Liver angiosarcoma, a rare liver malignancy, presented with intraabdominal bleeding due to rupture--a case report

Abstract

Liver angiosarcoma is a rare disease, however it still ranks as the third of most common primary liver maligancies. The prognosis of liver angiosarcoma is very poor with almost all patients with this kind of disease die within 2 years after diagnosis. No specific symptoms and signs are closely associated with this disease. Here, we report a case presenting shock status at first due to rupture of liver angiosarcoma- induced internal bleeding. After emergent transarterial embolization (TAE), she received partial hepatectomy two weeks later. 4 months after operation, she is still with a good performance status without obvious recurrence or metastasis identified.

Figure 1

Enhanced CT scan showed a ruptured irregular liver mass. Enhanced CT scan showed a ruptured irregular liver mass (balck arrow) with prominent enhancement at the liver surface inducing contrast leakage into the right subphrenic space.

Figure 2

The celiac trunk angiogram showed a hypervascular mass in right lobe of liver with contrast extravastion from the tumor surface (black arrow), which was compatible with CT findings of a hypervascular hepatic tumor bleeding. Figure 2B-After embolization, no contrast extravastion from the tumor was shown.

Figure 3

The section of resected liver showed a tumor composed of anastomosing vascular channels in an infiltrating growth pattern. The section of resected liver showed a tumor composed of anastomosing vascular channels in an infiltrating growth pattern. The vascular channels are lined by atypical endothelial cells with enlarged hyperchromatic nucle (black arrow).

Figure 4

The section of resected liver showed spindled tumor cells forming hemorrhagic nests and sheets. The section of resected liver showed spindled tumor cells forming hemorrhagic nests and sheets. Rudimentary vascular channels were noted within the tumor cell nest. The spindled tumor cells showed high grade nuclear atypia with brisk mitotic activity(black arrows).

Figure 5

Epithelioid areas. Epithelioid areas made up of large rounded tumor cells with high grade nuclear atypia and brisk mitotic activity were also seen(black arrows).

Figure 6

Immunohistochemical study. Immunohistochemical study showed that the tumor cells expressed vascular antigen CD31 strongly(black arrow, score 3+, clone 1A10, Novocastra).

Figure 7

Immunohistochemical study. Immunohistochemical study revealed that the tumor cells was strongly positive for vascular antigen CD34 (black arrow, score 3+, clone QBEnd-10, Dako).

Figure 8

Immunohistochemical study. Immunohistochemical study demonstrated that the tumor cells strongly expressed the mesenchymal marker, Vimentin (black arrow, score 3+, clone V9, Novocastra).

Figure 9

Immunohistochemical study. Immunohistochemical study revealed negative staining of hepatocyte paraffin antibody (HAS, clone OCH1E5, CellMarque) over tumor cells (black arrow).

Figure 10

Immunohistochemical study. Immunohistochemical study showed negative staining of Glypican-3 (GPC-3, clone 1G12, Bio SB) over tumor cells (black arrow).