Hepatic angiosarcoma: aspiration biopsy cytology and immunocytochemical contribution

In the absence of previously documented sarcoma, the initial diagnosis of angiosarcoma (AS) on fine-needle aspiration (FNA) biopsy of the liver is difficult. However, awareness of its occurrence and the assistance of immunocytochemical stains may aid in arriving at the correct diagnosis. In this paper, a 59-yr-old smoker and alcoholic woman presented after a syncopal episode and was found to have a palpable right abdominal mass. An abdominal CT scan confirmed multiple centrally necrotic liver masses, from which an FNA biopsy was obtained. The smears were bloody with groups of relatively dishesive and singly dispersed spindle cells in a somewhat necrotic background. The nuclei were elongated to ovoid-round with small nucleoli. The cytoplasm was ample and ill-defined. The cells were reactive for factor VIII-related antigen and CD31 but negative for cytokeratin immunocytochemical stains, and a diagnosis of "suspicious for angiosarcoma" was entertained. The patient declined further studies or treatment but presented 4 mo later with light-headedness and hypoglycemia. Laparoscopic tissue biopsies of the liver/abdominal masses were obtained and revealed AS. Rarely, liver masses may represent AS. Pathologists should be aware of their cytomorphology and characteristic immunostaining to avoid their misinterpretation.