Metastasis of hepatic angiosarcoma to the gastric vein

Abstract

A 29-year-old female clerical worker was admitted to hospital with sudden right upper quadrant pain in September 1994. Her family history was noncontributory, and there was no prior exposure to vinyl chloride monomer, Thorotrast (thorium dioxide), or arsenic. Results of blood chemistry analyses, including alpha-fetoprotein, carcinoembryonic antigen, and carbohydrate antigen 19-9 were normal. Computed tomography (CT) disclosed heterogeneous liver tumors in segment 5 (1.5 cm) and segment 6 (5.0 cm), and angiography showed deep tumor staining with neovascularization. A malignancy was suspected and the patient underwent laparotomy. Tumors were removed by wedge resections and surgical margins of 8 mm were obtained. Pathological findings were consistent with diagnostic criteria 1 for primary hepatic angiosarcoma (PHA) (Fig. 1).Two years and 6 months later, the patient was found to have a recurrence. Ultrasonography revealed a 1.5-cm hypoechoic lesion near the portal trunk. Three-dimensional CT revealed a nodule in the left gastric vein (Fig. 2a). Extrahepatic recurrence was suspected, and a laparotomy was performed. A solid 1.5-cm tumor was detected directly under the lesser omentum. The tumor formed a solid lesion protruding into the left gastric vein, which diverged from the portal trunk. There was no infiltration outside the vascular wall. Tumor embolism in the portal trunk, peritoneal metastasis, and splenic metastasis were not seen. The cephalic side of the tumor was cut with an adequate surgical margin from the gastric wall. As the caudate side of the tumor extruded into the portal trunk, it was resected by a side clamp of the portal trunk. Thus, the tumor was removed with resection of the left gastric vein (Fig. 2b). The pathological findings were similar to those of the PHA, which indicated that the tumor in the left gastric vein was a metastasis. The surgical margins were tumorfree. At present, 6 years after the second operation, the patient is healthy, with no signs of recurrence.This patient had PHA that revealed heterochronous metastasis only to the left gastric vein. PHA, a rare mesenchymal tumor, can be induced by Thorotrast or vinyl chloride monomer. Reportedly fatal metastatic sites include the lung (35%), bone (18%), and spleen (18%). 1 Strategies for treating PHA have not been confirmed, and the prognosis for these patients has been hopeless. 2

Melena as a first sign of metastatic hepatic angiosarcoma: A case report

“…Metastasis of hepatic angiosarcoma to the gastric vein 19 and to the gastric mucosa without bleeding from the lesion was previously reported 20 .…”

Statistics and outlook of primary hepatic angiosarcoma based on clinical stage

“…In addition, 6 cases from Tri-Service General Hospital were included. Finally, 34 patients in 16 case reports and from our hospital were enrolled in the analysis (10,(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). The mean age at diagnosis was 58.9 years (range, 29-83 years).…”

Primäre Lebersarkome – Empfehlungen zur chirurgischen Therapie

“…Angiosarkome-[9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40, 4166,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,…”