Hepatic Angiosarcoma Masquerading as Hemangioma: A Challenging Differential Diagnosis.

Hemangiomas are usually diagnosed based on ultrasound findings. The presence of symptoms, rapid growth or atipical imagiological findings should make us consider other diagnoses, including malignant tumors such as angiosarcomas. We describe the case of a previously healthy 46-year-old female without a history of exposure to carcinogens who presented with abdominal pain for two months. Diagnostic work-up revealed elevated gamma-glutamyl transferase and lactate dehydrogenase levels. Abdominal ultrasound described a large nodular lesion in the right lobe of the liver described as a hemangioma. One month later, a computed tomography-scan was made and revealed the same lesion, which had grown from 13.5 to 20 cm, maintaining typical imaging characteristics of a hemangioma. A right hepatectomy was performed and pathology revealed an angiosarcoma. After surgery, a positron emission tomography-computed tomography scan showed hepatic and bone metastasis. The patient started taxane-based chemotherapy and lumbar palliative radiotherapy, but died 10 months after surgery. This case shows how difficult it is to diagnose hepatic angiosarcoma relying only on imaging findings. Two abdominal computed tomography -scans were performed and none suggested this diagnosis. Angiosarcoma is a very aggressive tumour with an adverse prognosis. Surgery is the only curative treatment available. However, it is rarely feasible due to unresectable disease or distant metastasis.

Apesar do diagnóstico de hemangioma ser habitualmente simples e baseado na ecografia, a presença de sintomas, o crescimento rápido ou a presença de atipias imagiológicas devem-nos fazer considerar a hipótese de outras entidades, algumas delas malignas como o angiossarcoma. É descrito o caso de doente do sexo feminino de 46 anos, previamente saudável sem exposição a carcinogéneos, refere queixas de dor abdominal durante dois meses. O estudo analítico revelou elevação da gama glutamil transferase e lactato desidrogenase e a ecografia abdominal evidenciou uma lesão nodular de grandes dimensões no lobo direito do fígado, descrita como hemangioma. Um mês mais tarde, realizou uma tomografia computadorizada abdominal que revelou aumento das dimensões da lesão (13,5 para 20 cm), mantendo características imagiológicas de hemangioma. A doente foi submetida a hepatectomia direita e a histologia revelou a presença de angiossarcoma. Após cirurgia, uma tomografia por emissão de positrões-tomografia computadorizada evidenciou metastização hepática e óssea. A doente foi submetida a radioterapia e quimioterapia paliativa com paclitaxel, tendo falecido 10 meses após a cirurgia. Este caso exemplifica a dificuldade do diagnóstico do angiosarcoma baseado apenas nos exames de imagem. Foram realizadas duas tomografias computadorizadas abdominais e nenhuma sugeriu o diagnóstico. Os angiossarcomas são tumores muito agressivos com prognóstico reservado, sendo a cirurgia o único tratamento curativo. No entanto, raramente é realizada devido a doença irressecável ou disseminação à distância.

Clinical analysis of diagnosis and treatment of orbital cavernous hemangiomas / 中华实验眼科杂志

Background Orbital cavernous hemangiomas (OCH) is a common benign orbital tumor in adult,and accurate localization and diagnosis before operation supports the significant premise for surgical safety and success of tumor extraction.Objective This study was to research the clinical characteristics,preoperative diagnosis,the selection for different surgical approaches,therapeutic effectiveness and complication prevention of OCH.Methods The clinical data of 117 eyes of 117 patients with OCH who received surgery were retrospectively analyzed.The patients received surgery in Henan Eye Institute,Henan Eye Hospital from January 2011 to December 2014 and followed-up for 3 months to 5 years.The visual acuity,exophthalmos,ocular movement,orbital A/B ultrasound,color Doppler image,CT and MRI were examined before and after surgery.Results The primary clinical manifestations of OCH were gradual exophthalmos and impaired vision.The accordance rate of preoperative diagnosis and pathological diagnosis was 100％ in the group of patients.The surgical approachs included conjunctival approach in 52.14％ (61/117),lateral orbitectomy in 30.77％ (36/117),anterior approach in 16.24％ (19/117) and lateral combined with medial approach in 0.85％ (1/117).At the end of followed-up,visual acuity was significantly improved in 30.77％ (36/117),declined in 8.55％ (10/117) and unchanged in 60.68％ (71/117).Temporary complications after surgery were pupil dilatation in 14.53％ (17/117),emorrhoea in 1.71％ (2/117),ocular motility disorders in 16.24％ (19/117) and ptosis in 4.27％ (5/117).The permanent complications after operation were pupil dilatation in 2.56％ (3/117),visual loss in 0.85％ (1/117) and permanent abduction imitation in 0.85％ (1/117).Conclusions Accurate qualitative and site-specific diagnosis and correct choice of surgeries for OCH depend on clinical and iconographical examinations.Suitable surgical approach and operative skill are helpful to the therapeutic outcome and safety of OCH.