Solitary small hepatic angiosarcoma: initial and follow-up imaging findings

Abstract

We report an uncommon case of solitary, small hepatic angiosarcoma that was initially considered as a hemangioma. We present the imaging findings, with an emphasis on the initial and follow-up CT and MR findings, as well as report on the more suggestive findings of angiosarcoma than those of a hemangioma.

Fig. 1

A 60-year-old man with hepatic angiosarcoma. A. The arterial phase contrast-enhanced CT image shows a 1.1 cm low attenuated lesion in the hepatic dome (arrow). B. The portal-venous phase contrast-enhanced CT image shows some peripheral nodular enhancement (arrow). C. The delayed phase contrast-enhanced CT image shows a persistent, homogeneous enhancing mass (arrow). D. The T1-weighted gradient-echo (TR/TE = 120/4.2 msec) MR image three months later shows a hypointense mass with focal hyperintense foci that were considered as hemorrhage within the mass in the hepatic dome. Note the increased size of the mass (arrow) compared with the initial CT (A-C). E. The fat-suppressed T2-weighted fast spin-echo (TR/TE = 6666/91 msec) MR image shows a heterogeneous hyperintense mass with areas of low signal intensity (arrow). F. The arterial phase contrast-enhanced gradient echo (TR/TE = 180/1.5 msec) MR image shows faint peripheral rim enhancement (arrow). G. The portal-venous phase contrast-enhanced gradient echo (TR/TE = 180/1.5 msec) MR image reveals centrally septal-like enhancement (arrow). H. The delayed phase contrast-enhanced gradient echo (TR/TE = 180/1.5 msec) MR image shows heterogeneous and persistent enhancement (arrow). I. Photograph (original magnification, ×400; H & E staining) of the specimen shows the numerous and irregular vascular spaces separated by fibrous septa and lined by pleomorphic and hyperchromatic endothelial tumor cells.