Paraneoplastic Phenomena of Disseminated Intravascular Coagulopathy in Hepatic Angiosarcoma – Rare, Challenging and Fatal. Case Report and Literature Review

An acute progressing hepatic angiosarcoma in a young male diagnosed by contrast-enhanced ultrasound-guided liver needle biopsy: a case report

Background

Primary hepatic angiosarcoma (PHA) is a rare hepatic malignancy primarily observed in the elderly. It carries a poor prognosis as a result of the characteristics of rapid progression, high aggressiveness, and resistance to traditional chemo- and radiotherapies. Its nonspecific clinical manifestations, along with the lack of laboratory features and various imaging findings, make it hard to recognize in clinic, especially among non-high-risk populations. Hence, pathological diagnosis is essential to establish an accurate diagnosis.

Case Description

In the present report, a young male presented with right upper quadrant abdominal pain and hemoperitoneum was eventually diagnosed as hepatic angiosarcoma based on the immunohistochemical staining results of a liver needle biopsy. Contrast-enhanced ultrasound (CEUS) effectively improved the accuracy of the liver needle biopsy in this case. This report describes the epidemiology, presentation, laboratory tests, imaging findings, and pathological features of a rare hepatic angiosarcoma seen in this young male. The patient rapidly developed severe abdominal hemorrhage. Transcatheter hepatic artery embolization, blood transfusions, and symptomatic treatments were administered. The family members abandoned treatment because the patient was in critical condition and could not receive antitumor therapy.

Conclusions

This case emphasizes the significance of pathological findings in the diagnosis of PHA especially in non-high-risk individuals, and the supportive role of CEUS in guiding the liver needle biopsy. Abdominal hemorrhage is one of the serious complications of PHA and transarterial embolization (TAE) should be considered for controlling life-threatening bleeding from ruptured tumor. Further investigation is required to early diagnosis and to improve the prognosis of patients with PHA.

Rare infiltrative primary hepatic angiosarcoma: A case report and review of literature

BACKGROUND

The most primary sites of angiosarcoma are the skin, breast gland, and soft tissues. Primary hepatic angiosarcoma (PHA) is a rare malignant tumor of mesothelial tissue originating from the liver. PHA often presents with multiple intrahepatic foci or metastasis at the time of presentation due to its nonspecific clinical presentation and highly aggressive nature. There are no established or effective treatment guidelines for PHA, so early detection and early treatment are of great value for patient survival. Unfortunately, there is a paucity of literature on the imaging features of PHA, making the diagnosis and treatment of this disease a considerable challenge.

CASE SUMMARY

In this case report, we present a 59-year-old man who initially presented with abdominal pain and radiating pain in the right shoulder. Magnetic resonance imaging and positron emission tomography-computed tomography revealed multiple intrahepatic nodules that needed to be differentiated from tumors of vascular epithelial origin and tumors with progressive enhancement features, and signs of tumor metastasis were assessed. The patient was then subjected to contrast-enhanced ultrasonography (CEUS) to further clarify the extent of tumor infiltration and the state of microcirculatory perfusion. The manifestations observed on CEUS were similar to the classical characteristic presentation of hepatocellular carcinoma, called "quick wash-in and quick wash-out". In addition, CEUS showed that the lesion exhibited gradual infiltration and growth along the liver pedicle structures with no invading blood vessels. Finally, based on pathological and immunohistochemical tests and the above imaging manifestations, it was confirmed that the patient had infiltrating PHA, which is a rare pathological type of PHA. The patient underwent transcatheter arterial chemoembolization and chemotherapy. Four months after the onset of symptoms, the follow-up radiological examination revealed poor treatment efficacy and rapid deterioration.

CONCLUSION

This case report complements the imaging modalities of a rare infiltrative PHA, in which CEUS and quantitative analysis are found to offer substantial advantages in characterizing the microcirculatory perfusion of the lesion, providing clinicians with diagnostic information at the earliest opportunity to make a diagnosis and develop a treatment strategy to prolong the patient survival.

Primary hepatic angiosarcoma: A case report

BACKGROUND

Primary hepatic angiosarcoma (PHA) is a rare malignant tumor of the vascular endothelium. Clinical manifestations and laboratory and imaging examinations often lack specificity for PHA. We report a case of PHA, and describe the ultrasound characteristics and characteristic changes in laboratory values associated with PHA.

CASE SUMMARY

A 75-year-old woman presented with right upper quadrant abdominal pain for half a month. Magnetic resonance imaging (MRI) at a local hospital revealed multiple liver space-occupying lesions, and she was admitted to our hospital for further diagnosis. Contrast-enhanced ultrasound (CEUS) revealed multiple slightly hyperechoic nodules in the liver, which were suspected to be of malignant vascular origin. Contrast-enhanced computed tomography revealed multiple low-density nodules in the liver, considered to be metastatic hematopoietic malignancies. Contrast-enhanced MRI showed that the multiple liver nodules shared features with infectious lesions. Laboratory examination revealed normal alpha-fetoprotein levels, slightly increased other liver enzymes, decreased platelets, and significantly increased D-dimer levels. Liver biopsy and histopathology confirmed the presence of PHA.

CONCLUSION

CEUS can provide valuable clues for the diagnosis of PHA and greatly improve the success rate of puncture biopsy.