therapy for kaposiform hemangioendothelioma complicated by Kasabach-Merritt phenomenon: case report and review of the literature. Pediatr Hematol Oncol. 1998;15:295-305 pubmed
    We present the management challenge provided by a patient with kaposiform hemangioendothelioma associated with Kasabach-Merritt phenomenon...
  52. Zukerberg L, Nickoloff B, Weiss S. Kaposiform hemangioendothelioma of infancy and childhood. An aggressive neoplasm associated with Kasabach-Merritt syndrome and lymphangiomatosis. Am J Surg Pathol. 1993;17:321-8 pubmed
    ..It appears that treatment should consist of wide local excision and supportive therapy for associated symptoms...
  53. Nishimura Y, Tajima G, Dwi Bahagia A, Sakamoto A, Ono H, Sakura N, et al. Differential diagnosis of neonatal mild hypergalactosaemia detected by mass screening: clinical significance of portal vein imaging. J Inherit Metab Dis. 2004;27:11-8 pubmed
    ..Additionally, determination of total bile acids and alpha-fetoprotein is helpful in identifying the aetiology of hypergalactosaemia in infants. ..
  54. Pires I, Queiroga F, Silva F, Pinto C, Lopes C. Kaposi-like vascular tumor of the urinary bladder in a cow. J Vet Med Sci. 2009;71:831-3 pubmed
    Kaposiform hemangioendothelioma is a rare human vascular neoplasm. In veterinary medicine this tumor type was only recognized in the dog. Here we describe an unusual case arising in the urinary bladder of a Holstein-Friesian adult cow...