Liver transplantation for cryptogenic liver failure caused by diffuse hepatic angiosarcoma: case report

Liver Transplantation in a Patient With Hepatic Angiosarcoma

Liver transplantation (LT) is an accepted form of therapy for selected cases of malignant tumors of the liver that include primary and fibrolamellar hepatocellular carcinoma, cholangiocarcinoma limited to Klatskin distribution, neuroendocrine tumors, epithelioid hemangioendothelioma, and hepatoblastoma. This is the case of a 61-year-old previously healthy female transferred from an outside hospital for a second opinion for a liver transplant. Computed tomography of the abdomen with contrast showed cirrhosis and multiple masses with arterial enhancement in her liver. She underwent a liver biopsy that showed a low-grade vascular tumor. She underwent an exploratory laparotomy with open liver biopsy which showed no visual evidence of omental spread. The pathology was reported as a low-grade vascular lesion, which was likely a small vessel neoplasm. After denial for LT secondary to an unknown low-grade vascular tumor, she presented to our medical center. Oncology was consulted and diagnosed with her liver vascular tumors as benign with an overall favorable prognosis. She was listed for liver transplant with a model for end-stage liver disease-sodium score of 25 and developed hepatorenal syndrome type 1. She was on hemodialysis for approximately 10 weeks prior to her LT and was eventually listed for simultaneous liver and kidney transplants. She underwent an orthotopic liver transplant 10 weeks after presenting to UNMC. The amount of necrosis and the elevated mitotic rate was sufficient to classify the tumor as a Federation Nationale des Centres de Lutte le Cancer grade 3 of three angiosarcomas. She was scheduled for a living donor kidney transplant three days after her liver transplant, but it was postponed after she continued to have increased urine output that responded to a trial of diuretics with continued improvement in kidney function. She successfully completed 16 months post-LT without any known recurrence of primary angiosarcoma.

A pooled analysis of treatment and prognosis of hepatic angiosarcoma in adults

BACKGROUND

Hepatic angiosarcoma is a rare malignant vascular tumor presenting unique treatment challenges. The aim of the present study was to determine the treatment and prognosis of this entity.

DATA SOURCES

A systematic literature search was conducted using PubMed, Embase and Chinese Biomedical Literature database, to identify articles published from January 1980 to July 2017. Search terms were "hepatic angiosarcoma" and "liver angiosarcoma". Additional articles were retrieved through manual search of bibliographies of the relevant articles. Pooled individual data concerning the prognosis following various therapeutic modalities were analyzed.

RESULTS

A total of 75 articles involving 186 patients were eligible for inclusion. The median overall survival (OS) was 8 months, with 1-, 3-, and 5-year OS rates of 36.6%, 22.3%, and 12.0%, respectively. The median OS after partial hepatectomy (n = 86), chemotherapy (n = 36), liver transplantation (n = 17), and supportive care (n = 46) were 15, 10, 5 and 1.3 months, respectively. Small tumor size (<10 cm) was the only significant favorable factor for OS after partial hepatectomy (P = 0.012).

CONCLUSIONS

Despite the dismal prognosis, partial hepatectomy could prolong the survival of hepatic angiosarcoma patients, particularly those with tumors <10 cm. Chemotherapy could be an option for unresectable disease. Liver transplantation is not a recommendable option for the management of this malignancy.

Primary hepatic angiosarcoma with spleen metastases in an adult woman: a case report and literature review

Primary hepatic angiosarcoma (PHA) is a rare malignancy that carries a poor prognosis, accounting for less than 2% of all primary hepatic tumors. It is reported to be associated with chronic exposure to environmental carcinogens, but the majority of patients were still with unknown etiology. For patients with PHA often present with nonspecific symptoms and its rapid progression, accurate and early diagnosis is difficult and necessary. We described a 41-year old woman with no history of exposure to toxic chemicals having intermittent abdominal distention for 1 month. Imaging examinations showed multiple nodules with different sizes throughout markedly enlarged liver and spleen. Liver histology showed majority of necrotic lesions with foci of atypical cells, which displayed immunoreactivity for endothelial markers CD31, CD34 and FLi-1, supporting the diagnosis of angiosarcoma. She was finally diagnosed as PHA concomitant with spleen metastases through imaging technology combined with the histopathologically results. Then the patient showed a rapidly worsening clinical course. Finally the patient received liver transplantation and splenectomy. Unfortunately, the patient died of infection in 35 days after liver transplantation.