Hepatic angiosarcoma


This patient has received bilateral lung transplants 5 years prior and has been chronically immunosuppressed. Considerations for atypical infection and PTLD were raised. Metastasis from an unknown primary would be a less likely consideration. 

One of the new liver lesions was biopsied using ultrasound:

Macroscopy:  Labeled "Liver lesion core biopsy". Tan core biopsy 20mm.
Microscopy: The sections of the core biopsy show hepatic parenchyma with preserved architecture. The sinusoids are expanded by atypical cells which track within the existing sinusoidal spaces without marked destruction of the adjacent hepatic plates. The tumor cells contain moderately pleomorphic, enlarged and irregular ovoid nuclei with finely granular chromatin and occasional nucleoli. Occasional tumor cells show vacuolisation fo the cytoplasm and occasional rudimentary intracytoplasmic lumina containing eosinophilic globules. Numerous mitotic figures, including atypical forms, are present. Within the region of the tumor, lobular and intra-sinusoidal clusters of small mature CD3 positive T lymphocytes are present.  Immunohistochemically the tumor cells show strong reactivity for CD31. No reactivity for CD68, CD20, Pax5, CD3 or CD5, EBV-LMP or HHV8 is seen within tumor cells.  There is no background myxoid matrix.
Conclusion: Liver lesion, core biopsy: Angiosarcoma.

Although a rare malignancy, hepatic angiosarcoma is still the third most common primary liver tumor