Hepatic Angiosarcoma : Liver Biopsy
Diagnostic Considerations: Obtaining a liver biopsy for tissue diagnosis of hepatic angiosarcomas is quite challenging. Due to the vascular nature of the tumor, the risk of hemorrhage is substantial. This complication is seen in about 25% of cases and results in death in 5% of patients.
Open liver biopsies give better diagnostic yield and permit easier hemostasis than closed biopsies. Percutaneous biopsies are more sensitive because they contain larger cores than transjugular liver biopsies. Regardless of the approach, false negative biopsies are a significant problem due to high frequency of hemorrhagic and necrotic foci within the tumor.
This image shows a well-differentiated focus of primary hepatic angiosarcoma. The left half shows anastomosing vascular channels lined by minimally atypical endothelium. In the right half, the atypical endothelial cells with hyperchromatic nuclei are seen spreading along preexisting sinusoids replacing the normal endothelium.