Contrast uptake in primary hepatic angiosarcoma on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging in the hepatobiliary phase

Abstract

Primary hepatic angiosarcoma is the most common malignant mesenchymal tumor of the liver. It has a poor prognosis and various appearances on magnetic resonance (MR) images. We report a case of hepatic angiosarcoma with a characteristic appearance on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MR imaging in the hepatobiliary phase. A 72-year-old man was admitted with a complaint of abdominal pain. Gd-EOB-DTPA-enhanced MR imaging revealed a liver tumor that showed slight hyperintensity in the hepatobiliary phase. These findings suggested Gd-EOB-DTPA uptake in the tumor. An autopsy revealed the solid proliferation and sinusoidal spreading of hepatic angiosarcoma cells. Immunohistochemistry indicated that the tumor was negative for OATP1B3. Gd-EOB-DTPA uptake in the liver tumor in the hepatobiliary phase suggested sinusoidal tumor invasion with residual normal hepatocytes.

Keywords: Cirrhosis; Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid; Hepatic angiosarcoma; Hepatocellular carcinoma.

Figure 1

Abdominal ultrasonography. A: B-mode ultrasonography; B: Arterial phase; C: Venous phase images obtained using contrast-enhanced computed tomography; D: T1-weighted phase; E: T2-weighted phase; F: Arterial phase; G: Venous phase; H: Hepatobiliary phase images obtained using gadolinium ethoxybenzyl-diethylenetriamine-enhanced magnetic resonance imaging. In the hepatobiliary phase, the tumor showed slightly elevated intensity, a finding that suggested uptake of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid in the tumor.

Figure 2

Histological findings from a liver tumor biopsy revealed the solid proliferation of spindle cells. A: Hematoxylin and eosin (HE) staining, × 20; B: CD34 staining, × 20; C: Macroscopically, a large tumor and many satellite nodules were observed in the liver; D: A hepatobiliary phase image obtained using gadolinium-ethoxybenzyl-diethylenetriamine-enhanced magnetic resonance imaging, depict almost the same plane of C; E: The proliferation of atypical spindle cells and hemorrhage were seen (HE staining, × 100); F: Tumor cells had spread to the sinusoids in most of the liver, although normal hepatic cells remained (HE staining, × 100); G: Tumor cells were positive for CD34 (CD34 staining, × 400); H: Tumor cells were negative for OATP1B3, and hepatic cells were positive for OATP1B3 (OATP1B3 staining, × 400).