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Hepatic angiosarcoma is a rare malignancy but is still the third most common primary liver tumor. 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.
Hepatic angiosarcoma was previously known as Kupffer cell sarcoma.
Hepatic angiosarcomas account for ~1% of primary liver tumors. They most commonly occur in patients 60-70 years of age with a male predominance (M:F = 4:1) 1-3.
Histology demonstrates varied appearances of solid nodules/masses or as sinusoidal or cavernous spaces.
Hepatic angiosarcomas most commonly present as multiple masses but can occur as a single heterogeneous mass 2,4.
hypoattenuating masses (some may be hyperattenuating reflecting hemorrhage) on both non-contrast and contrast-enhanced CT
nodular enhancement is common
Findings reflect the hemorrhagic nature of angiosarcomas with fluid-fluid levels often a feature 2:
T1/T2: heterogeneous areas of high signal reflecting mixed tumor and hemorrhage
T1 C+ (Gd): heterogeneous enhancement with progressive filling
The tumors 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 6 months and survival beyond 1 year is rare.
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