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Vojnosanitetski pregled
2019, vol. 76, iss. 2, pp. 219-223
article language: English
document type: Case Report
published on: 25/04/2019
doi: 10.2298/VSP160923073S
Creative Commons License 4.0
Melena as a first sign of metastatic hepatic angiosarcoma: A case report
aUniversity of Belgrade, Faculty of Medicine + Clinical Center of Serbia, Clinic for Gastroenterology and Hepatology, Belgrade
bClinical Center of Serbia, Clinic for Gastroenterology and Hepatology, Belgrade
cClinical Center of Serbia, Emergency Center, Belgrade
dClinical Center of Serbia, Department for Pathohistology, Belgrade



Introduction. Angiosarcomas are malignant tumors of vascular endothelium that may arise from different locations. Although primary hepatic angiosarcoma accounts for only 1.8% of primary liver tumors, it is the most common malignant mesenchymal tumor of the liver. We report a case of primary hepatic angiosarcoma with melena as an unusual initial manifestation of this extremely rare tumor. Case report. Forty-four-years old patient with melena was referred to our Clinic because melena was not resolved after repeated argon plasma coagulation of bleeding lesions during esophagogastroduodenoscopy in the regional hospital. Abdominal ultrasound and multislice computed tomography (MSCT) revealed enlarged liver, with focal lesion 6 cm in diameter localized in the left lobe with multiple satellite lesions in both liver lobes, enlarged spleen and extremely dilated and long umbilical vein. Double-balloon enteroscopy and video capsule endoscopy detected the multiple bleeding vascular lesions in the small bowel. Histopathological examination and immunohistochemistry of the small bowel lesions revealed malignant mesenchymal proliferation with vascular/endothelium differentiation of neoplastic cells. The patient was diagnosed with metastatic angiosarcoma probably of hepatic origin with metastasis in the small bowel, that caused melena, and in the lumbar spine, causing back pain. Conclusion. Rare causes of melena include bleeding from primary or metastatic hemangiosarcoma localized in the gastrointestinal tract, especially small bowel.



Ahmad, Z., Nisa, A., Idrees, R., Minhas, K., Pervez, S., Mumtaz, K. (2008) Hepatic angiosarcoma with metastasis to small intestine. J Coll Physicians Surg Pak, 18(1): 50-2
Ali, J.A., Ko, H.H., Owen, D., Steinbrecher, U.P. (2006) Epithelioid angiosarcoma of the small bowel. Gastrointestinal Endoscopy, 64(6): 1018-1021
Allison, K.H., Yoder, B.J., Bronner, M.P., Goldblum, J.R., Rubin, B.P. (2004) Angiosarcoma Involving the Gastrointestinal Tract. American Journal of Surgical Pathology, 28(3): 298-307
Baxter, P.J. (1981) The British Hepatic Angiosarcoma Register. Environmental Health Perspectives, 41: 115
Chaudhary, P., Bhadana, U., Singh, R.A.K., Ahuja, A. (2015) Primary hepatic angiosarcoma. European Journal of Surgical Oncology (EJSO), 41(9): 1137-1143
de Francesco, V., Bellesia, A., Corsi, F., Pennella, A., Ridola, L., Zullo, A. (2015) Multifocal Gastrointestinal Angiosarcoma: a Challenging Diagnosis?. J Gastrointestin Liver Dis, 24(4): 519-22
Föhrding, L.Z. (2012) Small intestine bleeding due to multifocal angiosarcoma. World Journal of Gastroenterology, 18(44): 6494
Forbes, A., Portmann, B., Johnson, P., Williams, R. (1987) Hepatic sarcomas in adults: a review of 25 cases. Gut, 28(6): 668-674
Grewal, J.S., Daniel, A.R. M., Carson, E.J., Catanzaro, A.T., Shehab, T.M., Tworek, J.A. (2008) Rapidly progressive metastatic multicentric epithelioid angiosarcoma of the small bowel: a case report and a review of literature. International Journal of Colorectal Disease, 23(8): 745-756
Hsu, J., Chen, H., Lin, C., Yeh, C., Hwang, T., Jan, Y., Chen, M. (2005) Primary angiosarcoma of the spleen. Journal of Surgical Oncology, 92(4): 312-316
Kim, T., Kim, G., Heo, J., Kang, D., Song, G., Cho, M. (2005) Metastasis of hepatic angiosarcoma to the stomach. Journal of Gastroenterology, 40(10): 1003-1004
Molina, E., Hernandez, A. (2003) Clinical manifestations of primary hepatic angiosarcoma. Digestive Diseases and Sciences, 48(4): 677-682
Nakayama, H., Masuda, H., Fukuzawa, M., Takayama, T., Hemmi, A. (2004) Metastasis of hepatic angiosarcoma to the gastric vein. Journal of Gastroenterology, 39(2): 193-194
Ni, Q., Shang, D., Peng, H., Roy, M., Liang, G., Bi, W., Gao, X. (2013) Primary angiosarcoma of the small intestine with metastasis to the liver: a case report and review of the literature. World Journal of Surgical Oncology, 11(1): 242
Ruffolo, C., Angriman, I., Montesco, M.C., Scarpa, M., Polese, L., Barollo, M., Pagano, D., d'Amico Davide, F. (2005) Unusual cause of small bowel perforation: metastasis of a subcutaneous angiosarcoma of the head. International Journal of Colorectal Disease, 20(6): 551-552
Santonja, C., Martín-Hita, A., Dotor, A., Costa-Subias, J. (2001) Intimal angiosarcoma of the aorta with tumour embolisation causing mesenteric ischaemia. Virchows Archiv, 438(4): 404-407
Schmid, E., Port, S. J., Carroll, R.M., Friedman, N.B. (1984) Primary metastasizing aortic endothelioma. Cancer, 54(7): 1407-1411
Sullivan, H.C., Edgar, M.A., Cohen, C., Kovach, C.K., HooKim, K., Reid, M.D. (2014) The utility of ERG, CD31 and CD34 in the cytological diagnosis of angiosarcoma: an analysis of 25 cases. Journal of Clinical Pathology, 68(1): 44-50
Talard, P., Lemmens, B., Duval, J.L., Dubayle, P., Bouchiat, C., Carloz, E. (1992) Angiosarcoma of the aorta disclosed by intestinal metastasis. Arch Mal Coeur Vaiss, 85(4): 453-6. (French)
Taxy, J.B., Battifora, H. (1988) Angiosarcoma of the gastrointestinal tract a report of three cases. Cancer, 62(1): 210-216
Timaran, C.H., Grandas, O.H., Bell, J.L. (2000) Hepatic angiosarcoma: longterm survival after complete surgical removal. Am Surg, 66(12): 1153-7
Winkelmann, R.K., van Heerden, J.A., Bernatz, P.E. (1971) Malignant vascular endothelial tumor with distal embolization. American Journal of Medicine, 51(5): 692-697