Contributed by Randall G. Lee, M.D.
PATIENT HISTORY: Per referral letter, the patient is a 49-year-old female with a remote history of a small breast carcinoma for which she elected to undergo bilateral mastectomies because she had a family history of breast cancer. Recently, she complained of fullness in the epigastric region and was found to have a large (10 cm) mass crossing the midline of the liver on CT scan. She used oral contraception from 1966 to 1974. Her radiological workup included, in addition to the CT scan, an ultrasound, a liver- spleen scan, and an hemangioma scan. Review of outside material.

Final Diagnosis (Case 37)


Previous Biopsies on this Patient:

TPIS Related Resources:
National Cancer Institute PDQ treatment information on liver cancer
Liver Transplant Topics

Gross Description - Case 37

The specimen consists of twelve (12) consult slides. No pathology report is received.

Microscopic Description - Case 37

The sections comprise one needle core consisting of thin-walled vascular channels with rounded and irregular profiles within a loose fibrous stroma that contains proliferated ductules, occasional arteries, and associated scattered neutrophils. These vascular channels are lined by occasionally plump and focally hyperchromatic cells that are demonstrated to be endothelial in nature by factor VIII and Ulex immunostains. No solid nests, foci of necrosis, or mitoses are identified. Additional needle cores show relatively normal liver parenchyma with focal congestion and sinusoidal dilatation. The portal tracts are largely unremarkable. Scattered in the sinusoids are occasional large sinusoidal lining cells that prove to be Ulex and factor VIII positive.

The mass seen here does not conform well to any of the standard liver neoplasms. The lesion appears to be vascular in nature and not typical of focal nodular hyperplasia, hepatocellular adenoma, or mesenchymal hamartoma. Features that are unusual for the typical hemangioma of the liver include the size and hyperchromasia of occasional nuclei lining the vascular spaces, and the finding of similar nuclei within the adjacent normal liver, suggesting some degree of local invasion. We are unable to make an outright diagnosis of angiosarcoma, but the atypical features raise the possibility of a low-grade malignancy. Consequently the lesion should be resected, if at all possible. This case was also reviewed by Drs Nalesnik and Demetris, who agree with the diagnosis.

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