Liver Angiosarcoma with Poor Prognosis in a 61-Year-Old Woman: A Case Report and Literature Review

Abstract

Purpose: Hepatic angiosarcoma is very rare malignancy and more common in men than in women. To date, only a few female cases of liver angiosarcoma have been reported. Here, we report a female case of liver angiosarcoma, first detected in Vietnam, with a high malignancy stage, rapid progression, and poor prognosis.

Case presentation: A 61-year-old woman was admitted to the Bach Mai Hospital with fatigue, anorexia, weight loss, and severe pain in the right upper quadrant for 2 weeks prior. Clinical examination detected a firm 4-cm hepatomegaly below the right costal margin and grade I splenomegaly. Abdominal ultrasonography and CT revealed diffuse lesions in the entire liver parenchyma, spreading to the spleen, while MRI showed signs of bone metastasis. Blood tests showed elevated transaminase enzymes, especially Gamma Glutamyl Transferase 501 U/L; thrombocytopenia; no anemia; and other tumor markers such as AFP, CEA, and CA19-9 were within normal limits. On CT images, the dots and nodules in the liver and spleen appeared hyperenhanced in the arterial phase and washout in the venous phase. The results of both histopathology and immunohistochemistry showed liver angiosarcoma. Surgery and radiation were not indicated due to the suspicion of bone metastasis. Chemotherapy with doxorubicin at a dose of 60 mg/m2 and intravenous infusion once every 21 days was administered. Unfortunately, during the first dose of chemotherapy with doxorubicin, side effects appeared. Since the disease developed continuously and uncontrollably, the patient was subsequently exhausted, anemic, presented peritoneal fluid, and eventually died of intra-abdominal bleeding.

Conclusion: For the diagnosis of liver angiosarcoma, ultrasound-guided liver biopsy could be applied for safe and effective histopathology, and selective embolization of the hepatic artery is necessary to prevent bleeding complications. The disease has a very poor prognosis, and if chemotherapy does not respond, the patient can die within six months of diagnosis.

Keywords: case report; hepatectomy; liver angiosarcoma; primary tumor.

Figure 1

Before injection (A). After injection, nodules in the liver and spleen appeared hyper-enhanced in the arterial phase (B), washed out in the venous phase (C).

Figure 2

Pelvic MRI showed multifocal lesions in the pelvis and femur.

Figure 3

(A) Ultrasound-guided biopsy of the left liver; (B) selective embolization of the left hepatic artery by spongel.

Figure 4

(A) Liver tumor tissues were rhombus-shaped (HE x 100); (B) liver tumor tissues were rhombus-shaped (HE x 200); (C) CD34-positive cells, Monoclonal Mouse Anti-Human CD34 Class II Clone QBEnd. (D) Factor VIII-positive cells, Rabbit Polyclonal Antibody. (E) ERG-positive cells, Rabbit Monoclonal Primary Antibody. (F) Ki-67 positive 10%, Monoclonal Anti-Human Ki-67 Antigen Clone MIB-1.