Primary hepatic angiosarcoma misdiagnosed as hemangioma despite repeated negative biopsies and sclerotherapy: A...

Primary hepatic angiosarcoma is a very rare vascular malignancy with highly variable imaging and pathologic appearances, occasionally resembling a benign hemangioma. We describe a 62-year-old woman who presented with profound anemia and severe thrombocytopenia and multifocal hepatic lesions repeatedly interpreted as hemangioma on core needle biopsies. She underwent 1 sessions of sclerotherapy. With rapid interval enlargement and atypical MRI features, a repeat biopsy established the diagnosis of hepatic angiosarcoma, supported by immunohistochemistry. Her course was complicated by acute kidney injury requiring hemodialysis; she subsequently suffered 2 cardiac arrests 1 day apart and finally died despite resuscitation. This case underscores the need to revisit the diagnosis when a presumed hemangioma shows progressive growth, atypical enhancement patterns, or discordant clinical behavior.