Introduction: Angiosarcoma is a rare primary malignant tumor of the liver. The prognosis of hepatic angiosarcoma (HA) is extremely poor with an average life expectancy of 6 months following diagnosis. The diagnosis of HA is challenging because of nondiagnostic liver biopsy or specious history and radiologic presentation. We report two cases with HA wich were diagnosed in the native liver after liver transplantation (LT).

Case 1: A 38-year-old male with complaints of abdominal pain, weakness and weight loss and with history of chronic hepatitis B virus infection for four years, was referred to hospital. Hepatosplenomegaly, ascites, and jaundice were noted in the phisical examination. The serum alpha-fetoprotein levels were in normal limits. Radiological examination and liver function tests showed decompensated cirrhotic liver. Therefore the patient underwent LT. The gross examination revealed a multinodular and sponge-like apparence with cystic spaces full of with blood in the native liver specimen. A diffuse infiltrative vascular neoplasm was seen microscopically. Neoplastic cells had high grade nuclei, but not high mitotic activity. The tumor was diagnosed as HA. The patient was lost of followup after discharged from hospital, postoperative 14th days.

Case 2: A 43-year-old male with complaint of abdominal pain, with findings of hepatomegaly, ascites, jaundice, and pleural effusion had end-stage-liver function tests and high serum levels of CA19.9, normal serum levels of CEA and alpha-fetoprotein. Radiological examination revealed multiple nodules in both lobes of the liver, and the patient was underwent to liver tru-cut biopsy. Epithelioid hemangioendothelioma was diagnosed in the biopsy specimen that composed of single tissue core. The patient underwent LT after 3 days of the diagnosis. The gross examination of the native liver showed that multiple nodular lesions involving both lobes of the liver. An infiltrative vascular neoplasm with nodular growing pattern was noted microscopically. The neoplasm had more complex dissecting proliferation of thin-walled vascular channels, compared to the tumor was seen in the first biyopsy specimen. Contrary to the first biyopsy, hepatectomy specimen had some criteria of malignancy histopathologically; the findings of lymphovascular invasion, and presence of atypical cells with necrosis. Thus the final diagnosis was given as HA. Eight months after LT, a recurrence of the HA was noted in allograft liver by tru-cut biopsy. The patient was died of HA in 18th month, after LT.

Conclusions: Diagnosis of HA is a challenging issue for LT because of the multinodular appearance in both of liver cirrhosis and HA on radiological examination. The multinodular pattern of HA may be mistaken for the nodularity of cirrhosis. Thus, in order to eliminate the unexpected malignancy multiple liver biopsies must be done before the LT. Because, the efficacity of LT on the life expectancy of the patients with HA is controversial yet.