A0526 - Angiosarcoma Presenting as Hemorrhagic Shock: A Rare Diagnosis of Liver Lesions in a Young Patient

Shivani Trivedi, DO¹, Vikas Sethi, DO², Kritos Vasiloudes, MD³, Amit Toor, MD³, Gilad Shapira, DO³, Salah Al-andary, MD³, Joseph Namey, DO^4
1HCA Healthcare/USF Morsani College of Medicine GME, Largo Medical Center, Largo, FL; ²HCA Healthcare, Clearwater, FL; ³HCA Healthcare, Largo, FL; ⁴Largo Medical Center, Largo, FL

Introduction: Angiosarcoma is an aggressive tumor and rare in young healthy patients. Angiosarcoma is associated with exposure to arsenic, vinyl chloride, and oral contraceptives¹. This is an unusual case of angiosarcoma in a young patient presenting with an acute abdomen from hemorrhagic shock. Angiosarcoma has poor prognosis and even removal and transplantation of the Liver is no sufficient ¹. It is important to include angiosarcoma in the differential for patients presenting with acute abdomen and explore aggressive medical therapy along with surgical resection.

Case Description/Methods: A 19-year-old male with no past medical history presented with sudden severe diffuse abdominal pain, difficulty breathing, nausea, vomiting, and diarrhea. FAST exam showed large volume of free fluid in the abdomen. Initial labs showed elevated liver associated enzymes, Hgb 5.4, lactic acidosis, fibrinogen 171. CT of abdomen and pelvis showed hepatomegaly with multiple small hypervascular lesions in liver [Figure 1]. Massive transfusion protocol was initiated, and he subsequently required emergent exploratory laparotomy with 3L of old-appearing blood drained. Intraoperatively, the liver was found to be multinodular, woody, enlarged, and cirrhotic with fresh heme. Final surgical pathology showed angiosarcoma with atypia over epithelioid hemangioendothelioma. Patient continued losing blood and required a hepatic angiogram with embolization. He continued to worsen, developing acute liver failure. Patient continued to decompensate and eventually required palliative care.

Discussion: Angiosarcoma often presents in elderly patients with nonspecific symptoms such as abdominal distention, abdominal discomfort, weight loss, and fatigue^2,3,4. Differentiating liver tumors such as hepatoma, adenoma, or vascular malformations on imaging is challenging and surgical resection is essential. Average survival of patients with untreated liver angiosarcoma is approximately 6 months and it increases by 2 years with treatment^2,3,4. The standard treatment for liver angiosarcoma is surgical resection. Liver transplant is not indicated because of the high recurrence rate and poor prognosis^2,3,4. There are no standardized treatments for patients presenting with hemorrhagic shock besides embolization and resection. More treatments need to be explored for aggressive treatment for hepatic angiosarcoma, as this case highlights a healthy 19-year-old patient dying one month after initial diagnosis with limited options for therapeutic intervention.



Disclosures:


Shivani Trivedi, DO¹, Vikas Sethi, DO², Kritos Vasiloudes, MD³, Amit Toor, MD³, Gilad Shapira, DO³, Salah Al-andary, MD³, Joseph Namey, DO⁴. A0526 - Angiosarcoma Presenting as Hemorrhagic Shock: A Rare Diagnosis of Liver Lesions in a Young Patient, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.