Hepatic angiosarcoma
Updates to Article Attributes
Hepatic angiosarcoma is a rare malignancy but is still the third most common primary liver tumour. They have a variable appearance on both CT and MRI, reflecting the pleomorphic histological nature. Prognosis is very poor, with survival uncommon beyond one year from diagnosis.
Terminology
Hepatic angiosarcoma was previously known as Kupffer cell sarcoma.
Epidemiology
Hepatic angiosarcomas account for ~1% of primary liver tumours. MostThey most commonly occursoccur in patients in their 60-70s60-70 years of age with a male predominance (M:F = 4:1) 1-3.
Clinical presentation
Patients typically have non-specific abdominal symptoms and may present with an abdominal mass or hepatomegaly. PatientsThey can also present with spontaneous rupture and haemoperitoneum 1,5.
Pathology
Hepatic angiosarcomas arise from malignant spindle cells of endothelial origin. Metastases are common at presentation, affecting lung and spleen.
Aetiology
Most hepatic angiosarcomas arise spontaneously, although haemochromatosis and neurofibromatosis type 1 have also been associated.
Environmental exposure to Thorotrast, arsenic, ionising radiation, and vinyl chloride have been implicated as risk factors, but such exposure is now rare.
HistologyMicroscopic appearance
Histology demonstrates varied appearances of solid nodules/masses or as sinusoidal or cavernous spaces.
Radiographic features
Hepatic angiosarcomas most commonly present as multiple masses but can occur as a single heterogeneous mass 2,4.
CT
hypoattenuating masses (some may be hyperattenuating reflecting haemorrhage) on both non-contrast and contrast-enhanced CT
nodular enhancement is common
MRI
Findings reflect the haemorrhagic nature of angiosarcomas with fluid-fluid levels often a feature 2:
T1/T2: heterogeneous areas of high signal reflecting mixed tumour and haemorrhage
T1 C+ (Gd): heterogeneous enhancement with progressive filling
Nuclear medicine
The tumours are avid on FDG PET-CT 5
Treatment and prognosis
It typically rapidly progresses with metastases and high recurrence rate although partial liver resection may be successful if it is confined to one lobe of the liver.
Prognosis is poor with hepatic angiosarcomas being resistant to chemotherapy and radiation therapy. Median survival is less than six6 months and survival beyond one1 year is rare.
-<p><strong>Hepatic angiosarcoma</strong> is a rare malignancy but is still the third most common primary <a href="/articles/liver-tumours">liver tumour</a>. They have a variable appearance on both CT and MRI, reflecting the pleomorphic histological nature. Prognosis is very poor, with survival uncommon beyond one year from diagnosis. </p><h4>Terminology</h4><p>Hepatic angiosarcoma was previously known as Kupffer cell sarcoma. </p><h4>Epidemiology</h4><p>Hepatic <a href="/articles/angiosarcoma">angiosarcomas</a> account for ~1% of primary liver tumours. Most commonly occurs in patients in their 60-70s with a male predominance (M:F = 4:1) <sup>1-3</sup>. </p><h4>Clinical presentation</h4><p>Patients typically have non-specific abdominal symptoms and may present with an abdominal mass or <a href="/articles/hepatomegaly">hepatomegaly</a>. Patients can also present with spontaneous rupture and <a href="/articles/haemoperitoneum">haemoperitoneum</a> <sup>1,5</sup>. </p><h4>Pathology</h4><p>Hepatic angiosarcomas arise from malignant spindle cells of endothelial origin. Metastases are common at presentation, affecting <a href="/articles/lung">lung</a> and <a href="/articles/spleen-1">spleen</a>.</p><h5>Aetiology</h5><p>Most hepatic angiosarcomas arise spontaneously, although <a href="/articles/haemochromatosis">haemochromatosis</a> and <a href="/articles/neurofibromatosis-type-1">neurofibromatosis type 1</a> have also been associated.</p><p>Environmental exposure to <a href="/articles/thorotrast">Thorotrast</a>, arsenic, <a href="/articles/ionising-radiation">ionising radiation</a> and <a href="/articles/vinyl-chloride-toxicity">vinyl chloride</a> have been implicated as risk factors, but such exposure is now rare.</p><h5>Histology</h5><p>Histology demonstrates varied appearances of solid nodules/masses or as sinusoidal or cavernous spaces. </p><h4>Radiographic features</h4><p>Hepatic angiosarcomas most commonly present as multiple masses but can occur as a single heterogeneous mass <sup>2,4</sup>. </p><h5>CT</h5><ul>-<li>hypoattenuating masses (some may be hyperattenuating reflecting haemorrhage) on both non-contrast and contrast-enhanced CT</li>-<li>nodular enhancement is common</li>- +<p><strong>Hepatic angiosarcoma</strong> is a rare malignancy but is still the third most common primary <a href="/articles/liver-tumours">liver tumour</a>. They have a variable appearance on both CT and MRI, reflecting the pleomorphic histological nature. Prognosis is very poor, with survival uncommon beyond one year from diagnosis. </p><h4>Terminology</h4><p>Hepatic angiosarcoma was previously known as Kupffer cell sarcoma. </p><h4>Epidemiology</h4><p>Hepatic <a href="/articles/angiosarcoma">angiosarcomas</a> account for ~1% of primary liver tumours. They most commonly occur in patients 60-70 years of age with a male predominance (M:F = 4:1) <sup>1-3</sup>. </p><h4>Clinical presentation</h4><p>Patients typically have non-specific abdominal symptoms and may present with an abdominal mass or <a href="/articles/hepatomegaly">hepatomegaly</a>. They can also present with spontaneous rupture and <a href="/articles/haemoperitoneum">haemoperitoneum</a> <sup>1,5</sup>. </p><h4>Pathology</h4><p>Hepatic angiosarcomas arise from malignant spindle cells of endothelial origin. Metastases are common at presentation, affecting <a href="/articles/lung">lung</a> and <a href="/articles/spleen-1">spleen</a>.</p><h5>Aetiology</h5><p>Most hepatic angiosarcomas arise spontaneously, although <a href="/articles/haemochromatosis">haemochromatosis</a> and <a href="/articles/neurofibromatosis-type-1">neurofibromatosis type 1</a> have also been associated.</p><p>Environmental exposure to <a href="/articles/thorotrast">Thorotrast</a>, arsenic, <a href="/articles/ionising-radiation">ionising radiation</a>, and <a href="/articles/vinyl-chloride-toxicity">vinyl chloride</a> have been implicated as risk factors, but such exposure is now rare.</p><h5>Microscopic appearance</h5><p>Histology demonstrates varied appearances of solid nodules/masses or as sinusoidal or cavernous spaces. </p><h4>Radiographic features</h4><p>Hepatic angiosarcomas most commonly present as multiple masses but can occur as a single heterogeneous mass <sup>2,4</sup>. </p><h5>CT</h5><ul>
- +<li><p>hypoattenuating masses (some may be hyperattenuating reflecting haemorrhage) on both non-contrast and contrast-enhanced CT</p></li>
- +<li><p>nodular enhancement is common</p></li>
-<li>-<strong>T1/T2:</strong> heterogeneous areas of high signal reflecting mixed tumour and haemorrhage</li>-<li>-<strong>T1 C+ (Gd):</strong> heterogeneous enhancement with progressive filling</li>-</ul><h5>Nuclear medicine</h5><ul><li>avid on FDG PET-CT <sup>5</sup>-</li></ul><h4>Treatment and prognosis</h4><p>It typically rapidly progresses with metastases and high recurrence rate although partial liver resection may be successful if it is confined to one lobe of the liver. </p><p>Prognosis is poor with hepatic angiosarcomas being resistant to chemotherapy and radiation therapy. Median survival is less than six months and survival beyond one year is rare.</p>- +<li><p><strong>T1/T2:</strong> heterogeneous areas of high signal reflecting mixed tumour and haemorrhage</p></li>
- +<li><p><strong>T1 C+ (Gd):</strong> heterogeneous enhancement with progressive filling</p></li>
- +</ul><h5>Nuclear medicine</h5><p>The tumours are avid on FDG PET-CT <sup>5</sup>.</p><h4>Treatment and prognosis</h4><p>It typically rapidly progresses with metastases and high recurrence rate although partial liver resection may be successful if it is confined to one lobe of the liver. </p><p>Prognosis is poor with hepatic angiosarcomas being resistant to chemotherapy and radiation therapy. Median survival is less than 6 months and survival beyond 1 year is rare.</p>