A0547 - Hepatic Angiosarcoma Masquerading as Benign Venous Malformation of the Liver: A Commonly Underdiagnosed Case

Sravan K. Ponnekanti, MD¹, Suryanarayana Reddy Challa, MD², Sudhir Pasham, MD¹, Leonard Walsh, MBBS³, Anusha Tipparthi, MBBS⁴, Jaahnavi Konidala, MBBS^5
1Guthrie Robert Packer Hospital, Sayre, PA; ²Howard University Hospital, Washington, DC; ³Robert Packer Hospital, Sayre, PA; ⁴Osmania Medical College, Hyderabad, Telangana, India; ⁵Indira Gandhi Medical College and Research Institute, Pittsburgh, PA

Introduction: Hepatic angiosarcoma (HA) is uncommon yet notoriously deadly, accounting for 0.1- 2% of total primary liver malignancies. It is clinically challenging to diagnose due to its nonspecific presentation and absence of tumor markers.

Case Description/Methods: A 75 y/o male with a history of COPD and GERD presented with complaints of chronic fatigue. A routine CT chest identified an incidental liver mass 11 x 8 mm along with lower esophageal thickening and pulmonary nodules. Initial lab work-up showed AST/ALT-44/45 u/l, ALP-94 u/l, T Bil- 0.6 mg/dl, and acute hepatitis panel was negative. The patient was discharged for outpatient follow-up. Due to persistent symptoms, two months later, he was then referred to gastroenterology. He denied exposure to vinyl chloride, arsenic, thorium dioxide, and anabolic steroids. Tumor markers came back normal, CA 19-9 -8 u/ml, & AFP- 1.82 ng/ml. An MRI showed benign venous malformation, but a liver biopsy confirmed HA. Eventually, the patient started chemotherapy with a suspicion of metastasis based on prior CT imaging. He could not tolerate the side effects of Paclitaxel after two doses, so he opted for hospice care and was discharged.

Discussion: Hepatic angiosarcoma rapidly progresses with a potential for metastases increasing mortality. Often, radiological findings can be misleading in the initial stages, warranting an invasive approach, liver biopsy, to confirm the diagnosis. Due to its rare occurrence and absence of specific symptoms, we encourage a multi-disciplinary approach, particularly involving gastroenterology during the initial stages, to decrease the mortality in these cases. Also, additional research is required to improve diagnostic accuracy, establish treatment guidelines, and guide our future therapies.


Disclosures:


Sravan K. Ponnekanti, MD¹, Suryanarayana Reddy Challa, MD², Sudhir Pasham, MD¹, Leonard Walsh, MBBS³, Anusha Tipparthi, MBBS⁴, Jaahnavi Konidala, MBBS⁵. A0547 - Hepatic Angiosarcoma Masquerading as Benign Venous Malformation of the Liver: A Commonly Underdiagnosed Case, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.