case_images: PMC10624939_01
case_images: a Arterial phase contrast-enhanced image showed the presence of a 40-mm tumor in both lobes of the liver. b The delayed phase image showed persistent central enhancement.
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case_images: F1
case_images: Contrast-enhanced CT scan showed ascites effusion with high density and 40 mm tumors in both lobes of the liver with delayed enhancement from arterial to delayed phases (Fig. 1a, b).
case_images: a Abdominal angiography revealed pooling of the contrast medium called a cotton wool appearance. b Dense staining disappeared after embolization.
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case_images: F2
case_images: Angiography showed the tumor with a cotton wool-like staining pattern (Fig. 2a) because a CT scan 6 months earlier revealed no intrahepatic tumor (data not shown), which suggested extremely rapid growth. Embolization was performed in the tumor lateral and anterior segments using a 300~500 mum Embosphere  (Nipponkayaku, Tokyo, Japan), and disappearance of staining was confirmed in the tumor (Fig. 2b).
case_images: Arterial phase contrast-enhanced image showed the tumor area was paler than before (a), and the delayed phase image showed persistent enhancement (b).
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case_images: F3
case_images: A CT scan showed increased dense ascites (Fig. 3a). Although the arterial phase of the tumor area was paler than before (Fig. 3a), the delayed phase was stained dense as in the previous examination, suggesting blood flow to the tumor from the portal vein was not reduced (Fig. 3b).
case_images: The pathological findings of the liver at autopsy. a The liver showed 40 mm-sized tumors in both lobes, with partial membrane disruption in the left lobe lesion. b Hematoxylin-eosin (H&E) staining (x200) showing spindle-shaped tumor cells. c Cytokeratin AE1/AE3 staining (x200). d CD 31 staining (x200). e CD34 staining (x200). f, g H&E staining (x40) showing Embosphere used during embolization was also identified within the hepatic lobar artery. Inflammatory changes were absent around embolized arteries and surrounding tissue and ischemic changes and necrotic changes were also absent in the surrounding tissue. h VEGF in the vicinity of tumor cells was negative (x200).
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case_images: F4
case_images: An autopsy revealed 40 mm tumors in both lobes of the liver with partial disruption of the tumor membrane in the left lobe (Fig. 4a). The pathology showed proliferation of spindle-shaped tumor cells and red blood cells filling spaces between tumor cells (Fig. 4b). Cytokeratin AE1/AE3 was negative in tumor cells (Fig. 4c), and CD31 and CD34 were positive, consistent with hepatic angiosarcoma (Fig. 4d, e). However, inflammatory changes were scarce in surrounding tissues, and there was no evidence of tumor cell necrosis or ischemic tissue change in proximity to the same arteries (Fig. 4f, g).