Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009 Dec 28;1(2):e33.
doi: 10.4081/rt.2009.e33.

Hepatic angiosarcoma five years following spontaneous intraperitoneal bleed of a hepatic mass

Jessica L Cioffi-Pretti  1 , Alexandra N Kalof, George Ebert, Laurence E McCahill
Affiliations

Hepatic angiosarcoma five years following spontaneous intraperitoneal bleed of a hepatic mass

Jessica L Cioffi-Pretti et al. Rare Tumors. .

Abstract

Primary hepatic angiosarcoma is a rare and rapidly fatal disease. We present the highly unusual identification of this lesion five years after the initial clinical presentation.In 2003, a 32-year-old man presented with abdominal pain, tachycardia, and evidence of hemorrhage. A CT scan showed a hepatic mass with intralesional hemorrhage, intraperitoneal blood, and splenomegaly. The patient was stabilized clinically. Laparoscopic core biopsies demonstrated no malignancy, only findings consistent with an old hemorrhage. Contralateral lobe biopsies revealed normal liver tissue. A metastatic workup was negative and the decision was made to observe the patient clinically with radiographic follow-up, given his suspected portal hypertension based on thrombocytopenia and splenomegaly.Sequential imaging demonstrated a decrease in the size of the mass from 12.0 cm in 2003 to 3.0 cm in 2007. Subsequent newly identified esophageal varices prompted a reevaluation of the case. A repeat biopsy demonstrated a neoplasm of vascular etiology and uncertain malignant potential. By early 2008 the lesion had increased to 4.8 cm and was resected via a left hepatic lobectomy. An extremely vascular lesion with surrounding dense fibrosis was identified and pathologic examination demonstrated a high-grade angiosarcoma.We are unaware of any previous reports suggesting such a prolonged natural history of hepatic angiosarcoma. This case may represent the possibility of malignant transformation of a lower grade vascular neoplasm such as hepatic epithelioid hemangioendothelioma to an angiosarcoma.

Keywords: hepatic angiosarcoma; hepatic mass; spontaneous intraperitoneal bleed..

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: the authors report no conflicts of interest.

Figures

Figure 1
Figure 1
CT images showing regression rather than progression of the liver lesion, (A) initial presentation in 2003, (B) diminished to 3.0 cm in 2007, and (C) progression in 2008.
Figure 2
Figure 2
Gross liver resection specimen.
Figure 3
Figure 3
Hepatic mass and adjacent liver parenchyma with associated capsular disruption and inflammatory reaction (H&E stain, 40× magnification).
See this image and copyright information in PMC

References

    1. Mark RJ, Poen JC, Tran LM, et al. Angiosarcoma. A report of 67 patients and a review of the literature. Cancer. 1996;77:2400–6. - PubMed
    1. Mani H, Van Thiel DH. Mesenchymal tumors of the liver. Clin Liver Dis. 2001;5:219–57. viii. - PubMed
    1. Molina E, Hernandez A. Clinical manifestations of primary hepatic angiosarcoma. Dig Dis Sci. 2003;48:677–82. - PubMed
    1. Koyama T, Fletcher JG, Johnson CD, et al. Primary hepatic angiosarcoma: findings at CT and MR imaging. Radiology. 2002;222:667–73. - PubMed
    1. Louagie YA, Gianello P, Kestens PJ, et al. Vinylchloride induced hepatic angiosarcoma. Br J Surg. 1984;71:322–3. - PubMed

LinkOut - more resources