De-Novo Hepatic Angiosarcoma in a Liver Transplant Recipient

Angiosarcoma (AS) is a rare and highly aggressive soft tissue tumor. Cases of de-novo hepatic angiosarcoma after liver transplantation have not been described in the literature. Here, we present an exceedingly rare case of hepatic AS developing in a patient with a liver transplant (LT). A 72-year-old male with a history of orthotopic LT presented with cholestatic pattern of liver enzyme elevation for 3 months. Six years prior, he had undergone LT for treatment of alcohol-associated cirrhosis. He was on everolimus (1 mg twice daily) and low-dose tacrolimus (0.5 mg twice daily) for immunosuppression without evidence of allograft rejection. At presentation, his ALP and GGT were elevated to 1-2 times the upper limit of normal. He endorsed a 20-pound weight loss, anorexia, abdominal pain, and distention. A right upper quadrant ultrasound with doppler revealed a 14 cm liver mass and moderate ascites. This was followed by a multiphasic abdominal MRI, which revealed a 14.9 cm central hepatic mass involving the right and left hepatic lobes with extension into the hepatic veins and the inferior vena cava. The patient underwent a core biopsy of the tumor, which was suggestive of high-grade liver AS. A follow-up PET/CT scan was concerning for right adrenal gland and bilateral pulmonary metastasis. Patient was discussed at multidisciplinary tumor board and started on palliative chemotherapy with a single agent (docetaxel). Due to medication intolerance, patient discontinued the regimen after 1 cycle, and opted to transition to comfort care. He passed away 3 months after initial diagnosis.