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Primary Hepatic Angiosarcoma: Findings at CT and MR Imaging¹

¹ From the Department of Diagnostic Imaging and Nuclear Medicine, School of Medicine, Kyoto University, Japan (T.K.); Departments of Radiology (J.G.F., C.D.J.) and Anatomic Pathology (K.N., L.J.B.), Mayo Clinic, 200 First St SW, Mayo East 2B, Rochester, MN 55905; and Department of Radiology, Scottsdale Medical Imaging, Ariz (M.S.K.). Received May 2, 2001; revision requested June 8; revision received and accepted September 7. Address correspondence to J.G.F. (e-mail: fletcher.joel@mayo.edu).

View larger version (181K): [in a new window]   Figure 1a. Images show angiosarcoma in a 62-year-old man. (a) Transverse contrast-enhanced CT scan shows multiple hypoattenuating liver lesions, some with foci of enhancement (arrowheads), which are of decreased attenuation compared with the aorta. (b) Photomicrograph shows dilated, cavernous vascular channels (arrows) lined with neoplastic cells. (Hematoxylin-eosin stain; original magnification, x50.)

View larger version (169K): [in a new window]   Figure 1b. Images show angiosarcoma in a 62-year-old man. (a) Transverse contrast-enhanced CT scan shows multiple hypoattenuating liver lesions, some with foci of enhancement (arrowheads), which are of decreased attenuation compared with the aorta. (b) Photomicrograph shows dilated, cavernous vascular channels (arrows) lined with neoplastic cells. (Hematoxylin-eosin stain; original magnification, x50.)

View larger version (136K): [in a new window]   Figure 2a. Images show angiosarcoma associated with a chronic organized subcapsular hematoma (arrowheads) in a 76-year-old man. (a) Transverse CT scan in the portal phase demonstrates a heterogeneous enhancement pattern in the lesion (arrows). At resection, the tumor was found adherent to (but not invading) the diaphragm. (b) Transverse contrast-enhanced dynamic delayed-phase CT scan demonstrates progressive enhancement over time (arrows). (c) Transverse T1-weighted spin-echo (266/14) MR image shows a massive tumor (arrow) in the vicinity of a chronic organized subcapsular hematoma (arrowheads). The lesion contains focal areas of high intensity, which suggest hemorrhage. (d) Transverse fat-saturated T2-weighted fast spin-echo (8,571/70) MR image shows the marked heterogeneous appearance of the lesion (arrows) and hematoma (arrowheads). (e) Cut section of the gross specimen shows a hemorrhagic mass with a chronic organized subcapsular hematoma (white arrowheads). Fibrotic scar (hyalinization), which is whitish in color, is notable in the central area of the lesion (black arrowhead).

View larger version (129K): [in a new window]   Figure 2b. Images show angiosarcoma associated with a chronic organized subcapsular hematoma (arrowheads) in a 76-year-old man. (a) Transverse CT scan in the portal phase demonstrates a heterogeneous enhancement pattern in the lesion (arrows). At resection, the tumor was found adherent to (but not invading) the diaphragm. (b) Transverse contrast-enhanced dynamic delayed-phase CT scan demonstrates progressive enhancement over time (arrows). (c) Transverse T1-weighted spin-echo (266/14) MR image shows a massive tumor (arrow) in the vicinity of a chronic organized subcapsular hematoma (arrowheads). The lesion contains focal areas of high intensity, which suggest hemorrhage. (d) Transverse fat-saturated T2-weighted fast spin-echo (8,571/70) MR image shows the marked heterogeneous appearance of the lesion (arrows) and hematoma (arrowheads). (e) Cut section of the gross specimen shows a hemorrhagic mass with a chronic organized subcapsular hematoma (white arrowheads). Fibrotic scar (hyalinization), which is whitish in color, is notable in the central area of the lesion (black arrowhead).

View larger version (136K): [in a new window]   Figure 2c. Images show angiosarcoma associated with a chronic organized subcapsular hematoma (arrowheads) in a 76-year-old man. (a) Transverse CT scan in the portal phase demonstrates a heterogeneous enhancement pattern in the lesion (arrows). At resection, the tumor was found adherent to (but not invading) the diaphragm. (b) Transverse contrast-enhanced dynamic delayed-phase CT scan demonstrates progressive enhancement over time (arrows). (c) Transverse T1-weighted spin-echo (266/14) MR image shows a massive tumor (arrow) in the vicinity of a chronic organized subcapsular hematoma (arrowheads). The lesion contains focal areas of high intensity, which suggest hemorrhage. (d) Transverse fat-saturated T2-weighted fast spin-echo (8,571/70) MR image shows the marked heterogeneous appearance of the lesion (arrows) and hematoma (arrowheads). (e) Cut section of the gross specimen shows a hemorrhagic mass with a chronic organized subcapsular hematoma (white arrowheads). Fibrotic scar (hyalinization), which is whitish in color, is notable in the central area of the lesion (black arrowhead).

View larger version (143K): [in a new window]   Figure 2d. Images show angiosarcoma associated with a chronic organized subcapsular hematoma (arrowheads) in a 76-year-old man. (a) Transverse CT scan in the portal phase demonstrates a heterogeneous enhancement pattern in the lesion (arrows). At resection, the tumor was found adherent to (but not invading) the diaphragm. (b) Transverse contrast-enhanced dynamic delayed-phase CT scan demonstrates progressive enhancement over time (arrows). (c) Transverse T1-weighted spin-echo (266/14) MR image shows a massive tumor (arrow) in the vicinity of a chronic organized subcapsular hematoma (arrowheads). The lesion contains focal areas of high intensity, which suggest hemorrhage. (d) Transverse fat-saturated T2-weighted fast spin-echo (8,571/70) MR image shows the marked heterogeneous appearance of the lesion (arrows) and hematoma (arrowheads). (e) Cut section of the gross specimen shows a hemorrhagic mass with a chronic organized subcapsular hematoma (white arrowheads). Fibrotic scar (hyalinization), which is whitish in color, is notable in the central area of the lesion (black arrowhead).

View larger version (144K): [in a new window]   Figure 2e. Images show angiosarcoma associated with a chronic organized subcapsular hematoma (arrowheads) in a 76-year-old man. (a) Transverse CT scan in the portal phase demonstrates a heterogeneous enhancement pattern in the lesion (arrows). At resection, the tumor was found adherent to (but not invading) the diaphragm. (b) Transverse contrast-enhanced dynamic delayed-phase CT scan demonstrates progressive enhancement over time (arrows). (c) Transverse T1-weighted spin-echo (266/14) MR image shows a massive tumor (arrow) in the vicinity of a chronic organized subcapsular hematoma (arrowheads). The lesion contains focal areas of high intensity, which suggest hemorrhage. (d) Transverse fat-saturated T2-weighted fast spin-echo (8,571/70) MR image shows the marked heterogeneous appearance of the lesion (arrows) and hematoma (arrowheads). (e) Cut section of the gross specimen shows a hemorrhagic mass with a chronic organized subcapsular hematoma (white arrowheads). Fibrotic scar (hyalinization), which is whitish in color, is notable in the central area of the lesion (black arrowhead).

View larger version (136K): [in a new window]   Figure 3a. MR images show angiosarcoma in a 37-year-old man with known aplastic anemia. (a) Transverse T1-weighted spin-echo (250/17) MR image shows a diffuse lesion involving almost the entire posterior segment of the right lobe of the liver. Numerous small nodules of high intensity suggest a focal area of hemorrhage. Diffuse decrease in signal intensity in the liver, spleen (not shown), and bone marrow is consistent with patient’s known secondary hemochromatosis. (b) Transverse fat-saturated T2-weighted spin-echo (2,500/120) MR image shows compartmentalization within the lesion that contains numerous focal areas of high intensity.

View larger version (111K): [in a new window]   Figure 3b. MR images show angiosarcoma in a 37-year-old man with known aplastic anemia. (a) Transverse T1-weighted spin-echo (250/17) MR image shows a diffuse lesion involving almost the entire posterior segment of the right lobe of the liver. Numerous small nodules of high intensity suggest a focal area of hemorrhage. Diffuse decrease in signal intensity in the liver, spleen (not shown), and bone marrow is consistent with patient’s known secondary hemochromatosis. (b) Transverse fat-saturated T2-weighted spin-echo (2,500/120) MR image shows compartmentalization within the lesion that contains numerous focal areas of high intensity.

View larger version (154K): [in a new window]   Figure 4a. MR images show angiosarcoma in a 65-year-old man. (a) Transverse T1-weighted spin-echo (250/15) MR image shows multiple low-intensity lesions (arrows) that contain focal areas of slightly high T1-weighted signal intensity. (b) Transverse fat-saturated T2-weighted spin-echo (2,500/100) MR image shows heterogeneous signal intensity throughout the dominant mass. Fluid-fluid levels can be seen in smaller satellite lesions (arrows).

View larger version (148K): [in a new window]   Figure 4b. MR images show angiosarcoma in a 65-year-old man. (a) Transverse T1-weighted spin-echo (250/15) MR image shows multiple low-intensity lesions (arrows) that contain focal areas of slightly high T1-weighted signal intensity. (b) Transverse fat-saturated T2-weighted spin-echo (2,500/100) MR image shows heterogeneous signal intensity throughout the dominant mass. Fluid-fluid levels can be seen in smaller satellite lesions (arrows).

View larger version (165K): [in a new window]   Figure 5a. Images show angiosarcoma that diffusely involves the entire liver in a 64-year-old-man. (a) Transverse T1-weighted spin-echo (500/15) MR image shows slightly heterogeneous signal intensity of the liver and ascites. (b) Transverse T2-weighted spin-echo (2,000/100) MR image shows little abnormality. (c) Photomicrograph with a low-power view (hematoxylin-eosin stain; original magnification, x25) shows hyperchromatic cells diffusely involving the liver parenchyma along the portal tracts without forming macronodular lesions.

View larger version (153K): [in a new window]   Figure 5b. Images show angiosarcoma that diffusely involves the entire liver in a 64-year-old-man. (a) Transverse T1-weighted spin-echo (500/15) MR image shows slightly heterogeneous signal intensity of the liver and ascites. (b) Transverse T2-weighted spin-echo (2,000/100) MR image shows little abnormality. (c) Photomicrograph with a low-power view (hematoxylin-eosin stain; original magnification, x25) shows hyperchromatic cells diffusely involving the liver parenchyma along the portal tracts without forming macronodular lesions.

View larger version (144K): [in a new window]   Figure 5c. Images show angiosarcoma that diffusely involves the entire liver in a 64-year-old-man. (a) Transverse T1-weighted spin-echo (500/15) MR image shows slightly heterogeneous signal intensity of the liver and ascites. (b) Transverse T2-weighted spin-echo (2,000/100) MR image shows little abnormality. (c) Photomicrograph with a low-power view (hematoxylin-eosin stain; original magnification, x25) shows hyperchromatic cells diffusely involving the liver parenchyma along the portal tracts without forming macronodular lesions.