Autopsy and Case Reports
https://autopsyandcasereports.org/article/doi/10.4322/acr.2018.048
Autopsy and Case Reports
Article / Autopsy Case Report

Multiple hepatic metastases of cardiac angiosarcoma

Marlone Cunha-Silva; Daniel Ferraz de Campos Mazo; Igor Logetto Caetité Gomes; Marcello Rabello Imbrizi; Tiago Sevá-Pereira; Nayana Fonseca Vaz; Mariana Sandoval Lourenço; Larissa Bastos Eloy da Costa; Cecilia Amelia Fazzio Escanhoela; Jazon Romilson de Souza Almeida

Downloads: 2
Views: 620

Abstract

The differential diagnosis of hepatic focal lesions is challenging because the etiology can be inflammatory, infectious, and even neoplastic. A rare cause of metastatic liver nodules is cardiac angiosarcoma. We report a case of this tumor, which was diagnosed only after autopsy.

A 26-year-old Caucasian man was admitted for progressive dyspnea and cough over the past 3 weeks. Physical examination showed only hypophonetic heart sounds. Laboratory analysis demonstrated anemia and elevated inflammatory markers, despite normal biochemical parameters and liver function. Transthoracic echocardiography revealed massive pericardial effusion. Abdomen computed tomography (CT) showed multiple hepatic nodules, the largest of which measured 3 cm, but the percutaneous biopsy revealed only lobular necrosis and perisinusoidal fibrosis without granulomas or neoplastic cells. During hospitalization, the patient had fever and night sweats with weight loss, and empiric treatment for extrapulmonary tuberculosis associated with corticosteroids was initiated. The outpatient follow-up revealed complete improvement of the pericardial effusion, but maintenance of the liver lesions. After 2 months of hospital discharge, the patient was readmitted with hemorrhagic shock due to bleeding liver lesions, which were evidenced by CT. Embolization of the right hepatic artery was performed, but the patient soon died. The autopsy revealed a primary cardiac angiosarcoma with multiple hepatic metastases, rupture of the Glisson’s capsule and laceration of the liver. The case shows how important and difficult the diagnosis of focal liver lesions is, since it may result in an unexpected fatal outcome.

Keywords

Sarcoma, Neoplasm Metastasis, Heart Neoplasms

References

Fonseca-Neto OCL. Metástases Hepáticas – abordagem atual. JBM. 2014;102(2):29-33.

Ellent ES, Chong-Yik R, Khan AM. Metastatic Cardiac Angiosarcoma in a 26-Year-Old Male. Ochsner J. 2016;16(3):324-8. [PMID:27660586]

Choi CH, Konda S, Shake JG. Angiosarcoma of the right atrium presenting as hemoptysis. Proc Bayl Univ Med Cent. 2016;29(1):79-80. [https://doi.org/10.1080/08998280.2016.11929370]. [PMID:26722181]

Saraiva F, Antunes M, Providência LA. Cardiac angiosarcoma in a pregnant woman: a case report and review of the literature. Acta Cardiol. 2012;67(6):727-31. [https://doi.org/10.1080/AC.67.6.2184678]. [PMID:23393946]

Taywade SK, Damle NA, Tripathi M, et al. Unusual presentation of a rare cardiac tumor: the role of F-18-fluorodeoxyglucose positron emission tomography/computed tomography. Indian J Nucl Med. 2017;32(2):157-8. [https://doi.org/10.4103/0972-3919.202233]. [PMID:28533653]

Patel SD, Peterson A, Bartczak A, et al. Primary cardiac angiosarcoma: A review. Med Sci Monit. 2014;20:103-9. [https://doi.org/10.12659/MSM.889875]. [PMID:24452054]

Lima PRL, Crotti PLR. Malignant cardiac tumours. Rev Bras Cir Cardiovasc. 2004;19(1):64-73.

Iglézias JCR, Velloso LGC, Dallan LA, Benvenuti LA, Verginelli G, Stolf NAG. Angiossarcoma de átrio direito. Rev Bras Cir Cardiovasc. 2000;15(2):186-91. [https://doi.org/10.1590/S0102-76382000000200013].

Lin CT, Ducis K, Tucker S, Tranmer B. Metastatic cardiac angiosarcoma to the lung, spine, and brain: a case report and review of the literature. World Neurosurg. 2017;107:1049.e9-12. [https://doi.org/10.1016/j.wneu.2017.08.023]. [PMID:28803168]

Fukunaga N, Kitai T, Imai Y, Furukawa Y, Koyama T. Three-year survival in primary cardiac angiosarcoma. J Med Invest. 2017; 64(1.2): 181-183

Habibi R, Faramarzi N, Altamirano AJ, Dadkhah S. A patient presenting with cardiac tamponade and the challenges of finding its cause: a cardiac Angiosarcoma. Case Rep Cardiol. 2018;2018:2084390. [https://doi.org/10.1155/2018/2084390]. [PMID:29682355]

Ambrus N, Havasi K, Kalapos A, et al. Primary cardiac angiosarcoma: A case report. Echocardiography. 2018;35(2):267-71. [https://doi.org/10.1111/echo.13808]. [PMID:29349900]

Butany J, Yu W. Cardiac angiosarcoma: two cases and a review of the literature. Can J Cardiol. 2000;16(2):197-205. [PMID:10694590]

Pernick, N. Heart Cardiac tumors. Malignant Angiosarcoma. Michigan: Pathology Outlines.com; 2018 [cited 2018 Jul 10]. Available from: http://www.pathologyoutlines.com/topic/hearttumorangiosarcoma.html

Pedrassa BC, da Rocha EL, Kierszenbaum ML, Bormann RL, Torres LR, D’Ippolito G. Uncommon hepatic tumors: iconographic essay - Part 1. Radiol Bras. 2014;47(5):310-6. [https://doi.org/10.1590/0100-3984.2013.1760]. [PMID:25741106]

Hur CJ, Min BR, Lee YJ, et al. Clinical courses of primary hepatic angiosarcoma: retrospective analysis of eight cases. Korean J Gastroenterol. 2015;65(4):229-35. [https://doi.org/10.4166/kjg.2015.65.4.229]. [PMID:25896157]

Kupsky DF, Newman DB, Kumar G, Maleszewski JJ, Edwards WD, Klarich KW. Echocardiographic features of cardiac angiosarcomas: The Mayo Clinic Experience (1976-2013). Echocardiography. 2016;33(2):186-92. [https://doi.org/10.1111/echo.13060]. [PMID:26460068]

Riles E, Gupta S, Wang DD, Tobin K. Primary cardiac angiosarcoma: a diagnostic challenge in a young man with recurrent pericardial effusions. Exp Clin Cardiol. 2012;17(1):39-42. [PMID:23204900]

Vyas M, Jain D. A practical diagnostic approach to hepatic masses. Indian J Pathol Microbiol. 2018;61(1):2-17. [https://doi.org/10.4103/IJPM.IJPM_578_17]. [PMID:29567877]

 

 

 


Publication date:
10/09/2018

5bbca1ac0e8825f921d262d3 autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections