Hepatic Epithelioid Angiosarcoma with Abberrant Synaptophysin and CDX2 Expression Mimicking Neuroendocrine/Metastatic Carcinoma: A Fatal Case Report
Muhammad Usman, Muhammad Usman Shahbaz, Arsalan Ahmed, Muahammad Zawar Asif, Adnan Memon, Laiba Murtaza, Rafif AhmedABSTRACT
We report a fatal case of presumed primary hepatic epithelioid angiosarcoma (PHEA) in an 82-year-old woman with back pain, abdominal distension, and hyponatremia. Imaging showed ascites and hypodense hepatic lesions. Ascitic cytology was negative. Liver biopsy showed malignant cells with positive erythroblast transformation-specific regulated gene 1 (ERG) and cluster of differentiation 31 (CD31) on immunohistochemistry. Patchy synaptophysin and caudal-type homeobox 2 positivity initially suggested a neuroendocrine tumor but proved aberrant; negative chromogranin with ERG/CD31 positivity supported PHEA. She was transitioned to hospice care due to rapid clinical decline. This case highlights the atypical presentation, diagnostic pitfalls, and aggressive clinical course of PHEA.