Hepatic Angiosarcoma: A Challenging Diagnosis

Abstract

Hepatic angiosarcoma (HA) accounts for 2% of primary liver tumors. Though rare, it is exceptionally deadly. The initial presentation of HA is nonspecific and no tumor markers have been associated with it. In general, liver function is maintained until later stages of the disease, often leading to diagnosis once the disease is already advanced or metastatic. In this report, we present the case of a 54-year-old male whose vague symptoms and non-diagnostic liver biopsy delayed the diagnosis of a rapidly progressing HA.

Keywords: angiosarcoma; hepatic angiosarcoma; hepatic malignancy.

Figure 1. Side-by-side CT abdomen and pelvis with and without contrast imaging

The study on the left was conducted at initial presentation and shows two liver lesions. The image on the right was performed one month later and demonstrated rapid disease progression with extensive metastatic disease infiltrating the parenchyma of the liver. CT: computed tomography

Figure 2. Side-by-side MRI abdomen and pelvis with and without contrast

The study on the left was conducted at initial presentation and shows multiple liver lesions (small, dark gray lesions in the liver, the largest of which is highlighted with a red arrow). The follow-up MRI two months later revealed the progression of metastatic disease within the liver, spleen, and spine (light gray; the largest three lesions highlighted by the red arrows). MRI: magnetic resonance imaging; CT: computed tomography

Figure 3. Hematoxylin and eosin stain preparations of the tumor from the second liver biopsy

Demonstration of elongated spindle cells (black arrow) with vascular proliferation (green arrow) seen in the top-right and bottom-right (within green square) images. An example of the extent of malignant proliferation, leaving very few normal hepatic cells (bottom left). CD31 biomarker positive staining in brown seen in the top-left panel (orange arrow).