CT and pathological features of primary hepatic angiosarcoma

Objective To present the computed tomography (CT) findings and associated pathological features of eight cases of primary hepatic angiosarcoma (PHA) .Methods All cases were confirmed by pathology.After a CT scan of the upper abdomen, all cases of PHA underwent enhanced scans in the arterial phase, portal venous phase, and delayed phase to observe the CT manifestations.The surgical specimens were subjected to conventional hematoxylin- eosin staining and immunohistochemistry and observed under a microscope.Results Of all patients, 5 cases were massive type, 2 cases were mixed type, and 1 case was multiple nodule type.CT scans revealed inhomogeneous low- density lesions, with necrosis of even lower density in the central part.In 4 cases of massive type, scattered high- density small pieces were observed in low- density areas;in one case of mixed type, high- density nodules were observed on the edge of mass.There were 7 cases of peripheral nodular irregular enhancement in the arterial phase, including 1 case with flocculent central enhancement and another with no enhancement.Lesions remained enhanced in the portal venous and delayed phases, but 1 case had no enhancement.Five in 9 lesions had sharp edges in the arterial and portal venous phases, with“sharpen rim perpendicular to pleura”signs at the boundaries with the surrounding normal liver tissue.The outer edges of 7 lesions were found to have“pseudocapsules”in the portal venous phase.Conclusion CT scans showed a large hypodense lesion with irregular necrotic areas or scattered hemorrhage in PHA patients, whist enhanced scans showed a progressive filling and necrotic area in the central part.There could be“sharpen rim perpendicular to pleura”and“pseudocapsule”signs at the edge.It might be helpful to improve the diagnosis through the above characteristic features.