PMC7184854_01
PMC7184854_02
Histopathological examination of tumor tissue in case 2. a Histopathological study (hematoxylin-eosin stain, x40) showed the tumor cells (T) grow along sinusoids adjacent to hepatic cords (L). b The tumor cells appearabundant, poorly defined cell borders, pleomorphic with hyperchromatic nuclei. The abnormal vessels also showed enlarged endothelial cells with nuclear atypia (x400). The Immunohistochemical study showed positive staining for CD 34 (c) and factor VIII (d).
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F1
Histopathological study was consistent with PHA (Fig. 1).
PMC7184854_03
Multiphase CT scan of liver in case 3 demonstrates a large hemorrhagic hepatic mass 15 x 20 x 23 cm in size with an enhanced solid part at the anterosuperior part on plain phase.
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F2
The scheduled CT scan 2 weeks after embolization showed a larger diameter of hemorrhagic mass from 20.7 to 23.0 cm, lysed perihepatic hematoma, without distance metastasis (Fig. 2).
Histopathological finding of primary hepatic angiosarcoma in case 3. a Histological examination of tumor tissue (hematoxylin-eosin stain, x40) showed an area of the tumor tissue (T) infiltrated in the liver tissue (L). b The tumor cells present diffuse proliferation of abnormal small vessels and enlargement of endothelial cells with nuclear atypia (x400). The immunohistochemical study of the same tissue showed positive staining for CD 34 (c) and factor VIII marker (d), which indicated hepatic angiosarcoma.
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F3
The immunochemical staining was positive for CD34 and factor VIII, consistent with PHA (Fig. 3).
PMC7184854_04
Multiphase CT scan of the liver in case 4 illustrates multiple scattered hypervascular infiltrative masses and nodules, about 1-9 cm in size in an almost entire enlarged liver. The masses have progressive enhancement on portal venous phase, and most of them have surrounding ground-glass opacity which is a typical finding for hemorrhage in angiosarcoma.
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F4
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).