Multiple hepatic metastases of cardiac angiosarcoma

  • Marlone Cunha-Silva University of Campinas (Unicamp), School of Medical Sciences
  • Daniel Ferraz de Campos Mazo University of Campinas (Unicamp), School of Medical Sciences
  • Igor Logetto Caetité Gomes University of Campinas (Unicamp), School of Medical Sciences
  • Marcello Rabello Imbrizi University of Campinas (Unicamp), School of Medical Sciences
  • Tiago Sevá-Pereira University of Campinas (Unicamp), School of Medical Sciences
  • Nayana Fonseca Vaz University of Campinas (Unicamp), School of Medical Sciences
  • Mariana Sandoval Lourenço University of Campinas (Unicamp), School of Medical Sciences
  • Larissa Bastos Eloy da Costa University of Campinas (Unicamp), School of Medical Sciences
  • Cecilia Amelia Fazzio Escanhoela University of Campinas (Unicamp), School of Medical Sciences
  • Jazon Romilson de Souza Almeida University of Campinas (Unicamp), School of Medical Sciences
Keywords: Sarcoma, Neoplasm Metastasis, Heart Neoplasms

Abstract

The differential diagnosis of hepatic focal lesions is challenging because the etiology can be inflammatory, infectious, and even neoplastic. A rare cause of metastatic liver nodules is cardiac angiosarcoma. We report a case of this tumor, which was diagnosed only after autopsy. A 26-year-old Caucasian man was admitted for progressive dyspnea and cough over the past 3 weeks. Physical examination showed only hypophonetic heart sounds. Laboratory analysis demonstrated anemia and elevated inflammatory markers, despite normal biochemical parameters and liver function. Transthoracic echocardiography revealed massive pericardial effusion. Abdomen computed tomography (CT) showed multiple hepatic nodules, the largest of which measured 3 cm, but the percutaneous biopsy revealed only lobular necrosis and perisinusoidal fibrosis without granulomas or neoplastic cells. During hospitalization, the patient had fever and night sweats with weight loss, and empiric treatment for extrapulmonary tuberculosis associated with corticosteroids was initiated. The outpatient follow-up revealed complete improvement of the pericardial effusion, but maintenance of the liver lesions. After 2 months of hospital discharge, the patient was readmitted with hemorrhagic shock due to bleeding liver lesions, which were evidenced by CT. Embolization of the right hepatic artery was performed, but the patient soon died. The autopsy revealed a primary cardiac angiosarcoma with multiple hepatic metastases, rupture of the Glisson’s capsule and laceration of the liver. The case shows how important and difficult the diagnosis of focal liver lesions is, since it may result in an unexpected fatal outcome

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Published
2018-11-12
How to Cite
Cunha-Silva, M., Mazo, D., Gomes, I., Imbrizi, M., Sevá-Pereira, T., Vaz, N., Lourenço, M., Costa, L., Escanhoela, C., & Almeida, J. (2018). Multiple hepatic metastases of cardiac angiosarcoma. Autopsy and Case Reports, 8(4), e2018048. Retrieved from http://www.revistas.usp.br/autopsy/article/view/151743
Section
Article / Autopsy Case Report