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Angiosarcoma : Clinical & Gross

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Clinical Features: Hepatic angiosarcoma usually occurs late in life, predominantly in the 6th and 7th decades with a male predilection (M:F = 3:1). Patients present with vague symptoms and signs of liver disease and the diagnosis is often delayed. The clinical presentation consists of abdominal pain, fatigue, weight loss, anorexia, nausea, vomiting, abdominal mass, ascites, and jaundice.

About 15%-20% of patients present to the ER with hemoperitoneum from tumor necrosis and rupture. Rare cases present with acute liver failure. Many patients are asymptomatic and the tumor is discovered incidentally at autopsy. Patients may develop hematologic complications, including thrombocytopenia, microangiopathic hemolytic anemia, and disseminated intravascular coagulation.

Gross Pathology: Angiosarcomas of the liver can show multiple nodules involving both lobes, large dominant mass, mixed pattern of dominant mass with satellite nodules, and diffusely infiltrating micronodular tumor. The lesions consist of variably-sized hemorrhagic-looking spongy areas with ill-defined margins scattered throughout the liver. Some areas may have well-demarcated borders. High-grade foci are more solid with gray-white appearance. Image courtesy of: Dr. Ibrahim Zardawi; used with permission.

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