Multiple hepatic metastases of cardiac angiosarcoma

Abstract

The differential diagnosis of hepatic focal lesions is challenging because the etiology can be inflammatory, infectious, and even neoplastic. A rare cause of metastatic liver nodules is cardiac angiosarcoma. We report a case of this tumor, which was diagnosed only after autopsy.A 26-year-old Caucasian man was admitted for progressive dyspnea and cough over the past 3 weeks. Physical examination showed only hypophonetic heart sounds. Laboratory analysis demonstrated anemia and elevated inflammatory markers, despite normal biochemical parameters and liver function. Transthoracic echocardiography revealed massive pericardial effusion. Abdomen computed tomography (CT) showed multiple hepatic nodules, the largest of which measured 3 cm, but the percutaneous biopsy revealed only lobular necrosis and perisinusoidal fibrosis without granulomas or neoplastic cells. During hospitalization, the patient had fever and night sweats with weight loss, and empiric treatment for extrapulmonary tuberculosis associated with corticosteroids was initiated. The outpatient follow-up revealed complete improvement of the pericardial effusion, but maintenance of the liver lesions. After 2 months of hospital discharge, the patient was readmitted with hemorrhagic shock due to bleeding liver lesions, which were evidenced by CT. Embolization of the right hepatic artery was performed, but the patient soon died. The autopsy revealed a primary cardiac angiosarcoma with multiple hepatic metastases, rupture of the Glisson’s capsule and laceration of the liver. The case shows how important and difficult the diagnosis of focal liver lesions is, since it may result in an unexpected fatal outcome.

Primary cardiac angiosarcoma directly invading the right lung: An autopsy report

“…In addition, while cardiac metastasis of liver angiosarcoma is rare, the liver is a common metastatic site of PCA. 12 In the current case, the patient had no history of exposure to thorium oxide, vinyl chloride, arsenic, or anabolic steroids, all of which are risk factors for hepatic angiosarcoma. Moreover, the cardiac lesion was single, and the hepatic lesions were multiple.…”

“…11 Furthermore, the incidence of angiosarcoma in the cutaneous soft tissue, liver, or spleen is higher than that in the heart. 11 In this regard, Cunha-Silva et al 12 suggested the following factors to evaluate whether the cardiac angiosarcoma is primary or not: (1) patient's age and lifestyle history, (2) number of lesions (ie, single or multiple) in the heart, and (3) location of the lesion in the heart. In addition, while cardiac metastasis of liver angiosarcoma is rare, the liver is a common metastatic site of PCA.…”

“…In this regard, Cunha‐Silva et al 12 suggested the following factors to evaluate whether the cardiac angiosarcoma is primary or not: (1) patient's age and lifestyle history, (2) number of lesions (ie, single or multiple) in the heart, and (3) location of the lesion in the heart. In addition, while cardiac metastasis of liver angiosarcoma is rare, the liver is a common metastatic site of PCA 12 . In the current case, the patient had no history of exposure to thorium oxide, vinyl chloride, arsenic, or anabolic steroids, all of which are risk factors for hepatic angiosarcoma.…”

Diarrhea: a missed D in the 4D glucagonoma syndrome

“…In this setting, feasible hypotheses are hepatic and skin metastases or paraneoplastic cutaneous syndromes. Often, despite etiological elucidation and treatment, liver spread may determine an unfavourable prognosis 3 , 4…”