Maluf D, Cotterell A, Clark B, Stravitz T, Kauffman H M, Fisher R A
Department of Transplantation, Virginia Commonwealth University, Medical College of Virginia Hospitals, 1101 E. Marshall Street, Richmond, VA 23298, USA.
Transplant Proc. 2005 Jun;37(5):2195-9. doi: 10.1016/j.transproceed.2005.03.060.
Hepatic angiosarcoma is a rare malignant vascular tumor that accounts for up to 2% of all primary liver tumors. Accurate diagnosis of this tumor is difficult, especially if the patient has no history of exposure to specific carcinogens including thorotrast, arsenicals, and vinyl chloride monomer. Diagnosis of diffuse angiosarcoma by means of liver biopsy has been reported as treacherous and nondiagnostic. Herein, we present a case of a 61-year-old Caucasian male with history of cryptogenic cirrhosis, normal alpha-fetoprotein, and pretransplant abnormal liver MRI who underwent nondiagnostic liver biopsies followed by liver transplantation. High grade diffuse angiosarcoma was diagnosed in the explanted liver. The patient developed bone metastases at 8 months and is alive 1 year posttransplantation. Diffuse liver tissue infiltration seen pretransplant on CT scan or MRI, suggesting the possibility of diffuse liver lesions (HCC, angiosarcoma, etc) must be fully investigated with all techniques available including multiple open liver biopsies to avoid the sacrifice of a liver allograft in these patients.
肝血管肉瘤是一种罕见的恶性血管肿瘤，占所有原发性肝肿瘤的比例高达2%。准确诊断这种肿瘤很困难，尤其是当患者没有接触过包括钍造影剂、砷剂和氯乙烯单体在内的特定致癌物的病史时。据报道，通过肝活检诊断弥漫性血管肉瘤具有风险且无法确诊。在此，我们报告一例61岁的白种男性病例，该患者有隐源性肝硬化病史，甲胎蛋白正常，移植前肝脏MRI异常，在接受了无法确诊的肝活检后接受了肝移植。在移植肝中诊断出高级别弥漫性血管肉瘤。患者在移植后8个月出现骨转移，移植后1年仍存活。移植前CT扫描或MRI上可见弥漫性肝组织浸润，提示可能存在弥漫性肝脏病变（肝癌、血管肉瘤等），必须采用包括多次开放式肝活检在内的所有可用技术进行全面检查，以避免在这些患者中牺牲肝移植供体。
