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Rojas S, Rey Chaves CE, Robledo S, Conde D, Sabogal Olarte JC. Primary hepatic angiosarcoma: a systematic review. Ann Med Surg (Lond) 2024; 86:1601-1605. [PMID: 38463049 PMCID: PMC10923304 DOI: 10.1097/ms9.0000000000001584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 11/24/2023] [Indexed: 03/12/2024] Open
Abstract
Background Hepatic angiosarcoma is a rare type of tumour. In adults, the diagnosis remains challenging as the clinical manifestations are generally nonspecific and are usually made too late when complications or metastases are already present, associated with a poor prognosis. Due to the lack of agreement regarding the optimal treatment approach, a comprehensive analysis of the evidence in the literature on the surgical and survival outcomes in terms of disease-free survival time (DFS) and overall survival (OS) for patients treated for primary hepatic angiosarcoma is needed. Study design A systematic review of articles published in Pubmed, EMBASE, and Scopus, from 2000 to 2023 with the search terms hepatic angiosarcoma and liver resection or hepatectomy. Pooled individual data concerning the prognosis following various therapies was analyzed. Results A total of 15 articles involving 886 patients were eligible for inclusion. The male population represents 66.2% (n=586) of the population, with a median age of 57 years (41-66). The median survival rate was 7 months. The median OS after surgical resection was 17.18 months (SD 12.6) vs. 3.72 months (SD 4.6) for patients treated without a surgical approach. The median DFS was 15.2 months (SD 11). Conclusion Primary liver angiosarcoma remains a surgical challenge with a poor prognosis even with complete surgical resection and adjuvant therapy. Surgical management shows increased overall survival in comparison with non-surgical management. Early diagnosis could change the natural history of the disease. The literature available is scarce, and further studies are required to create standardized diagnostic and treatment protocols.
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Affiliation(s)
| | | | - Sofía Robledo
- Estudiante de pregrado, Pontificia Universidad Javeriana, Facultad de Medicina
| | - Danny Conde
- Cirugia Hepatobiliar y pancreática, Hospital Universitario Mayor Méderi, Universidad el Rosario
| | - Juan Carlos Sabogal Olarte
- Cirugía Hepatobiliar y páncreatica, Pontificia Universidad Javeriana, Facultad de Medicina, Hospital Universitario San Ignacio, Bogotá, Colombia
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Lin Y, Chen Z, Yang J, Lin Y, Chen S, Xie Y, Wu S. Advanced diffuse hepatic angiosarcoma treated successfully with TACE and targeted immunotherapy: A case report. Front Oncol 2023; 13:1071403. [PMID: 37152029 PMCID: PMC10157244 DOI: 10.3389/fonc.2023.1071403] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 04/10/2023] [Indexed: 05/09/2023] Open
Abstract
Primary hepatic angiosarcoma (PHA), a rare soft tissue tumor, accounts for only 2% of all liver malignancies. Pathologically challenging, PHA is difficult to be distinguished from other malignancies with ultrasound, Computed Tomography (CT), or Magnetic Resonance Imaging (MRI). Due to late diagnosis and resistance against traditional chemotherapy and/or radiotherapy, only 3% of PHA patients can survive up to two years after diagnosis. To our best knowledge, this case report presents the first case of an advanced diffuse PHA with ruptured hemorrhage that has been effectively treated with TACE and Anlotinib plus Camrelizumab. So far, the patient has received 10 cycles of treatment and is faring well. Latest MRI results show that the tumor has shrunk by 56% and can be assessed as a partial response (PR). This case report includes our experience in treating such a advanced malignancy, and we hope that larger studies on advanced PHA can better quantify the potential benefit.
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Affiliation(s)
- Yucheng Lin
- Department of Ultrasonography, Fuzhou No. 1 Hospital Affiliated with Fujian Medical University, Shengli Clinical Medical College, Fuzhou, China
| | - Zheng Chen
- Department of Oncology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Jianchuan Yang
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Ying Lin
- Department of Pathology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Sheng Chen
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Ying Xie
- Department of Hematology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- *Correspondence: Songsong Wu, ; Ying Xie,
| | - Songsong Wu
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- *Correspondence: Songsong Wu, ; Ying Xie,
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Liver Resection for Primary Hepatic Angiosarcoma: Bicentric Analysis of a Challenging Entity. J Clin Med 2022; 11:jcm11112990. [PMID: 35683376 PMCID: PMC9181818 DOI: 10.3390/jcm11112990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/16/2022] [Accepted: 05/22/2022] [Indexed: 11/16/2022] Open
Abstract
Primary hepatic angiosarcoma (PHA) is a rare malignant tumor of the liver, and data on patient outcome after surgical treatment are scarce. The aim of this study was to evaluate postoperative morbidity and overall survival (OS) of patients who underwent hepatectomy for PHA. This is a bicentric retrospective analysis of all consecutive patients who underwent liver resection in curative intent for PHA between 2012 and 2019 at the University Hospital of Muenster and the University Hospital of Bern. Nine patients (five female, four male) were included from both centers. Median age was 72 years (44–82). Most lesions (77.8%) were larger than 5 cm, and mean size of the biggest lesion was 9.4 ± 4.5 cm. Major hepatectomy was performed in four (44.4%), and radical resection (R0) was achieved in six (66.7%) patients. Postoperative complication rate was 88.8%, including 44.4% higher than 3a in the Clavien–Dindo classification. OS survival rates at 1, 2, and 3 years were 44.4%, 22.2%, and 12.5%, respectively, and median OS was 5 months. OS was significantly better after radical resection (R0: 15 months vs. R1: 0 months, p = 0.04), whereas presentation with tumor rupture at diagnosis was associated with the worst OS (0 months vs. 15 months, p = 0.005). Disease recurrence occurred in three patients (33.3%) between three and seven months after surgery. Radical resection remains the only potentially curative treatment option for PHA. However, postoperative morbidity is high, and the overall prognosis remains poor. Multimodal therapy options and management strategies are urgently needed and could improve the prognosis of patients suffering from PHA in the future.
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Manh Hung T, Tran TPT. Liver Angiosarcoma with Poor Prognosis in a 61-Year-Old Woman: A Case Report and Literature Review. Int J Womens Health 2022; 14:957-963. [PMID: 35924096 PMCID: PMC9342427 DOI: 10.2147/ijwh.s369271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/20/2022] [Indexed: 02/05/2023] Open
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.
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Affiliation(s)
- Tran Manh Hung
- Department of Surgery, Bach Mai Hospital, Hanoi, Vietnam
- Correspondence: Tran Manh Hung, Department of Surgery, Bach Mai Hospital, Hanoi, Vietnam, Tel +84-912-157-095, Email
| | - Thi Phuong Thao Tran
- Center for Population Health Sciences, Hanoi University of Public Health, Hanoi, Vietnam
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Shayesteh S, Fouladi DF, Blanco A, Fishman EK, Kawamoto S. Hepatic angiosarcoma in an adult who had Wilms tumor treated in childhood: A case report. Radiol Case Rep 2021; 16:353-357. [PMID: 33747329 PMCID: PMC7965976 DOI: 10.1016/j.radcr.2020.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 02/07/2023] Open
Abstract
Hepatic angiosarcoma is a rare, highly aggressive mesenchymal liver malignancy with poor prognosis that stems from the endothelial cells that line the walls of blood or lymphatic vessels. It is the third most common primary liver malignancy and is most prevalent among older males. It is difficult to diagnose due to various clinical presentations from asymptomatic to abdominal pain, pleural effusion, and liver failure. The diagnosis of liver angiosarcoma is suspected on imaging features and confirmed by histopathological assessment. Primary management is determined based on the stage of tumor from surgery to palliative care such as chemotherapy or tumor transarterial embolization. We report a 51-year-old female who presented with stage 4 liver angiosarcoma and a history of childhood Wilms tumor. We focus on tumor management using radiological modalities and pathological analysis and discuss secondary liver tumors in survivors of childhood Wilms tumor.
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Affiliation(s)
- Shahab Shayesteh
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, JHOC 3140E, 601 North Caroline St, Baltimore, MD, USA
| | - Daniel Fadaei Fouladi
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, JHOC 3140E, 601 North Caroline St, Baltimore, MD, USA
| | - Alejandra Blanco
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, JHOC 3140E, 601 North Caroline St, Baltimore, MD, USA
| | - Elliot K Fishman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, JHOC 3140E, 601 North Caroline St, Baltimore, MD, USA
| | - Satomi Kawamoto
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, JHOC 3140E, 601 North Caroline St, Baltimore, MD, USA
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Cao J, Wang J, He C, Fang M. Angiosarcoma: a review of diagnosis and current treatment. Am J Cancer Res 2019; 9:2303-2313. [PMID: 31815036 PMCID: PMC6895451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 10/03/2019] [Indexed: 06/10/2023] Open
Abstract
Angiosarcoma is a highly malignancy of endothelial tumor and represents 1-2% of all soft tissue sarcomas in humans. The aetiology of angiosarcoma is not clear but there are definite risk factors including chronic lymphoedema, history of radiation, environmental carcinogens and certain familial syndromes. Ultrasound, CT and MR are diagnostic tools, but final diagnosis requires pathological and immunohistochemical confirmation. The conventional options of treatment include surgery, radiotherapy and chemotherapy. Targeted medicines and immunotherapy have been studied as promising treatment of angiosarcoma. The goal of this review is to summarize the current data regarding of angiosarcoma and its clinical presentation and management, providing a useful clinical tool to explore the optimal treatment.
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Affiliation(s)
- Jun Cao
- Department of Comprehensive Medical Oncology, Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang Province, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer HospitalHangzhou, Zhejiang, China
| | - Jiale Wang
- Second Clinical Medical College, Zhejiang Chinese Medical UniversityHangzhou, Zhejiang, China
| | - Chiyu He
- Second Clinical Medical College, Zhejiang Chinese Medical UniversityHangzhou, Zhejiang, China
| | - Meiyu Fang
- Department of Comprehensive Medical Oncology, Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang Province, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer HospitalHangzhou, Zhejiang, China
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Singh G, Mills C, Asadi K, Testro A. Hepatic angiosarcoma as a cause of acute liver failure. BMJ Case Rep 2018; 2018:bcr-2018-225896. [PMID: 30093472 DOI: 10.1136/bcr-2018-225896] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Hepatic angiosarcoma is an extremely rare disease entity that accounts for approximately 0.1%-2% of primary liver malignancy. It is three times more common in men than women and usually affects the former in their sixth or seventh decade of life. Risk factors for the development of hepatic angiosarcoma include the use of oral contraceptives, exposure to anabolic steroids, radiation, thorium dioxide, arsenic and vinyl chloride. The prognosis of hepatic angiosarcoma is extremely poor which is attributable to early metastases to other organs, resistance to traditional chemotherapy and radiotherapy regimens and rapid progression of the tumour. Optimal management of patients is poorly demarcated due to the rarity of the tumour. We present a case series of two patients: one who passed away due to acute hepatic failure secondary to hepatic angiosarcoma and the second who underwent a liver transplantation and was subsequently diagnosed with hepatic angiosarcoma based on his explant histology.
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Affiliation(s)
- Gurpreet Singh
- Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
| | - Christopher Mills
- Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
| | - Khashayar Asadi
- Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
| | - Adam Testro
- Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
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