Primary hepatic angiosarcoma: A report of two cases and literature review

Figure 1 Magnetic resonance imaging. A: Markedly heterogeneous low signal intensity mass (white arrow) in the right lobe of the liver on T1-weighted imaging, with focal areas of high signal intensity that indicate fresh hemorrhage; B: Heterogeneous high signal intensity mass (white arrow) in the right lobe of the liver on T2-weighted imaging, with focal areas of higher signal intensity that indicate necrosis or hemorrhage; C: Mass (white arrow) shows high signal intensity on diffusion-weighted imaging that reveals restricted diffusion; D: Mass (white arrow) has a ring-like enhancement in the arterial phase; E: Progressive enhancement of the ring (white arrow) in the portal phase, revealing nodular enhanced foci within the ring; F: Progressive enhancement of the ring (white arrow) and nodular enhanced foci within the ring in the delayed phase.

Figure 2 Cross-section of the specimen showing a yellow-white lesion 6. 3 cm × 4.5 cm.

Figure 3 Histological examination. A: Spindle-shaped neoplastic cells exhibiting marked nuclear pleomorphism with whorled shape and fascicular clusters (HE stain; magnification × 400); B: Necrotic areas seen between the clusters of neoplastic cells (HE stain; magnification × 40); C: Immunohistochemical examination reveals positive staining of CD31 (magnification × 200). HE: Hematoxylin and eosin.

Figure 4 Computed tomography imaging. Emerging lesions in the right liver (white arrow) and enlarged retroperitoneal lymph nodes (black arrow) suggested postoperative tumor recurrence.

Figure 5 Computed tomography scan. A: Plain computed tomography scan reveals an oval shaped heterogeneous hypoattenuating mass with hyperattenuating foci (arrow) which suggests hemorrhage; B: Dominant mass lesion shows heterogenous enhancement with hyperattenuating enhanced foci (arrow), which indicate vasculature, in arterial phase; C: Dominant mass shows progressive enhancement and hyperattenuating enhanced foci enlarged in portal phase (arrows).

Figure 6 Histological examination. A: Neoplastic cells exhibiting marked nuclear pleomorphism, and vascular channels filled with erythrocytes (HE stain; magnification × 400); B: Clusters of neoplastic cells infiltrating liver parenchyma (HE stain; magnification × 100); C: Immunohistochemical examination reveals positive staining of CD34 (magnification × 200). HE: Hematoxylin and eosin.