Hepatic Angiosarcoma: A Case Presentation

Abstract

A 71-year-old male who presented with right upper quadrant pain was found to have hepatic angiosarcoma. We briefly review the epidemiology, presentation, imaging findings, and pathological diagnosis of hepatic angiosarcoma.

Keywords: hepatic angiosarcoma; hepatic tumors.

Figure 1. Representative CT images

Contrast-enhanced CT images in the axial (A) and coronal (B) planes demonstrate a diffusely enhancing, multifocal, heterogeneous, and infiltrative mass occupying most of the hepatic parenchyma. Mild capsular retraction (arrows) is noted secondary to the mass at the periphery of the liver. CT findings are highly concerning for a primary or metastatic hepatic malignancy.

Figure 2. Representative MRI images

Multiple axial MR images. (A) T2-weighted image demonstrates a largely T2 hyperintense infiltrative mass occupying the hepatic parenchyma (arrows) with scattered regions of T2 hypointensity likely representing necrosis (arrowhead). (B) The diffusion-weighted MR image demonstrates restricted diffusion throughout the mass-corresponding apparent diffusion coefficient images demonstrate hypointensity confirming diffusion restriction (arrows). (C) Precontrast T1-weighted MR image demonstrates relative hypointense signal in the region of the mass (arrows). (D) Gadolinium contrast-enhanced T1-weighted MR image demonstrates diffuse enhancement with regions of non-enhancement corresponding to the areas of necrosis (arrowhead).

Figure 3. Representative pathology slides from a liver core biopsy

(A) Low-power view of the patient’s liver biopsy showing the abnormal architecture of freely anastomosing vascular channels (arrows). (B) Small groups of hepatocytes (arrowhead) surrounded by large abnormal endothelial cells (arrow). (C) CD31 stain highlighting the abnormal endothelial cells (representative area within square). (D) Increased MIB-1 proliferation index noted in the endothelial cells (arrow) and not in the hepatocytes (arrowhead).