Hepatic Angiosarcoma Masquerading as Hemangioma: A Challenging Differential Diagnosis

Detalhes bibliográficos
Autor(a) principal: Garcia, Ana Rita
Data de Publicação: 2017
Outros Autores: Ribeiro, João, Gervásio, Helena, Castro-Sousa, Francisco
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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spelling 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
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