Ann Liver Transplant.  2022 Nov;2(2):151-156. 10.52604/alt.22.0020.

Liver transplantation for primary hepatic angiosarcoma: A report of two cases

• Kim SM
• Ahn CS
• Moon DB
• Ha TY
• Song GW
• Jung DH
• Park GC
• Kang WH
• Yoon YI
• Hwang S

• KMID: 2560911
• DOI: http://doi.org/10.52604/alt.22.0020

Abstract

Liver transplantation (LT) is an accepted treatment for some hepatic malignancies including hepatocellular carcinoma. We herein present two cases of primary hepatic angiosarcoma (PHAS) who underwent deceased donor LT (DDLT). The first case was a 61-year-old male who was diagnosed with cryptogenic liver cirrhosis. He underwent transarterial chemoembolization for multiple liver nodular lesions. Because of progressive hepatic failure with a model for end-stage liver disease (MELD) score of 40, he underwent DDLT. PHAS was not diagnosed for the explant liver at the time of DDLT. However, it was confirmed through immunohistochemical staining studies at 3 months after LT. The patient passed away at 5 months after LT due to tumor progression. The second case was a 74-year-old male with cryptogenic liver cirrhosis. He suffered from hepatorenal syndrome with a MELD score of 40. Thus, he underwent DDLT. PHAS was diagnosed for the explant liver at the time of DDLT. At 6 months after LT, tumor recurrence was identified and the patient passed away at 12 months after LT due to tumor progression. This is the first report of two adult cases of LT recipients with PHAS in Korea. If we had recognized the possibility of PHAS, the decision to perform LT would not be taken easily despite MELD score of 40. Our experience suggests that PHAS is still a contraindication of LT.

Keyword

Angiosarcoma; Liver transplantation; Recurrence; Survival; Prognosis

Figure

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  Figure 1 Pretransplant imaging findings of the Case 1. (A) Multiple hypervascular tumors were identified on liver magnetic resonance imaging. (B) Transarterial chemoembolization (TACE) was performed, in which multiple nodular tumor staining in both lobes was visualized. (C, D) Liver computed tomography showed increased hepatic volume compared with pre-TACE status, showing multiple hepatic nodules with heterogeneous parenchymal density.

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  Figure 2 Gross photograph of the explant liver of the Case 1. The specimen showed diffusely enlarged liver replacing with hemorrhagic nodules, up to 2.5 cm in greatest dimension. There were five totally necrotic nodules (1 and 2). These findings were suggestive of Budd–Chiari syndrome associated with angiosarcoma involving entire liver.

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  Figure 3 Posttransplant imaging findings of the Case 1. (A, B) Computed tomography (CT) taken two months after transplantation showed no abnormal finding. (C) CT taken at three months showed multiple nodular lesions in the liver graft. (D) Positron emission tomography-CT showed multiple bone metastasis from recurrent angiosarcoma.

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  Figure 4 Pretransplant imaging findings of the Case 2. (A, B) Computed tomography showed heterogeneous enhancement with multiple nodular lesions in the whole liver. (C, D) Liver magnetic resonance imaging showed multiple small nodules replacing the cirrhotic liver.

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  Figure 5 Posttransplant imaging findings of the Case 2. (A, B) Computed tomography (CT) taken two months after transplantation showed no abnormal finding. (C, D) CT taken at six months showed heterogeneous enhancement of the liver graft at the arterial and portal phases.

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  Figure 6 Gross photograph of explant liver of the Case 2. The whole liver was replaced with micronodules up to 0.1 cm in greatest dimension. There was no definite mass-like lesion. Multiple localized and diffuse sinusoidal spreading atypical endothelial cells proliferation was identified. These findings were suggestive of Budd–Chiari syndrome associated with low-grade angiosarcoma involving the entire liver.

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