Giant diaphragmatic angiosarcoma of adult: a case report and review of literature

Angiosarcoma involving solid organs and the gastrointestinal tract with life-threatening bleeding

We report a rare case of angiosarcoma involving the gastrointestinal tract, liver, spleen, pancreas, kidney, lung and vertebrae, as well as bulky dissemination in the pleuroperitoneal membranes. A 72-year-old man with no history of illness became aware of melena. Laboratory findings revealed anemia, and upper gastrointestinal endoscopy revealed multiple reddish nodules in the stomach and duodenum. However, biopsy specimens showed no evidence of histological features. Computed tomography and fluorodeoxyglucose positron emission tomography showed space-occupying lesions in the spleen, liver and vertebrae. Angiosarcoma was diagnosed by endoscopic ultrasound and fine needle aspiration biopsy of the spleen and repeated endoscopic biopsy of the stomach. We performed laparoscopic splenectomy to avoid rupture of the involved spleen. Due to continuous gastrointestinal bleeding, double balloon endoscopy was performed and multiple bleeding lesions were detected throughout the small intestine. Surgical hemostasis was performed by partial enterectomy, but anemia continued to worsen. Therefore, we conducted transcatheter arterial embolization. Despite attempting several modalities and frequent daily blood transfusion, the anemia did not improve, and the patient expired due to hemorrhagic shock. Subsequent autopsy revealed the cause of death as rupture and bleeding due to disseminated involvement of the small intestine.