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Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Hepatic angiosarcoma mimicking sinusoidal obstruction syndrome/venoocclusive disease: a pathologic-radiologic
Homer O Wiland1, Rish K Pai, Andrei S Purysko
1Department of Anatomic Pathology, Cleveland Clinic Foundation, OH 44195, USA. wilandh@ccf.org
Annals of Diagnostic Pathology
|February 7, 2012
Summary
A liver transplant patient initially diagnosed with veno-occlusive disease (VOD) was later found to have hepatic angiosarcoma. Autopsy revealed multifocal angiosarcoma, suggesting VOD findings may mask underlying vascular malignancy.
Area of Science:
- Hepatology
- Transplant Surgery
- Oncology
Background:
- Liver dysfunction and ascites post-lung transplant prompted clinical suspicion of veno-occlusive disease (VOD).
- Tacrolimus, a drug associated with VOD, was discontinued without clinical improvement.
Observation:
- Computed tomography revealed multiple hepatic lesions over several months.
- Liver biopsies showed changes consistent with VOD, including sinusoidal congestion and hepatocyte atrophy.
- Atypical cells were noted, but malignancy could not be definitively diagnosed on biopsy.
Findings:
- Autopsy confirmed multifocal hepatic angiosarcoma.
- The background liver exhibited features of VOD, likely secondary to the angiosarcoma.
- Histologic VOD findings may obscure the diagnosis of primary hepatic angiosarcoma.
Implications:
- Consider unsampled vascular malignancy in patients with hepatic masses and histology suggestive of VOD.
- Early detection of hepatic angiosarcoma is crucial, especially in post-transplant patients.
- This case highlights the importance of comprehensive diagnostic evaluation when initial treatments fail.
