Supplementary Material for: An autopsy of ruptured hepatic angiosarcoma treated by transcatheter arterial embolization

An 80-year-old Japanese man presented to our hospital with intra-abdominal hemorrhage due to a ruptured liver tumor. His vital signs included depressed blood pressure (80/52 mmHg), tachycardia (111 bpm), and distended abdomen. CT scan showed ascites effusion with high density and 40 mm tumors in lateral segment and 40mm tumor in anterior segment of the liver. Transcatheter arterial embolization (TAE) temporarily achieved hemostasis, but he died following re-rupture 4 days later. Based on autopsy findings, the liver tumor was diagnosed as hepatic angiosarcoma. Embolic agents used during embolization were identified within the hepatic small interlobular arteries. However, there were no findings of tumor cell necrosis or ischemic change in the angiosarcoma. In the present case, TAE alone did not induce ischemia-induced tumor necrosis, suggesting that TAE might be unsuitable to treat hepatic angiosarcoma. Treatment optimization for ruptured hepatic angiosarcoma is desired.

一例80岁日本男性因肝肿瘤破裂引发腹腔内出血至我院就诊。患者生命体征异常，表现为低血压（80/52 mmHg）、心动过速（111次/分）及腹部膨隆。计算机断层扫描（CT）可见高密度腹腔积液，肝脏外侧段与前段分别存在直径40 mm的肿瘤病灶。经导管动脉栓塞术（TAE）暂时实现了止血，但患者于4天后因肿瘤再次破裂死亡。经尸检确认，该肝肿瘤为肝血管肉瘤。术中使用的栓塞剂可在肝小叶间小动脉内被检出，但该血管肉瘤未出现肿瘤细胞坏死或缺血性改变。本病例中，单纯经导管动脉栓塞术未诱导出缺血性肿瘤坏死，提示该术式或不适用于肝血管肉瘤的治疗，亟需优化破裂型肝血管肉瘤的临床治疗方案。