An exceedingly rare case of de novo hepatic angiosarcoma in a transplanted liver

Figures

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  Fig. 1. (A and B) Contrast-enhanced computed tomography (CECT) axial images demonstrate new homogenous enhancing lesions in donor liver seen on Portal Venous phase (white arrow, Fig 1A), up to 33mm in the left lobe (white arrow, Fig 1B). Figs. 1C and D: CECT coronal images of the homogenous enhancing lesions (white arrows).

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  Fig. 2. Contrast enhanced CT images several months after initial identification of lesions. Fig. 2A: Non contrast axial CT demonstrates iso-dense appearance of lesions to background liver parenchyma. Fig 2B: Arterial phase axial CT demonstrates patchy arterial hyperenhancement of innumerable lesions including a dominant 83 × 60 × 45 mm lesion in Segment 2 (white arrow). Fig. 2C: Portal venous axial CT demonstrates persisting and more homogenous enhancement (right arrow). There is also a known hypo-enhancing subscapular abscess that has been monitored (left arrow). Fig. 2D: Delayed phase axial CT demonstrates that the lesions are iso-dense to background liver parenchyma. Fig 2E: Arterial phase coronal CT. Fig 2F: Arterial phase sagittal CT.

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  Fig. 3. (A) Non contrast axial T2-weighted MRI showing numerous T2 hyperintense lesions (white arrows). Fig 3B: Non contrast axial T1-weighted Dixon MRI also demonstrating T1 hypointense lesions. Fig 3C: Axial T1-weighted MRI 12.3 seconds post-Primovist showing contrast uptake within lesions. Fig 3D: Axial T1-weighted MRI post-Primovist PV phase with persistent contrast uptake. Fig 3E: Axial T1-weighted MRI 5 minutes post-Primovist.

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  Fig. 4. (A and B) FDG PET-CT demonstrates multiple regions of linear mild to moderately increased glucose metabolism, with the previously identified dominant Segment II lesion SUV = 4.3 (right arrow, Fig 1A). There is a known hypo-enhancing subscapular abscess that has been monitored (left arrow, Fig 1A).

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  Fig. 5. Tissue biopsy results. Fig 5A: CD 31 stain positive. Fig 5B: CD 34 stain positive. Fiv 5C: ERG stain positive. Fig 5D: Tumour cells infiltrating around hepatocytes and residual bile ductular structures.