A 69-year-old previously heathy woman presented with left upper quadrant pain for 2 months. She described her intermittent colicky abdominal pain, each attack lasting 10 min. She also noticed a weight loss of 3 kg in a week. Physical examination showed palpated liver 4 cm below the right costal margin and 6 cm below the xyphoid; the surface of the liver appeared to be lobulated with firm consistency; no hepatic bruit was heard.
The laboratory investigation showed: WBC count 5,080/dL, Hb 10.5 g/dL, and platelet count 99 x 103/dL, AST 84 U/L, ALT 33 U/L, ALP 187 U/L, TB 2.47 mg%, DB 1.48 mg%, PT 20 s and INR 1.89. The serum tumor markers included AFP, CEA, and CA 19-9 and were within normal limits. The scheduled CT scan demonstrated numerous masses, and multiple nodules size 1-9 cm across the entire liver, an osteoblastic lesion at L4 vertebrae, multiple small nodules 2-8 mm in size at both lungs with surrounding ground glass, which is typical for hemorrhage (Fig. 4).
For a definite diagnosis, she underwent real-time sonographic guidance percutaneous tumor biopsy. The specimen consisted of light brown soft tissue. The histopathological finding revealed a malignant vascular tumor, immunochemistry staining positive for CD 34 and factor VIII. These findings are consistent with angiosarcoma.
The patient had planned to have chemotherapy. Unfortunately, 2 weeks after diagnosis, she was admitted to the hospital due to severe abdominal pain. Investigations revealed a ruptured tumor, evidence of disseminated intravascular coagulopathy, and liver failure. Thus, she denied invasive therapy and passed away 1 week later.
The clinical manifestation, tumor feature, and treatment outcome of the four patients are summarized in Table 1.