A 65-year-old man presented with a three week history of jaundice with associated fevers, chills, nausea, vomiting and fatigue for five days. He had worked in a plastics manufacturing factory with exposure to vinyl chloride for seventeen years, from age 27-44. Pertinent positives on examination included icterus and a tender liver edge 3 cm below the costal margin. No stigmata of chronic liver disease or ascites were appreciated. Laboratory data included: creatinine 1.7 mg/dL, hemoglobin 9.9 gm/dL, albumin 2.3 gm/dL, bilirubin 12.9 mg/dL, alanine transferase 179 IU/L, and INR 1.6. Magnetic Resonance Imaging (MRI) revealed a liver replaced by innumerable nodules. Hospital Course: Liver biopsy confirmed the diagnosis of angiosarcoma. The patient developed encephalopathy and his condition deteriorated leading to death within eight days. Discussion: Hepatic angiosarcoma is a rare tumor of mesenchymal origin. It comprises less than 2 percent of all primary liver tumors and about 25 cases are diagnosed annually in the United States. It is strongly associated with exposure to gaseous vinyl chloride monomer during its polymerization to polyvinyl chloride, first noted in 1974. There may be a latency period of 19-22 years prior to development of tumor after exposure. Established treatment protocols do not currently exist. Chemotherapy and surgery have been tried with poor results. Liver transplantation carries a high rate of recurrence and is contraindicated. Median survival is about six months without treatment. We present a case of hepatic angiosarcoma presenting as acute liver failure-an extremely rare presentation and a review of the literature
Bhat, Y. M., Dorfmeister, J. Sheikh, H. A., Chopra, K. B., (2005). Hepatic Angiosarcoma: A Rare Cause of Acute Liver Failure. Practical Gastroenterology, 29(3):84-89.