title: [A rare cause of an indistinct liver lesion in an elderly woman].
abstract: METHODS
  A 76-year-old woman was admitted with a two-months history of pain in the right upper abdomen and nausea. There was no disease or premedication in her history.
  
  
  METHODS
  Labaratory tests revealed a normocytic anemia, elevated liver enzymes and signs of cholestasis. An MR of the abdomen showed a hyperperfused tumor in the liver segments IV, V and VIII, likely to be a hepatocellular carcinoma. However, tumor markers including AFP were not elevated. A liver biopsy revealed the final diagnosis of angiosarcoma.
  
  
  RESULTS
  Because the tumor was not resectable transarterial chemoembolisation (TACE) with doxorubicin was performed with palliative intent. Six weeks later a CT scan revealed extensive tumor progression. Therefore no further causal tretament was performed. With best supportive care the patient died within 4 weeks after she had been discharged. Occupational history revealed that the woman had been exposed to polyvinylchloride for six years when she had worked in a factory producing varnish aerosol cans 44 years ago.
  
  
  CONCLUSIONS
  Angiosarcomas of the liver are rare, highly malignant and diffuse infiltrating vascular tumors with rapid growth and poor prognosis. In patients who have been exposed to polyvinylchloride and present with an indistinct lesion of the liver an angiosarcoma should be considered.
authors.affiliation: Abteilung Innere Medizin II (Gastroenterologie, Hepatologie, Endokrinologie und Infektiologie), Universitätsklinikum Freiburg. nasser.semmo@insel.ch
authors.forename: N
authors.initials: N
authors.lastname: Semmo
authors.forename: B
authors.initials: B
authors.lastname: Seuthe
authors.forename: F
authors.initials: F
authors.lastname: Er
authors.forename: H C
authors.initials: HC
authors.lastname: Spangenberg
authors.forename: H E
authors.initials: HE
authors.lastname: Blum
mesh_terms: D000368:Aged; D016461:Chemoembolization, Therapeutic; D004317:Doxorubicin / Q000627:therapeutic use; D004781:Environmental Exposure; D017809:Fatal Outcome; D005260:Female; D006394:Hemangiosarcoma / Q000139:chemically induced* / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D008113:Liver Neoplasms / Q000139:chemically induced* / Q000175:diagnosis* / Q000628:therapy; D010166:Palliative Care; D011143:Polyvinyl Chloride
chemical_list: D004317:Doxorubicin; D011143:Polyvinyl Chloride