Melena as a first sign of metastatic hepatic angiosarcoma: Report of a case

Aleksandra Sokic-Milutinovic, Ljubisa Toncev, Tijana Glisic, Vera Matovic, Marjan Micev, Srdjan Djuranovic, Miodrag Krstic
2017 Vojnosanitetski Pregled  
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
more » ... 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. Uvod. Angiosarkomi su maligni tumori vaskularnog endotela koji mogu nastati na različitim lokacijama. Iako primarni angiosarkomi jetre čine samo 1.8% primarnih tumora jetre to su najčešći maligni mezenhimalni tumori jetre. Prikazujemo slučaj primarnog angiosarkoma jetre sa melenom kao neobičnom inicijalnom manifestacijom ovog vrlo retkog tumora. Prikaz slučaja. Bolesnik star 44 godine upućen je na našu Kliniku zbog melene koja je perzistirala nakon ponavljanih argon plazma koagulacija krvarećih lezija tokom ezofagogastroduodenoskopije u regionalnoj bolnici. Ultrazvuk i multislajsna kompjuterska tomografija (MSCT) abdomena ukazali su na uvećanu jetru sa fokalnom lezijom levog lobusa promera 6 cm i multiplim satelitskim lezijama u oba lobusa, uvećanu slezinu, kao i ekstremno proširenu i dugačku umbilikalnu venu. Double balloon enteroskopijom i endoskopskom video kapsulom uočene su brojne krvareće vaskularne lezije u tankom crevu. Patohistološki pregled i imunohistohemijska bojenja biopsija lezija iz tankog creva ukazala su na maligni mezenhimski tumor vaskularnog/endotelnog porekla. Zaključeno je da se kod bolesnika radi o metastatkom angiosarkomu sa najverovatnijim primarnim ishodištem u jetri i metastazama u tankom crevu, što je uzrokovalo melenu, i kičmenom stubu, što je uzrokovalo bol u leđima. Zaključak. Retki uzroci melene uključuju krvarenje iz primarnog ili metastatskog hemangiosarkoma lokalizovanog u gastrointestinalnom traktu, posebno u tankom crevu.
doi:10.2298/vsp160923073s fatcat:bdraj2ddfrf4zpulycizw7frs4