Hepatic Angiosarcoma Masquerading as Hemangioma: A Challenging Differential Diagnosis
Autor(a) principal: | |
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Data de Publicação: | 2017 |
Outros Autores: | , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10316/108083 https://doi.org/10.20344/amp.8593 |
Resumo: | Hemangiomas are usually diagnosed based on ultrasound findings. The presence of symptoms, rapid growth or atipical imagiological findings should make us consider other diagnoses, including malignant tumors such as angiosarcomas. We describe the case of a previously healthy 46-year-old female without a history of exposure to carcinogens who presented with abdominal pain for two months. Diagnostic work-up revealed elevated gamma-glutamyl transferase and lactate dehydrogenase levels. Abdominal ultrasound described a large nodular lesion in the right lobe of the liver described as a hemangioma. One month later, a computed tomography-scan was made and revealed the same lesion, which had grown from 13.5 to 20 cm, maintaining typical imaging characteristics of a hemangioma. A right hepatectomy was performed and pathology revealed an angiosarcoma. After surgery, a positron emission tomography-computed tomography scan showed hepatic and bone metastasis. The patient started taxane-based chemotherapy and lumbar palliative radiotherapy, but died 10 months after surgery. This case shows how difficult it is to diagnose hepatic angiosarcoma relying only on imaging findings. Two abdominal computed tomography -scans were performed and none suggested this diagnosis. Angiosarcoma is a very aggressive tumour with an adverse prognosis. Surgery is the only curative treatment available. However, it is rarely feasible due to unresectable disease or distant metastasis. |
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Hepatic Angiosarcoma Masquerading as Hemangioma: A Challenging Differential DiagnosisHemangiomaCavernous/diagnosisHemangiosarcoma/diagnosisLiver Neoplasms/diagnosisHemangioma Cavernoso/diagnósticoHemangiossarcoma/diagnósticoNeoplasias Hepáticas/diagnósticoDiagnosis, DifferentialFemaleHemangiomaHemangiosarcomaHumansLiver NeoplasmsMiddle AgedHemangiomas are usually diagnosed based on ultrasound findings. The presence of symptoms, rapid growth or atipical imagiological findings should make us consider other diagnoses, including malignant tumors such as angiosarcomas. We describe the case of a previously healthy 46-year-old female without a history of exposure to carcinogens who presented with abdominal pain for two months. Diagnostic work-up revealed elevated gamma-glutamyl transferase and lactate dehydrogenase levels. Abdominal ultrasound described a large nodular lesion in the right lobe of the liver described as a hemangioma. One month later, a computed tomography-scan was made and revealed the same lesion, which had grown from 13.5 to 20 cm, maintaining typical imaging characteristics of a hemangioma. A right hepatectomy was performed and pathology revealed an angiosarcoma. After surgery, a positron emission tomography-computed tomography scan showed hepatic and bone metastasis. The patient started taxane-based chemotherapy and lumbar palliative radiotherapy, but died 10 months after surgery. This case shows how difficult it is to diagnose hepatic angiosarcoma relying only on imaging findings. Two abdominal computed tomography -scans were performed and none suggested this diagnosis. Angiosarcoma is a very aggressive tumour with an adverse prognosis. Surgery is the only curative treatment available. However, it is rarely feasible due to unresectable disease or distant metastasis.Apesar do diagnóstico de hemangioma ser habitualmente simples e baseado na ecografia, a presença de sintomas, o crescimento rápido ou a presença de atipias imagiológicas devem-nos fazer considerar a hipótese de outras entidades, algumas delas malignas como o angiossarcoma. É descrito o caso de doente do sexo feminino de 46 anos, previamente saudável sem exposição a carcinogéneos, refere queixas de dor abdominal durante dois meses. O estudo analítico revelou elevação da gama glutamil transferase e lactato desidrogenase e a ecografia abdominal evidenciou uma lesão nodular de grandes dimensões no lobo direito do fígado, descrita como hemangioma. Um mês mais tarde, realizou uma tomografia computadorizada abdominal que revelou aumento das dimensões da lesão (13,5 para 20 cm), mantendo características imagiológicas de hemangioma. A doente foi submetida a hepatectomia direita e a histologia revelou a presença de angiossarcoma. Após cirurgia, uma tomografia por emissão de positrões-tomografia computadorizada evidenciou metastização hepática e óssea. A doente foi submetida a radioterapia e quimioterapia paliativa com paclitaxel, tendo falecido 10 meses após a cirurgia. Este caso exemplifica a dificuldade do diagnóstico do angiosarcoma baseado apenas nos exames de imagem. Foram realizadas duas tomografias computadorizadas abdominais e nenhuma sugeriu o diagnóstico. Os angiossarcomas são tumores muito agressivos com prognóstico reservado, sendo a cirurgia o único tratamento curativo. No entanto, raramente é realizada devido a doença irressecável ou disseminação à distância.Ordem dos Medicos2017-10-31info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttp://hdl.handle.net/10316/108083http://hdl.handle.net/10316/108083https://doi.org/10.20344/amp.8593eng1646-07580870-399XGarcia, Ana RitaRibeiro, JoãoGervásio, HelenaCastro-Sousa, Franciscoinfo:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-08-09T14:10:52Zoai:estudogeral.uc.pt:10316/108083Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T21:24:21.083765Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Hepatic Angiosarcoma Masquerading as Hemangioma: A Challenging Differential Diagnosis |
title |
Hepatic Angiosarcoma Masquerading as Hemangioma: A Challenging Differential Diagnosis |
spellingShingle |
Hepatic Angiosarcoma Masquerading as Hemangioma: A Challenging Differential Diagnosis Garcia, Ana Rita Hemangioma Cavernous/diagnosis Hemangiosarcoma/diagnosis Liver Neoplasms/diagnosis Hemangioma Cavernoso/diagnóstico Hemangiossarcoma/diagnóstico Neoplasias Hepáticas/diagnóstico Diagnosis, Differential Female Hemangioma Hemangiosarcoma Humans Liver Neoplasms Middle Aged |
title_short |
Hepatic Angiosarcoma Masquerading as Hemangioma: A Challenging Differential Diagnosis |
title_full |
Hepatic Angiosarcoma Masquerading as Hemangioma: A Challenging Differential Diagnosis |
title_fullStr |
Hepatic Angiosarcoma Masquerading as Hemangioma: A Challenging Differential Diagnosis |
title_full_unstemmed |
Hepatic Angiosarcoma Masquerading as Hemangioma: A Challenging Differential Diagnosis |
title_sort |
Hepatic Angiosarcoma Masquerading as Hemangioma: A Challenging Differential Diagnosis |
author |
Garcia, Ana Rita |
author_facet |
Garcia, Ana Rita Ribeiro, João Gervásio, Helena Castro-Sousa, Francisco |
author_role |
author |
author2 |
Ribeiro, João Gervásio, Helena Castro-Sousa, Francisco |
author2_role |
author author author |
dc.contributor.author.fl_str_mv |
Garcia, Ana Rita Ribeiro, João Gervásio, Helena Castro-Sousa, Francisco |
dc.subject.por.fl_str_mv |
Hemangioma Cavernous/diagnosis Hemangiosarcoma/diagnosis Liver Neoplasms/diagnosis Hemangioma Cavernoso/diagnóstico Hemangiossarcoma/diagnóstico Neoplasias Hepáticas/diagnóstico Diagnosis, Differential Female Hemangioma Hemangiosarcoma Humans Liver Neoplasms Middle Aged |
topic |
Hemangioma Cavernous/diagnosis Hemangiosarcoma/diagnosis Liver Neoplasms/diagnosis Hemangioma Cavernoso/diagnóstico Hemangiossarcoma/diagnóstico Neoplasias Hepáticas/diagnóstico Diagnosis, Differential Female Hemangioma Hemangiosarcoma Humans Liver Neoplasms Middle Aged |
description |
Hemangiomas are usually diagnosed based on ultrasound findings. The presence of symptoms, rapid growth or atipical imagiological findings should make us consider other diagnoses, including malignant tumors such as angiosarcomas. We describe the case of a previously healthy 46-year-old female without a history of exposure to carcinogens who presented with abdominal pain for two months. Diagnostic work-up revealed elevated gamma-glutamyl transferase and lactate dehydrogenase levels. Abdominal ultrasound described a large nodular lesion in the right lobe of the liver described as a hemangioma. One month later, a computed tomography-scan was made and revealed the same lesion, which had grown from 13.5 to 20 cm, maintaining typical imaging characteristics of a hemangioma. A right hepatectomy was performed and pathology revealed an angiosarcoma. After surgery, a positron emission tomography-computed tomography scan showed hepatic and bone metastasis. The patient started taxane-based chemotherapy and lumbar palliative radiotherapy, but died 10 months after surgery. This case shows how difficult it is to diagnose hepatic angiosarcoma relying only on imaging findings. Two abdominal computed tomography -scans were performed and none suggested this diagnosis. Angiosarcoma is a very aggressive tumour with an adverse prognosis. Surgery is the only curative treatment available. However, it is rarely feasible due to unresectable disease or distant metastasis. |
publishDate |
2017 |
dc.date.none.fl_str_mv |
2017-10-31 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10316/108083 http://hdl.handle.net/10316/108083 https://doi.org/10.20344/amp.8593 |
url |
http://hdl.handle.net/10316/108083 https://doi.org/10.20344/amp.8593 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
1646-0758 0870-399X |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.publisher.none.fl_str_mv |
Ordem dos Medicos |
publisher.none.fl_str_mv |
Ordem dos Medicos |
dc.source.none.fl_str_mv |
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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1799134128545726464 |