Primary Hepatic Angiosarcoma: A Rare and Very Aggressive Liver Tumour

Area of Science:

• Hepatology
• Oncology
• Radiology

Background:

• Primary hepatic angiosarcoma (PHA) is a rare, aggressive liver tumor originating from mesenchymal cells, accounting for <2% of primary liver cancers.
• Etiology is often unclear, though carcinogen exposure is implicated; most patients present with nonspecific symptoms, complicating early diagnosis.
• Imaging plays a limited role in definitive diagnosis, necessitating a high index of suspicion for rare liver malignancies.

Observation:

• A 52-year-old male with hepatitis B-related cirrhosis presented for liver transplant evaluation.
• Initial MRI revealed small liver lesions (5-6 mm) categorized as LI-RADS 3, prompting a 3-month follow-up.
• Subsequent MRI showed significant lesion growth to 8.5 cm, leading to biopsy and diagnosis.

Findings:

• PHA demonstrates rapid growth, transforming from small, subtle lesions to a large mass within three months.
• MRI revealed significant interval growth, underscoring the aggressive nature of this rare hepatic tumor.
• Pathological confirmation via ultrasound-guided tru-cut biopsy was crucial for definitive diagnosis.

Implications:

• This case emphasizes the importance of vigilant monitoring and follow-up imaging for indeterminate liver lesions, particularly in high-risk patients.
• Recognizing subtle MRI features and potential for rapid progression is critical for timely diagnosis and management of PHA.
• Highlighting PHA's aggressive trajectory underscores the need for further research into early detection and treatment strategies for this rare liver cancer.