Melena as a first sign of metastatic hepatic angiosarcoma: A case report

  • Aleksandra Sokic-Milutinovic Clinic for Gastroenterology and hepatology, Clinical centre of Serbia, Belgrade,Serbia
  • Ljubisa Toncev Clinic for Gastroenterology and hepatology, Clinical centre of Serbia, Belgrade,Serbia
  • Tijana Glisic Clinic for Gastroenterology and hepatology, Clinical centre of Serbia, Belgrade,Serbia
  • Vera Matovic Emergency Center, Clinical center of Serbia, Belgrade, Serbia
  • Marjan Micev Department of Pathology, Clinical center of Serbia, Belgrade,Serbia
  • Srdjan Djuranovic Clinic for Gastroenterology and hepatology, Clinical centre of Serbia, Belgrade,Serbia
  • Miodrag Krstic Clinic for Gastroenterology and hepatology, Clinical centre of Serbia, Belgrade,Serbia
DOI: https://doi.org/10.2298/VSP160923073S
Ključne reči: hemangiosarcoma, liver neoplasms, melena, diagnostic techniques and procedures, diagnosis, differential, palliative care

Sažetak


Abstract

 

Introduction. Angiosarcomas are malignant tumors of vascular endothelium that may arise from different loca­tions. Although primary hepatic angiosarcoma accounts for only 1.8% of primary liver tumors, it is the most common malignant mesenchymal tumor of the liver. We report a case of primary hepatic angiosarcoma with melena as an unusual initial manifestation of this ex­tremely rare tumor. Case report. Forty-four-years old patient with melena was referred to our Clinic because melena was not resolved after repeated argon plasma co­agulation of bleeding lesions during esophagogastroduo­denoscopy in the regional hospital. Abdominal ultra­sound and multislice computed tomography (MSCT) revealed enlarged liver, with focal lesion 6 cm in diame­ter localized in the left lobe with multiple satellite le­sions in both liver lobes, enlarged spleen and extremely dilated and long umbilical vein. Double-balloon en­teroscopy and video capsule endoscopy detected the multiple bleeding vascular lesions in the small bowel. Histopathological examination and immunohistochem­istry of the small bowel lesions revealed malignant mes­enchymal proliferation with vascular/endothelium dif­ferentiation of neoplastic cells. The patient was diag­nosed with metastatic angiosarcoma probably of hepatic origin with metastasis in the small bowel, that caused melena, and in the lumbar spine, causing back pain. Conclusion. Rare causes of melena include bleeding from primary or metastatic hemangiosarcoma localized in the gastrointestinal tract, especially small bowel.

Reference

REFERENCES

Chaudhary P, Bhadana U, Singh RA, Ahuja A. Primary hepatic angiosarcoma. Eur J Surg Oncol 2015; 41(9): 1137‒43.

Baxter PJ. The British hepatic angiosarcoma register. Environ Health Perspect 1981; 41: 115‒6.

Forbes A, Portmann B, Johnson P, Williams R. Hepatic sarcomas in adults: A review of 25 cases. Gut 1987; 28(6): 668‒74.

Molina E, Hernandez A. Clinical manifestations of primary he-patic angiosarcoma. Dig Dis Sci 2003; 48(4): 677‒82.

Allison KH, Yoder BJ, Bronner MP, Goldblum JR, Rubin BP. Angiosarcoma involving the gastrointestinal tract: A series of primary and metastatic cases. Am J Surg Pathol 2004; 28(3): 298‒307.

Taxy JB, Battifora H. Angiosarcoma of the gastrointestinal tract. A report of three cases. Cancer 1988; 62(1): 210‒6.

Ni Q, Shang D, Peng H, Roy M, Liang G, Bi W, et al. Primary angiosarcoma of the small intestine with metastasis to the liver: a case report and review of the literature. World J Surg Oncol 2013; 11: 242.

Zacarias Föhrding L, Macher A, Braunstein S, Knoefel WT, Topp SA. Small intestine bleeding due to multifocal angiosarcoma. World J Gastroenterol 2012; 18(44): 6494‒500.

Ahmad Z, Nisa A, Idrees R, Minhas K, Pervez S, Mumtaz K. He-patic angiosarcoma with metastasis to small intestine. J Coll Physicians Surg Pak 2008; 18(1): 50‒2.

De Francesco V, Bellesia A, Corsi F, Pennella A, Ridola L, Zullo A. Multifocal Gastrointestinal Angiosarcoma: a Challenging Diagnosis? J Gastrointestin Liver Dis 2015; 24(4): 519‒22.

Ruffolo C, Angriman I, Montesco MC, Scarpa M, Polese L, Barollo M, et al. Unusual cause of small bowel perforation: metastasis of a subcutaneous angiosarcoma of the head. Int J Colorectal Dis 2005; 20(6): 551‒2.

Winkelmann RK, van Heerden JA, Bernatz PE. Malignant vascular endothelial tumor with distal embolization. A new entity. Am J Med 1971; 51(5): 692‒7.

Schmid E, Port SJ, Carroll RM, Friedman NB. Primary metastasizing aortic endothelioma. Cancer 1984; 54(7): 1407‒11.

Talard P, Lemmens B, Duval JL, Dubayle P, Bouchiat C, Carloz E. Angiosarcoma of the aorta disclosed by intestinal metastasis. Arch Mal Coeur Vaiss 1992; 85(4): 453‒6. (French)

Santonja C, Martín-Hita AM, Dotor A, Costa-Subias J. Intimal angiosarcoma of the aorta with tumour embolisation causing mesenteric ischaemia. Report of a case diagnosed using CD31 immunohistochemistry in an intestinal resection specimen. Virchows Arch 2001; 438(4): 404‒7.

Hsu J, Chen H, Lin C, Yeh C, Hwang T, Jan Y, et al. Primary angiosarcoma of the spleen. J Surg Oncol 2005; 92(4): 312‒6.

Al Ali J, Ko HH, Owen D, Steinbrecher UP. Epithelioid angiosarcoma of the small bowel. Gastrointest Endosc 2006; 64(6): 1018‒21.

Grewal JS, Daniel AR, Carson EJ, Catanzaro AT, Shehab TM, Tworek JA. Rapidly progressive metastatic multicentric epithe-lioid angiosarcoma of the small bowel: A case report and a re-view of literature. Int J Colorectal Dis 2008; 23(8): 745‒56.

Nakayama H, Masuda H, Fukuzawa M, Takayama T, Hemmi A. Metastasis of hepatic angiosarcoma to the gastric vein. J Ga-stroenterol 2004; 39(2): 193‒4.

Kim T, Kim G, Heo J, Kang D, Song G, Cho M. Metastasis of he-patic angiosarcoma to the stomach. J Gastroenterol 2005; 40(10): 1003‒4.

Sullivan HC, Edgar MA, Cohen C, Kovach CK, HooKim K, Reid MD. The utility of ERG, CD31 and CD34 in the cytological diagnosis of angiosarcoma: An analysis of 25 cases. J Clin Pa-thol 2015; 68(1): 44‒50.

Timaran CH, Grandas OH, Bell JL. Hepatic angiosarcoma: long-term survival after complete surgical removal. Am Surg 2000; 66(12): 1153‒7.

Objavljeno
2021/02/11
Broj časopisa
Vol. 76 Br. 2 (2019): Vojnosanit pregl
Rubrika
Prikaz bolesnika