Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Jun 30 2020


  • Snapshot
    • A 75-year-old man presents to the clinic with complaints of generalized fatigue and weight loss. He states that over the past 3 years he lost a total of 15 lbs. without changes to his diet or his exercise. He notes that he can no longer copmlete his daily 2 mile walks because he would get extremely tired half way. Laboratory studies revealed mild normocytic anemia and mild elevations in transaminases. Physical examination reveals moderate tenderness to palpation at the right upper quadrant.
  • Introduction
    • Overview
      • hepatic angiosarcoma is a rare, high-grade malignant vascular neoplasm
    • Epidemiology
      • incidence
        • most common sarcoma arising in the liver
        • 0.1-2% of all primary tumors of the liver
      • demographics
        • occurs in older patients (> 60 years of age)
        • more common in men
      • risk factors
        • vinyl chloride
          • used to make polyvinyl chloride (PVC) pipes, wire coatings, plastic kitchen ware, and insulation
        • arsenic
        • anabolic steroids
        • thorium dioxide
    • Pathogenesis
      • majority of cases are of unknown etiology
      • malignant neoplasm of endothelial cells that line the walls of blood vessels of lymphatic vessels
        • can easily metastasize to distant sites
      • common sites of metastasis include spleen, lymph nodes, lung, bone, and the adrenals
    • Associated conditions
      • Secondary Budd-Chiari syndrome
        • thrombosis of the hepatic vein that drain the liver
        • due to compression of the veins by angiosarcoma
    • Prognosis
      • very poor prognosis as diagnosis is often very late in the disease process
      • mean survival time of 5 months
  • Presentation
    • Symptoms
      • weight loss
      • jaundice
      • weakness
      • pain
        • RUQ or epigastric
        • constant
        • dull
    • Physical exam
      • hepatomegaly
      • palpable mass
      • distension (ascites)
  • Imaging
    • Computed tomography
      • best initial imaging study
      • findings
        • numerous poorly defined variably sized nodules
        • entire liver is frequently involved
  • Studies
    • Serum labs
      • often accompanied by thrombocytopenia
      • usually normal liver function until late in disease process
    • Tumor biopsy
      • immunostaining positive for vascular markers
        • ERG transcription factor
        • CD31
        • CD34
        • factor VIII antigen
    • Histology
      • grossly hemorrhagic and necrotic tissue
      • tumor composed of pleomorphic spindle or epithelioid cells, often with bizarre or multinucleated forms and mitosis
  • Differential
    • Hepatocellular carcinoma
      • histology appears as hepatocytes with differing degree of differentiation
    • Cholangiocarcinoma
      • laboratory studies often reveal cholestatic pattern
  • Treatment
    • Medical treatment
      • adjuvant chemotherapy as needed
    • Surgical and interventional
      • partial or complete hepatectomy
        • depending on presentation or location of tumor
      • liver transplantation
        • high recurrence rate
  • Complications
    • Liver failure
    • Intraabdominal bleeding secondary to liver rupture
1 of 0
1 of 2
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options