An acute progressing hepatic angiosarcoma in a young male diagnosed by contrast-enhanced ultrasound-guided liver needle biopsy: a case report.

Background: Primary hepatic angiosarcoma (PHA) is a rare hepatic malignancy primarily observed in the elderly. It carries a poor prognosis as a result of the characteristics of rapid progression, high aggressiveness, and resistance to traditional chemo- and radiotherapies. Its nonspecific clinical manifestations, along with the lack of laboratory features and various imaging findings, make it hard to recognize in clinic, especially among non-high-risk populations. Hence, pathological diagnosis is essential to establish an accurate diagnosis.

Case description: In the present report, a young male presented with right upper quadrant abdominal pain and hemoperitoneum was eventually diagnosed as hepatic angiosarcoma based on the immunohistochemical staining results of a liver needle biopsy. Contrast-enhanced ultrasound (CEUS) effectively improved the accuracy of the liver needle biopsy in this case. This report describes the epidemiology, presentation, laboratory tests, imaging findings, and pathological features of a rare hepatic angiosarcoma seen in this young male. The patient rapidly developed severe abdominal hemorrhage. Transcatheter hepatic artery embolization, blood transfusions, and symptomatic treatments were administered. The family members abandoned treatment because the patient was in critical condition and could not receive antitumor therapy.

Conclusions: This case emphasizes the significance of pathological findings in the diagnosis of PHA especially in non-high-risk individuals, and the supportive role of CEUS in guiding the liver needle biopsy. Abdominal hemorrhage is one of the serious complications of PHA and transarterial embolization (TAE) should be considered for controlling life-threatening bleeding from ruptured tumor. Further investigation is required to early diagnosis and to improve the prognosis of patients with PHA.