Angiosarcoma of liver: A case report of a 56-year old with a highly aggressive tumor.

Introduction And Importance: Hepatic angiosarcoma is a rare and aggressive tumor of the vascular endothelial cells with a poor prognosis. Due to its nonspecific symptoms and rapid progression, early diagnosis poses a significant challenge. Histopathology and immunohistochemistry are essential for confirmation; however, treatment options remain limited.

Case Presentation: A 56-year-old male presented to us with right upper quadrant pain, anemia, and mild ascites. Computed Tomography (CT) imaging revealed multiple vascular liver and spleen lesions, initially suspected as metastatic. Tumor markers and Fine Needle Aspiration Cytology (FNAC) of a thyroid nodule were performed which turned out to be inconclusive. Due to internal hemorrhage, an emergency left lateral segmentectomy was performed. Cluster of Differentiation 34 (CD34) and Erythroblast transformation specific regulated gene (ERG) histopathology confirmed hepatic angiosarcoma. The patient was stable postoperatively and referred for oncology care. However, the patient deteriorated soon after and died due to massive intra-abdominal hemorrhage before initiating chemotherapy.

Clinical Discussion: Hepatic angiosarcoma is often multifocal with rapid metastasis, making complete resection almost impossible. CT and Magnetic Resonance Imaging (MRI) aid in detection but histopathology with vascular markers CD34 and ERG are essential for definitive diagnosis. In light of lack of treatment options surgical resection offers the best survival for localized disease, while chemotherapy and Transarterial Chemoembolization (TACE) remain good palliative options. With a median survival of 6 months, the prognosis of this disease is highly dismal.

Conclusion: Hepatic angiosarcoma is a highly fatal condition with limited treatment options. Histopathology is crucial for diagnosis, and surgery remains the best option for localized cases. Early recognition is key to improving outcomes.