Although epithelioid cell histiocytoma is considered a variant of fibrous histiocytoma (dermatofibroma), the histogenesis of this condition remains controversial. A recent investigation suggested the possibility that epithelioid cell histiocytoma is an angioformative fibrous histiocytoma. We report a case of epithelioid cell histiocytoma underlying a damaged artery. This epithelioid cell histiocytoma with a central area of hemorrhage was associated with a medium-sized artery in the reticular dermis running vertically up to the lesion. Both the artery in the reticular dermis and its centrally branched artery in the subcutaneous tissue showed mural injury and intraluminal epithelioid endothelial proliferation. Immunohistochemically, the labeling rate for each of the antibodies studied in the epithlioid cells was as follows: 40% for Factor XIIIa, 5% for CD34, 20% for factor VIII-related antigen, and 10% for alpha-smooth muscle cell actin. This case may support the view that epithelioid cell histiocytoma is a vascular and angioformative fibrous histiocytoma.